When it comes to infertility, there can be a variety of causes, and often there is more than one factor in play. If you are trying to cover all of your bases to determine what the problem may be, and therefore how to treat it, you are probably trying to learn all you can about the potential causes.
One condition you may have heard of is the uterine fibroid, often just referred to as a fibroid. The American Society for Reproductive Medicine has plenty of information on fibroids. But, let’s look at just the basics of what fibroids are, their symptoms, their possible effects on fertility, and treatment options.
What Are Fibroids?
Uterine fibroids are noncancerous, or benign, tumors made of muscle tissue. Sometimes uterine fibroids are also known as leiomyoma or myomas. Uterine fibroids can vary greatly in size. Some are too small to be seen with the human eye and others can be so large that they can enlarge or distort the shape of the uterus.
The location of fibroids may be described in three ways:
- Intramural, meaning within the uterine wall.
- Submucosal, meaning inside the uterine cavity.
- Subserosal, meaning they project to the outside of the uterus
Fibroids can occur in multiples, but some women only have a single uterine fibroid.
What Causes Fibroids?
Fibroids are formed by a single muscle cell in the uterine wall multiplying and growing. It then forms the noncancerous tumor. While this basic process (which applies to many benign tumors in other locations) is understood, there is no clear or exact cause of uterine fibroids. However, there is evidence that links uterine fibroids to environmental, hormonal, and environmental factors.
What are the Symptoms of Fibroids?
Some women have fibroids and show no symptoms. If the fibroids are symptomatic, the symptoms will depend on the location, size, and the number of fibroids.
Most commonly, women with uterine fibroids will experience some of the following symptoms:
- Pelvic pain
- Pelvic pressure
- Frequent urination
- Difficulty emptying the bladder
- Heavy menstrual bleeding
- Menstrual periods that exceed one week
- Leg pains
- Otherwise unexplained anemia
If you are experiencing these symptoms, you should see your doctor, especially if you have multiple symptoms and/or they persist without any relief. Extreme or acute pain may be felt if the fibroid dies because it outgrows its blood supply. This is a rare occurrence.
Can Fibroids Impact Fertility?
While fibroids can cause some fertility issues, most women with uterine fibroids are not infertile. Only 5-10% of infertile women suffer from uterine fibroids. However, fibroids can contribute to difficulties conceiving. Usually, this depends on the size and location of the fibroids. Other ways fibroids can affect your fertility include:
- Fibroids may block the fallopian tubes.
- Changes in the shape of the uterus due to fibroids. This can affect the movement of sperm or an embryo.
- The shape of the cervix may be altered by fibroids, which will affect the number of sperm entering the uterus.
- Fibroids can alter the growth and size of the uterine lining, therefore jeopardizing implantation of an embryo.
- If the blood flow to the uterus is limited by fibroids, then the embryo is less likely to implant in the uterine wall. Or, if it does implant, the development will be inhibited.
Bearing all of these things in mind, before you get treated for fibroids, other causes for infertility in both you and your partner should be ruled out. Your fertility specialist can help you determine if fibroids are contributing to infertility. Then they can also assist you when deciding how to treat them.
If you have fibroids and you get pregnant, the fibroids may not grow larger during the pregnancy. If the fibroids do grow, the growth usually happens during the first twelve weeks of gestation.
Treatment for Fibroids
Before you can be treated for fibroids, you need to be diagnosed. The diagnosis is usually made using tests such as an ultrasound or another lab test such as a CBC (complete blood count). The ultrasound will enable the doctor or technician to get images of the uterus and confirm the presence of any fibroids and map and measure them if they are present. The ultrasound could be performed transvaginally (inside the vagina) or transabdominal (over the abdomen).
Treatment options for fibroids are varied and you should talk with your doctor about which is best for you, especially if the treatment is intended to increase or preserve fertility.
Sometimes simply monitoring the symptoms over time is sufficient as many women live healthy lives despite fibroids. Menopause will usually help the fibroids shrink due to the decrease in reproductive hormones. Similarly, before menopause, hormonal medications can shrink fibroids, but not eliminate them completely.
Pain relief may be obtained by taking over the counter non-steroidal anti-inflammatory drugs (NSAIDs). Vitamins and supplements for iron may be recommended to combat anemia, especially if your symptoms include heavy menstrual bleeding.
Noninvasive or minimally invasive surgical procedures are also available when necessary. The Mayo Clinic has details about the different procedures available for uterine fibroids.
If you believe you have fibroids, or if you have been diagnosed with them and are concerned about the effect they may be having on your fertility, consult your OB/GYN and fertility specialist. If you are in the San Francisco, CA area, call Laurel Fertility at 415-673-9199 or request an appointment online. We are here to help you with all fertility concerns, including fibroids.