Uterine fibroids are common, non-cancerous growths that develop within the uterus. Many individuals are concerned about how these growths might affect their ability to conceive. Fibroids can vary significantly in size, number, and location, which influences their potential impact on fertility.
Understanding Uterine Fibroids
Uterine fibroids, also known as leiomyomas or myomas, are benign tumors composed of muscle and fibrous tissue that grow in or on the uterus. They are the most common non-cancerous growths found in the female pelvic area.
Fibroids are common, affecting between 20% and 80% of women by the age of 50. While many women have fibroids, a large number never experience symptoms or even know they have them. Fibroids can range in size from microscopic to large masses that can fill the entire uterus.
How Fibroids Influence Conception
The influence of fibroids on the ability to conceive largely depends on their location, size, and number within the uterus. Not all fibroids affect fertility, and many women with fibroids can get pregnant without difficulty. However, certain types and positions of fibroids can interfere with the reproductive process.
Submucosal fibroids, which grow directly into the uterine cavity, are particularly relevant to fertility. Even small submucosal fibroids can distort the uterine cavity, potentially interfering with embryo implantation. This distortion can make it challenging for a fertilized egg to attach to the uterine wall.
Intramural fibroids, located within the muscular wall of the uterus, are the most common type. If these fibroids are large, typically four centimeters or more, they might affect the uterus’s ability to contract properly or alter blood flow, which could impact implantation or early pregnancy. Very large intramural fibroids might also block the fallopian tubes, preventing the egg and sperm from meeting.
Subserosal fibroids grow on the outer surface of the uterus. These fibroids generally have less impact on fertility unless they become very large or press on nearby reproductive organs, such as the fallopian tubes. Occasionally, subserosal fibroids can be pedunculated, meaning they are attached by a stalk, but their location outside the uterine muscle usually minimizes their effect on conception.
Identifying Fibroids
The detection of uterine fibroids often begins during a routine pelvic examination, where a healthcare provider might feel irregularities in the uterus. If fibroids are suspected, imaging techniques are typically used to confirm their presence and determine their characteristics.
Ultrasound is the primary diagnostic tool for identifying fibroids. This non-invasive procedure uses sound waves to create images of the uterus, allowing for the visualization of fibroids, including their size, number, and location. Both transvaginal and abdominal ultrasounds can be utilized for this purpose.
For a more detailed assessment, especially when planning for surgical intervention or if ultrasound results are inconclusive, a magnetic resonance imaging (MRI) scan may be performed. MRI provides detailed images of soft tissues, offering a comprehensive view of the fibroids and their relationship to surrounding structures. In cases where submucosal fibroids are suspected, a hysteroscopy might be used; this procedure involves inserting a thin, lighted scope through the cervix to directly visualize the inside of the uterine cavity.
Managing Fibroids for Pregnancy
When pregnancy is desired, the management of fibroids focuses on approaches that preserve or improve fertility outcomes. For fibroids that are small, asymptomatic, or not significantly impacting fertility, a watchful waiting approach may be recommended, involving monitoring the fibroids over time without immediate intervention.
For fibroids that are believed to be interfering with conception, surgical removal is often the primary treatment. Myomectomy is a surgical procedure designed to remove fibroids while preserving the uterus, making it a suitable option for women who wish to become pregnant. This procedure can be performed through various methods, including open abdominal surgery, laparoscopy, or hysteroscopy, depending on the fibroids’ size, number, and location.
Other treatments, such as uterine artery embolization (UAE), are generally not preferred for women seeking pregnancy, as they can potentially affect ovarian function or future fertility. UAE works by blocking the blood supply to the fibroids, causing them to shrink. While effective for symptom relief, its impact on fertility outcomes is less certain compared to myomectomy. Treatment decisions are based on the individual’s specific fibroid characteristics and reproductive goals.