Fibroids and uterine abnormalities may play a role in hampering a couple’s ability to conceive. If the fibroids are in the uterine cavity or push on the fallopian tubes, they can affect a woman’s fertility. However, it is unclear whether fibroids in the uterine muscle affect fertility if they do not directly influence the movement of sperm, egg, or embryo.

• Changes in the position of the cervix (the vaginal opening to the womb) from the fibroids above may affect the number of sperm that can travel through the cervix.
• Changes in the shape of the uterus can interfere with sperm movement.
• Changes in the uterine muscle prevent the movement of sperm or embryo.
• Inflammation in the wall of the uterine cavity can affect implantation.
• Effects on the blood flow to the uterine cavity where the embryo would implant.
• Blockage of the fallopian tubes by the fibroids.
• The egg and tube are separated by fibroids, therefore, hindering its way into the tube.

Sizable fibroids are usually easily identified by simple vaginal–pelvic bimanual examination. However, even the smallest fibroid can be identified by transvaginal ultrasound.

Sometimes it is difficult to tell if a fibroid is impinging on the endometrial cavity. In such cases, a hysteroscopy (where a telescope-like instrument, is inserted via the vagina into the uterine cavity) or a hydrosonogram (where saltwater distends the uterine cavity, allowing for examination of its contour and inner configuration) can help distinguish between intramural and submucosal fibroids.

Magnetic Resonance Imaging (MRI) can be used to distinguish between fibroid tumors and a related condition called adenomyosis, in which diffuse of the endometrium is found within the myometrium.

The growth of fibroid tumors is estrogen-dependent. When a woman enters menopause and stops producing female hormones, fibroids tend to shrink in size.

The most common of these is treatment with a medication such as leuprolide acetate (Lupron), which shut off the communication of the brain with the ovaries, preventing hormone production.

However, this type of medication can only be taken for a limited period (usually 6 months) and once the medication is stopped the fibroids will usually regain their original size within a few months.

Therefore the medication is only a “temporary fix”; used mostly to decrease the size of large fibroids in order to make their ultimate surgical removal easier or to help a woman bridge the gap until spontaneous menopause sets in.