Fibroids and their effects on fertility - IVF | ICU | ICSI | OI/TI

Fibroids and their effects on fertility

fibroids

Fibroids are non-cancerous growths in the uterus that can develop during a woman’s childbearing years. There are three types of fibroids – intramural, sub-mucous, and sub-serous fibroids.

Some women who have fibroids get pregnant naturally. However, in some cases, fibroids can impact fertility. For example, submucosal fibroids, which are a type of fibroid that grows and bulges into the uterine cavity, increase the risk of infertility or pregnancy loss. Depending on where they are located, fibroids may prevent sperm and eggs from meeting for conception.

They can hamper the ability of an embryo to implant. Even in patients who get pregnant, they can grow in places or to sizes that cause complications like miscarriage, preterm delivery, or an abnormal position of the fetus, which makes pregnancy more challenging. During pregnancy, treatment for uterine fibroids is limited because of the risk to the fetus.

Fibroids not only affect spontaneous conception rates but also diminish IVF success rates. Myomectomy is a surgical procedure done to remove fibroids in patients seeking pregnancy. All sub-mucous fibroids and other fibroids of > 4cm need to be removed before planning IVF. They can be removed either by laparotomy (open surgery) or laparoscopy (keyhole surgery), depending on the size and location of the fibroids.

While myomectomy is a common procedure, it has a few drawbacks, especially for large and multiple fibroids:

  • Uterine scarring may sometimes cause difficulty in implantation`
  • If any part/ cells of fibroid are left behind, it may regrow in 50% of the cases
  • Surgery to the uterine wall can weaken the uterus and may compromise carrying a baby to term
  • The need for caesarean delivery increases

There are multiple studies that report increased pregnancy rates and take-home baby rates with myomectomy done prior to IVF, more so in sub-mucous fibroids and large intramural fibroids.

Hence, it is always better to address the problem before a planned pregnancy.