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Fibroids

Uterine fibroids are benign (noncancerous) tumours of muscle tissue in the uterus. Fibroids occur when a single muscle cell in the wall of the uterus multiplies and grows to form a noncancerous tumour. Fibroids can change the shape or size of the uterus and sometimes the cervix (lower part of the uterus).

Whether fibroids cause symptoms or require treatment depends on their location, size, and number.

Fibroids are usually found in or around the body of the uterus, but sometimes are in the cervix. There are three main types of fibroids based on where they are found:

  • Subserosal are in the outer wall of the uterus (55%)
  • Intramural are found in the muscular layers of the uterine wall (40%)
  • Submucosal protrude into the uterine cavity (5%)

Impact of Fibroids on Fertility

Fibroids are found in 20% of women of reproductive age, but are more common in African-American women (50%-80%). The exact cause of uterine fibroids is unclear, but there is evidence that it may be a combination of genetic, hormonal, and environmental factors.

There are several ways uterine fibroids can reduce fertility:

  • Enlarged size or specific location fibroids can hinder the transport of the sperm and egg, as well as their implantation
  • Fibroids seem to alter uterine contractions leading to an inflammatory reaction in the uterus. The latter may hinder implantation.
  • Blood flow to the uterine cavity can be affected. This can decrease the ability of an embryo to stick (implant) to the uterine wall or to develop.
  • Reduced endometrial receptivity: Two important markers – HOXA 10 and glycodelin, of endometrial receptivity are reduced in presence of fibroid.
  • A physical disruption of the junctional zone, caused by intramural fibroids, may also lead to implantation failure or early pregnancy loss
  • uNK cells are the most abundant and important immune cells in the uterus at the time of implantation. An alteration of uNK cell numbers has been associated with implantation failure .The presence of fibroids appears to influence the number of uNK cells and macrophage cells.

Surgical Management

Myomectomy as a potential surgical treatment for fibroids has been explored in many case studies. In general, approximately 50% of women with infertility and fibroids become pregnant after myomectomy, although the numbers differ depending on the study. Whether performed hysteroscopically or by laparotomy or laparoscopically ( depending on the location and the size), myomectomy has led to a rise in pregnancy rates; however, only the rise regarding submucosal fibroids was statistically significant. Then again, the literature review has shown that myomectomy before IVF has significantly increased the success rate in fibroids without submucosal component.

The benefit of myomectomy highly depends on the location and size of the fibroids.