The fibroids that disturb the uterine cavity tend to affect fertility the most. These are typically called submucous fibroids or larger intramural fibroids that have a submucous component. These fibroids tend to grow inside the uterine cavity, which can interfere with fertility. They can distort the shape of the uterine cavity, making it difficult for an embryo to implant properly. Additionally, they may reduce blood flow to the uterine lining, which is essential for supporting early embryo development.
There is an association of the fibroid uterus with fertility. More so when the fibroids are in the lining of the womb so, if the fibroid in the lining or we call it a submucous fibroids, if the size is more than one centimeter then, we do recommend removing it to improve the chances of implantation or conception. For the fibroids in the wall of the womb, intramural or outside, the evidence is not clear or categorical in saying that removing the fibroids improves the chances of conception. Sometimes, women who have fibroids going through IVF have found it difficult to collect the eggs just because of the access in those situations. We have done myomectomy to facilitate the process of IVF the egg collection. We have done myomectomies to improve overall the chance of conception as well but it is not a first line treatment as the evidence is not clear that myomectomy is needed for all fibroids.
Fibroids are growth of the muscles or the smooth muscles inside the wall of the uterus. They are divided based on the position or situation in the wall of the uterus. We divide them as an intramural fibroid which is a fibroid as the name implies that is in the wall of the uterus. Most of the time intramural fibroids do not cause or interfere with fertility except if they are very large in size. By very large in size, I mean if they are around 5-6 centimeters or larger or if there are plenty of them present inside the wall of the uterus. Obviously we know how to map the fibroids either by doing a three-dimensional ultrasound scan or very rarely your doctor might be requesting for you to do an MRI which will help in locating where specifically those fibroids are and what their sizes are and to check if they are interfering with fertility or not. So that was the intramural, there’s the subserosal which are the least fibroids to interfere with fertility because they are literally situated on the outside wall of the uterus and they are not pressing on the lining so, most of the time, those fibroids are ignored or they are not investigated further before fertility treatment. The fibroids that are most relevant for fertility and for fertility treatments are the submucosal fibroids or the fibroids that are literally sitting under the lining or under the endometrium because even if they are tiny in size, they might be causing a small bump inside the lining preventing embryos from implanting, causing heavier periods, causing more painful period. So two things are important when it comes to assessing a fibroid whether they are subserosal, submucosal or intramural. With submucosal being the most important and the size of the fibroid and the size of the fibroid might be not that relevant when it comes to submucosal while if it is intramural, the larger it is, it might be associated with fertility issues.
