Fibroids and Fertility: When Treatment is Necessary

Key Takeaways

• Uterine fibroids are very prevalent, especially in the African American female population and females of reproductive age. Not all fibroids require treatment.
• The size, number, and location of fibroids play a big role in fertility. They can interfere with a woman’s ability to get pregnant or maintain a pregnancy.
• If you’re noticing classic signs such as heavy menstrual bleeding or pelvic pressure, talk to a health professional. With a timely diagnosis, we hope to get you the best treatment possible!
• Treatment options range from watchful waiting to medication, to surgical and minimally invasive procedures. As always, plans should be tailored to the person’s specific symptoms and reproductive goals.
• Working with an experienced specialist and getting second opinions can help verify that the proper approach is taken both for maximizing fertility and symptom management.
• Developing a solid support system and being well-informed helps women decide what’s best for their fibroid and fertility treatment with confidence.

Fibroids are benign tumors that develop within or on the outside of the uterus. When they become large or obstruct the uterine cavity, they can impact a woman’s ability to conceive. When fibroids lead to heavy bleeding or pain, U.S. Doctors are more likely to recommend treatment. This is an important step in increasing the likelihood of conception for women who are having difficulty becoming pregnant.

Women with small fibroids or few mild symptoms may not require treatment. For those experiencing debilitating symptoms or multiple recurrent miscarriages, it may be a reasonable discussion to have with your gynecologist regarding surgical or medical management. Knowing when to treat fibroids is critical for women who want to start a family.

In this blog, we will cover what are the biggest warning signs to look out for. You’ll better understand how decisions are made about treatment and safe options available to protect your fertility.

Understanding Uterine Fibroids

What are uterine fibroids? Uterine fibroids, or leiomyomas, are non-cancerous tumors that develop from the muscle tissue of the uterus. They appear during a woman’s reproductive years, when African American women are among the most affected.

The majority of people with fibroids go their entire lives without knowing they have fibroids, as many fibroids can remain asymptomatic for decades. Some are tiny and isolated; others are colossal or form clusters. Equally important is the size, number, and positioning of the embryos in the uterus. All these factors have a major effect on fertility and the health of pregnant people.

What Exactly Are Fibroids?

Fibroids aren’t cancerous tumors. They originate from uterine smooth muscle tissue.

What types of fibroids are there? Subserosal fibroids — These fibroids rest on the outer wall of the uterus. Submucosal fibroids extend into the uterine cavity. Intramural fibroids are located deep within the wall of the uterus.

These growths can increase in size or decrease in size. In fact, some shrink by nearly 50% in as little as three months. Understanding what type and how fibroids grow assists doctors in developing the best treatment care plan. A fibroid larger than 3 cm can indicate greater complications in pregnancy; therefore, size is important.

Common Signs You Might Have Them

Unfortunately, not all women experience symptoms. Heavy periods, pelvic pain, and frequent urination are all telltale signs. Others report a feeling of heaviness or complications while pregnant.

Irregularities in periods or unusual pain should not be dismissed. Documenting these signs allows you to give your provider a better picture of what is happening.

How Doctors Diagnose Fibroids

Doctors primarily rely on pelvic exams and ultrasounds to identify fibroids. Occasionally, a hysteroscopy may be required to directly visualize the inside of the uterus.

Getting the correct diagnosis not only rules out other causes of abnormal bleeding, but it leads to more effective treatments. A thorough and thoughtful evaluation is a great place to start! Approximately 5-10% of infertile patients have fibroids.

Surgically removing these fibroids can increase pregnancy rates from 25% to 42%!

Fibroids: A Fertility Roadblock?

Often, these fibroids, or benign tumors in the uterus, are completely harmless and very common. About 70% of women with fibroids experience no difficulty conceiving. Studies relate fibroids to infertility in certain instances. Approximately 5-10% of infertile patients carry fibroids and they represent the only etiology of infertility in up to 2.4%. The impact of fibroids on fertility is based on their location, number, and size.

Location: The Critical Factor

Where fibroids grow has a huge impact on their effect. When fibroids distort the uterine cavity, as do submucosal fibroids, there is a decreased likelihood of achieving pregnancy. Regarding the reproductive outcomes, submucosal fibroids have a relative risk of 0.3 for pregnancy and 0.28 for implantation following ART.

Fibroids located around the fallopian tubes can obstruct the tube or restrict the egg’s movement through the tube. Subserosal fibroids, which grow on the outer wall, hardly impact fertility with the use of ART. To best treat fibroids, doctors determine their location through ultrasound or MRI.

Size and Number: Do They Matter?

The more fibroids, the larger the fibroids the greater the risks. Just because a fibroid is small and/or low in number doesn’t mean they don’t prevent conception. Additionally, myomectomy—removing large intramural fibroids greater than 50 mm—increases pregnancy rates, increasing them from 25% to 42%.

Doctors monitor how fast fibroids grow to determine treatment.

Fibroids’ Link to Miscarriage

Increasing evidence suggests that fibroids contribute to higher rates of miscarriage. Through their ability to alter the endometrial lining, they can disrupt the implantation or development of an embryo. Whether women have fibroids that are recognized prior to conception or not, regular monitoring and candid conversations with their care team can help.

Impact on Implantation Success

Fibroids can disturb the uterine environment and alter uterine blood flow. They can further change the cavity’s shape, creating a more difficult environment for an embryo to implant. In addition, women who have experienced repeated failed implantations should be screened for fibroids.

Deciding on Fibroid Treatment

Finding the right approach for fibroids and fertility takes a closer look at each person’s symptoms, health goals, and plans for having kids. These stories remind us that no two cases are the same, and treatment plans must adapt to real lives, priorities, and needs.

Factors like the size and spot of fibroids, symptoms, and fertility hopes play a big role in what comes next. Doctors do need to guide choices, but the individual patient’s voice should be heard as well. Managing symptoms proactively will make life considerably better, even before we get into the discussion about pregnancy.

1. When Symptoms Affect Daily Life

If fibroids lead to disabling pain, heavy bleeding, or bloating enough to make work and family time difficult, it’s time to get treatment. When symptoms begin to take a toll—such as lost workdays or avoiding friends—it’s important to seek help. Wait no longer; contact us today to get started!

Relief is possible. Relief is attainable through a range of treatments, from medications to invasive surgeries. Other drugs come with their own side effects. The reality is that treatments such as myomectomy or UAE can successfully shrink and/or remove fibroids.

In fact, the majority of people return to their regular daily routines within days of having UAE.

2. If Fibroids Clearly Hinder Conception

At times fibroids can obstruct the uterus or tubes, preventing pregnancy. When all tests indicate that fibroids are the obstacle, consulting a reproductive endocrinologist is beneficial.

Laparoscopic or abdominal myomectomy is typically recommended and can result in pregnancy rates up to 60%. Taking care of fibroids first provides the best chance of beginning a family.

3. Recurrent Pregnancy Loss Concerns

In women experiencing recurrent pregnancy loss, fibroids can be a contributing factor. A comprehensive evaluation can determine whether treatment might increase pregnancy success.

When you have open, frank discussions with your providers, it helps ensure that your care is compassionate and supportive.

4. Your Age and Family Goals

For younger women with a desire to have children, timeliness might be a greater concern. Considering how many children you wish to have can help inform your treatment path.

If that is a concern, treatments such as myomectomy provide the greatest chance for successful future pregnancies. Fibroids may recur in about 50 percent of cases within five years.

5. Doctor Advises Intervention Now

When a doctor tells you that you can’t postpone treatment, take heed! They typically have an excellent justification, such as intolerable symptoms or significant risk of complications.

By knowing not only the potential benefits but the risks, each individual can make an informed decision with their healthcare team.

Your Fibroid Treatment Choices

Treating fibroids takes thoughtful planning, particularly where fertility is at stake. Learn about both proven and emerging treatment options so you can choose the right one for your health. Each patient has their own considerations—age, symptoms, desire for more children, etc. The best decision tends to depend on these nuances.

The best plan of all is to have open and honest discussions with a healthcare professional who is privy to it all. Treatments include watchful waiting, medication, surgery and newer less-invasive procedures.

Watchful Waiting: A Valid Option?

For those patients, fibroids don’t hurt them or bother them. In these instances, watchful waiting—essentially doing nothing and monitoring the situation—can be the most effective course of action. This is particularly the case if you have no symptoms and your fibroids are small.

Routine ultrasounds and check-ups keep an eye on growth and monitor for any other changes. Comfort and personal preference play a role too. Some will prefer to take a wait and see approach, while some will be seeking more proactive measures.

Medications: Temporary Symptom Relief

Birth control pills and hormone shots may reduce heavy bleeding and menstrual cramps. Typical options are birth control pills, GnRH agonists, and anti-inflammatories. These don’t permanently shrink fibroids and come with side effects, such as hot flashes or mood swings.

Meds are most effective as a temporary measure, perhaps while arranging for surgery or while planning surgery in order to allow symptoms time to improve. Be sure to discuss benefits and trade-offs with your doctor.

Myomectomy: Uterus-Sparing Surgery

Myomectomy, or myo = muscle, ectomy = removal, is the surgical removal of only the fibroids, leaving the uterus intact. These can be performed through open abdominal, laparoscopic, or hysteroscopic approaches. For women who would like to have children one day, this is the best option by far.

Pregnancy rates following myomectomy are 50–60%, and the risk of uterine rupture is extremely rare (approximately 0.002%). This path is frequently recommended prior to IVF if significant intramural fibroids exist.

UFE: A Non-Surgical Alternative

Uterine fibroid embolization (UFE) is a minimally invasive procedure that cuts off blood flow to the fibroids to shrink them. It’s quick and easy, requiring less recovery time, with minimal risk of serious complications.

UFE (or UAE) can increase risk for miscarriage and birth rates are generally lower than with myomectomy. Nevertheless, when surgical procedures are not appropriate for you, it is an excellent choice.

Exploring Newer, Gentler Methods

These newer, laser or ultrasound-based procedures come with less pain and downtime. Technology continues to advance, and clinical trials are continuing to test the latest innovations.

So, continue to ask your provider what’s new, what’s proven, and what’s best for you.

Tailoring Your Fertility Plan

A good fertility plan for women with fibroids needs to fit each person’s body and life. Not everyone’s fibroids are the same. Some are small and quiet, while others cause pain or disrupt the shape of the uterus.

The best path forward depends on your health, the type of fibroid, and your goals for pregnancy. Doctors and patients often work as a team, looking at options and weighing risks. This way, treatment lines up with what you want and what your body needs.

Your Unique Reproductive Health

Asking the right questions is essential. Understanding your own health is step one. It’s important to remember that each woman’s history, age, and other medical conditions play a significant role.

A complete fertility workup comprises an evaluation of the uterine cavity. This process can identify concerns such as fibroids or other abnormalities that may impede a pregnancy. Other women have to consider their overall health—such as high blood pressure or diabetes—when conceiving.

Taking a holistic approach involves addressing the body as a whole, rather than just focusing on the fibroids.

Balancing Treatment with Conception Timing

So, when to treat may be just as important as how to treat. For women who are still wanting to conceive in the short term, timing is everything.

After major surgeries such as a myomectomy, it is usually recommended by physicians to wait approximately six months before attempting to conceive. This allows the uterus ample time to heal.

For women older than 40, freezing eggs or embryos prior to surgery is a prudent strategy. Plans should remain adaptable, changing as life or health evolves.

Assisted Reproduction: IVF and Fibroids

IVF can do a lot, but in some cases, fibroids reduce the chances. If a fibroid is pushing into the uterine cavity, then taking it out would potentially allow IVF to be more successful.

Before every patient who desires embryo transfer undergoes the procedure, they should have their uterine cavity checked. If applicable, add state specific information for the topic TAILORING YOUR FERTILITY PLAN ARTIFICIAL REPRODUCTION ASSISTED REPRODUCTION: IVF AND FIBROIDS.

When to Intervene for Best Results

This is particularly true if fibroids are resulting in pain and/or heavy bleeding. Although risks associated with surgery are typically low for healthy women, thoughtful planning and execution is imperative.

Regular monitoring can identify any new development, as fibroids may increase in size throughout maternity.

My Perspective: Your Fibroid Journey

Empowering yourself to take control of your fibroid journey starts with being educated, engaged, and persistent. Fibroids can affect up to 5% to 10% of all infertile women, with fibroids being the only cause at times. Where fibroids grow is important—submucosal fibroids, and large intramural fibroids, particularly those greater than 6 cm, are more likely to adversely impact fertility.

Don’t Just “Live With It”

So many believe that they simply need to learn to live with their fibroids, but relief is available. When symptoms such as heavy bleeding, pain, or difficulty conceiving are alleviated, the improvement is tangible. These treatments can vary from medication to surgery.

Myomectomy, in contrast, is an approach that removes fibroids, but strives to preserve the uterus, as healthy of a uterus as possible. Post surgery, recovery is fast—2 to 7 days for some patients—but full healing will take several weeks. Addressing fibroids directly can improve overall quality of life and can increase chances of becoming pregnant.

Why Second Opinions Are Key

Each one of those cases is unique. Second opinions are important because they give you a 360-degree view. Some doctors may suggest surgery before assisted reproductive technology if you have an intramural fibroid over 5 cm or a history of miscarriage.

Maybe you think differently. Having more than one specialist on your side gives you a complete view of what’s possible. This not only saves them from undue risk, like intrauterine adhesions from hysteroscopic surgery.

Trusting Your Intuition

Trusting your intuition is crucial. Your voice is a powerful weapon against misinformation. If a treatment path you’re being offered doesn’t feel right or doesn’t fit your short term and longterm goals, speak up.

It may feel uncomfortable at first, but open, honest discussions with your physician are the most important. You need to feel like your concerns are being addressed and your treatment plan is aligned with your life.

Building Your Support Network

The journey of managing fibroids can often be isolating. Support groups, counseling, and friends with big ears are essential. Other women who have gone through the same struggles can offer wisdom and encouragement.

Frequently Asked Questions

What are uterine fibroids?

What are uterine fibroids? They are exceedingly common in women of reproductive age and can produce symptoms such as heavy menstrual bleeding, pelvic pain, or pressure.

Can fibroids affect my chances of getting pregnant?

Can fibroids affect my chances of getting pregnant? If you have large or many fibroids, they may obstruct the fallopian tubes. They can even alter the shape of the uterus, which can impact one’s ability to get pregnant or stay pregnant.

When should I consider treatment for fibroids if I want to get pregnant?

When should I seek treatment for fibroids if I want to become pregnant? If your physician finds that your fibroids might pose a risk to your pregnancy or your reproductive prospects, get assistance right away.

What are my treatment options for fibroids?

What are my treatment options for fibroids. Treatment may involve medication, minimally invasive procedures, or surgery. Your doctor should advise you on the best option for you, depending on your symptoms, size of fibroids, and plans for future pregnancy.

Are all fibroids treated the same way for fertility concerns?

Are all fibroids treated the same regardless of fertility concerns? Your doctor should tailor your treatment to provide you with the most opportunity for a healthy pregnancy.

Can fibroid treatment improve my fertility?

Can fibroid treatment increase my fertility? Yes, treating fibroids—particularly those distorting the uterus—can optimize fertility and increase the likelihood of a successful pregnancy.

Should I see a specialist for fibroids and fertility issues in Los Angeles?

The good news is that Los Angeles is home to some of the world’s most experienced OB-GYNs and fertility specialists. Having an expert in your own backyard means you receive the most individualized and cutting-edge care right where you need it.