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Fibroid Management

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in Fertility Care

Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous smooth muscle tumors of the uterus. They are very common, affecting up to 70%-80% of people with uteruses by menopause and often go undiagnosed due to minimal or no symptoms. However, they can sometimes cause heavy menstrual bleeding, pelvic pain, and reproductive issues, especially when they distort the uterine cavity.

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Fibroid Management

What is Fibroid Management ?

Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous smooth muscle tumors of the uterus. They are very common, affecting up to 70%-80% of people with uteruses by menopause and often go undiagnosed due to minimal or no symptoms. However, they can sometimes cause heavy menstrual bleeding, pelvic pain, and reproductive issues, especially when they distort the uterine cavity.

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When it is Considered ?

Fibroids are particularly relevant in cases of infertility when:

  • They distort the uterine cavity, such as submucosal fibroids, which disrupt implantation and embryo development.
  • Intramural fibroids alter the structure or function of the uterine wall or junctional zone, even without distorting the cavity
  • Fibroids coexist with other conditions like endometriosis, complicating diagnosis and treatment
  • Recurrent pregnancy loss occurs where fibroids may play a contributing role.

Types and Their Impacts

Uterine fibroids are categorized by location, each with differing effects on fertility:

Submucosal Fibroids

  • Grow into the uterine cavity and significantly impair fertility, affecting implantation, embryo transfer, and increasing miscarriage risk.
  • Women with such fibroids have substantially lower pregnancy and implantation rates

Intramural Fibroids

  • Located within the muscular wall; may impact uterine contractility and hormone expression in the junctional zone, potentially affecting
  • Evidence of their effect on fertility is mixed and controversial.

Subserosal Fibroids

  • Project outward from the uterus into the pelvic cavity and have minimal or no impact on fertility, since they rarely affect the uterine cavity or internal function.

Step Process

Procedure / How They Affect Fertility ?

Fibroids may negatively impact fertility through several mechanisms:

Step 1 : Altered Uterine Anatomy
  • Submucosal fibroids distort the cavity and reduce endometrial lining receptivity.
  • They may reduce uterine blood flow, disrupt endometrial development (e.g., HOX gene expression), and affect the uterine junctional zone's contractility.
  • Submucosal and some intramural fibroids are associated with lower pregnancy and live birth rates, as well as higher miscarriage rates, in IVF cycles.
  • Rarely, fibroids may physically block the entry of sperm or eggs by altering the position of fallopian tubes or cervix.

Results & Outcomes

  • Myomectomy (Surgical Removal)
    Particularly effective for submucosal and select intramural fibroids, it can significantly increase pregnancy rates, one study showed rates rising from 25% to 42%
  • Submucosal Resection (Hysteroscopic)
    Offers good long-term fertility outcomes and is minimally invasive.
  • Intramural Myomectomy
    May help, but benefits must be carefully weighed against surgical risks, including uterine scarring.
  • Uterine Artery Embolization (UAE)
    Not recommended for infertile women due to higher miscarriage rates and lack of evidence for improving fertility.