Fibroids and Fertility
Basic Facts of Fertility
The number of eggs you have affects the chances of getting pregnant. Egg numbers decrease as women age, and unfortunately you do not create new eggs
A woman’s age is an important factor in getting pregnant. Egg quality is determined by age and decreases with advancing age. After the age of 35, fertility decreases drastically.
Are your Fallopian tubes open? Scar tissue and compression of the tubes can cause blockages in your tubes, which is often assessed by performing an HSG (hysterosalpingogram is an x-ray dye test that allows your provider to see your uterus and fallopian tubes).
Uterus structure: Factors include uterine anomalies, fibroids, adenomyosis and other conditions can affect fertility.
Other factors: A male partners sperm, other hormone conditions can affect fertility (PCOS, etc) and finally rare genetic disorders
Impact of Fibroids on Fertility:
1. Fibroid location:
Location of fibroids with in the uterus affects fertility. The closer your fibroid is to the inner lining of your uterus, the higher the risk of infertility. Intracavity (pedunculated submucosal), submucosal and intramural fibroids are known to adversely affect fertility.
2. Fibroid Size
The size of your fibroids affects fertility. Statistically, a fibroid that is larger than 4 cm can cause issues with your fertility and interfere with your ability to carry a pregnancy to term.
3. Fibroid Numbers:
The number of fibroids play a role in infertility with a larger count typically causing more issues.
4. Normal Gene Expression
Some studies state that just having fibroids can negatively affect the normal gene expression, which is critical for embryo implantation. Fibroids impact the entire endometrium, not only the part that is in direct contact with the fibroid.
Fibroid Treatment and Fertility:
Fertility is often at the forefront during discussions of fibroid treatment options with your doctor and primary care providers. If you are of childbearing age and plan on becoming pregnant you may be subject to the same narrative – invasive surgery is the only viable solution to cure your fibroids.
Treatment of fibroids include myomectomy (surgery cutting out fibroid(s)) and UFE (non-surgical shrinking of fibroids).
Studies have shown, however, that a solution that ends in myomectomy is far from a cure for fibroids. In fact, its impact on your fertility might be contrary to what you desire.
Comparing Research Studies
- 1. Among 1,095 women who underwent myomectomy, 91 reported live birth during 36 months of follow-up (8.3% live birth rate). (Ref:FertilSteril. 2022 May;117(5):1083-1093).
- 2. In a study of 144 patients with fibroids who wanted to conceive, those who had more than 6 fibroids surgically removed (myomectomy) had a pregnancy rate of 22.9%. 45% of these women who got pregnant had to have fertility treatments to get pregnant. (Ref: J Minim Invasive Gynecol. Sep-Oct 2018; 25(6)1002-1008.)
- 3. In another study that analyzed patients having REPEAT open incision myomectomy, of the 47 women who had repeat myomectomy for fertility reasons, six women conceived and two live birth at term (4% live birth rate). (Ref: J ObstetGynaecol. 2020 Jul;40(5):673-677)
- 4. In a study of 398 female patients under the age of 43 years who were treated by Uterine Artery Embolization (UAE/UFE) between 2003 and 2017 for symptomatic fibroids and/or adenomyosis, 109 live births occurred. (Live birth rate of 27.4%) (Ref: J Obstet Gynecol. 2021 Oct;225(4): 403.e1-403.e22).
- 5. In a study of 53 patient having robotic-assisted laproscopic myomectomy with an average of 2 fibroids cut out, the live birth rate was 41.5%. (Ref: Int J Med Robot. 2020 Feb;16(1):e2059). There are NO COMPARABLE STUDIES available for UFE since the procedure is seldom performed for such a low number of fibroids. As such there is no data to support that UFE is inferior to Myomectomy when in comes to fertility.
In Summary:
While extensive research has not been conducted to conclusively decide in favor of one versus the other fibroid treatment option and its impact on female fertility, it is important to consider several factors that play a key role in affecting your fertility.
The greater number of fibroids you have, the harder it is to get pregnant. The older you are, the harder it is to get pregnant. The closer the fibroid is to the inner lining, the harder it can be to get pregnant. Finally, the larger the fibroid is, the harder it is to get pregnant.
To determine which treatment option will impact your fertility the most, it is vital to determine the size, location and number of fibroids that are afflicting you through MRI. MRI studies are far more accurate study of your uterus than a pelvic ultrasound, which is why all patients seen at Atlanta Fibroid Clinic receive an MRI study.
