Can fibroids cause infertility? What you should know about conceiving with uterine fibroids

Fibroids are surprisingly common, affecting 70%-80% of women before the age of 50. In many cases, these fibroids don't cause any issues, and women go on to have healthy pregnancies. However, fibroids can cause problems with conceiving or having a healthy pregnancy.

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What are Fibroids?

Fibroids are benign, or noncancerous growths that occur in or near the uterus. They form when a single muscle cell multiplies, forming a mass or noncancerous tumor. While they are benign, meaning they are not cancerous, they can cause issues depending on their size, location, and the number of fibroids. 

Can Fibroids Cause Infertility? 

If you are wondering, "Can you get pregnant with fibroids?" the answer is yes. However, some types of fibroids can cause infertility. The good news is that the most common type of fibroid, subserosal fibroids, rarely causes infertility. Submucosal fibroids are the most likely to affect fertility, but intramural fibroids can also cause fertility problems. 

Subserosal Fibroids 

Subserosal Fibroids are the most common type, accounting for about 55% of all uterine fibroids. These fibroids are found in the outer wall of the uterus. This type of fibroid typically grows outward toward the pelvis. 

Can Subserosal Fibroids Cause Infertility? 

Subserosal fibroids typically don't impact fertility, because they tend to affect neighboring organs rather than the uterus itself. 

Subserosal Fibroid Symptoms 

Subserosal fibroids are often asymptomatic, which means you may not experience any symptoms at all. One of the most common symptoms of fibroids, heavy or longer menstrual periods, is not usually associated with this type of fibroid.

This is because of the fibroids' position, which causes them to affect other organs like the bladder rather than the uterus. Being positioned on the outside of the uterus also makes subserosal fibroids unlikely to impact fertility. 

Common symptoms of subserosal fibroids include: 

• A feeling of heaviness or fullness in the lower abdomen/pelvis
• Frequent need to urinate
• Constipation
• Bloating
• Abdominal pain/cramping
• Swelling of the lower abdomen
• Painful sex
• Pain in the lower back or legs 
• Inability to empty the bladder completely

Intramural Fibroids 

Intramural fibroids are the second most common type. These fibroids are found in the middle layer of the uterine wall. They account for 40% of all uterine fibroids and can range from the size of a pea to the size of a grapefruit. 

There are three types of intramural fibroids. Anterior intramural fibroids are located in the front of the uterus. Posterior intramural fibroids are located in the back of the uterus, and fundal intramural fibroids are located in the upper part of the uterus.

Can Intramural Fibroids Affect Fertility?

Intramural fibroids can affect fertility, depending on their size and location.  Some intramural fibroids can block the fallopian tubes, which prevents the egg from being released. If the egg isn't released, it can't be fertilized, so pregnancy can't occur. They can also change the shape of the uterus or affect the uterine lining, which makes it harder for a fertilized egg to implant into the uterus. If the egg can't implant into the uterus, this is known as implantation failure, and causes the pregnancy to end at an early stage. 

Intramural Fibroid Symptoms 

While many women may have mild symptoms, intramural fibroids can impact uterine function. They typically cause heavy menstrual bleeding, prolonged periods, or bleeding between periods. This is because intramural fibroids can impact the body's ability to contract and shed your endometrial lining. 

Other symptoms include:

• Pelvic pain
• Lower back pain
• Anemia and associated fatigue
• Frequent urination or difficulty emptying the bladder
• Constipation
• Uterine enlargement

Submucosal Fibroids 

Submucosal fibroids are located in the interior wall of the uterus, and can enter the uterine cavity. This type of fibroid accounts for only 5% of all fibroids. 

Can Submucosal Fibroids Affect Fertility?

While submucosal fibroids are rare, they are also the most likely to cause infertility, because they grow into the uterine cavity. Fertility rates decrease by up to 70% with submucosal fibroids. 

They can distort the uterine lining, which makes it difficult for the embryo or fertilized egg to implant into the uterine lining. 

They can also change the shape of the cervix, which interferes with sperm movement. This makes getting pregnant more difficult.  

Finally, submucosal fibroids can affect the blood supply to the uterine lining, which can lead to infertility. 

Fibroids in Pregnancy 

If you conceive with fibroids or discover fibroids during your pregnancy, it's natural to be concerned. While fibroids do increase risks during pregnancy, most women go on to have healthy pregnancies and births. Around 10% of pregnant women will have uterine fibroids seen on a prenatal ultrasound. 

Fibroids can grow or shrink during pregnancy. Fibroids that are larger than 5 cm at the time of conception are more likely to grow. In many cases, fibroids will shrink or stay the same size throughout the pregnancy. 

Can Fibroids Affect Pregnancy?

Fibroids can affect pregnancy. Some women with fibroids are classified as high risk, because they are at a higher than average risk of complications or adverse outcomes. If you are considered high risk, you'll need more frequent appointments throughout your pregnancy. You may also have more tests, including ultrasounds and stress tests as the pregnancy progresses. 

Risks Associated with Fibroids in Pregnancy 

It's important to keep in mind that most women with fibroids have normal, healthy pregnancies and deliveries. However, depending on the size and location of the fibroids, you may be at increased risk of some complications. 

Fetal Malpresentation 

Fetal malpresentation means that the baby is not in the head-down position when labor begins. This can occur because the fibroid affects the shape of the uterus, or prevents the baby from getting into the head-down position. 

Preterm Labor and Preterm Birth

Uterine fibroids increase the risk of preterm labor and preterm birth. Preterm labor means that labor contractions occur before 37 weeks. Preterm birth means the baby is born before 37 weeks.

A meta-analysis showed that women with at least one fibroid were at a slightly increased risk of preterm birth compared to women without fibroids. Women with one or two fibroids have a risk of 12.8%, compared to 8.6% of women without fibroids. Women with three or more fibroids had a higher risk of 18.5%. 

The size of fibroids also impacts risk. Women with fibroids smaller than 5 cm have a risk of 12.4%. Fibroids between 5-10 cm increased the risk to 15.5%. Women with fibroids larger than 10 cm had the greatest risk, with 21.4% having preterm birth.

There's also a connection between fibroids and how early preterm labor occurs. Preterm birth is considered giving birth before 37 weeks. Women with two or more fibroids, particularly fibroids larger than 10 cm, were more likely to have very early births, which means an increased risk of birth before 34,32, or 28 weeks. 

Placenta Problems 

Uterine fibroids do increase the risk of issues with the placenta, including placenta previa and placental abruption. 

Placenta previa occurs when the placenta partially or completely covers the cervix. Women with fibroids have a two to three times higher risk of developing placenta previa, although it's still considered a rare condition. 

Placenta previa increases the risk of bleeding during pregnancy and during and after delivery, as well as preterm birth and fetal distress. 

Larger fibroids, especially if they are located in the lower uterus or cervix, may further increase the risk of placenta previa. 

Placental abruption occurs when the placenta detaches from the uterus before birth. This poses a risk to the baby, because they are unable to get oxygen or nutrients once the placenta detaches. It can also cause bleeding in the mother, which can be life threatening.

Can Fibroids Cause Miscarriage?

Yes, fibroids can cause miscarriage. Women with fibroids are significantly more likely to miscarry, particularly in the first trimester. The average risk of miscarriage is 7%, but this number rises to 14% for women with fibroids. Having multiple or large fibroids can further increase the risk of miscarriage. 

C-Section Delivery

Your risk of a C-section delivery goes up six times if you have fibroids, with submucosal fibroids carrying the greatest risk. Fibroids increase the risk of C-section because they can prevent the uterus from contracting properly. In some cases, the fibroid can block the birth canal, which requires a C-section delivery. It's important to note that while a C-section delivery does carry risks, most women have a healthy baby and recover fully afterward. 

Postpartum Hemorrhage

Postpartum hemorrhage can occur after delivery. Having fibroids increases the risk of postpartum hemorrhage. The risk is associated with the size of the fibroids, with medium-sized fibroids having a risk 1.65 times that of small fibroids. Women with large fibroids had a 2.4 times higher risk than those with smaller fibroids. Women with fibroids in the cervix or lower part of the uterus had a risk 1.49 times that of women with fibroids in other locations. 

Final Thoughts 

We've learned that fibroids do increase the risk of infertility and pregnancy complications. However, the majority of women with fibroids can go on to conceive and have a healthy pregnancy and birth. 

If you have fibroids, it's important to work closely with your healthcare provider. They can discuss any concerns as well as potential treatment options. 

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