Uterine fibroids are the most common benign tumor in women of reproductive age.
By the time women reach 50 years old, 75% will uterine fibroids, at least one. Fibroids, also called leiomyomas or myomas, are present in up to 10% of women with infertility and they are the sole infertility factor identified in up to 3% of women when an infertility evaluation is performed. Besides infertility, fibroids may cause pelvic pain and pressure, painful periods, and heavy menstrual flow.
Do all fibroids affect fertility?
The size and location of fibroids are important in determining their risk of causing infertility. Fibroids can be located within the uterine muscle (intramural fibroids), inside the uterine cavity (submucosal fibroids), or on the outside of the uterus (subserosal fibroids).
Fibroids located on the outside of the uterus have little effect on fertility. Fibroids pushing into the cavity of the uterus have been shown in studies to both lower pregnancy rates and increase miscarriage rates. These fibroids seem to make the uterine lining less receptive for implantation of the embryo. Intramural fibroids may affect fertility if they are of sufficient size. Larger fibroids may impinge upon the uterine cavity or may divert blood flow away from the uterine lining and a developing pregnancy. Intramural fibroids larger than 3 cm have been shown to reduce pregnancy rates, and they should usually be removed. After surgical removal of a fibroid, pregnancy rates may improve significantly.
How are fibroids removed?
The optimal surgical approach to remove fibroids depends primarily on the fibroid(s) size and location. Many fibroids can be removed using minimally invasive techniques like laparoscopy or hysteroscopy. Larger or more complex fibroids may require a larger abdominal incision (laparotomy) in order to get the best result. Because of this, surgery for fibroid(s) may be performed as an outpatient with a few days of recovery, or it may require a night’s stay in the hospital followed by a few weeks of recovery. The surgical approach is usually determined in advance and is based on both physical exam and ultrasound. Sometimes findings discovered during surgery may cause a change in the approach.
Are there other treatments for fibroids?
There are many treatment options for fibroids, including medications or other minimally invasive procedures. Uterine artery embolization is a procedure performed by a specially trained radiologist. During this procedure, performed typically in a radiology suite, small coils are placed through a large blood vessel in a woman’s groin and guided into the blood vessels that feed the fibroid. The coils diminish blood flow to the fibroid, causing it to shrink. Fibroids can also occasionally be treated using high frequency sound waves directed into the fibroids using a special instrument during laparoscopy. As these procedures are relatively new, there are very limited data evaluating the effect of these treatments on future pregnancy. Therefore, most reproductive endocrinologists tend to only recommend well accepted surgical treatments.
In some occasions, medical treatment of fibroids may be appropriate. Some treatments, specifically GnRH analogues such as leuprolide acetate, can actually cause fibroids to shrink. When given monthly for 3-6 months, leuprolide can cause fibroids to shrink by up to 60%. Unfortunately, however, these treatments are only temporary, as fibroids regrow to their original size within 3 months of discontinuing medical treatment. Therefore, most reproductive endocrinologists only use medical treatment in cases where fibroid shrinkage would allow a myomectomy to be performed through a smaller incision or in cases of significant anemia. In these cases, leuprolide acetate can stop all menstrual bleeding so that a woman’s blood count will rise before surgery – minimizing the risk that she would need a blood transfusion during or after surgery. Currently, the best way to treat fibroids in order to rapidly maximize the chance for pregnancy is surgery.
If you have any questions, please contact our San Antonio fertility center.