Many women go on to conceive naturally if they have fibroids, but fibroids can affect fertility chances. Most women with fibroids will not be infertile, however, it is best to determine if your fibroids are hampering your ability to conceive The size and location and rate of growth of the fibroids will determine whether or not they affect fertility.
Fibroid can have a negative impact by mechanical factors. They may distort the cervix and increase the size of the womb and endometrial cavity. The fallopian tubes may also be distorted or blocked and the ovaries and the tubes may be a long way apart. These factors may make it difficult for the sperm and the egg to get together. Fibroids that are bigger than 6 cms in size are more likely to be relevant.
Fibroids that are inside the uterine cavity (submucosal) or growing on the inner wall of the uterus and into the uterine cavity, can disrupt implantation and embryo growth, by having a negatively impact on the receptivity of the uterine lining, resulting in infertility or pregnancy loss.
Most women with fibroids do not experience complications during pregnancy
Problems that are encountered are:
- Vaginal bleeding
- Pain as fibroids grow
- Malposition of the baby at term
In some severe cases, they can also cause very preterm births.
There does not seem to be an increased risk of:
- Fetal growth problems
- Placental problems, unless the placenta is implanted over the fibroid
- Caesarean delivery (C-section) is more common among women who have fibroids
- Women may bleed more after the delivery as the womb fails to contract well after the delivery.
Examining research performed to date there is insufficient evidence from randomised controlled trials to evaluate the role of myomectomy to improve fertility. Regarding the surgical approach to myomectomy, current evidence from two randomised controlled trials suggests there is no little if any difference between the laparoscopic and open approach regarding fertility performance. This evidence needs to be viewed with caution due to the small number of studies. Finally, there is currently no evidence from randomised controlled trials regarding the effect of hysteroscopic myomectomy on fertility outcomes.
The majority of evidence suggesting an improvement in pregnancy rates (ranging from 10% to 77%) after myomectomy is derived from case series rather than randomised controlled trials. In addition, myomectomy carries inherent risks that may be detrimental to the chances of fertility through complications such as peritoneal and intrauterine adhesions, and the risk of scar rupture in a future pregnancy.
The decision to remove fibroids on fertility grounds must be taken very carefully. Perhaps its place should be reserved for women undergoing IVF and those women where a particular problem in pregnancy has previously arisen as a direct result of the presence of the fibroids.