Fibroids and their Impact on Fertility

Understanding Uterine Fibroids and Their Impact on Fertility

Uterine fibroids are one of the most common reproductive conditions, affecting up to 70% of women by age 50. Many are harmless and go unnoticed — but in some cases, fibroids can interfere with fertility or pregnancy.

The good news is that fibroids are treatable, and with proper care, many people go on to conceive and carry healthy pregnancies.

1. What Are Uterine Fibroids?

Fibroids (also called leiomyomas or myomas) are non-cancerous growths of muscle tissue that develop in or around the uterus.

They vary widely in size — from tiny nodules to large masses — and can grow:

• Inside the uterine wall (intramural)

• Into the uterine cavity (submucosal)

• On the outer surface of the uterus (subserosal)

The type, size, and location of fibroids determine how they might affect fertility and symptoms.

2. What Are the Symptoms?

Some people have no symptoms at all, while others experience noticeable changes in their menstrual cycle or pelvic comfort.

Common symptoms include:

• Heavy or prolonged menstrual bleeding

• Pelvic pressure or fullness

• Painful periods or cramps

• Bloating or abdominal distension

• Frequent urination or constipation (if fibroids press on nearby organs)

• Difficulty getting pregnant or staying pregnant

Because fibroids grow slowly and symptoms vary, they’re often discovered during routine exams or fertility evaluations.

3. How Are Fibroids Diagnosed?

Fibroids are typically detected through imaging or during fertility workups.

Common diagnostic tools include:

• Transvaginal ultrasound: The most common first step to identify fibroid size and location.

• Sonohysterogram (saline ultrasound): Provides a clearer view of the uterine cavity.

• MRI: Used for detailed mapping before surgery or fertility treatment.

• Hysteroscopy: Allows direct visualization and, in some cases, removal of fibroids inside the uterine cavity.

Blood tests may also check for anemia (from heavy bleeding) or hormone imbalances.

🧪 Test Values Explained: Hormone and Uterine Health Markers

Test	What It Measures	Typical Findings in Fibroids	Typical Range
Estradiol (E2)	Estrogen levels	May be elevated, as fibroids grow in response to estrogen	30–80 pg/mL (day 3 of cycle)
Progesterone	Luteal phase hormone	Often low or imbalanced	>3 ng/mL (mid-luteal phase)
Hemoglobin (Hgb)	Blood oxygen-carrying cells	Low if heavy bleeding occurs	12–15 g/dL (normal range for women)
FSH (Follicle-Stimulating Hormone)	Ovarian function	Usually normal	<10 mIU/mL
Ultrasound / MRI Findings	Uterine structure	One or more fibroids visible (intramural, submucosal, subserosal)	—

➡️ Fibroids aren’t caused by hormone levels alone, but their growth is influenced by estrogen and progesterone balance.

4. How Fibroids Affect Fertility

Fibroids can impact fertility in several ways — depending largely on their location within the uterus:

• Submucosal fibroids (inside the uterine cavity) can distort the lining, making it harder for embryos to implant.

• Intramural fibroids (within the uterine wall) may affect blood flow to the uterus or interfere with embryo development.

• Subserosal fibroids (on the outer wall) usually don’t affect fertility but can cause pelvic discomfort or pressure.

Fibroids may also increase the risk of miscarriage, preterm labor, or complications during pregnancy if left untreated.

5. Treatment Options

Treatment depends on your symptoms, fertility goals, and the size and location of the fibroids.

💊 Medical Management

• Hormonal therapy: Birth control pills, progestins, or GnRH analogs can shrink fibroids or control bleeding.

• Non-hormonal treatments: Medications to reduce heavy bleeding or pain.

🌿 Surgical and Procedural Options

• Hysteroscopic Myomectomy: Removes fibroids inside the uterine cavity; typically an outpatient procedure.

• Laparoscopic or Robotic Myomectomy: Removes fibroids from the outer or deeper layers of the uterus with small incisions.

• Abdominal Myomectomy: Used for larger or numerous fibroids.

• Uterine Artery Embolization (UAE): Blocks blood flow to fibroids, causing them to shrink (not recommended for those seeking pregnancy).

  
  

6. Fertility After Fibroid Treatment

Removing fibroids — especially those that distort the uterine cavity — often improves pregnancy rates significantly.Most patients are advised to wait 2–3 months after myomectomy before trying to conceive or beginning IVF, allowing the uterus to heal.

During IVF, fibroids can affect both embryo

implantation and uterine receptivity, so pre-treatment evaluation is key. Your fertility team will review imaging to determine if removal is recommended before treatment.

💗 The Takeaway:

Uterine fibroids are common, manageable, and highly treatable — even when fertility is affected. With the right diagnosis, personalized care, and expert treatment, many patients go on to conceive naturally or through fertility treatments like IVF.