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Fibroids and Pregnancy
Fibroids are the commonest type of benign tumors to grow in the womb. They are extremely common and the prevalence is estimated to range between 20 and 50% of all adult women. They are commonest among women of black African ancestry but they are seen in women of all races. The prevalence increases with increasing age and therefore they are rarely seen in women in their teens or early 20s. They are commonest in women in their 30s and 40s. They will tend to gradually shrink after the woman has gone through menopause, which usually occurs in the late 40s and early 50s.
Fertility and body weight are factors in the presence of fibroids as they tend to be commoner among women who remain childless and those who are overweight or obese. The two are independent factors.
Fibroids come in different sizes. They can be smaller than a pea and on the other end of the spectrum bigger than a melon.
Fibroid’s effect on Fertility:
Fibroids can be a factor in fertility difficulties for an individual even though they are a minor factor in the overall infertility and sub-fertility sphere, being significant in less than 3% of all cases.
What this means is that, even though very common, fibroids are normally inconsequential when it comes to conceiving and successfully carrying a pregnancy.
Types of Fibroids
For some women, however, fibroids do turn out to be a negative factor or a direct cause of fertility problems. Fibroids that tend to be problematic are those that grow inside the womb cavity. These are called submucosal fibroids. The other (two) types of fibroids are the ones known as intramural and subserosal. The former grow and are embedded within the wall of the womb and the latter grow outside the womb-cavity appearing to be attached to the womb on the outside. There is no evidence that either of these two types could influence fertility.
Some sub-mucosal fibroids grow to a size which virtually fills the womb cavity. A fibroid does not have to be very big to achieve this since a non-pregnant womb is usually rather small, no more than a little girl’s fist. When the cavity is so filled, it may be difficult for an embryo to implant. In some cases, implantation takes place successfully but miscarriage follows because of the less than ideal environment. Some fibroids could block one or even both openings of the fallopian tubes thus curtailing fertilisation or movement of the fertilized egg into the womb cavity for implantation.
What can be done:
When a woman presenting with infertility is found to have that type of fibroid and when other factors have been ruled out, she could be offered surgical excision of the fibroid. This is if it is of a size or position deemed to be a probable significant factor. Excision is usually done via a hysteroscope, the so-called key-hole approach. This procedure is extremely safe and successful but is not entirely without risk. There is a very small risk of womb perforation during the procedure. Also, in the aftermath, scarring could develop within the cavity (synechiae) thus complicating the very problem the procedure was meant to solve. However, these complications are relatively rare.
Fibroids and delivery
Fibroids can also impact timing and mode of delivery. There is evidence, albeit weak, that some fibroids could trigger early onset of labour and preterm delivery. This is not a common.
Some submucosal and intramural fibroids do distort the cavity causing the baby to assume an abnormal position. This, in effect, means a caesarean delivery becomes inevitable.
Fibroids can also increase the risk of heavy blood loss after delivery, be it vaginal or by caesarean section. This is not common.
In some cases fibroids do interfere with the mechanism of contractions during labour. This can be to an extent that intervention in the form of caesarean section becomes necessary.
Effect of Pregnancy on Fibroids
Sometimes fibroids increase significantly in size during pregnancy. This is thought to be the effect of the estrogen hormone, the levels of which are quite high during pregnancy.
Fibroids can also undergo degeneration during pregnancy. Red degeneration is characterized by quite severe pain which is because the fibroid suddenly loses its blood supply and in effect dies. This could trigger onset of labour, even prematurely. It is rare.
Fibroid surgery during pregnancy
It is difficult to see any indication of fibroid surgery during pregnancy. In fact this is probably always an out and out bad idea as it is likely to be fraught with risk of heavy bleeding and could even trigger a miscarriage.
In Summary
There are many ways in which fibroids can influence fertility, pregnancy and delivery. However, in the overwhelming majority of cases, presence of fibroids is of no consequence and they are innocent bystanders.
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