Uterine fibroids are a very common condition, and affected women often wonder if their pregnancy challenges are related to their fibroids. In this article, we discuss the ‘classic’ view on how fibroids can affect fertility, and the effects of different fibroid treatment options on fertility.
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Fibroids
It is estimated that between 5% and 21% of women have symptomatic fibroids during their childbearing years.3 This figure excludes asymptomatic cases, which represent the majority. Uterine fibroids are benign (non-cancerous) smooth muscle tumors of the uterus. Common symptoms are excessive bleeding, pelvic pain, and sometimes unexplained weight gain. Fibroids can range in size from small seedlings to large tumors that affect the shape of the uterus and obstruct nearby organ systems including the urinary and gastrointestinal anatomy.7 It’s logical then to think that fibroids could also have a detrimental effect on fertility.
Fibroids And Infertility
Fibroids have been suspected to contribute to infertility since their discovery. A few observations precede this hypothesis. Fibroids that are just underneath the uterine lining (submucosal) and in the wall of the uterus (intramural) are known to distort the uterine cavity’s shape and/or obstruct the fallopian tubes.1-2 Logically, these alterations could interfere with the movement of sperm through the cervix and/or possibly prevent proper egg implantation,1 voiding pregnancy. These suspicions were backed up, in small part, by an observational study that investigated the cause of infertility in a cohort of women with infertility challenges. This study determined that 2.4% of this cohort had uterine fibroids, but no other identifiable cause of infertility, leading researchers to believe that fibroids were the probable cause.1 The connection between fibroids and infertility is by no means definitive and continues to be debated.
Fertility After Fibroid Surgery
It could be argued that treatment choice is the real threat to fertility in women affected by symptomatic fibroids. Hysterectomy, a surgical procedure in which the uterus is partially or completely removed, remains the most common treatment for fibroids. In the US, 29% of women diagnosed with uterine fibroids undergo a hysterectomy,3 and hysterectomy comprises 65% of all surgical and sub-surgical fibroid treatments.4 While hysterectomy guarantees permanent, life-lasting relief from fibroids, it completely eliminates any possibility of pregnancy in the future. Interestingly, it’s common for a fibroids diagnosis to be made by a gynecologist, whom is surgically-trained and inclined to offer hysterectomy as a first-line treatment option despite alternatives.
Fibroid Treatments That Spare Fertility
Although pregnancy following fibroid treatment is by no means guaranteed, there are alternative that do not eliminate the prospect of a future pregnancy.5 Two alternative treatments that are less-invasive and commonly labeled as ‘fertility-sparing’ are myomectomy surgery and minimally invasive uterine fibroid embolization (UFE). Both of these treatment options have been shown to be as effective as a hysterectomy in terms of a relief from symptoms and patient satisfaction.6-7 Fortunately, there are also several well-documented cases of successful full-term pregnancies after myomectomy and UFE.5
- Myomectomy: A surgical technique to isolate and remove fibroids while leaving he uterus intact.
- UFE: A non-invasive technique that involves the injection of micro-sized particles into the blood vessels that feed fibroids. This causes them to starve and shrink.
Closing Thoughts
In summary, hysterectomy (removal of the uterus) completely eliminates a woman’s ability to bear children, while myomectomy and uterine fibroid embolization are fertility sparing and can even improve fertility in some cases.8
It is unclear if a hysterectomy is the dominant treatment choice among women because they are unaware of fertility-sparing alternatives, or if they are truly comfortable foregoing any opportunity for pregnancy in the future. In any case, we encourage women with fibroids to empower their treatment decisions with knowledge prior to committing to a major, irreversible surgery. We don’t yet have a perfect treatment for uterine fibroids, but there are logical tradeoffs with the current options depending on your current lifestyle and future life plans.
References
[1] Duhan, N., & Sirohiwal, D. (2010). Uterine myomas revisited. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 119–125.
[2] Donnez, J., & Dolmans, M. M. (2016). Uterine fibroid management: From the present to the future. Human Reproduction Update, 22(6), 665–686.
[3] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.
[4] Bonafede, M. M., Pohlman, S. K., Miller, J. D., Thiel, E., Troeger, K. A., & Miller, C. E. (2018). Women with Newly Diagnosed Uterine Fibroids: Treatment Patterns and Cost Comparison for Select Treatment Options. Population Health Management, 21(S1), S-13-S-20.
[5] Karlsen, K., Hrobjartsson, A., Korsholm, M., Mogensen, O., Humaidan, P., & Ravn, P. (2018). Fertility after uterine artery embolization of fibroids: a systematic review. Archives of Gynecology and Obstetrics, 297(1), 13–25.
[6] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).
[7] Pelage, J.-P., Cazejust, J., Pluot, E., Le Dref, O., Laurent, A., Spies, J. B., … Lacombe, P. (2005). Uterine Fibroid Vascularization and Clinical Relevance to Uterine Fibroid Embolization. Radiographics, 25, S99–S117.
[8] Pritts, E. A., Parker, W. H., Olive, D. L., & D, M. (2009). UTERINE FIBROIDS Fibroids and infertility: an updated systematic review of the evidence. Fertility and Sterility, 91(4), 1215–1223.