When Fibroids Affect Fertility
For women with fibroids who are experiencing otherwise unexplained fertility problems, the best course of action is less clear. It can be difficult to determine which came first, the fibroids or the difficulty getting or maintaining a pregnancy.
“Just because you have fibroids and you have problems with fertility, don’t automatically jump to the conclusion it’s the fibroids,” says Dr. Stewart. “You and your partner have to go through a complete infertility evaluation before you can start to think that the fibroids are the root cause.” She adds, “You don’t want to treat your fibroids and then learn you have blocked tubes.”
Couples in which the man or woman already has an infertility diagnosis and who are contemplating IVF may not require fibroid treatment. Women with subserosal tumors, for instance, appear to be as likely as those without them to become pregnant and deliver a baby after IVF, according to the analysis by Drs. Olive and Pritts. Pregnancy rates for women with and without intramural fibroids are similar too, but studies suggest that the chances of the embryo implanting is about 19 percent lower in the fibroid group. If implantation occurs, however, women have similar delivery rates. This suggests that intramural fibroids should come out prior to undergoing an assisted technology. Then, too, the decision may not be yours to make. A lot of IVF programs won’t treat women until after their fibroids are removed.
Fibroid Treatments to Avoid
You may be tempted by some of the new, minimally-invasive procedures for shrinking or removing fibroid tumors, but beware: They haven’t been proven safe for women who want to preserve their fertility and get pregnant some day. Exablate, for instance, the latest technique to receive FDA approval for the treatment of fibroids, uses magnetic resonance imaging to locate the exact position of the tumor, then directs heat at it through highly-focused ultrasound waves, destroying the tissue. But it’s too early to know the longterm effects of this procedure on pregnancy. Uterine artery embolization (UAE), which is becoming more popular, uses polyvinyl particles to cut off the blood supply to fibroids, causing them to shrink. This procedure, however, can also decrease blood supply to the ovaries, resulting in premature menopause in some women. Dr. Jacoby adds that there’s not enough data about “how UAE affects the delicate lining of the uterus that the embryo implants in. Or on how the placenta functions without a constant flow of blood into the uterus.”
Myolysis, another technique, also cuts off blood supply to fibroids, in this case via an electrical current. But, as with the previous methods, the effect on pregnancy is unknown. Finally, medications to shut down the ovaries’ production of estrogen can shrink fibroids, but they also prevent pregnancy (and, the fibroids grow after treatment is stopped). One hope for the future: Scientists are currently conducting clinical trials of a new drug that shrinks fibroids by shutting down progesterone production, and so far that drug doesn’t appear to interfere with getting or staying pregnant.