Fibroid specialist Dr. Michael Lalezarian explains if fibroids can cause infertility, how they affect fertility, and discusses alternatives to hysterectomy that can potentially preserve fertility in women with fibroids.
A large percentage of women with symptomatic uterine fibroids undergo hysterectomy during their reproductive years, effectively eliminating any future childbearing potential. While it’s generally accepted that fibroids themselves can cause reproductive challenges,¹⁻² hysterectomies are by far the biggest contributor to lost childbearing potential in women with uterine fibroids,³⁻⁴ even though ‘fertility-sparing’ treatment options are available. In this article, we measure the impact of uterine fibroids on fertility and briefly discuss alternatives to hysterectomy that may provide women an opportunity to preserve their fertility.
Age of Fibroids Diagnosis
In a recent article, we discussed the experiences of women living with uterine fibroids. Much of that conversation referenced survey responses from the Uterine Bleeding and Pain Women’s Research Study (UBP-WRS), which surveyed 21,479 women of childbearing age (age 15-49). 1,533 (7%) of the study participants reported that they had been diagnosed with symptomatic uterine fibroids. The UBP-WRS also asked their participants to provide the age at which they were diagnosed with fibroids and found that most women are diagnosed before age 40 (see chart below).³
While there is a lot to unpack from these studies, one of the main takeaways is that a large percentage of women are diagnosed with uterine fibroids during their childbearing years. Depending on their number, size, and location, fibroids can be entirely asymptomatic or cause a host of debilitating symptoms that include excessive menstrual bleeding and pelvic pain - to the extent that a large proportion of affected women are willing to undergo a major procedure to find relief from their symptoms.
Fibroids And Fertility Challenges
Fibroids have been implicated in cases of infertility and miscarriage for the last two decades. From a physiological perspective, there’s some merit to the cause-effect relationship between fibroids and pregnancy problems. Fibroids just underneath the uterine lining (submucosal) and in the wall of the uterus (intramural) are thought to distort the shape of the uterine cavity, while intramural fibroids could also obstruct the fallopian tubes.¹⁻² In either case, these alterations to the uterus would interfere with sperm movement, or possibly prevent egg implantation.¹ One study found that uterine fibroids are present in 2.4% of women facing infertility challenges without any other identifiable causes of infertility. It’s also easy to imagine how fibroids could have a disruptive effect on gestation, but recent results from a high-quality study found no definitive link between uterine fibroids and miscarriage.⁵
The real threat to fertility in women with symptomatic fibroids is hysterectomy. According to the UBP-WRS, 29% of women diagnosed with uterine fibroids in the United States reported that they had been hysterectomized,³ and a recent study on the treatment patterns of uterine fibroids showed that hysterectomy accounts for around 65% of all uterine fibroid interventions in 2015.⁴
The decision to be hysterectomized is not a trivial one. Women suffering from intractable fibroid symptoms face a tough choice. On one hand, hysterectomy virtually guarantees permanent symptom relief, but on the other hand, it completely eliminates any future childbearing potential. The finality of this decision can be especially challenging for women who have several childbearing years left, as they may later regret being hysterectomized.
Fertility-Sparing Fibroid Treatment
Although preservation of fertility is not a sure bet with any uterine fibroid treatment, it is much more likely with ‘fertility-sparing’ treatments such as myomectomy or uterine fibroid embolization (UFE).⁶ As opposed to eliminating the entire uterus, myomectomy is a surgical technique to isolate and remove fibroids while leaving the uterus intact. UFE, on the other hand, is a noninvasive technique of injecting particles into the blood vessels that feed the fibroids, thereby causing them to starve and shrink. Both of these less invasive, fertility-sparing methods have been shown to be as effective as hysterectomy in providing symptom relief and patient satisfaction,⁷ and examples of successful full-term pregnancies are well-documented for both UFE and myomectomy.⁶
It’s unclear if hysterectomy remains the dominant treatment choice amongst women with uterine fibroids because they all decide that they have no ambitions to bear children in the future, or if many of these women are unaware that fertility-sparing options are available to them. In general, if you’ve been told that you need to have a hysterectomy, you should explore all of your treatment options before making a decision on what makes the most sense for you. And if you’re a practicing medical professional, we encourage you to explore alternatives to hysterectomy if you haven’t already, especially for patients of yours that express concerns about their childbearing potential.
About the Author
Dr. Michael Lalezarian is a practicing interventional radiologist with the Fibroid Specialists of University Vascular in Los Angeles, CA. In addition to patient care, Dr. Lalezarian teaches and supervises medical students, residents, and fellows as a full time teaching Professor in the Department of Radiology at UCLA. He is regarded as an expert in uterine fibroid embolization. You can view Dr. Lalezarian's full bio here.
This blog post was written with research and editorial assistance from OnChart™.
References
[1] Duhan, N., & Sirohiwal, D. (2010). Uterine myomas revisited. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 119–125.
[2] Donnez, J., & Dolmans, M. M. (2016). Uterine fibroid management: From the present to the future. Human Reproduction Update, 22(6), 665–686.
[3] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.
[4] Bonafede, M. M., Pohlman, S. K., Miller, J. D., Thiel, E., Troeger, K. A., & Miller, C. E. (2018). Women with Newly Diagnosed Uterine Fibroids: Treatment Patterns and Cost Comparison for Select Treatment Options. Population Health Management, 21(S1), S-13-S-20.
[5] Hartmann, K. E., Edwards, D. R. V., Savitz, D. A., Jonsson-Funk, M. L., Wu, P., Sundermann, A. C., & Baird, D. D. (2017). Prospective Cohort Study of Uterine Fibroids and Miscarriage Risk. American Journal of Epidemiology, 186(10), 1140–1148.
[6] Karlsen, K., Hrobjartsson, A., Korsholm, M., Mogensen, O., Humaidan, P., & Ravn, P. (2018). Fertility after uterine artery embolization of fibroids: a systematic review. Archives of Gynecology and Obstetrics, 297(1), 13–25.
[7] Gupta et al. (2014). Uterine artery embolization for symptomatic uterine fibroids (Review). Cochrane Library, (5).
Medical Disclaimer
The Materials available on the FibroidSpecialists.org blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.