Depending on the location and size of the fibroids, you might experience heavy bleeding, pelvic pain, discomfort during sex, and other unwanted symptoms. But do fibroids affect pregnancy and fertility?

Fibroids and Fertility

Unfortunately, fibroids can impact your ability to get pregnant. However, the good news is that most women with fibroids can conceive naturally. With guidance and care from a fibroids specialist, the odds of having a successful pregnancy are even higher. Fertility issues are relatively rare. Whether or not they cause infertility depends on many factors.

One crucial detail that makes fibroids affect pregnancy and fertility is location. These tumors can develop in various parts of the uterus. Submucosal fibroids generally have the most impact on fertility. These growths appear just under the endometrium and protrude into the uterine cavity. This type of fibroid makes up just five percent of all fibroid cases. They’re the rarest but also one of the most problematic.

Larger fibroids over six centimeters in diameter are also to blame for fertility issues. Regardless of the tumor’s location, the sheer size of the growth can cause significant fertility problems.

These types of fibroids can affect fertility in a few different ways.

First, the growths can change the shape of the uterus entirely. As a result, fewer sperm can enter the uterus. Furthermore, the malformed nature of the uterus can disrupt the sperm’s movement as it makes its way to the egg during conception.

Fibroids can also block the fallopian tubes or change the size of the uterine lining. Even if the sperm successfully penetrates the egg, there’s no guarantee that the embryo will implant in the uterine wall. Fibroids can restrict blood flow, stopping development before it even begins.

It’s true that fibroids affect pregnancy, but these cases are rare. Most women with these tumors can conceive without any issues. If you’re in doubt, don’t hesitate to reach out. Dr. Tahery specializes in fibroid evaluation and treatment.

RELATED: Minimally Invasive and Non-Surgical Fibroid Treatment Options

Fibroids During Pregnancy

One of the most common questions people have about these non-cancerous growths is whether or not fibroids affect pregnancy and delivery. Once again, it’s possible but rare.

Between two and 12 percent of pregnant women receive a fibroid diagnosis. But an estimated 10 to 30 percent of that figure develop complications during pregnancy. That means most women with fibroids have perfectly normal pregnancies without any challenges.

In those instances when fibroids affect pregnancy, it’s usually in the first trimester. Experts believe that these growths rely on estrogen to grow. Because your body produces more estrogen during the first third of the gestation period, that’s when complications manifest.

The biggest concern due to fibroids in pregnant women is preterm births and the possibility of miscarriage. Unfortunately, women with fibroids have an estimated 14 percent chance of miscarriage. That’s noticeably higher than the 7.6 percent risk in women without fibroids. The dangers increase with larger tumors.

Fibroids can also put you at a higher risk of preterm birth before 37 weeks and cesarean delivery.

Other potential concerns include extreme pain and developmental problems. As the uterus expands in the second and third trimesters, it can push against the tumors. The fibroids may twist or even outgrow their blood supply, creating severe stomach pain that could result in miscarriage.

In cases of extreme fibroid growth, placental abruption can occur. When this happens, the placenta tears away from the uterine wall, cutting off oxygen to the fetus and causing heavy bleeding.

Diagnosis and Treatment of Fibroids

The best way to minimize the ways fibroids affect pregnancy is to be proactive about treatment. Diagnosing these uterine tumors is a straightforward process. We use 3D ultrasound technology to evaluate the size, location, and the number of growths.

After diagnosis, we can recommend a course of action that’s right for your needs. Possible treatment options include hormone therapy, radiofrequency ablation, and embolization. Hormone therapy uses gonadotropin-releasing hormone agonists to decrease estrogen and progesterone levels that feed the fibroids. Meanwhile, ablation and embolization aim to reduce the size of the tumors and cut off their blood supply.

Whether you have plans to get pregnant or not, contact Dr. Michael Tahery to explore treatment options for your fibroids. Dr. Michael Tahery is a urogynecologists who understands the complex nature of fibroids and their potential impact on pregnancy and fertility. Contact our offices today to learn more and schedule your appointment.

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The use of NSAIDS in pregnancy have been restricted. It is well established that NSAID use in the third trimester of pregnancy significantly prohibits fetal urine production and amniotic fluid volume. It also increases the risk of premature constriction of the ductus arteriosus leading to fetal heart failure and even death.

Recent research from Kaiser Permanente has found more bad news. Use of Nonsteroidal anti-inflammatory drugs in the first trimester also increases the rate of miscarriage. NSAIDS prohibit prostaglandin production essential to successful implantation of the embryo. Abnormal implantation increases the risk of miscarriage. Nonsteroidal anti-inflammatory drugs effect on the risk of miscarriage has been shown to be dose-related. The higher the frequency and the dosage the higher the risk of miscarriage. Women at lower body mass index may be most vulnerable to this effect.

My policy in pregnancy and otherwise has been the least use of medication possible. History and experience have shown that many of the medications we use and take their safety for granted will be found to be harmful in ways we never imagine today. Natural remedies and holistic approaches are always best when possible.

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Postpartum Depression (PPD)

Postpartum mood disorders range from short lived “blues” (80% of new mothers), to more severe depression (20%), and much less common psychosis (1/1000). Causes are complex and treatment may require cooperation from multiple specialties.

Postpartum blues are described as anxiety, irritability, insomnia, and crying episodes. This condition is short lived (less than two weeks) and usually requires no treatment. Rest and family support is sufficient to overcome this temporary mood disorder.

Postpartum depression is more severe and prolonged. It lasts longer than two weeks and without intervention worsens. The symptoms are severe depressive and mood changes, fatigue and loss of interest and loss of joy in pleasurable activities, insomnia, mental fogginess, feeling of inadequacy and shame. Difficulty bonding to the baby and feeling of detachment from family and loved ones is other features of PPD.

Postpartum psychosis fortunately rare but a very serious condition. This disorder is marked by hallucinations, agitation, self-mutilation, suicidal ideation, and attempts at harming self or the baby.

Cause

Causation is complex. Postpartum hormonal changes, lack of sleep and exhaustion, physical changes, traumatic experiences during pregnancy, labor, delivery, and postpartum can contribute. Mothers with history of depression and depression in a previous pregnancy are at higher risk.

Diagnosis

The most essential key to diagnosis is listening and asking the appropriate questions. Validating patient concerns and taking complaints seriously. Close and early follow up postpartum is helpful. PPD questionnaires can be used in prenatal as well as postpartum setting to diagnose high risk mothers.

Treatment

Early treatment is essential to effectively treating PPD and psychosis. Treatment requires a combination of psychotherapy, antianxiety and anti-depressive medication. Hormonal therapy may also be effective in treating this condition. The vast majority of women treated early will recover and will avoid long term consequences for themselves and their baby.

If you think you might be struggling with Postpartum depression, schedule an appointment with Dr Michael Tahery at the Glendale office or the West Los Angeles office to find out more about the treatment options available.

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How many couples do you know trying to get pregnant and have difficulty? Or have “fertility anxiety”?

On any given day in my practice, I am faced with the seemingly straight forward, yet complex question from women at various stages of their lives; “can I get pregnant?”. Women in their twenties and nervous about their health; those in their thirties worried about the metaphorical clock ticking away; and women in their forties optimistically seeking guidance. Some may have tried a few cycles naturally to get pregnant and others may not be ready yet.

Fertility is big news because the rate of infertility is increasing in both men and women. Several factors are implicated and the most common are environment, age, genetics, and medical conditions.

Diet and environmental toxins are very concerning topic. Pesticides, hormones added to foods, chemicals in the air we breathe and water we drink may play an important role. It effects the health of the female ovaries and the eggs they produce; it also effects the number and quality of sperm in men.

Advanced maternal age is another big factor. As ovaries age, the produced eggs are harder to fertilize. The number of eggs also decrease with age. The rate of attrition increases after 30, speeds up after 35 and at 40 very few eggs are left. If you are from a family with children born to mothers in their forties, your chance of having children later in life also increases. Genetics is an important factor and is much harder to analyze. Testing can determine your approximate egg count and quality and many of the factors that impede fertility.

Medical conditions that may not play a significant role in the fertility of a young adult can become serious factors as the person ages. Fibroids and endometriosis are two common examples. These conditions worsen with age and cause damage to reproductive organs. Hormonal imbalance such as polycystic ovarian syndrome, disrupt ovulation cycles and make eggs weaker. Simple office evaluation can diagnose many of these medical conditions.

Some of the fertility anxiety experienced by women may be justified and many are not, and most are easily treated. Discuss any concerns with a gynecologist. There are many ways your fertility can be evaluated. Simple, tried and true instructions can increase your odds of pregnancy, such as treating your body better with a balanced diet, exercise, and getting your checkup at least annually. In my practice, at times, simple solutions and early detection have made tremendous improvements in a couples fertility.

Oddly enough, anxiety about fertility has shown to reduce the chances of pregnancy. So, relax. Seek the help of a gynecologist.

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Another common urinary condition after pregnancy, especially vaginal delivery, is Stress Incontinence. This is the leakage of urine with any strenuous activity. This could include jumping, coughing, laughing, or even sneezing. During a vaginal delivery, the supports for the bladder become stretched or torn. The damage is responsible for stress incontinence. Several patients have complained that after their pregnancy and delivery, they could feel the urine fall when they walked or jumped.

If you notice that you have developed urinary control problems after having a baby, report it to your gynecologist. You can also schedule a consultation with a urogynecologist, a physician that specializes in repairing damages resulting from a pregnancy. Dr. Tahery is a urogynecologist in practice for the past 22 years and heads the Center of Excellence at Cedars Sinai in Women’s Pelvic Health.

Evaluation and testing is done in our office in an efficient and effective manner. Treatment options can include exercise, therapy, medication, minimally invasive surgery or out-patient surgical procedures.

As always, the most important message is that the earlier you address the problem, the easier it is to treat.

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During pregnancy, significant changes occur to a woman’s body in order to support the pregnancy, including the following:

• Swelling of the extremities
• 25-30 pounds of weight gain (on average)
• Stretching of the abdomen and the breasts due to the engorgement of the breast glands and growing uterus
• Hormonal changes that affect mood and a sense of wellbeing
• Changes in the body resulting in a disfavorable self-perception and body image
• Tearing forces during labor may compromise control of the bowel and bladder function
• Sex may become uncomfortable, unpleasant or even painful
• Desire for sex and libido may suffer in some women
• A bulge in the abdomen may indicate diastasis recti (an exacerbating hernia or splitting of the abdominal muscles)
• Persistent back and arm pains affecting mobility
• Bulging tissue from the anal area and bleeding with bowel movement may indicate fissures and hemorrhoids
• Other mental, psychological and physical changes that leave the body different than the one prior to pregnancy

By paying attention to these changes, we have solutions that can correct or minimize the after effects of a pregnancy and allow the body to return to its emotional, psychological and physical state.

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