Fibroids and Fertility

What are uterine fibroids?

These are non-cancerous growths that come from the muscle layer of the uterus. Fibroids are commonly found in women of reproductive age. They can be single or multiple, have varying shapes and can be located inside the uterine cavity, within the walls of the uterus, or on the outer surface of the uterus. They are slow-growing (about 1-2cm a year) and will typically start to shrink once a woman reaches menopause. 

Can fibroids affect my fertility?

Many women get pregnant naturally even when they have fibroids. Whether fibroids affect fertility depends on their size and location. Fibroids that cause infertility are typically the ones which grow and bulge into the uterine cavity (submucosal fibroids), where the embryos are supposed to implant and grow into a baby. These can cause problems with your periods (heavy periods, bleeding in between periods), infertility and/or increase your risk of pregnancy loss.

How can I find out if my fibroid is the kind that affects my fertility?

Your gynaecologist will need to take a detailed menstrual history and do a pelvic examination. A pelvic ultrasound is required to check the number, size and location of your fibroids. For fibroids that seem to be growing into the uterine cavity, a hysteroscopy may be recommended to check the degree of bulge. 

What is the treatment for fibroids that affect fertility?

As the uterus needs to be preserved for fertility, there is always a risk of fibroid recurrence. 

• Hysteroscopy: for fibroids growing into the uterine cavity. This is typically a day surgery procedure, although more than 1 procedure may be required if the fibroid is large. Not all of the fibroid can be removed (e.g. if 50% of the fibroid is growing into the uterine cavity and another 50% inside the wall of the uterus, only the former can be removed). The aim of this surgery is to restore the normal shape and size of the uterine cavity.

•  Myomectomy: surgical removal of fibroids – this is suitable for women who also have fibroids elsewhere that they want removed at the same time. Depending on the size of fibroids, this can be done laparoscopically or open.

After treatment, you will be advised by your gynaecologist on the time interval you should wait before trying to conceive – depending on whether the uterine cavity was breached, this may be for a few months or longer.