Fibroids and Your Fertility

Uterine fibroids can not only cause a variety of symptoms including heavy bleeding but they have also been associated with fertility challenges. Uterine leiomyomas, otherwise known as uterine fibroids, are one of the most common causes of infertility and adverse pregnancy outcomes. Now although some uterine fibroids will present with symptoms like heavy bleeding, some will be completely asymptomatic. In women with asymptomatic uterine fibroids, their only symptom may be infertility or recurrent pregnancy loss. 


Uterine fibroids can be present in a variety of areas in the uterus. We often classify fibroids based on their location as either intramural, submucosal, subserosal or as cervical fibroids. Although any uterine fibroid has the possibility of impacting your ability to get pregnant, submucosal fibroids seem to have the biggest impact on your fertility. Submucosal fibroids are derived from myometrial cells just below the endometrium.This abnormal protuberance impacts not only a woman’s ability to get pregnant but their ability to stay pregnant. In fact, submucosal fibroids can delay the time to conception and have also been associated with a higher risk of pregnancy loss, lower implantation rates, as well as, poor placental growth and development. Since submucosal fibroids can impact both your ability to get and stay pregnant, treating your uterine fibroid whether you are trying to conceive naturally or you are gearing up for IVF, should be a top priority. 


So, what causes fibroids? Are there natural treatments we can use to shrink them? Is surgery or lupron our only option? 


I’m glad you asked! Let’s dive in. 


When it comes to uterine fibroids, researchers tend to believe that the development of fibroids is most likely multifactorial and may be due to a combination of genetic, environmental and lifestyle factors. Uterine fibroids are like the “perfect storm”. But for those trying to conceive, that perfect storm can feel like a hurricane. But have no fear, Dr. Zen is here! 


At NMD Wellness of Scottsdale, we provide evidence-based integrative fertility care. As a naturopathic doctor, my goal is to implement early screening options and to provide an integrative treatment plan that allows us to use the best of both conventional and natural medicine to help you get and stay pregnant. 


If you have recently been diagnosed with a uterine fibroid, your fertility doctor may have recommended treatment options including surgery, as well as, pharmaceutical interventions like Lupron or selective progesterone receptor modulators, like Mifepristone. Depending on your particular case including your age, your estimated ovarian reserve, how long you have been trying to conceive as well as your pregnancy and fertility history, your doctor will recommend an option that is most suitable for you. Unfortunately, too often, short office visits with your fertility clinic can leave you feeling lost and overwhelmed about your options. So let’s talk about options and why integrative approaches can be so valuable. 


Two of the most common conventional treatment options your doctor may have discussed with you include surgery and/or Lupron. 


So, let’s talk about the pros and cons. 


Surgery can be a great and precise way to treat the root cause of your infertility. By removing uterine fibroids, we can enhance your ability to get and stay pregnant. This can be a great option for many women. However, surgery isn’t for everyone. In fact, one disadvantage of surgical uterine fibroid removal is that surgeons generally recommend waiting 6 to 12 months after surgery to start trying to conceive again. If you are 30 years old, have optimal AMH levels and have no other signs of premature ovarian insufficiency, taking a 6 to 12 month break from actively trying may be in your best interest in order to remove a uterine fibroid and reduce your risk of poor implantation and pregnancy complications associated with an untreated uterine fibroid. If however, you are considered to be of “advanced maternal age”, have low AMH levels and/or have symptoms of suspected premature ovarian insufficiency (POI), you may not be comfortable with waiting an additional 6 to12 months. This is where surgery may not be the most suitable option for you during your fertility journey. 


Another common treatment option is the use of Lupron. Lupron, otherwise known as leuprolide, is a GnRH agonist that works by inhibiting gonadotropin (GnRH) releasing hormone from the brain to suppress hormones like estrogen and progesterone. This is used to help reduce the size of a uterine fibroid. One of the benefits of using Lupron is, unlike surgery, once a patient has completed their lupron treatment (which is typically 3 to 6 months), they are immediately eligible to get pregnant. This can be a great option, especially in women with advanced maternal age or low ovarian reserve who don’t necessarily have the time to wait an additional 6 to 12 months before trying to conceive after surgery. In terms of maximizing your ovarian reserve, lupron is often one of the least invasive and most beneficial treatment options to consider. Now although Lupron does come with possible side effects, including possible bone loss, most of these side effects are temporary. Since patients are taking Lupron for a short period of time, if there was to be any bone loss, it is likely reversible. This is also where an integrative treatment plan options can be extremely beneficial and can be a way to mitigate the possible side effects associated with Lupron. Lupron often gets a bad rap because patients have read that Lupron puts them in a “temporary menopause” however, this isn’t actually accurate. Lupron can be a great option for many women especially for those who want to address the root cause of their infertility and shrink a fibroid that may be inhibiting their ability to get and stay pregnant. 


 Although there are other conventional treatment options available, surgery and lupron are the two most common. Some doctors will recommend other medications including selective progesterone receptor modulators (SPRMs) however these have fallen out of favor, especially in women with unexplained infertility. This is because SPRMS seemed to be less effective in patients with unexplained infertility due to a lower receptivity of the uterus itself. 

Now you may be wondering if there is a more “natural” alternative to surgery or Lupron. You may have read about “estrogen dominance” and using supplements to resolve a fibroid. But here is the thing, as an evidence-based naturopathic doctor, I am always interested in what the research is telling us and how I can maximize my patients results. As we know, for a woman struggling to conceive, every month counts and the last thing we want to do is tell a woman who already doesn’t have time on her side to “wait and see” by using some natural supplement that has absolutely no evidence or research supporting it. Instead, natural medicine should be used in combination with conventional treatments like surgery and Lupron. In fact, since uterine fibroid can delay your time to conception because you are either a) gearing up for surgery or b) just starting Lupron, what we do during those 3-12 months prior to conception can have a vital impact on your dreams of becoming a mother.


This is where as a naturopathic doctor, we shine! We can help patients identify nutrient deficiencies, support ovarian reserve and egg quality and, most importantly, help women build the diet and lifestyle strategies they need to become the healthiest version of themselves. This may include evaluating their diet, addressing underlying factors including Vitamin D deficiencies, anemias and insulin resistance, as well as, helping them understand which supplements are most beneficial to their care. We also help patients avoid supplements that may impede their fertility success. One great example of this is resveratrol. Resveratrol has been coined as an antioxidant powerhouse and although it has been thought to potentially support ovarian reserve, resveratrol has been shown to lower the effect of lupron. This is just one of the many ways naturopathic fertility care can help patients fast track their journey to motherhood with evidence-based integrative approaches.  


About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...