Do fibroids affect fertility?

By Moona Arabkhazaeli, MD
Minimally Invasive Gynecologic Surgeon

Background Info on Fibroids

Please see previous blogposts for an overview of fibroids and treatment options! This post will focus specifically on how fibroids may impact fertility and pregnancy.

Do fibroids cause infertility?

Fibroids are very common and affect up to 80% of women. The majority of women who have fibroids go on to have successful pregnancies without needing their fibroids treated. Most of the time the fibroids are small (less than 5cm), or in an area of the uterus that does not affect reproductive potential.

What type of fibroids can affect fertility?

The main factor that determines whether a fibroid is going to impact fertility is the location. Submucosal fibroids, or those that are located along or within the uterine cavity, may increase risk of infertility and pregnancy loss. These types of fibroids are generally worth treating, with a hysteroscopic procedure discussed below. Fibroids that are not in contact with the endometrium or uterine cavity, also known as intramural fibroids, are not suspected to impact fertility. That being said, if they are very large they may, by distorting the shape of the uterus. These specifics are worth an individualized conversation with your Ob/Gyn.

Can fibroids lead to complications in pregnancy?

The vast majority of the time no! Rarely they can cause the following complications:

• Preterm contractions or preterm labor: fibroids respond to hormones, and as such they tend to grow during a pregnancy. If the fibroids grow to be large, they can “stretch” out the uterus, and the uterus may react by contracting. Usually these contractions do not lead to labor, but rarely they can result in preterm labor.
• Pain: rarely fibroids outgrow their blood supply during pregnancy, leading to something called fibroid degeneration. When this occurs, someone can experience pain in the location of the fibroid. This is usually managed supportively, and passes with time.
• Breech or transverse baby: if a fibroid is distorting the uterine cavity, it can affect the baby’s position in the uterus.

What options do I have for treatment?

As above, most of the time fibroids don’t affect fertility or pregnancy and therefore are managed with observation! However, if you have symptoms or concerns, I encourage you to discuss with your Ob/Gyn what treatment option is best for you. There are several uterine-sparing surgical treatments to remove or shrink fibroids, as discussed in a previous blogpost. However, the only one that has enough data proving safety before pregnancy is a myomectomy, which refers to surgical removal of the fibroid(s). There are two options for this:

• Hysteroscopic myomectomy: this is a procedure where the doctor enters the uterus with a camera, and removes the fibroids from within the uterine cavity. It is very minimally invasive, with a one day recovery and very little risks or downsides. However, it is only possible to remove submucosal fibroids in this manner, ie those that are partially or completely within the uterine cavity. As above, these are the ones most likely to affect fertility.
• Abdominal or laparoscopic myomectomy: this is a procedure where fibroids are removed from the uterus through an incision in the abdomen. As compared to a hysteroscopic procedure, all fibroids are able to be accessed and removed. However, downsides compared to a hysteroscopic approach is that the recovery is longer, and the risks are higher. Further, it is recommended to wait 3-6 months before becoming pregnant after this procedure, to allow the scars on the uterus to heal, and your provider may recommend you delivery by cesarean section.

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