The good news about uterine fibroid tumors is that they are almost always benign. The bad news is they can also cause infertility. With as many as 80% of women developing fibroid tumors at some point in their life, these non-cancerous tumors are one of the most common causes of uterine fertility factors.
In most cases, these tumors come and go without presenting any symptoms at all, so you may not even know you have them. In others, their position or size may cause discomfort, pain or changes in your menstrual cycle. For the most part, physicians opt to leave fibroids alone unless they fall into the painful or disruptive category; the exception to this is when fertility is in question – between 5% to 10% of women with an infertility diagnosis have fibroids.
In medical terms, we call fibroids leiomyomas or myomas. The tumors develop in the muscular tissue of the uterine wall, which is why they’re so fibrous. You can have one tumor or you can have many – it just depends. They can be miniscule or can grow as large as a small melon. When leiomyomas do cause physical symptoms, women typically experience pelvic pain or discomfort, heavy menstrual bleeding, and other side effects.
As we mentioned above, fibroid tumors are only treated when they cause an issue, and treatment involves hysteroscopic myomectomy (surgery to remove the tumor). It’s important to select a surgeon who is very experienced in this type of surgery to ensure minimal scarring – especially if you are fertile and want to get pregnant. Uterine scarring can also cause infertility.
Interestingly, the causes of fibroid tumors are somewhat of a mystery. Genetic predisposition and hormone levels are certainly factors – higher estrogen and progesterone levels being significant culprits. You can read more about these specifics on the ASRM website.
There are three different types of fibroid tumors:
- Submucous fibroids. These are the most likely culprits to cause infertility. They grow on the interior side of the uterine wall, and can wind up growing into the endometrial lining and the uterine cavity. If a tumor’s size, location or shape causes enough of a disruption to the uterine cavity, a fertilized egg can’t attach properly and will absorb back into the body or be shed during your next period. Even if a fertilized egg does attach, tumors can grow so far into the uterine cavity that they don’t leave enough room for the baby to grow, or the endometrial supply might be disrupted – leading to miscarriage or preterm labor. If you’ve suffered recurrent miscarriages (three or more) your doctor will most likely screen you for uterine fibroids.
- Intramural fibroids. These tumors grow right in the middle of the uterine wall. If intramural fibroids are smaller or extend outwards, they may never impact the endometrial lining or the uterus. If they grow large enough, however, they’ll have the same effects as a submucous fibroid. The verdicts are mixed when it comes to removing these tumors – some studies show women are more likely to have a successful full-term pregnancy after the procedure while others contradict those findings. Speak with your doctor to determine whether it makes sense for you to go through a surgical procedure to remove intramural myomas.
- Subserous fibroids. The third type of fibroid grows on the outside edge of the uterus and are called subserous fibroids. So far, studies cannot find any link between incidences of subserous fibroids and infertility rates.
Once a woman is past her childbearing years or women who are sure they don’t want children, doctors may recommend a hysterectomy if recurrent fibroid growth becomes a problem. Another treatment used to treat women with painful or disruptive fibroids is called embolization. This treatment should NOT be used for women trying to get pregnant. It blocks the blood vessels leading from the uterus to the fibroids, “starving” them into submission and recession. However, this procedure can disrupt uterine function and can cause premature menopause. Embolization can also lead to adhesions or scarring inside the uterus (called Asherman’s Syndrome), causing infertility.
What do I do if I have fibroids that require surgical treatment?
If you suspect you have Submucous or intramural fibroids, or have been diagnosed with them in the past, don’t panic. Request an ultrasound from your OB to see whether the tumors are present when you’re ready to conceive (because, remember, they ebb and flow over time). If they are, s/he’ll probably be able to tell whether or not they’re affecting the interior shape of the endometrial cavity. If you find out they’re not, proceed with timed intercourse at home and see what happens. If you are younger than 35-years old without any other known fertility issues, give yourself 12-months. If you’re older than 35-years of age, give yourself six-months and then schedule an appointment with a fertility specialist if you don’t get pregnant.
If the fibroids are causing discomfort and/or you’ve been diagnosed with fibroids that are compromising the integrity of the uterus or endometrium, you’ll need surgery to remove them. Your first goal is to find a doctor who specializes in hysteroscopic myomectomy. Most surgeons worth their salt will ask about your future fertility plans but, if not, make sure the surgeon knows you’re trying to conceive so they’ll be extra careful.
If you’ve had surgery to remove multiple tumors and/or tumors that are embedded deep in the uterine wall, you may require a C-section. While uterine tissue does heal, any parts of the uterus that are thinner than the rest are prone to tearing (placenta abruptia), a very dangerous complication. Rather taking that risk, your OB will schedule a cesarean so the baby is delivered safety and with decreased risk to the uterine walls. This scenario is more rare and is only the case when multiple tumors have been removed and/or they were embedded so deeply into those walls that the uterus lining was thinned out in those spots.
Are you concerned that fibroid tumors and/or prior uterine surgery have compromised your fertility? Contact us here at the Reproductive Resource Center to schedule a consultation.