Impact of fibroids on fertility, pregnancy loss, and preconception management

PURPOSE OF REVIEW: Although fibroids are understood to be a predominantly benign and common pathology, they can have significant impacts on patients' quality of life and reproductive health. This review summarizes the impact of uterine fibroids on fertility and spontaneous abortion, while also addressing how the treatment for fibroids can affect fertility. Lastly, the review will address strategies for preconception management of fibroids to optimize patients' reproductive health. RECENT FINDINGS: The data regarding the impact of fibroids on fertility and pregnancy loss is evolving. However, it is agreed that the impact of fibroids is predominantly determined by their location in the uterus. Fibroids located in the submucosal layer or otherwise disrupting the endometrial cavity can impede the implantation of an embryo or potentially increase the risk of spontaneous abortion. When treating fibroids for the purpose of fertility, surgical management is preferred over medication management. There is limited data supporting procedures such as uterine artery embolization or radiofrequency ablation for the management of fibroids to improve fertility. Surgical management of fibroids not impacting the uterine cavity remains controversial. SUMMARY: Uterine fibroids can have a detrimental impact on fertility and therefore require purposeful attention to both the diagnosis and management of the condition in reproductive-aged women. The treatment of fibroids for the purpose of fertility alone remains controversial. Regardless, fibroid size and location should be cataloged, and surgical management should be offered to patients experiencing difficulties with conception.