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Ask the Experts - Fibroids: To Keep or Remove?

**Q.** I sought our physician's opinion about how my fibroids might impact our desire to get pregnant. Eight doctor opinions later, we are no closer to a decision. About half of the experts advise surgical removal; and the other half tell us to try to get pregnant despite them. Why is the medical community divided on this? **A.** Fibroid(s) of the uterus, also known as leiomyomas or just myomas, are benign growths that may be located on the exterior of or within the muscle layer of the uterus, or may be growing within the lining of the uterus. For the vast majority of women, fibroids do not cause significant health problems. A few women who desire pregnancy may need to have their fibroids removed (myomectomy) prior to conceiving if the fibroids are very large (greater than 6 cm) and/or if they impinge upon and distort the uterine cavity. Various surgical approaches to removal are [further described on PFC's web site](http://www.pacificfertilitycenter.com/treat/surgical.php), along with a more in depth summary of the factors that our physicians consider when counseling a patient to undergo a myomectomy. You probably received different opinions because the impact of fibroids as related to pregnancy chances depends on the size and location of the fibroids. Other issues to consider are that fibroids are dependent on estrogen to grow, and high levels of estrogen produced during pregnancy can lead to rapid growth of the fibroid(s). If the fibroid is on the outer surface of the uterus, this may present little problem. If the fibroid is located within the uterus muscle wall or nearer the uterine cavity where the fetus is growing, a patient may be at higher risk for various pregnancy complications (miscarriage, preterm labor...). In rare cases, the fibroid may grow so rapidly during pregnancy that it outgrows its blood supply and starts degenerating, which can be painful and sometimes lead to pregnancy complications. Also uncommon but of significance is the fact that some fibroids may block the lower portion of the uterus, prohibiting the baby's head to descend into the birth canal, making cesarean delivery necessary. However, it is important to keep in mind that the **majority** of patients with fibroids experience no problems during pregnancy. What is the impact of fibroids on pregnancy chances? It is unclear that there is any negative impact, **if** the fibroids are small and not growing within or distorting the uterine cavity.