FIBROID AND FERTILITY (PART 2)

Last week, we explained fibroid growths, causes, symptoms and risk factors. This week, we will be concluding with the effects of fibroids on fertility, diagnosis, management and treatment options available.
CAN FIBROIDS DECREASE FERTILITY?

Fertility is the natural capability to produce offspring. Most people will have strong desire to conceive a child at some points during their lifetime.

Approximately 5%-10% of infertile women have fibroids. Their size and locations determines whether fibroids affect fertility. Examples include fibroids that are inside the uterine cavity (submucosal) or very large (>5cm in diameter) within the wall of uterus (intramural). Fibroids may affect female fertility. Women with fibroids and partners should be thoroughly evaluated to find other problems with fertility before fibroid is treated. A Fertility Specialist/Gynaecologist can help to access if fibroids might be hampering conceptions or not.

HOW FIBROIDS CAUSES INFERTILITY

There are several ways which uterine fibroids can reduce fertility in women.
• Fibroids that change the shape of the cervix can affect the number of sperm to be able to enter the uterus.
• Changes in the shape of the uterus can decrease the number of places an embryo can successfully implant or reduce uterine space needed for embryo development.
• Fibroids that block the fallopian tubes can make the journey of a fertilized egg to implantation difficult or impossible.
• Blood flow to the uterine cavity can be affected. This can decrease the ability of embryo to stick (implant) to the uterine wall or to develop.
• They can impact on the size of the lining of the uterine cavity or decrease the blood supply to a growing embryo thereby resulting in miscarriage.
If you have fibroid and are trying to get pregnant, it is important to discuss it with your Fertility Specialist/Gynaecologists whether the fibroids are in places that might prevent conception, or are in places that could cause complications in pregnancy. If so, removing fibroids to improve the chance for conception and pregnancy may be recommended.

FIBROID IN THE UTERINE CAVITY

Fibroids in the cavity of the uterus, also known as submucosal fibroids, can be a cause of infertility. In a normal pregnancy after fertilization occurs in the fallopian tube, embryo develops and move to implant in the endometrium (inner womb lining), the presence of a fibroid occupying the space for implantation possess a threat to normal implantation and development of embryos in which case the fibroid may have to be surgically removed.

WHAT HAPPENS TO FIBROIDS DURING PREGNANCY?
Fibroids are found in 2% to 12% of pregnant women, but not all fibroids get larger to cause problems in a pregnancy. If fibroids grow, it usually does so in the first 12 weeks of pregnancy.

WHAT CAN HAPPEN WITH FIBROIDS DURING PREGNANCY?

The biggest concern in pregnancy is whether the fibroids will increase the chance of preterm birth or miscarriage. In some cases, fibroids can outgrow their blood supply and cause severe pain. Hospitalization might be required in some cases.
Also fibroids can change the baby position in the uterus (womb). This can increase the risk of miscarriage, preterm delivery and caesarean section.
If a woman conceives after having a fibroid removed, she should discuss this with the obstetrician who will deliver the baby.

HOW CAN FIBROIDS BE DIAGNOSED?

• Physical Examination: Large sized fibroids may be diagnosed by your doctor through abdominal and pelvic palpation. Fibroids may be felt as smooth or irregular, nodular mass resembling the feel of a pregnancy.
• Ultrasound Scan: is a non-invasive and highly tolerable procedure which is capable of revealing the location, the number and size of the fibroids.
• Hysterosonogram (HSN): a less invasive procedure which allows visualization into the uterine cavity. This may be helpful in making diagnoses for fibroid inside the endometrium.
Your doctor may recommend further test based on the outcome of the basic investigations.

MANAGEMENT OF FIBROIDS

Several factors will be considered in deciding treatment options for patient with fibroids and they include;
• Whether the fibroids are slow or fast or growing.
• The size and location of the fibroids.
• Whether the woman is considering fertility in the future or not.
TREATMENT OPTIONS MAY BE:
• Medical management using drugs and injectable.
• Surgical management which includes open myomectomy or the endoscopic approach which does not require outright opening up (laparoscopy and hysteroscopy). For women with symptomatic fibroids which do not desire future fertility, options such as Hysterectomy (removal of the womb) may be an option.

ADJUVANT THERAPY FOR FIBROID MANAGEMENT

Dietary changes can help as well.
• Avoid excessive red meats and high calorie foods.
• Avoid or limit alcohol.
• Opt for foods high in flavonoids, green vegetables, green tea, cold water fish such as tuna or salmon, and take high fibre diet.Get enough vitamin D.
• Managing your stress level and losing weight, if you are overweight has also been found helpful in management of symptoms of fibroids.
Some women have fibroids and do not have any challenges getting pregnant. Therefore understanding that there are different causes of infertility, and only some women may be affected as a result of fibroids helps a person or couple know when it is time to seek help. Uterine fibroids are common and can affect fertility in different ways from fertilization, embryo implantation, pregnancy outcome, growth and positioning of the baby. Your fertility specialist/ Gynaecologist will examine you carefully to determine what treatment option best suites you.