The Effect of Fibroids on Fertility and Pregnancy

Uterine fibroids, commonly known as leiomyomas, are abnormal tumours that grow in or on the uterus of women. Uterus is the womb and home of the baby until birth.

These tumours sometimes grow huge and cause severe abdominal pain and heavy menstrual flow (periods). This condition affects 20 – 27 percent of all women of reproductive age. However, it is more common among black women. Over the past few decades, uterine fibroids in pregnancy have been on the increase. This is as a result of women delaying childbearing till later in their reproductive years. Because of this, women are constantly confronted with these questions:

Can I become pregnant if I have a fibroid?

Can I conceive after fibroid removal?

Should I be worried about fibroids during my pregnancy?

Can uterine fibroids harm my pregnancy?

To address these concerns, we will briefly discuss the causes, types, and symptoms of uterine fibroids and then discuss the effect of uterine fibroids on fertility and pregnancy.

DO FIBROIDS REALLY HAVE ANY IMPACT ON FERTILITY AND PREGNANCY?

Fibroids may impact fertility and pregnancy chances because they can affect the shape, size, and function of the uterus.

These circumstances can cause the endometrium to not meet the optimal conditions for the embryo to implant, or spontaneous abortions to occur in the first weeks of gestation.

Malignant fibroids may prevent or affect pregnancy. Fortunately, only a small percentage of fibroids become malignant. Less than 1% of cases will lead to a malignant tumour, called leiomyosarcoma.

CAUSES OF FIBROIDS

What specifically causes fibroids, one would wonder?

Although the exact cause is yet unknown, research suggests that fibroids may be caused by the following:

• Hormones: The ovaries produce the hormones oestrogen and progesterone. They may encourage the growth of fibroids and cause the uterine lining to renew during the menstrual cycle.
• Family history: Women frequently inquire about the hereditary nature of fibroids. Studies have demonstrated a relationship between hereditary factors and fibroids. For instance, you are more likely to have fibroids if your mother, grandmother, or sister did.
• Inflammatory gynaecological diseases, endocrine-metabolic diseases (diabetes mellitus, chronic diseases of internal organs, thyroid gland diseases), and intrauterine interventions (abortions, curettage, use of intrauterine devices) can also lead to fibroids.
• Some clinical research suggests that red meat, alcohol, obesity, and other factors may also be to blame.

TYPES OF FIBROIDS

Not all fibroids are the same because they are classified based on their location. This is what determines whether pregnancy is viable in the presence of fibroids.

• Submucosal Fibroids: This type of fibroid forms and grows in the uterine cavity where the baby grows throughout pregnancy. This type of fibroid affects the uterine endometrium and usually causes the most symptoms and mass infertility problems. Fortunately, they only account for 5% of cases of uterine fibroids.
• Intramural Fibroids: This type of fibroid grows in the muscular wall of the uterus, which can cause a deformation of the uterus. Approximately 40% of uterine fibroids are of this type and it is not usually directly related to problems conceiving. When this type of fibroids occupies the entire muscle thickness, they are called transmural fibroids.
• Subserosal Fibroids: It is the one that is located just under the outer covering of the uterus. This type of fibroid usually grows towards the outside of the uterine cavity, giving the uterus a bulging appearance. However, it does not prevent pregnancy or childbirth, so it is not usually necessary to remove it.

COMMON SYMPTOMS OF FIBROIDS

Most uterine fibroids do not cause any symptoms. However, some symptoms require consultation with the gynaecologist. These symptoms include:

• Very heavy menstrual bleeding, sometimes with blood clots.
• Bleeding between periods.
• Menses that may last longer than normal.
• Frequent Urination.
• Cramps or pain during your period.
• Feeling of being full or having some pressure in the lower abdomen.
• Possible discomfort or pain during sexual intercourse.

EFFECT OF FIBROIDS ON FERTILITY

While most women will not encounter fertility problems or pregnancy troubles as a result of these tumors, research has shown that fibroids are present in 10% (one out of every ten women) of infertile women. Submucosal fibroids, for example, that grow and bulge into the uterine cavity, increase the chance of infertility.

Because fibroids grow inside the uterine cavity, they can act as a foreign body, reducing the space available for embryo implantation and foetal development, resulting in infertility.

EFFECT OF FIBROIDS ON PREGNANCY

The potential effects of fibroids on pregnancy are a significant clinical issue, especially since the benign tumors are widespread in women of reproductive age.

Pregnancy problems caused by fibroids include:

• Placental Abruption: Abruption is the early detachment of the placenta from its attachment to the uterine wall. According to studies, women with fibroids had a two-to threefold greater risk of abruption. This can be caused by abnormal blood flow to the placental location, resulting in placental ischaemia.
• Foetal Growth Restriction: Fibroids can grow and take up a lot of space in the womb, as well as the blood supply.
• Preterm Labour: Women with fibroids are at a higher risk of preterm labor (labor that begins before 37 weeks of pregnancy).
• Miscarriage: Because fibroids can interfere with implantation, placentation, and uteroplacental circulation, some forms of fibroids are associated with a higher risk of miscarriage.
• Breech Position: Fibroids can create an irregular lie of the baby, such as breech, oblique, or transverse, which increases the risk of a caesarean delivery.

DETECTION AND DIAGNOSIS OF UTERINE FIBROIDS

Although a physical examination can assess the size, shape, and consistency of the uterus as well as the presence of fibroids, imaging studies are always required to validate these findings.

• Ultrasound is the most effective method for detecting uterine fibroids because it helps to pinpoint their size and location, as well as many of their potential complications.
  This is typically a vaginal ultrasound, but an abdominal ultrasound may be required in some circumstances to complete the assessment.
  Other imaging procedures, such as pelvic and abdominal computed tomography, can be used to evaluate the neighbouring organs and assess the potential impact of the fibroid on those organs.
• Nuclear magnetic resonance imaging is another test used to diagnose uterine fibroids. It is a more precise imaging technique than ultrasound for detecting and locating uterine fibroids, even those that are very small. It is a very valuable test for planning the surgical procedure.

TREATMENT OPTIONS

There are several fibroids treatment options available, and you may be surprised to learn that not all of them require surgery. The treatment options include:

• Uterine Fibroid Embolization (UFE): This minimally invasive procedure is performed by a vascular specialist, such as an intervention radiologist. This minimally invasive procedure treats the fibroids by starving them of their needed blood supply causing them to shrink and die.
• Laparoscopic Myomectomy: A Laparoscopic myomectomy is a surgical operation that removes fibroids from the wall of the womb. Unlike a hysterectomy, which removes the entire uterus, a myomectomy merely removes the fibroids, leaving the uterus and the woman’s reproductive potential intact.
• Medical Treatment: Medicines can help manage fibroid-related symptoms. For instance, a drug called GnRH agonists stimulate the body to produce less estrogen and progesterone. This shrink fibroids. GnRH agonists interrupt the menstrual cycle without affecting fertility after treatment is completed.

CONCLUSION

Uterine fibroids may cause fertility issues. They may also affect your ability to carry a pregnancy to term. However, most women will have no difficulty conceiving or becoming pregnant as a result of these tumours.

But if you’re having problems conceiving and maintaining a pregnancy, we recommend contacting a fertility specialist to rule out other possible causes. While fibroids cannot be avoided, a healthy lifestyle may minimize your risk.

Similarly, living a healthy lifestyle, which includes maintaining a healthy weight, might minimize your chances of developing infertility issues and high-risk pregnancies.