Fibroids causing infertility? These treatments can help!
Uterine fibroids are the most common benign neoplasm in women, affecting as many as 70 to 80% of women, says the American National Library of Medicine (NLM).
While many women are asymptomatic, as many as 30% of patients develop various debilitating symptoms such as heavy menstrual bleeding (HMB), pelvic pain or pressure, urinary or bowel obstruction, and infertility. It is crucial not to ignore fibroids, as they can cause many reproductive complications leading to infertility. This article will discuss the treatments available for fibroids, with a special focus on treatment to protect against infertility.
Amongst the known causes of infertility, fibroids are fairly common and are present in a significant 5-10% of infertile patients. Fibroids may also be the sole cause of infertility in 1-2.4% of patients, says the American National Library of Medicine (NLM). Fibroids can cause infertility by, for example, obstructing the fallopian tubes and impairing the movement of the eggs and embryos through the fallopian tubes; or by preventing embryos from implanting successfully in the uterus.
Fortunately, many options and approaches exist for treatment but It’s important to first understand what fibroids are and why they occur.
What are fibroids
Fibroids are benign growths of the uterus, also known as uterine leiomyoma, and often appear during a woman’s reproductive years. This is because fibroids depend on oestrogen and progesterone to grow, and are therefore only relevant during the childbearing years and before menopause. Fibroids are known to decrease in size or calcify after menopause, due to a drop in hormone production.
A woman can have one uterine fibroid or multiple fibroids. Accounting for about 3% of infertility cases among women, fibroids are quite common and can cause recurrent miscarriages.
Uterine fibroids are commonly described based on their location in the uterus.
Intramural fibroids grow within the muscular walls of the uterus and they are most common. Submucosal fibroids bulge into the uterine cavity beneath the inner lining of the uterus and may disrupt the function of the lining and the ability of the embryo to implant. Subserosal fibroids grow beneath the serosa and project to the outside of the uterus. Cervical fibroids are located in the wall of the cervix.
Uterine fibroids rarely develop into cancer and are not associated with an increased risk of uterine cancer.
Causes and symptoms of fibroids
Research points to a few factors why fibroids occur. The two hormones oestrogen and progesterone, which enhance the development of the uterine lining during each menstrual cycle in preparation for pregnancy, are known to promote the growth of fibroids.
Abnormalities in the blood vessel system are also known risk factors, as well as hereditary factors such as family history, and race as women of African descent are three times more likely to develop fibroids due to reasons that are still unclear. Other possible causes include obesity, polycystic ovary syndrome, diabetes, alcoholism, vitamin D deficiency, and eating large amounts of red meat.
Many women with fibroids don’t develop symptoms, however, if symptoms do appear they may include the following:
* periods that last longer than normal;
* bleeding between periods;
* heavy bleeding during a period, sometimes with blood clots;
* pelvic cramping or pain with periods;
* lower back pain;
* pain during intercourse;
* a feeling of fullness or pressure in the lower belly;
* enlargement of the lower abdomen;
* needing to urinate often;
* infertility; and
Heavy bleeding, increased cramping, or bleeding between periods, as well as fullness or heaviness in your lower belly, are warning signs to contact a healthcare provider without delay.
Fibroid diagnosis and treatment
Depending on the symptoms, a specialist may carry out some testing and/or use imaging techniques. Ultrasound provides a picture of the uterus, enabling the doctor to confirm the presence of fibroids and to pinpoint the locations thereof.
If there is heavy menstrual bleeding, the doctor may order a lab test to investigate potential causes. These may include a complete blood count to see if there is anaemia, and other blood tests to rule out the possibility of a bleeding disorder or thyroid problems. Magnetic Resonance Imaging (MRI) can show the location and size of the fibroids.
A hysterosonography, also called sonohysterography may also be used for diagnosis, where the uterine cavity can be expanded by using sterile saline, making it easier to get a picture of submucosal fibroids. Hysterosonography may be recommended if fertility is a concern. Hysteroscopy allows the doctor to better examine the walls of the uterus and the openings of the fallopian tubes.
Non-surgical treatment procedures involve the use of medications and focus on regulating the menstrual cycle hormones and treating symptoms such as pelvic pain and heavy menstrual bleeding. It does not remove the fibroids but can shrink them. Medication may include medication for pain and to help with heavy bleeding, a progestin-releasing intrauterine device to, hormone agonists to induce a temporary post-menopausal stage.
With a lower dose of oral contraceptives, the surgical procedures may include: a hysterectomy, myomectomy, MRI-guided focused ultrasound surgery (FUS), and uterine artery embolization.
Fibroids and fertility treatment
If you are trying to get pregnant, it is important to realise that not all fibroid treatments are suitable. Due to this reason, determining for certain whether fibroids are preventing you from getting pregnant, or whether there is another possible cause of infertility is crucial.
Fortunately, advanced modern technology can now precisely determine if fibroids are preventing pregnancy using innovations such as ultrasound, Magnetic Resonance Imaging (MRI), hysterosonography, hysterosalpingography (HSG), hysteroscopy, or laparoscopy.
For example, it may be that not all fibroids need to be removed. Similarly, a surgery that removes fibroids inside the uterus can better improve the chances of achieving a successful pregnancy compared to others. Removing fibroids in other locations of the uterus may not improve your chances. Microscopic fibroids directly below the uterine lining can also be missed most easily, even at the time of surgery, causing fibroids to also recur following surgery.
For all these reasons, it is important that only a competent qualified fertility specialist perform this advanced surgery. Procedures will depend on the position, size, and growth rate as determined by a fertility specialist.
If it has been established that fibroids are indeed the cause of your infertility or miscarriages, it is crucial to choose an accredited fertility clinic that will develop a unique fertility treatment plan for you, based on your situation. It would be wise to choose a fertility clinic with qualified, experienced experts with the right facilities, technology, and equipment.
At Medfem’s accredited and purpose-designed medical facility, our fertility specialists have access to all these technologies to determine for certain if fibroids are preventing you from getting pregnant. Our team of Medfem fertility specialists also have the expertise and advanced equipment to offer you all the fibroid treatment options – including those that will enhance your chances of getting pregnant – so you can choose the option that is right for you.
If you would like to meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
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