Uterine Fibroids and Fertility

The degree to which uterine fibroids impede fertility is the subject of ongoing research and study. Generally the most important factor attributed to fertility obstruction is the anatomical location of the uterine fibroid(s)(1). 

How do uterine fibroids impede fertility? 
• Uterus distortion subserosal fibroids developing outside the uterus can distort the uterine cavity or compress the fallopian tubes, preventing the sperm from reaching the eggs(1,2). 
• Intramural fibroids developing in the cervical region can prevent the entry of the sperm into the uterus (2,3). 
• Submucosal fibroids, developing in the lining of the uterus, may block the fallopian tube preventing ovum release and sperm from entering (2,3). 
• Both intramural and submucosal fibroids may increase the size of the uterus cavity, forcing sperm to travel a greater distance (2,3). 
• Uterine fibroids may also disturb implantation or gestation (1).

Uterine fibroids greater than 5 cm in size, or located near the ostia of the fallopian tubes, are more likely to cause fertility problems (4). 

Fertility and uterine fibroid treatment - ExAblate*
A fertility study conducted by Elizabeth Stewart, MD of the Mayo Clinic, was recently honored by the Royan Institute of Iran, which awarded her its International Research Award in the category of Female Infertility and Reproductive Imaging.

Stewart and her team learned from their research: that MR-guided FUS is a promising therapy for women who want to become pregnant after undergoing fibroid treatment. In the study – entitled "Safely Extending Focused Ultrasound Surgery for Uterine Leiomyomas to Women Who Desire Future Pregnancies"– the researchers found that the time to become pregnant following treatment was about the same as that for uterine artery embolization (UAE), a well-established, minimally invasive procedure that blocks the blood supply to fibroids. With MR-guided FUS, delivery rates were higher and cesarean section rates lower than with UAE.

Among the women in the study, 41 percent had a live birth following a focused ultrasound procedure and another 20 percent had an ongoing pregnancy beyond 20 weeks at the time of report. Sixty-four percent of the women were able to have a vaginal delivery. Importantly, there were no low birth weight infants and no pattern of complications for the baby or the mother.



*USA Patients should have completed child bearing before seeking treatment with the magnetic resonance-guided focused ultrasound surgery (MRgFUS) system. 

More about uterine fibroids and pregnancy,

What are common symptoms of uterine fibroids?

Find an Exablate treatment center near you. 

Studies: Fertility following uterine fibroid treatment using focused ultrasound surgery
1.  Morita Y, Ito N, Ohashi H.Pregnancy following MR-guided focused ultrasound surgery for a uterine fibroid. Int J Gynaecol Obstet. 2007
2. Hanstede MF, Tempany MC, Stewart EA. Focused Ultrasound Surgery of Intramural Leiomyomas May Facilitate Fertility: A Case Report, Fertility & Sterility, 2007.
3. Gavrilova-Jordan LP, Rose CH, Traynor KD, Brost BC, Gostout BS. Successful Term Pregnancy Following MR-guided Focused Ultrasound Treatment of Uterine Leiomyoma, Journal of Perinatology, 2007, 27:59-61.
4. Rabinovici J, Inbar Y, Eylon-Cohen S, Schiff E, Hananel A, Freundlich D Pregnancy and live Birth after Focused Ultrasound Surgery for Symptomatic Focal Adenomyosis: A Case Report, Human Reproduction, 2006, pp. 1-5.


References:
1. Walker CL, Stewart EA. Uterine fibroids: the elephant in the room, Science, 2005, 308:1589-92.
2. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor and delivery with uterine leiomyomas: a population based study, Obstet Gynecol., 2000, 95:764-9.
3. Yoon SW, Kim KH, Kim SH, Ha DH, Lee C, Lee SY, Jung SG, Kim SJ. Pregnancy and natural delivery following magnetic resonance imaging-guided focused ultrasound surgery of uterine myomas, Yonsei Med J, 2010, 51(3):451-453.
4. Hasan F, Arumugam K, Sivanesaratnam V. Uterine Leiomyomata in pregnancy, Int. J Gynecol Obstet, 1990, 34:45-48.