Can Fibroids cause Infertility?

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Fibroids & Infertility

The role of fibroids as a cause of infertility is a very controversial one. Fibroids commonly occur in both normal fertile and infertile women and there is no cause evidence that their mere presence is casually linked to infertility. A study previously showed infertility affected about two percent of women undergoing myomectomy which means that other factors are inclusive and responsible for most cases other than the presence of fibroids.

Another study of women taking follicle maturing drugs without assisted reproduction technology noticed that the presence of fibroids do not adversely affect conception outcome in vivo pregnancies. The author however quickly added that larger studies will be needed as his study was limited as it only studied the effect of small fibroids (6cm) and not submucosal and the fibroids did not compress the endometrial cavity. Cases where fibroids are the sole factor in infertility is due to submucous fibroids, known to cause the greatest impairment and subserouse ones.

Be that as it may, some studies have shown that the chances of clinical pregnancy after IVF-ET treatment, is low in women with intramural and submucosal fibroids .Pregnancy rate was not influenced by the presence of subserous fibroids. Theories explain the possible cause of infertility in women with fibroids which include;

Distortion of the endometrial cavity

Greater distance for sperm travel

Impairment of blood supply to the endometrium

Atrophy,inflammation of ulceration of the endometrium thereby preventing implantation

Dysfunctional uterine contractility with impaired gamete transfer

Enhanced androgen environment

Fibroids in Pregnancy

Fibroids are more important feature in pregnancy. Greatest risk of fibroids growth occurs when women are not pregnant up to their late thirties. However fibroids do not enlarge during pregnancy. A study showed that 78% of fibroids did not enlarge in pregnancy but is associated with higher rate of miscarriage especially if implantation occurs in relation to submucous fibroids. Another study showed 41% miscarriage rate against 19% after it was surgically removed. Other complications that could occur with the marriage of fibroids and pregnancy are; preterm labour, preterm PROM, abdominal pain, abruption placenta, placenta previa, IUGR, obstructed labour, post-partum haemorrhage and puerperal sepsis.

Treatment options

About 70-80% of uterine fibroids is asymptomatic and is discovered initially during routine pelvic examinations. For most of such people, explanation, reassurance and re-examination at periodic intervals are all that may be needed. Other treatments options are; hysterectomy, laparoscopic myomectomy and abdominal myomectomy.

Abdominal Myomectomy

This is used when conserving the uterus is desired in the treatment of uterine fibroids. The abdominal is entered, the uterus isolated, the fundus is incised, the myomas excised and the uterus and abdominal wall are surgically repaired. Some of the circumstances where this surgery is done are;

Menorrhagia associated with sub-mucous or intramural fibroids

Infertility associated with uterine cavity distortion after other avenues have been explored

Recurrent miscarriage associated with sub-mucous fibroids

Pressure symptoms on bowel or bladder or uterus

Pregnancy complications associated with malpresentations-with other causes excluded.

Non surgical treatments include medical therapy and uterine artery embolization.