Fibroids and Infertility
Fibroids, or uterine fibroids as they are called, are quite common among older women and a known cause of infertility in women. In this article, we look at what fibroids are, why they can cause infertility, who are most likely to be affected by fibroids and how to know if you have fibroids. We also list the treatment options are available and how to know which one is right for you.
What are fibroids?
Uterine fibroids, also known as myomas, are benign, non-cancerous growths or tumours derived from the uterine muscle cells. These tumours develop when the muscle cells become extremely sensitive to normal estrogen levels and start dividing very rapidly.
Fibroids can be so tiny that a microscope is required to see them. However, they can also grow very large – filling the entire uterus and weighing several pounds. Just one fibroid can develop, but usually there are more than one. If more than one muscle fibre is affected, multiple fibroids are usually present.
Fortunately, fibroids can be treated very effectively, removing this cause of infertility.
How fibroids affect infertility
For successful embryonic growth and development, the uterus must be free of large polyps or fibroids.
This is because once an egg is fertilised, the embryo must travel through the fallopian tube and embed in the uterine lining or endometrium. Since the embryo implants in the endometrial layer, it must be thick and vascular to provide nutrients essential for embryonic development.
Fibroids directly below the uterine lining can cause infertility. These fibroids take up valuable space in or beneath the cavity of the uterus and limit the blood supply to the foetus, preventing pregnancy or causing miscarriages. In fact, these fibroids may mimic the function of an intra-uterine contraceptive device (“loop”).
In addition, small fibroids directly below the uterine lining can be most easily missed by internal gynaecological examination by a doctor and may even not even be seen at the time of surgery. For this reason, fibroids may recur following treatment.
Who is affected by fibroids?
Fibroids are rare in women under age 20, but as women grow older, fibroids become quite common, especially during the 30s and 40s through menopause. As many as 1 in 5 women may have fibroids during their childbearing years, and half of all women have fibroids by age 50. Thankfully, fibroids often shrink and cause no symptoms in women who have gone through menopause.
In addition to age, certain factors can increase a woman’s risk of developing fibroids, including family history, ethnic origin, obesity and eating habits.
Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average. Ethnic origin also plays a role, with African women being more likely to develop fibroids. In addition, women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average. Related to this are eating habits. Eating a lot of red meat is linked to a higher risk of fibroids, while eating plenty of green vegetables seem to protect women from developing fibroids.
How do I know if I have fibroids?
Many women don’t feel any symptoms with uterine tumours or fibroids.
But for others, these fibroids can cause periods that last longer than normal; bleeding between periods; and heavy bleeding during a period, sometimes with blood clots.
Women who have fibroids may also experience pelvic cramping or pain with periods; lower back pain or pain during intercourse. There may also be a feeling fullness or pressure in your lower belly; enlargement of the lower abdomen; and needing to urinate more often. And, of course, infertility and miscarriages are an indication that fibroids may be present.
When to Contact a Medical Professional
If you are experiencing heavy bleeding, increased cramping, or bleeding between periods, as well as fullness or heaviness in your lower belly area, it is important that you contact a healthcare provider without delay.
A doctor may find fibroids during a physical exam or other test – uterine fibroids are frequently found during a routine pelvic exam. Fibroids can usually – but not always – be felt by gynaecological examination. Irregularities in the shape of your uterus may be felt, suggesting the presence of fibroids.
However, more accurate diagnosis can be made through modern technologies such as ultrasound, MRI, hysterosonography, hysterosalpingography (HSG), hysteroscopy or laparoscopy. Each one is discussed in more detail below.
Ultrasound diagnosis is very accurate. An ultrasound uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. Intra-vaginal (internal) ultrasound scans are much more accurate than the external ultrasound scanning done through a full bladder.
Magnetic Resonance Imaging (MRI) is an imaging test that can show the size and location of fibroids, identify different types of tumours and help determine appropriate treatment options.
A hysterosonography uses sterile saline to expand the uterine cavity, making it easier to get images of the uterine cavity and endometrium. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound.
Hysterosalpingography (HSG) uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. In addition to revealing fibroids, it can help your fertility specialist to determine if your fallopian tubes are blocked, another possible cause of infertility.
During a hysteroscopy, a tiny, lighted telescope called a hysteroscope is inserted through your cervix into your uterus. Saline injected into your uterus expands the uterine cavity, allowing the walls of your uterus and the openings of your fallopian tubes to be examined.
A laparoscopy involves a long thin scope which is inserted into a tiny incision made in or near the navel. The scope has a bright light and a camera, enabling the uterus and other organs to be viewed on a monitor during the procedure and images to be captured.
What are the treatment options?
Not all fibroids need to be removed. Whether they need to be removed or not will depend on the position, size and growth rate, as determined by regular follow-up evaluations by a fertility specialist.
In terms of the role fibroids play in infertility, removing fibroids inside the uterus that prevent a fertilised egg from implanting in the uterus will improve the chances of achieving a successful pregnancy. However, removing fibroids in other locations of the uterus may not improve your chances of becoming pregnant.
The treatment options for fibroids include various types of surgery – from traditional open surgery and hysterectomy or uterus removal, to more modern options such as myomectomy or fibroid removal; hysteroscopic surgery and laparoscopic or keyhole surgery. You can read more about these treatment options here…
What Treatment Option is Right for Me?
Given the many options are available, you are likely to wonder how you will know which treatment would be right for you? The answer is simple: an initial consultation with a fertility specialist.
A 30 – 60 minute initial consultation is your first step in any infertility treatment plan, regardless of which specific treatments you may require.
During your initial consultation at Medfem Fertility Clinic, you will meet one of our four highly qualified and experienced fertility specialists, who will discuss with you your medical history, conduct a comprehensive physical exam and blood tests, explain your treatment options, answer all your questions, and plan your treatments with you.
Simply click here or contact us on +27 (11) 463 2244 to book your initial consultation.
We look forward to welcoming you.