Gynecological conditions such as uterine fibroids and ovarian cysts are common among women of reproductive age. While many women live with these conditions without significant symptoms, others experience pain, heavy menstrual bleeding, hormonal disturbances, or fertility challenges that affect their physical health, emotional well-being, and quality of life. Despite their prevalence, fibroids and cysts are often surrounded by stigma and misinformation, making it crucial for women to understand their implications—especially when surgery is being considered.
To shed light on how these conditions affect fertility and the role of surgical intervention, we spoke with Dr. Jahnavi Chandrasekar, Consultant – Gynaecology, RG Hospitals, Saidapet, Chennai.
Understanding Fibroids and Their Effect on Fertility
Uterine fibroids are non-cancerous growths made up of muscle and fibrous tissue that develop within or on the uterus. They most commonly occur in women in their 30s and 40s, although they can appear earlier. Globally, fibroids are among the most prevalent gynecological conditions, with studies suggesting that nearly 70–80% of women may develop fibroids by the age of 50—often without realising it, as symptoms can be mild or mistaken for routine menstrual discomfort.
The impact of fibroids on fertility depends largely on their size and location. Submucosal fibroids, which grow into the uterine cavity, are known to interfere most significantly with conception. Research indicates that women with submucosal fibroids experience a 28% reduction in implantation rates and a 36% decrease in clinical pregnancy rates compared to women without fibroids. These fibroids can alter the uterine environment, making implantation and pregnancy maintenance more difficult.
Ovarian Cysts and Reproductive Health
Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. Many cysts are functional, forming as part of the normal menstrual cycle, and typically resolve on their own without affecting fertility. However, not all cysts are harmless.
Certain types, such as endometriomas, can negatively affect ovarian reserve by damaging healthy ovarian tissue and creating chronic inflammation. Other persistent or complex cysts—such as dermoid cysts or cystadenomas—may grow large, cause pain, or interfere with ovulation. In such cases, fertility may be compromised if left untreated.
While surgery may be necessary for some cysts, it is important to note that surgical removal can sometimes reduce ovarian reserve, particularly if healthy tissue is inadvertently affected. Larger cysts tend to pose a greater risk to ovarian function, making careful assessment and individualised treatment planning essential. Fertility goals should always be discussed before proceeding with surgery.
Surgical Options and Fertility Preservation
For women who wish to preserve fertility, myomectomy—the surgical removal of fibroids while keeping the uterus intact—is generally the preferred approach. Advances in minimally invasive surgery, including laparoscopic and hysteroscopic techniques, have significantly improved recovery times and reproductive outcomes.
Clinical studies show that approximately 43–52% of women conceive after undergoing submucosal myomectomy, compared to about 27% who do not receive surgical treatment. Success rates depend on several factors, including age, number and location of fibroids, extent of uterine incisions, and previous infertility history.
Hysteroscopic myomectomy, which targets fibroids within the uterine cavity, has been shown to improve implantation rates, increase live birth rates, and reduce the risk of miscarriage. Although considered safe, potential complications—such as uterine perforation or fluid overload—highlight the importance of experienced surgical care.
For ovarian cysts, ovarian cystectomy is recommended when cysts are persistent, symptomatic, or pose a threat to fertility. Surgeons must employ meticulous techniques to preserve as much healthy ovarian tissue as possible, particularly in women planning future pregnancies. Emerging technologies, including robotic-assisted surgery, offer enhanced precision and may help minimise tissue damage during both fibroid and cyst removal.
Risks, Recurrence, and Alternative Treatments
One important consideration is recurrence. Fibroids can return in up to 50% of women within five years of myomectomy, making long-term follow-up essential. For some women, less invasive alternatives may be considered.
Uterine artery embolisation (UAE) reduces fibroid size by blocking their blood supply. While ovarian function is often preserved and successful pregnancies have been reported, the risk of ovarian impairment and placental complications is higher—particularly in women over 40.
Radiofrequency ablation (RFA) uses controlled heat to destroy fibroid tissue through minimally invasive techniques. Early data on fertility outcomes are encouraging, with most reported pregnancies resulting in full-term deliveries without significant maternal or neonatal complications.
Making an Informed Choice
Fibroids and ovarian cysts are common conditions that can affect fertility, particularly when they alter the uterus or compromise ovarian function. Surgical interventions such as myomectomy and cystectomy can improve reproductive outcomes for carefully selected patients, but they are not without risks.
With advances in minimally invasive techniques and greater emphasis on fertility preservation, women today have more options than ever before. An informed discussion with a gynecologist—taking into account symptoms, age, reproductive goals, and long-term health—is key to choosing the most appropriate treatment and safeguarding future fertility.
