Uterine fibroids are common non-cancerous growths that develop in the uterus. Many individuals with fibroids are concerned about their potential impact on the ability to conceive and carry a pregnancy to term. This article explores the relationship between uterine fibroids and fertility, including their influence on conception and pregnancy outcomes. It also addresses challenges during pregnancy with fibroids and management options.
What Are Uterine Fibroids
Uterine fibroids, also known as leiomyomas or myomas, are benign growths composed of muscle cells and fibrous tissue within the uterine wall. They are common, affecting an estimated 20 to 80 percent of women by age 50. Fibroids vary considerably in size, from as small as a pea to larger than a grapefruit.
Fibroids are classified by their location within the uterus. Submucosal fibroids grow into the uterine cavity, while intramural fibroids are located within the muscular wall. Subserosal fibroids develop on the outer surface. Not all fibroids cause symptoms or affect fertility; many are discovered incidentally during a pelvic exam or ultrasound.
How Fibroids Influence Pregnancy Chances
Uterine fibroids can impact the ability to conceive, though most women with fibroids have normal fertility. The effect of fibroids on conception largely depends on their size, number, and location. Submucosal fibroids, which protrude into the uterine cavity, are most likely to interfere with conception. These fibroids can alter the shape of the uterine cavity, making it difficult for an embryo to implant successfully.
Intramural fibroids, located within the uterine muscle wall, can influence fertility if large enough to distort the uterine cavity or reduce blood flow to the uterine lining. Altered blood flow within the uterus due to fibroids might create a less hospitable environment for embryo implantation. While fibroids can pose challenges, other causes of infertility are often more common, and many individuals with fibroids conceive without intervention.
Pregnancy With Existing Fibroids
If conception occurs, uterine fibroids can sometimes lead to complications during pregnancy, though many pregnancies proceed without significant issues. The most common complication is pain, particularly with fibroids larger than 5 centimeters in later pregnancy. This pain can be attributed to the fibroid outgrowing its blood supply.
Fibroids may increase the risk for adverse outcomes, including miscarriage. Other potential complications involve an increased risk of preterm labor and preterm birth. Fibroids can also be associated with placental abruption, where the placenta separates prematurely from the uterine wall. Issues during delivery, such as breech position or an increased likelihood of needing a cesarean section, may also occur.
Addressing Fibroids for Conception
When fibroids contribute to conception difficulty or are likely to cause significant pregnancy complications, medical interventions may be considered. Fertility-preserving treatments aim to remove fibroids while maintaining the uterus’s ability to carry a pregnancy. Myomectomy, the surgical removal of fibroids, is a primary option for women wishing to conceive. This procedure can be performed through various approaches, depending on fibroid characteristics.
Other less invasive options exist, such as uterine artery embolization (UAE), which works by cutting off blood supply to the fibroids, causing them to shrink. However, the implications of UAE for future fertility can be complex and are often a point of discussion with a healthcare provider. The decision to treat fibroids for fertility purposes is individualized, emphasizing the importance of consulting with a specialist to determine the most appropriate course of action based on the specific circumstances.