Fibroids are the most common tumour of the uterus. 1 in 5 women in the general population will have fibroids. It is three times more common in women of African origin. 2 out of 3 African women are likely to have fibroids in their uterus. Do fibroids stop you from getting pregnant? How do we treat them? This video discusses how fibroid can affect your fertility.

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Uterine fibroids, also called myoma or leiomyoma, are tumours of the uterine wall. They are formed by overgrowth of the muscle of the uterus. They are typically benign (non-cancerous) tumours (the risk of cancer in a fibroid is less than 0.1% i.e less than 1 in 1000). They vary widely in their number, size and location.
When they remain only in the wall of the uterus, they are called an intramural fibroid. They can push towards the cavity of the uterus and come close to the lining of the uterus and are called a submucosal fibroid. They can push inwards and be completely inside the cavity, called intracavitary fibroids.

They can push outwards, towards the outer wall of the uterus, called a subserosal fibroid. Sometimes they can be connected to the uterus by a stalk, called a pedunculated fibroid.
They grow under the effect of oestrogen and they tend to shrink after menopause.
Symptoms depend on the location and size of the fibroids. Many women have no symptoms and you diagnose fibroid while doing an ultrasound scan for other reasons.
The main symptom is heavy bleeding during period. In some women, periods can be painful as well. The heavy bleeding can cause anaemia.
For those with large fibroids, can have abdominal discomfort, backache, abdominal swelling, urinary frequency due to fibroid pressing on the bladder, constipation due to fibroids pressing on bowels and in some there can swelling of the kidneys or ureter due to fibroids pressing on them. This can affect the quality of life.

Most women with fibroids will conceive naturally and are not infertile. Depending on their location, fibroids can sometimes reduce your chances of getting pregnant. The submucosal fibroids, incavitary fibroids are mostly associated with infertility.
Subserosal fibroids rarely cause infertility.
Intramural fibroids can sometimes be associated with infertility if they are causing distortion of the cavity.

Rather than the size, their location is more important for fertility. A small fibroid inside the uterus can interfere with pregnancy than a large size fibroid outside the uterus.
The exact way in which the fibroid causes infertility is not known. It could be in various ways:
Blocking the cervix, reducing the sperm that goes in the uterus,
Blocking the tubes
Distorting the uterine cavity, interfering with the movement of the sperm or embryo.
By being present in the cavity the submucosal fibroids can reduce the ability of the embryo to implant.
The blood flow could be diverted, leading to inadequate development of the lining of the uterus, which can stop embryos from implanting or cause early miscarriage.
If you have fibroids, then it is important to ensure that the fibroids are not coming inside the cavity or causing distortion of the cavity.
This can be done by:
A transvaginal ultrasound scan or
Saline sonography, which involves inserting saline inside the uterus while performing the transvaginal scan. It gives a better view of the uterine cavity. It can be performed along with a 3D scan, which increases the accuracy of the diagnosis even more.
Hysteroscopy, which involves direct visualisation of the cavity. This can be done with or without general anaesthetic.
MRI- It is very accurate in mapping out the location of fibroids mainly when you have multiple fibroids.
If you have been investigated and no obvious cause for infertility is found, you have every chance of falling pregnant naturally, even if you have fibroids.
Management of fibroid has to be decided on a case-by-case basis.
Most women with fibroids will have an uneventful pregnancy and have a normal delivery. However, in some pregnancies, there can be complications.

Surgery video clip credit: Video by Andrey Kirievskiy from Pexels
Surgery photo credit: Photo by Vidal Balielo Jr. from Pexels

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