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Fibroids, Fertility
& Pregnancy

How to deal with fibroids before, during, and after pregnancy

Woman with fibroids and pregnancy
Women with uterine fibroids are often diagnosed during their childbearing years [1]. In fact, a small percentage of expecting mothers learn about their fibroids for the first time during their prenatal ultrasound exam [2]. While small fibroids are extremely common and often inconsequential, larger fibroids have been associated with infertility and complicated pregnancy. Women with fibroids should also be aware that certain treatment options can affect their fertility, and may increase the risk of obstetric complications. Our fibroid specialists go in-depth on how uterine fibroids can adversely affect fertility and pregnancy, and how to deal with fibroids during pregnancy. We also discuss each of the unique treatment options that are available to women with fibroids, and explain how each of them impacts fertility and pregnancy. Read on to learn more.

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Uterine Artery Embolization Specialist Dr. Michael Lalezarian

Fibroid Specialist
in Los Angeles

ProFibroidMD is a leading provider of uterine artery embolization, the non-surgical, fertility-preserving treatment option for uterine fibroid symptom relief. Our Fibroid Specialists have helped numerous women overcome their fibroids and have successful pregnancies without going through a major surgery.
5-star fibroid symptom relief
“He is truly dedicated, and an extraordinary physician who’s really concerned with his patients!” Adrianne S, October 2018

Fibroids and Fertility

Fibroids have been implicated in cases of infertility and miscarriage, with claims about fibroids and fertility becoming commonplace in the medical literature in the 1990’s. From a physiological perspective, there’s some merit to the cause-effect relationship between fibroids and fertility challenges. 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 [3,4]. These alterations to the uterus would interfere with sperm movement, or possibly prevent egg implantation [3]. One study found that uterine fibroids are present in 2.4% of women facing infertility challenges without any other identifiable causes of infertility. In these rare cases, fibroid treatment may actually be recommended to aspiring mothers in an attempt to restore fertility. It’s also easy to imagine how fibroid growths could have a disruptive effect on gestation. However, recent results from a high-quality clinical study found no definitive link between uterine fibroids and miscarriage, suggesting that fibroids do not significantly increase the risk of miscarriage [5].
Woman with fibroids reading a positive pregnancy test

Fibroids and Pregnancy

Uterine fibroids are present in 3-12% of pregnant women [6]. Compared to the general population, women with fibroids have an increased risk of certain obstetric complications, particularly if they have submucosal fibroids. The effects of intramural or subserosal fibroids are less clear, and may have minimal impact on pregnancy. Women with fibroids are at increased risk of the following [7]:

  • Pregnancy-induced hypertension, preeclampsia, or eclampsia; women with fibroids have an 8% higher risk of pregnancy-induced hypertension, preeclampsia, or eclampsia than the general population.
  • Placenta previa – a condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery of a baby; women with fibroids have a 38% higher risk of placenta previa than the general population.
  • Preterm birth – when the baby is born before 37 weeks of pregnancy; women with fibroids have a 17% higher risk of preterm birth than the general population.
  • Fetal malpresentation – a condition in which the baby is in an unusual position as the birth approaches, usually requiring a cesarean delivery.
  • Cesarean section (c-section) – delivery through surgical incisions made in the abdomen and uterus; women with fibroids have a 17% higher risk of c-section than the general population.
  • Peripartum hemorrhage – heavy bleeding after giving birth.

Fortunately for most women with fibroids, the increased risk of pregnancy complication is marginal, and even when fibroids are a factor, healthy full-term pregnancy is the most common outcome [7].

How to Deal with Fibroids During Pregnancy

Unfortunately, options are limited when it comes to dealing with fibroids during pregnancy. Fibroid treatments pose a significant risk to the pregnant uterine environment, potentially harming the mother or the baby. Unless you’re dealing with a health emergency, fibroid treatments are not advised during pregnancy. However, if you’re currently pregnant, now is a good time to become familiar with your treatment options and determine which fibroid treatment is right for you. Generally, we recommend waiting at least six months after childbirth before pursuing fibroid treatment, as the uterus will shrink significantly during the postpartum period. If you’re concerned about your fibroids or are experiencing fibroid-related symptoms during your pregnancy, you should coordinate with your physician to ensure that you’re being adequately monitored for fibroid-related pregnancy complications.
Fertility-Preserving Fibroid Treatment
See a Specialist in Los Angeles
Pregnant woman with fibroids visiting physician for checkup

How Do Fibroid Treatments Affect Fertility and Pregnancy?

We often say that there is no perfect treatment for uterine fibroids. Women with fibroids have options, and each of those options have trade-offs. These trade-offs are especially important to consider when it comes to fertility and pregnancy, where fibroid treatment can have lifelong implications. We review each of the options below.

Hysterectomy and Pregnancy

Hysterectomy is a major surgical procedure most-commonly performed by a gynecologist or a general surgeon in a hospital setting. The goal of the procedure is to partially or completely remove the uterus. By removing the uterus, fibroids within the uterus are also removed. Hysterectomy removes the uterus (the womb) permanently, eliminating any possibility of pregnancy afterward. If you plan to become pregnant in the future, or if there’s any chance at all that you would like to bear children, you should not get a hysterectomy.

Myomectomy and Pregnancy

Myomectomy is another major surgical procedure, but instead of completely removing the uterus, a gynecologist or surgeon selectively cuts out the fibroids while preserving the rest of the uterus. Myomectomy is a uterus-sparing procedure, meaning that it is still possible to get pregnant after having a myomectomy. However, myomectomy is not always possible, particularly if your fibroids have developed in certain areas, or if you have too many fibroids to treat surgically.

Uterine Artery Embolization and Pregnancy

Uterine artery embolization is a non-surgical, minimally invasive treatment. Rather than cutting into the uterus to remove the fibroids, micro sized beads are injected into the arteries that feed the fibroids. When injected, the beads block blood flow to the fibroids, causing the fibroids to ‘starve’ and shrink. Uterine fibroid embolization is usually performed by a Vascular and Interventional Radiologist (IR) that specializes in vascular anatomy and minimally-invasive, image-guided procedures. Uterine artery embolization is a uterus-sparing procedure, meaning that it is still possible to get pregnant after uterine artery embolization.

If you spend time researching the effects of uterine artery embolization on fertility, you will likely find web pages or articles that state that uterine artery embolization can increase the risk of obstetric complications. Some even go as far as to say that uterine artery embolization should be avoided if you plan to conceive afterwards. This guidance is outdated and should be ignored. The evidence is inconclusive on whether or not uterine artery embolization affects fertility or pregnancy complications. More importantly, there are several reports of healthy full-term pregnancies following this therapy [8], including one study that saw a 100% successful pregnancy rate [9].

Endometrial Ablation and Pregnancy

Endometrial ablation refers to the surgical destruction of the endometrium, the inner lining of a woman’s uterus. Endometrial ablation is not a typical surgical procedure, as the operator never uses a scalpel or makes an incision. Instead, the uterine cavity is accessed through the vaginal canal. Endometrial ablation is most beneficial for those who suffer from excess or abnormal bleeding due to their fibroids. It works by destroying the fibroid tissue that causes the abnormal bleeding, but it is only effective for fibroids that can be accessed via the uterine cavity. According to the current body of clinical evidence, women who undergo endometrial ablation for fibroids are not recommended to become pregnant, as the procedure significantly alters the uterus and leads to increased risk of abnormal pregnancy. [10]
Fertility-Preserving Fibroid Treatment
See a Specialist in Los Angeles
Woman consulting with her physician about uterine artery embolization and pregnancy
More Resources
Woman discussing surgical vs. non-surgical fibroid treatment options with Fibroid Specialist

Surgical vs. Non-Surgical Fibroid Treatments: Which Is Best?

When it comes to fibroid treatment, we believe that less is more. A less invasive procedure means less trauma, less risk, and shorter recovery time. Learn more about why we opt for UFE, the least invasive treatment for uterine fibroids.

Uterine artery embolization

Uterine Artery Embolization

Uterine artery embolization is a minimally-invasive procedure that we offer at ProFibroidMD to relieve heavy bleeding, pain, and other symptoms in patients with uterine fibroids. Learn more about our specialty procedure.
Fibroid Specialist in Los Angeles

Fibroid Specialist in Los Angeles

Learn more about Los Angeles Fibroid Specialist Dr. Michael Lalezarian.

References [1] 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. [2] Shields, J. (2020). Can uterine fibroids harm my pregnancy? UT Southwestern Medical Center. Accessed 7/30/2022. Retrieved from: https://utswmed.org/medblog/fibroids-options-pregnancy/ [3] Duhan, N., & Sirohiwal, D. (2010). Uterine myomas revisited. European Journal of Obstetrics Gynecology and Reproductive Biology, 152(2), 119–125. [4] Donnez, J., & Dolmans, M. M. (2016). Uterine fibroid management: From the present to the future. Human Reproduction Update, 22(6), 665–686. [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] Parazzini, F., Tozzi, L., & Bianchi, S. (2016). Pregnancy outcome and uterine fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology, 34, 74–84. http://doi.org/https://doi.org/10.1016/j.bpobgyn.2015.11.017 [7] Parazzini, F., Tozzi, L., & Bianchi, S. (2016). Pregnancy outcome and uterine fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology, 34, 74–84. http://doi.org/https://doi.org/10.1016/j.bpobgyn.2015.11.017 [8] Mclucas, B. (2013). Pregnancy following uterine artery embolization: An update, 39–44. http://doi.org/10.3109/13645706.2012.689768 [9] InterventionalNews. (2020). Fertility after uterine artery embolization: Still an unsolved issue, CIRSE delegates heard. Retrieved from: https://interventionalnews.com/fertility-after-uae-unsolved/ [10] Singh SS, Belland L. Contemporary management of uterine fibroids: focus on emerging medical treatments. Curr Med Res Opin. 2015;31(1):1-12.

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