Uterine Fibroids and Fertility Potential
Page author Richard Sherbahn MD
Uterine Fibroids (proper medical terminology is myoma or leiomyoma)
Fibroids are very common - they are benign (non cancerous) tumors of the uterine muscle. The size and location of the fibroid are important. The large majority of them are very small or located in an area of the uterus such that they will not have any impact on reproductive function.
3-D ultrasound images showing coronal planes through the uterus and large fibroid
Left Photo: Ultrasound picture of a fibroid in the uterus (coronal plane)
Right Photo: Marked up image showing outer contour of uterus in green, uterine cavity outlined in red and the 5 cm fibroid at top of the uterus (called the "fundal" area, or fundus) outlined in blue
R = area where the right tube would come off the uterus
L = area where the left tube would come off the uterus
C = cervical area
There are 3 general locations for fibroids:
- Subserosal - on the outside surface of the uterus
- Intramural - within the muscular wall of the uterus
- Submucous - bulging in to the uterine cavity
- The only type that is supposed to have a large impact on reproductive function (unless they are large or numerous) is the submucous type that pushes in to the uterine cavity.
- These are much less common than the other 2 types of fibroids.
- Because of their location inside the uterine cavity, submucous fibroids can cause fertility problems and miscarriages.
- Submucous fibroids can often be surgically resected to improve fertility.
Subserosal fibroid or myoma
Laparoscopic view of a uterus with a pedunculated myoma (fibroid). This is a subserosal myoma. This should not affect chances for pregnancy or miscarriage.
Laparoscopy is a surgery that uses a narrow scope that is put in through the belly button area
Intramural fibroid or myoma
Ultrasound picture of a uterus with an intramural (within the uterine wall) myoma. Image on right shows uterus outlined in blue, uterine lining in red, myoma in green. A fibroid in this location hopefully would not have much impact on chances for pregnancy or miscarriage.
For comparison; ultrasound images of a uterus with a normal endometrial lining and no myomas visible. Image on right shows the uterus outlined in blue and the "triple stripe" uterine lining (landing pad for the embryos) outlined in yellow.
Submucous fibroids - uterine myomas
Ultrasound sonohysterogram shows large fibroid in cavity - "submucous" location.
Image on right shows uterus oulined in red and labels on fibroid, cavity, bladder and cervix.
Hysteroscopy view of the same submucous fibroid
Uterine cavity (C) continues behind the fibroid (F)
Ultrasound views with 3-D ultrasound showing coronal planes through the uterus
Left Photo: Ultrasound picture of a normal uterine cavity. Smooth triangular cavity seen between the R, L and C.
Right Photo: Same kind of view, but with a fibroid tumor bulging well into the cavity at "F".
R = area of right tubal opening
L = area of left tubal opening
C = cervical area
F = fibroid inside uterine cavity
Hysterosalpingogram showing a uterus with a submucous myoma (fibroid) that is pushing in to the cavity. Another myoma on the outside of the uterus is circumscribed by dye along the red line. The myoma inside the cavity might cause reproductive problems.
Left Photo: Hysteroscopic view inside a normal uterine cavity. Office hysteroscopy - looking up from the cervix toward the top of uterine cavity.
Right Photo: Hysteroscopic view of a uterus with 2 submucous fibroids that are pushing down into the cavity (rounded bulges at top).