What’s the Deal With Fibroids and Infertility?

Fibroids Infertility

If your doctor told you that you have uterine fibroids—or even if you just think you might have them—you’re probably wondering if they’re going to mess with your chances of getting pregnant. Yeah, fibroids are benign…but they’re still weird growths inside your uterus, when what you really want growing in there is a baby.

The good news is that fibroids are pretty common. The better news is that you may even totally ignore some of them. Here’s the 411 on fibroids.

What causes fibroids?

Fibroids are technically tumors, but they aren’t cancerous and shouldn’t increase your risk of uterine cancer, according to the Office on Women’s Health. Yay, right? Slightly less yay: there’s no clear answer about why these growths appear, but doctors do think there’s a genetic component.

“Fibroids develop when one cell starts to divide and grow,” explains Dr. Anthony Propst, reproductive endocrinologist at Texas Fertility Center. According to Dr. Propst, they can be as small as a marble or as big as a volleyball. (Yup, you read that right. A volleyball—yikes.)

Dr. Propst says that 50% of reproductive-age women have one or more fibroids, and that they’re more common among African American women. A 2013 study in the Journal of Women’s Health showed that African American women were more likely to experience severe fibroid symptoms (like heavy periods) and more likely to report that fibroids affect their physical activities.

What symptoms will I have?

Infertility is one symptom of fibroids, says Dr. Propst, but if you haven’t been trying to conceive yet then you may be totally in the dark about these little suckers. If that’s the case, here are some other symptoms to look out for:

  • Heavy bleeding during menstruation
  • Prolonged and/or painful periods
  • Pelvic pain or pressure
  • Lower back pain
  • Painful sex

UCLA Health reports that about one-third of fibroids are large enough to be detected by your OB/GYN during a physical, so don’t blow off those annual exams, ladies.

How do I know if I have fibroids?

An ultrasound is the best way to tell if you have uterine fibroids. It will also reveal their location and size. Depending on your doctor, this may be an abdominal ultrasound or a transvaginal one. If you haven’t had one of those yet, we know it might sound intimidating, but trust us, it’ll be super helpful in getting a really good look around.

How do fibroids relate to infertility?

Hate to say it, but there’s no one answer here. According to Dr. Mark Trolice, infertility specialist at Fertility CARE: The IVF Center in Florida, it’s not the size of fibroids but the location that determines their overall effect on fertility.

“Unless the uterine cavity is affected by fibroids, we leave them alone,” he says. “But if there’s a distortion of the cavity—like if the fibroid is growing there, or is pushing into the cavity—then surgery is recommended,” since that might affect fertility.

The exception to this would be intramural fibroids, or fibroids growing within the muscle of the uterus. It’s usually recommended to remove those as well, as fibroids within the womb can impact your pregnancy chances by preventing the implantation of an embryo.

Do I need to do something about my fibroids?

Once more, for the people in the back: it depends on where they’re located.

“With those intramural fibroids, the bigger they get, the more likely they are to affect fertility,” says Dr. Propst, who recommends surgery in those cases. So if your fibroid is large and located in the uterine muscle, you’re gonna have to problem-solve.

According to the Mayo Clinic, surgery for fibroids could include:

  • A noninvasive ultrasound procedure (done inside an MRI scanner)
  • A minimally invasive procedure, like a laparoscopy or myomectomy (you’ll go home the same day)
  • A traditional abdominal surgery (you’ll have to stay overnight…but get to eat lots of Jell-O)
  • A hysterectomy (not good, but don’t panic…this is a worst-case scenario)

Whether or not to undergo fibroid surgery is a decision you’ll have to make with your doctor, but there are pluses and minuses, so make sure you’re well-informed.

You may not be thrilled about surgery (especially if your fibroids aren’t causing symptoms), but Dr. Trolice says that there are risks of pregnancy complications with fibroids, especially larger ones, and a 2014 study published in the American Journal of Obstetrics and Gynecology backs this up: it suggests that the size, number, location, and type of fibroid can contribute to higher rates of preterm birth, cesarean delivery, and postpartum blood loss and hemorrhage. Because there are also risks associated with surgery, however, you might want to get a second opinion before choosing a course of action.

What’s the bottom line with fibroids and fertility? Location, location, location. You might never know you have them, and even if you do, you might never need to do anything about them—unless they’re in a spot where they could interfere with a future pregnancy, in which case you’ll have a few mostly-not-terrible surgery options to choose from.

Sarah Bradley

Sarah Bradley is a freelancer writer from Connecticut, where she lives with her husband and three sons. Her reported features and personal essays in the parenting and women's health spheres have appeared at On Parenting from The Washington Post, Real Simple, Women's Health, Parents, Lifehacker's Offspring, and Romper, among others.

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