An interview with “The Fibroid Doc”

Did you know that 4 out of 5 women will be affected by fibroids? And by age 50, 90 percent of black women will develop fibroids? Despite being so common, fibroids are often misdiagnosed and misunderstood. That’s why we sat down with Dr. Cheruba Prabakar, the renowned Fibroid Doc, to shed light on what every woman should know about this condition, especially those hoping to conceive.

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Dr. Prabakar is a board-certified OBGYN and fellowship-trained minimally invasive surgeon based in the East Bay, California.  She specializes in robotic surgery and utilizes the latest technological advancements to provide the best care for her patients. With her expertise in minimally invasive techniques, she can remove fibroids through same-day procedures that involve only a few small abdominal incisions. This approach, requiring additional surgical expertise, contrasts with traditional methods, which require larger incisions (similar to a C-section scar) and a hospital stay of several days.

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Collab founder Dr. Thalia Segal and Dr. Prabakar became friends during their medical residency in Long Island, NY. Today, they both run medical practices in the East Bay, where they collaborate on individual cases to help people grow their families.

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Continue reading to discover insights from Dr. Prabakar on how common fibroids are, their symptoms, available treatment options, their potential impact on fertility and pregnancy, and how fibroid surgery can be integrated into a woman's IVF journey to maximize the chances of successful conception.

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Thanks for joining us today and for being a friend of Collab Fertility. How did you become the “Fibroid Doc” with expertise in fibroid surgery?

After medical school, I did a four-year residency in Long Island, where I encountered many women dealing with fibroids. Following my residency, I pursued a two-year fellowship in minimally invasive surgery in Brooklyn, NY, where I worked with a diverse patient population and deepened my expertise. I then moved to the Bay Area and began practicing in Oakland, where I continued to treat many patients suffering from fibroids.

Caring for these women became my passion. I realized that many of them had not been receiving adequate care. They were struggling with heavy bleeding, pain, and infertility yet were not being offered all available treatment options. It seemed like the attitude from some doctors was, "This is just part of being a woman—deal with it." But I wanted to empower women with all the options available to them and help them become pain- and symptom-free. So, when I started my practice, I decided to specialize in fibroids, with a commitment to marrying my technical expertise with compassionate care.  

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What are fibroids, and how common are they?

Fibroids are benign tumors that grow in the muscular wall of the uterus. They are little balls of muscle tissue made up of the same material as the uterus. They are almost always benign and are not always symptomatic. Fibroids are very common, but many women don’t even know they have them. The most common symptoms include heavy bleeding, pain, pressure (urinary frequency), painful sex, and infertility. In their lifetime, 80 percent or 4 out of 5 women will be affected by fibroids. And by age 50, 90 percent of black women will develop fibroids.

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What causes fibroids?

We wish we knew what causes fibroids; that is the million-dollar question. There is a genetic component to it. Anecdotally, patients will tell me that their mothers, grandmothers, and aunts had hysterectomies due to fibroids. Also, research suggests a possible connection between high red meat consumption and fibroids. Overall, a vegetarian/anti-inflammatory diet helps reduce the number and size of fibroids. So, there are some links to the environment and food. But we don’t have a gene identified for fibroids, so a diagnosis can catch many women by surprise.

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How do fibroids impact fertility?

Fibroids can impact fertility in many ways. There are many different places where fibroids can be found. But simply stated, if they are inside the uterine cavity, they can block the embryo and prevent it from implanting and should 100% be removed.

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How risky is pregnancy with fibroids?

Not all fibroids are bad, and not all fibroids will affect pregnancy. However, some fibroids do adversely affect pregnancy based on their location and their size. Sometimes, the embryo may still implant when a fibroid is located in the middle of the uterine cavity. Still, its presence can interfere with the embryo's development and cause miscarriage. Other times, fibroids outside the cavity can grow so big that they impact the uterus's shape and restrict an embryo's normal growth.

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Another risk related to pregnancy is that fibroids can degenerate, causing pain that mimics labor. This pain can send pregnant women to the hospital thinking they are in pre-term labor, which can be a scary thing.  

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Is it better to remove fibroids before pregnancy?

As I mentioned before, if any fibroids are present inside the uterine cavity, they should be removed before becoming pregnant.

If fibroids are present in other areas, it depends on the size. I tell my patients that there is no way to predict if fibroids will grow rapidly in pregnancy. Some fibroids grow with estrogen stimulation, and some do not. Most women pursuing IVF will opt for surgery to remove all fibroids before starting fertility treatment.

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How do fibroids impact IVF?

A lot of women come to me at the beginning stages of IVF. These women are typically getting lots of scans, so fibroids are detected. They want the fibroids removed so they can continue their IVF journey. In these cases, I remove the fibroids to minimize the risks before the woman has an embryo transfer.

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After I operate on someone to remove fibroids, I want to give their uterus a rest to recover before they become pregnant - this can be anywhere from 4 to 6 months.

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Can a woman get pregnant after fibroid removal?

Yes. In fact, I’m thinking about the numerous patients I have operated on in the last two years for fibroids, and most of them have successfully gotten pregnant.

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Can the fibroids grow back after removal?

Fibroids have about a 30% recurrence. It won’t be the same fibroids, but they will show up in other locations. People who make fibroids will tend to keep making fibroids. That is why the timing of surgery and IVF is really important. I don’t want too much time to lapse between fibroid surgery and pregnancy because I don’t want new fibroids to pop up.

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Anything else you’d like to share with our audience?

Yes, if you have fibroids and are trying to conceive, having an excellent medical team that communicates with each other is essential. Dr. Segal and I often refer patients to each other, and we communicate about these patients to ensure they get the best care possible.

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Advocate for yourself and get your doctors talking to each other.

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We are here to support you

If you're struggling with fertility, Collab is here to help. As part of our comprehensive fertility testing, all of our patients have ultrasounds that will detect any fibroids. If fibroids are found, we work closely with several minimally invasive gynecological surgeons to provide you with the best treatment options. Schedule a consultation with us today to learn how we can help you take the next step toward building the family you want.

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How fibroids cause infertility

Obstructing the fallopian tubes‍

Fibroids can block fallopian tubes, preventing eggs from reaching the uterus for fertilization.

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Altering the uterine cavity ‍

Fibroids can distort the uterine cavity, making it more challenging for an embryo to implant successfully or may contribute to an early pregnancy loss or miscarriage.

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Affecting the uterine lining

Fibroids that impact the uterine cavity can alter the thickness and quality of the uterine lining, which may hinder embryo implantation and development.

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Reducing blood flow‍

Fibroids can reduce blood flow to the uterus, making it more difficult for an embryo to implant and thrive.

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Changing the cervix‍

Fibroids can alter the shape of the cervix, potentially limiting the number of sperm that can enter the uterus.

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