“Do fibroids cause infertility?”
A question we often get asked by patients and it transpires that little is known by patients about this condition.
What are fibroids?
Formally referred to by healthcare professionals as uterine fibroids/myeomas. Fibroids are benign smooth muscle tumours of the uterus. In other words, they are non-threatening lumps in the muscle wall of the uterus.
Uterine fibroids as seen during surgery
How common are fibroids?
Very common. For instance, in 2013, it was estimated that 171 million women were affected worldwide. Figures of 20% to 80% prevalence in the female population are often quoted. For these figures to make sense you need to look at female age.
This is because the incidence increases with age, as can be seen by this breakdown:
- 20-30 years of age: 4% incidence
- 30-40 years of age: 11-18% incidence
- 40 and older: 33% incidence
These figures are taken from a reliable study of 800 women, which used ultrasound to diagnose the condition.
What causes them?
The cause is not known. However, they run in families and appear to be partly determined by hormone levels. Obesity may also play a part in the condition. Other known risk factors include diabetes, polycystic ovary syndrome and high blood pressure.
What are the symptoms?
Many women do not have any symptoms of fibroids. When present, typical symptoms include:
- Abdominal pain
- Anaemia
- Increased bleeding
Rarer symptoms include pain during intercourse, rectal pressure, and distended abdomen, the condition can look like early pregnancy.
What about infertility?
We can see that fibroid development occurs when a woman is in her thirties and forties. In previous decades women had children earlier so the question of fibroids and fertility did not arise.
Nowadays, with women having children later in life, the question of a relationship between fibroids and infertility is much more important.
The good news is that fibroids shouldn’t generally affect one’s fertility. For instance, even if one has fibroids, they may stay small or occur in areas that don’t affect the reproductive system.
However, fibroids are thought to account for about 3% of the reasons why a woman may not be able to have a child. In these cases, depending on where they are located, fibroids may prevent sperm and egg from meeting for conception.
- Fibroids that change the shape of the cervix can affect the number of sperm able to enter the uterus
- Uterine fibroids that block the fallopian tubes can hinder or prevent the journey of a fertilised egg to implantation
- Fibroids that change the shape of the uterus may decrease the number of places an embryo can successfully implant. They can also reduce uterine space needed for embryo development
- Fibroids that weaken the lining of the uterus or decrease the blood supply to a growing embryo can cause miscarriage.
Pregnancy considerations
The other issue to take into account with fibroids is pregnancy itself. Complications caused by fibroids may occur during pregnancy and labour. Pregnant mothers with fibroids have a six-time greater risk of caesarean section compared to women who don’t.
Prevention of fibroids
Since the causes are largely unknown and many women are unaware that they have them, fibroids are hard to prevent.
That said, diet may be important. Diets high in fruits and vegetables have been shown to lower the risk of developing fibroids. A study has also shown that maintaining normal dietary levels of vitamin D may reduce the risk of developing fibroids. Vitamin D may be found in found in fish, cheese and eggs,
Treatment of fibroids
Generally, for the reasons outlined above, treatment is not necessary. However, when the symptoms of fibroids interfere with normal life, or when fibroids interrupt fertility, then treatment is available.
Treatment falls into two categories:
- Medical: various medications can shrink fibroids and control symptoms with good results, but will not remove them entirely
- Surgical: fibroids can be removed with surgery. This is effective but complications of this procedure can include scarring, and also fibroids may return within a couple of years
- Uterine artery embolization (UAE): this is non-surgical option. A radiologist blocks off the arteries that feed the fibroids, which causes the fibroids to shrink.
So, in short fibroids may be an added complication in older women seeking to conceive. However, they are unlikely to be a major impediment. If they are a problem, or look like they may become one, they can be treated or removed fairly easily.
As always, if you have any concerns your health care professional can advise you as to your best options.
