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Uterine fibroids, can they affect pregnancy?

Uterine fibroids are benign tumours that develop in the uterus. If you are told you have such fibroids it is natural that you would experience anxiety. You may have questions about how this might affect your chances of conceiving or pregnancy and whether it may be necessary to undergo surgery to eliminate them.

The truth is that many women with small uterine fibroids become pregnant easily without experiencing problems during pregnancy. However, in certain circumstances, the presence of uterine fibroids can pose challenges in terms of fertility.

We see many patients at Tambre who ask whether if it is necessary to remove uterine fibroids before undergoing IVF treatment. When this is necessary it understandably raises some apprehension about the consequences of surgery on the uterus and whether this could make pregnancy difficult or impossible. In this article we are going to address these concerns about uterine fibroids and their impact on conception and pregnancy.


What are uterine fibroids?

Uterine fibroids, also known as leiomyomas, are one of the most common benign tumors in women of childbearing age. Only in a small proportion of cases can the cells become malignant, known as leiomyosarcoma.

Uterine fibroids are composed mainly of muscle and fibrous tissue. Their size can vary from small, barely visible nodules to growths that can swell the uterus significantly.

Why can fibroids negatively affect your ability to achieve a pregnancy? Basically, because these benign tumours can alter the shape, volume and function of the uterus and even block the fallopian tubes or the birth canal. Depending on the type of fibroid and its size, in some circumstances they could affect embryo implantation in the endometrium, as well as increase the risk of spontaneous abortions in the first weeks of gestation and other complications during pregnancy, since fibroids can grow during the gestation.


Symptoms of uterine fibroids

Many women with fibroids have no symptoms and discover their presence during routine gynaecological check-ups or fertility-related exams. The frequency of symptoms is related to the size and location of the fibroids. Although they are usually asymptomatic, if they are not, the most frequent symptoms are:

  • Heavy menstrual bleeding (menorrhagia)

The most common symptom of fibroids is excessive menstrual bleeding, sometimes with blood clots, which can lead to longer and heavier periods.

  • Bleeding between periods (metrorrhagia)

Fibroids can cause bleeding outside of the regular menstrual cycle, leading to an irregular and unpredictable period.

  •  Pelvic pain and cramps

Uterine fibroids can cause pain in the lower abdomen, severe menstrual cramps, and discomfort in the pelvic region.

  •  Abdominal pressure or bloated feeling

Larger uterine fibroids can make the abdomen feel swollen and create a feeling of pressure in the lower abdomen.

  • Need to urinate more frequently

If they put pressure on the bladder, fibroids can cause a frequent need to urinate.

  • Difficulty evacuating the intestine

Fibroids that put pressure on the rectum can also cause difficulties with bowel movements.

  • Discomfort during sexual relations

In some cases, fibroids can cause discomfort or pain during sexual intercourse.

  • Infertility or difficulties conceiving 

In women trying to get pregnant, fibroids can make conception difficult if they interfere with embryo implantation or block the fallopian tubes.


Types of uterine fibroids

There are several types of uterine fibroids, which are classified according to their location within the uterus. The location has a direct relationship with the possibility of conceiving with a fibroid.

  • Subserosal fibroids

These fibroids develop in the outer layer of the uterus, known as the serosa. They usually grow outside the uterus and generally do not affect the uterine cavity. They tend to cause fewer symptoms related to heavy menstrual bleeding. Invariably they do not require treatment unless they cause discomfort by compressing on neighbouring organs.  

  • Intramural fibroids

Intramural fibroids grow in the muscular wall of the uterus, known as the myometrium. They are the most common fibroids and can cause symptoms such as heavy menstrual bleeding, pelvic pain and abdominal pressure. Since intramurals can affect the shape and size of the uterus, it is possible that  they could interfere with fertility or the development of a pregnancy.

  • Submucosal fibroids

Submucosal fibroids develop in the inner layer of the uterus, known as the endometrium. They grow into the uterine cavity and are often associated with symptoms such as abnormally heavy menstrual bleeding. Due to their location, submucosal fibroids are more likely to affect fertility and embryo implantation. They may require treatment, such as hysteroscopic removal to relieve symptoms and improve fertility.


Fibroids and IVF, is it advisable to remove uterine fibroids to facilitate a pregnancy?

It is not always necessary to remove uterine fibroids to facilitate a natural pregnancy or in order to carry out successful IVF treatment. The decision of whether fibroids should be removed is made by taking into account several factors, such as location, size and number, as well as the presence of symptoms and fertility problems.

If the fibroid is not too large, is located in a way that interferes with implantation or the development of the pregnancy, it is possible to undergo IVF treatment without having to remove it first. It is important to note that fibroids that initially do not seem to require surgery potentially could, if they grow significantly, change appearance or compromise the uterine cavity. 

Finally, if it is a submucosal fibroid, which hinders the possibility of embryo implantation, its removal is recommended.

The surgical removal of uterine fibroids is called myomectomy. When the fibroid is submucous, the technique of choice is hysteroscopy, a minimally invasive and outpatient technique that allows us to access the fibroids located in the endometrium. Access is achieved with the introduction of a small camera through the opening of the cervix. For subserosal and intramural fibroids, the technique of choice is laparoscopy as long as the location and size of the fibroid allow it.


Do you need a diagnosis?

At Tambre, we consider all the factors that may contribute to implantation failure or other fertility problems, such as uterine fibroids. To do this, we carry out a comprehensive diagnosis using the latest technology available, such as 3D or 4D ultrasounds and a hysteroscopy. The  hysteroscopy, in addition to being a surgical technique, is also used to diagnose possible endometrial involvement of some types of fibroids.

If you have questions about uterine fibroids and their impact on IVF treatments and pregnancy or want more information about the assisted reproduction treatments that we offer at Tambre, contact us and book your first appointment at +44  (0) 20 38 688 650.

Esther Marban doctor at clínica Tambre Spain Fertility Clinic