Fibroids

Uterine fibroids are benign (noncancerous) tumors of muscle tissue in the uterus. They are also called myomas or leiomyomas.. Fibroids can change the shape or size of the uterus and sometimes the cervix (lower part of the uterus). Women may have one or multiple fibroids. Whether fibroids cause symptoms or require treatment depends on their location, size, and number.

Fibroids are usually found in or around the body of the uterus, but sometimes are in the cervix. Types of fibroids based on where they are found: Subserosal Intramural, Submucosal

Can fibroids decrease fertility?

Approximately 5% – 10% of infertile women have fibroids. Their size and location determines whether fibroids affect fertility. Most women with fibroids will not be infertile. Women with fibroids and their partners should be thoroughly evaluated to find other problems with fertility before fibroids are treated. A fertility specialist can help assess if fibroids might be hampering conception.

How do fibroids cause infertility?

There are several ways uterine fibroids can reduce fertility:

Changes in the shape of the cervix can affect the number of sperm that can enter the uterus.

Changes in the shape of the uterus can interfere with the movement of the sperm or embryo.

Fallopian tubes can be blocked by fibroids.

Blood flow to the uterine cavity can be affected. This can decrease the ability of an embryo to stick (implant) to the uterine wall or to develop.

They can impact the size of the lining of the uterine cavity.

Intramural fibroids less than 3 cm in diameter or those that are > 1 cm away from the endometrial lining are harmless. Large intramural fibroids >3-4 cm in diameter, especially located < 1 cm from the uterine lining may cause infertility and may need to be removed.

Sometimes the fibroids are on the outer wall of the uterus, also called subserous fibroids. If the subserous fibroids are asymptomatic & less than 5 cm in size, they are left alone, and patients can be treated with IUI or IVF. However, it is better to remove very large subserous fibroids especially those that may come in the way of the egg retrieval. Besides infertility fibroids can also cause repeated pregnancy losses/miscarriages.

Summary

Uterine fibroids are common and can affect fertility in many ways. They can affect whether sperm and egg meet, they can affect whether an embryo can implant, they can affect whether a pregnancy can continue, and they can affect the growth and positioning of the baby.

Treatment is decided on a case-by-case basis. It is based on the symptoms of fibroids and may improve overall fertility. How and whether you treat your fibroids depends on the severity of your symptoms and your doctor’s recommendations.