Myoma (Fibroids) and Fertility

The degree to which myoma (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) (ref. 1).

How do myoma impede fertility?

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

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

Fertility and myoma treatment – ExAblate*
 
The Royal Women's Hospital in Australia reported that that their staff had successfully treated about 110 women with Exablate - Focused ultrasound , including several who have gone on to fall pregnant and deliver healthy babies (ref. 5). 

To date among all the women who were treated with ExAblate worldwide, there have been over 80 pregnancies with 45 deliveries with no treatment related adverse effects.* 

* Following European CE mark change, women planning future pregnancies should consult with their physicians before seeking treatment with the magnetic resonance-guided focused ultrasound surgery (MRgFUS) system.

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Studies: Fertility following 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. 
5.  Zaher S, Lyons D, Regan L., Successful In Vitro Fertilization Pregnancy Following Magnetic Resonance-guided Focused Ultrasound Surgery for Uterine Fibroids, J Obstet Gynecol Res., 2011, 37(4):370-3.

References:
1. Bajekal, N., TC Li, Human Reproduction Update, Vol.6, No.6 pp.614-620, 2000
2. Buttram, V.C. Jr and Reiter, R.C. 1981 Uterine leiomata:etiology, symptomatology and management. Fertil. Steril., 36, 433-445
3. Hunt, J.E. and Wallach, E.E. 1974: Uterine factor in infertility: an overview. Clin. Gynecol., 44-64.
4. Ubaldi, F., Tournaye, H., Camus, M. et al. 1995 Fertility after hysteroscopic myomectomy. Hum. Reprod. Update, 1, 81-90 
5. Revolutionary uterine fibroid treatment breeds new life