Uterine fibroids, medically known as leiomyomas, are non-cancerous growths that develop in or around the uterus. Affecting up to 70% of women by age 50, these benign tumors raise important questions about reproductive health, particularly for women trying to conceive. Understanding how fibroids impact fertility is crucial for making informed decisions about treatment and family planning.
Not all fibroids affect fertility equally. The impact largely depends on their size, number, and particularly their location. Submucosal fibroids, which grow into the uterine cavity, pose the greatest risk to fertility, with pregnancy and live birth rates appearing to be low in women with these fibroids. Research indicates that submucosal fibroids that distort the uterine cavity carry a relative risk of 0.3 for pregnancy and 0.28 for implantation after assisted reproductive technologies, representing up to a 70% reduction in conception rates.
Intramural fibroids, located within the muscular uterine wall, appear to have decreased fertility and increased pregnancy loss, particularly when large or numerous. Conversely, subserosal fibroids, which grow on the outer uterine wall, do not seem to affect fertility outcomes.
Fibroids are diagnosed in approximately 5-10% of women with infertility and may be the sole cause of infertility in 2-3% of women. They can create multiple barriers to successful pregnancy through various mechanisms:
Beyond conception challenges, fibroids can significantly complicate pregnancy. Women with fibroids are at increased risk for several adverse outcomes:
During early pregnancy:
During late pregnancy and delivery:
It's important to note that the incidence of fibroids in pregnancy ranges from 0.1-10.7% of all pregnancies, and while these complications are possible, most women with fibroids have uneventful pregnancies. The risk of complications is particularly high with fibroids larger than 5 cm in diameter or when multiple fibroids are present.
The decision to treat fibroids before attempting pregnancy depends on several factors: symptom severity, fibroid characteristics, age, and reproductive goals. Myomectomy, surgical removal of fibroids while preserving the uterus, is often recommended for women desiring future pregnancy, though adequate healing time (typically 3-6 months) is necessary before conception attempts.
Resection of submucosal fibroids has been shown to improve pregnancy rates. However, recommendations concerning intramural fibroid treatment remain unclear and should be discussed individually with the patient.
If you have fibroids and are concerned about fertility, consultation with a gynecologist is essential. In the Newport Beach area, Dr. Marinescu at OBGYN-CARE specializes in the comprehensive management of fibroids and fertility concerns. Dr. Marinescu provides personalized treatment plans that take into account your specific fibroid characteristics, reproductive goals, and overall health to optimize your chances of conception and a healthy pregnancy.
Imaging studies can determine fibroid size and location, helping predict their impact on fertility. Many women with fibroids conceive naturally and carry healthy pregnancies to term, especially when fibroids are small or favorably located. Understanding your specific situation empowers you to make informed decisions about timing, treatment options, and reproductive strategies that align with your family-building goals.
