I have witnessed several women's joy when first finding out that they are pregnant.  Bringing a child into the world, for some women, is the most significant event of their lives.  Unfortunately, myomas are known to interfere with the ability to become pregnant and to carry a pregnancy.  However, it is very difficult to give an accurate prognosis in a given individual. One woman was told at the age of 28 that she could not get pregnant because she had fibroids of the uterus.  Her uterus was estimated to be the size of a three and a half month pregnancy.  Naturally, she was greatly distressed by this, but she was extremely fearful of undergoing surgery that had been recommended to correct her condition because her mother had died on the operating table many years ago. 

She avoided any treatment over the next two years, during which time, because of her understanding that she was infertile, she used no contraception.  She was surprised when she missed a period and that's when she learned of her pregnancy.  At her first prenatal visit, she was calculated to be eight weeks pregnant; however, her uterus was the size of a four and a half month pregnancy.  Although her uterus continued to be excessively large, the remainder of her pregnancy was uncomplicated.  She gave birth to a normally formed, healthy, seven pound six ounce baby boy.  This is a good example of the fact that most women with myomas are able to conceive and carry normal pregnancies and it highlights the medical profession's inability to be highly accurate in estimating the potential risks of fibroids to fertility.

Although concern is often expressed by many women the possible impact of fibroids on their ability to conceive, fortunately for most of you fibroids will not interfere with your fertility.  It is well established that the overwhelming majority of women who have this disorder will be able to conceive and carry a normal, healthy, pregnancy to term.  A minority of women will have problems with infertility and pregnancy complications. 

Infertility as a consequence of fibroids presents itself in two ways.  The first is an inability to get pregnant at all; and in the second instance, although pregnancy occurs it ends in miscarriage.  It is not always possible for the gynecologist to determine exactly why the tumors are causing problems in this area.  Of course some women may have their fallopian tubes blocked by the fibroids. 

Other women may have a fibroid growing in the cavity of the uterus (a submucous fibroid), which either acts as an intrauterine contraceptive device preventing the establishment of a pregnancy to begin with, or causing such distortion of the wall of the womb that the pregnancy cannot properly implant and grow.  If proper implantation is prevented then you will experience repeated miscarriage each time you become pregnant. 

Another patient of mine had been attempting pregnancy for several years with no success.  She had undergone a year of infertility treatment and no cause for infertility could be established except for the presence of a fibroid in the uterus.  As a consequence, she underwent a myomectomy, which resulted in her conceiving seven months after the procedure.  Ultimately she delivered a healthy six and a half pound baby girl. 

The impact of fibroids on fertility is not well understood. Most often they cause no problem with fertility or pregnancy.  The good news is that after proper evaluation by an infertility specialist, if no other problem other than fibroid can be identified, myomectomy (the removal of the fibroids from the uterus) can be highly successful in correcting the problem.  According to most authors, you can expect a forty to eighty percent increase in fertility after myomectomy under these circumstances.  Remember, however, that it is very important to make sure that there are not other causes for infertility before undergoing myomectomy since myomectomy itself, in an otherwise fertile woman, can cause sufficient scarring that could result in infertility. 

A question that continues to be pondered is, "At what point should myomectomy be performed in order to protect future fertility in a woman who is not currently nor has in the past attempted to get pregnant?"  There is no hard and fast rule however generally it is recommended when the fibroid uterus reaches the size of a four-month pregnancy.  If a woman is not currently attempting pregnancy, strong consideration should be given to removing the fibroid to protect her ability to conceive in the future.  Remember, however, women have been able to conceive although not often with successful outcomes with uteruses larger than a four-month pregnancy. 

There are a number of pregnancy-related complications that have been observed.  It, however, cannot be overemphasized that for the majority of you who conceive with fibroids your pregnancy is unlikely to be affected in any significant way by the tumors.  For most women with the tumors, the most that has been demonstrated is a tendency to deliver two to three weeks earlier than normal.  This results in an insignificant degree of prematurely which poses little or no threat to the infant. 

Some women, in the middle three months of pregnancy especially, will develop moderate to severe pain in their tumors.  This is referred to as acute degeneration of a fibroid.  This occurs because the tumor may enlarge rapidly and outgrow its blood supply.  When this occurs the tumor dies, which is associated with pain. Sometimes there may be bleeding into the fibroid and there may also be a low-grade fever, usually not greater than 101 degrees Fahrenheit.  For most women, degeneration is a short duration problem lasting at most several days, although some may have this for several weeks.  It usually is easily treated with mild pain medication by mouth such as Ibuprofen or similar compounds. - Francis L. Hutchins, Jr., M.D.

Fibroids:  Pregnancy & Contraception (Page 2)