Fibroids, also known as uterine leiomyomas, are non-cancerous growths of the uterus that affect up to 70-80% of women by the age of 50. While many women with fibroids conceive without complications, in some cases, these benign tumors can contribute to infertility and pregnancy-related issues. Understanding the impact of fibroids on fertility, diagnosis, and treatment options is essential for women planning pregnancy. 

What Are Fibroids? 

Fibroids are smooth muscle tumors that develop within the uterus. They vary in size, number, and location and are classified into three main types based on their location: 

1. Subserosal Fibroids – Grow on the outer layer of the uterus and usually do not affect fertility unless they become extremely large. 

2. Intramural Fibroids – Develop within the muscular wall of the uterus and can alter uterine shape, potentially impacting implantation. 

3. Submucosal Fibroids – Grow beneath the endometrial lining and can directly interfere with embryo implantation and pregnancy maintenance. 

How Do Fibroids Affect Fertility? 

Fibroids can contribute to infertility in several ways: 

• Distortion of the Uterine Cavity – Fibroids, particularly submucosal and large intramural fibroids, can distort the endometrial cavity, making implantation difficult. 

• Blockage of Fallopian Tubes – Large fibroids can compress the fallopian tubes, preventing sperm from reaching the egg or blocking fertilized egg transport. 

• Altered Uterine Blood Flow – Fibroids can compromise blood supply to the endometrium, making implantation less likely. 

• Hormonal Imbalance – Some fibroids produce growth factors and hormones that can affect ovulation and endometrial receptivity. 

• Inflammatory Changes – Fibroids may trigger inflammatory reactions in the uterus, creating an unfavorable environment for embryo implantation. 

Diagnosing Fibroids in Infertile Women 

A comprehensive evaluation is necessary to determine if fibroids are impacting fertility. Diagnostic methods include: 

1. Ultrasound (Transvaginal & Abdominal) – First-line imaging for detecting fibroids. 

2. Hysterosonography (Saline Infusion Sonogram, SIS) – Provides detailed assessment of submucosal fibroids. 

3. Hysteroscopy – Direct visualization of the uterine cavity to identify fibroids affecting implantation. 

4. Magnetic Resonance Imaging (MRI) – Useful for mapping fibroid location and planning treatment. 

5. Hysterosalpingography (HSG) – Assesses fallopian tube patency and detects intracavitary fibroids. 

Treatment Options for Women with Fibroids and Infertility 

The treatment approach depends on the severity of symptoms, fibroid size, location, and the woman’s reproductive goals. Options include: 

1. Medical Management 

• GnRH Agonists (Gonadotropin-releasing hormone agonists) – Temporarily shrink fibroids but are not a long-term fertility solution. 

• Selective Progesterone Receptor Modulators (SPRMs) – Help reduce fibroid size but are not recommended for pregnancy planning. 

• Non-hormonal Treatments – Tranexamic acid and NSAIDs help manage bleeding but do not improve fertility. 

2. Surgical Management 

• Hysteroscopic Myomectomy – Best for submucosal fibroids, improving implantation rates. 

• Laparoscopic or Abdominal Myomectomy – Preferred for large intramural or multiple fibroids, preserving fertility. 

• Uterine Artery Embolization (UAE) – Not recommended for women trying to conceive as it may impair endometrial function. 

3. Assisted Reproductive Techniques (ART) 

• In Vitro Fertilization (IVF) – Often recommended for women with fibroids who fail natural conception. 

• Pre-IVF Myomectomy – Beneficial for women with large or cavity-distorting fibroids. 

Fibroids and Pregnancy Outcomes 

Women with fibroids may experience higher risks of pregnancy complications, including: 

• Miscarriage – Particularly with submucosal fibroids. 

• Preterm Labor – Due to uterine irritability. 

• Fetal Growth Restriction – Caused by reduced blood flow. 

• Placental Abnormalities – Higher risk of placenta previa and placental abruption. 

• Cesarean Delivery – Increased likelihood due to obstructed labor or fetal malposition. 

Lifestyle and Preventive Measures 

• Maintain a Healthy Weight – Obesity is linked to fibroid growth. 

• Exercise Regularly – Reduces estrogen dominance, which fuels fibroid growth. 

• Eat a Balanced Diet – A diet rich in fruits, vegetables, and whole grains helps regulate estrogen levels. 

• Manage Stress – Chronic stress may contribute to hormonal imbalances. 

Conclusion 

Fibroids can be a significant factor in infertility, especially when they alter the uterine cavity or disrupt implantation. Fortunately, several medical and surgical treatment options are available to improve fertility outcomes. Women diagnosed with fibroids who are trying to conceive should consult a reproductive specialist for personalized management. With appropriate intervention, many women with fibroids can achieve successful pregnancies. 

Authors : Dr.Chaitra Sathyanarayan