Uterine fibroids are very common benign growths in the uterus, and many women wonder about fibroids and fertility, specifically, whether fibroids might impact their ability to conceive or carry a pregnancy. Fibroids are found in roughly 5–10% of women struggling with infertility, but they are the sole cause of infertility in only about 2–4%. This means most women with fibroids can still get pregnant; however, certain fibroids can indeed interfere with conception or pregnancy. The key is identifying when a uterine fibroid treatment is necessary to improve fertility prospects. In this post, we’ll explain in simple terms how fibroids affect fertility, which fibroids are most likely to cause problems, and what the best fibroid treatments are for women who want to preserve their fertility.
Prevalence of Fibroids
Fibroids are found in a significant proportion of people with uteruses during their reproductive years, with estimates suggesting that up to 70% will develop fibroids by the age of 50. The prevalence can vary depending on factors such as age, race, genetics, and overall health, but the numbers consistently highlight that fibroids are not a rare occurrence. Many people may have fibroids without ever knowing it, as these growths often remain asymptomatic and are only discovered incidentally during routine pelvic exams or imaging for unrelated reasons.
The likelihood of developing fibroids increases with age, particularly during the 30s and 40s, and tends to decline after menopause. While fibroids can occur in younger individuals, they are most commonly diagnosed in those between the ages of 35 and 50. Genetics also plays a role, as having a family member with fibroids increases one’s risk of developing them. Despite their high prevalence, not everyone with fibroids will experience symptoms or require treatment. The asymptomatic nature of many fibroids means that true prevalence rates may even be underestimated, as some individuals may never be diagnosed unless they undergo imaging for another reason. It also highlights the importance of regular gynecological check-ups, particularly for individuals with risk factors such as a family history or belonging to a higher-risk demographic group. For anyone concerned about fertility or experiencing symptoms such as heavy periods, pelvic pain, or pressure, knowing that fibroids are a standard part of the reproductive landscape can be reassuring.
What Are Uterine Fibroids?
Uterine fibroids are noncancerous tumors made of muscle and fibrous tissue that grow within the uterus. They can range in size from tiny to very large. Fibroids can grow in different parts of the uterus, and their location often determines whether they might affect fertility. The main types include: intramural fibroids (growing in the muscle wall of the uterus), submucosal fibroids (growing just beneath the uterine lining and bulging into the uterine cavity), and subserosal fibroids (growing on the outer surface of the uterus).
Fibroids may cause symptoms like heavy menstrual bleeding, prolonged periods, pelvic pain or pressure, but many women have no symptoms at all. Since symptoms vary, women might not even know they have fibroids until a doctor finds them during a pelvic exam or ultrasound. When it comes to fertility, the fibroid’s size and, importantly, its location are critical. Some types of fibroids affect fertility much more than others. Generally, submucosal fibroids and large intramural fibroids are the ones to watch out for in terms of fertility impact. Small intramural fibroids or subserosal fibroids often have little to no effect on conceiving. Here are some common ways fibroids may reduce fertility or affect pregnancy:
- Distorting the uterine cavity: Fibroids that push into the cavity where a baby would develop can make it difficult for an embryo to implant in the uterine lining. A misshapen cavity can also increase the risk of miscarriage.
- Blocking the fallopian tubes: A fibroid in the uterine corner or near the tubes can block the passage of the egg or sperm, preventing fertilization.
- Changing the cervix or uterine muscle function: Fibroids near the cervix might alter its position or shape, potentially reducing the number of sperm that enter the uterus. Fibroids in the uterine wall can disrupt the regular contractions that help sperm and embryos move, hindering their journey.
- Reducing blood flow or causing inflammation: Fibroids can create areas of inflammation in the uterus and may affect blood supply to the uterine lining, which can interfere with implantation and embryo development.
- Contributing to biochemical imbalance: Though hormones like estrogen drive fibroids themselves, they might create an environment in the uterus that is less receptive to pregnancy.
Not all fibroids will cause these issues. The vast majority of fibroids are small or located in places that do not impact fertility.
Impact of Fibroids on Fertility
Fibroids can affect fertility mainly when they distort the normal anatomy of the uterus. There is broad medical consensus that submucosal fibroids (those growing into the uterine cavity) are the most likely to harm fertility – they’re associated with lower pregnancy rates and higher miscarriage rates. In contrast, subserosal fibroids (on the outer surface of the uterus) generally do not appear to have any significant effect on fertility, since they don’t interfere with the inside of the uterus where pregnancy happens Intramural fibroids fall in a gray area: if an intramural fibroid bulges into or deforms the uterine cavity, it can act much like a submucosal fibroid and potentially reduce fertility.
It’s also important to consider fibroid size and number. A single small fibroid (say 1–2 cm) in the uterine wall will likely have minimal impact, but multiple fibroids or a very large fibroid can alter the uterus enough to cause problems. A fibroid larger than about 4–5 cm, especially if intramural, may reduce fertility even if it isn’t visibly poking into the cavity, simply because it can disrupt uterine blood flow or muscle function. Furthermore, fibroids can contribute to recurrent miscarriage or pregnancy complications in some cases. For example, a submucosal fibroid can increase the risk of miscarriage because it hampers the embryo’s growth environment. Intramural fibroids have been linked to lower IVF success rates as well.
Most fibroids do not need to be removed when it comes to fertility, especially if they are not causing any distortion or symptoms. It’s reassuring to know that many women with fibroids conceive naturally. However, if you have fibroids in the wrong place or huge fibroids, they can stand in the way of a successful pregnancy.
Fibroid Treatment Options for Fertility Preservation
The good news is that there are effective fibroid removal options while keeping the uterus intact. There are various surgical approaches to myomectomy, depending on the type and size of the fibroids.
- Hysteroscopic Myomectomy (Hysteroscopy): This is a minimally invasive procedure used for submucosal fibroids (those inside the uterine cavity). In a hysteroscopic myomectomy, no external incisions are needed. Instead, the surgeon inserts a thin, lighted scope through the vagina and cervix into the uterus – this scope allows visualization of the uterine interior on a screen. Tiny surgical instruments can be passed through the scope to shave off or cut out fibroids from inside the cavity. The hysteroscopy procedure is typically done under light anesthesia and is outpatient. It’s a type of uterine endoscopy (looking inside the uterus with a camera). By using this hysteroscopy uterine fibroids technique, doctors can remove fibroids that are causing miscarriages or implantation failure without any abdominal surgery. Recovery is usually quick, with minimal pain and a short downtime. Importantly for fertility, hysteroscopic removal of submucosal fibroids has a proven benefit: studies have found that women with submucosal fibroids who undergo hysteroscopic myomectomy have significantly higher pregnancy rates than those who leave the fibroids in place. In one landmark analysis, removing submucosal fibroids roughly doubled the chances of pregnancy for infertile women compared to not removing them. This underscores why hysteroscopic myomectomy is often recommended – it can significantly enhance fertility outcomes when fibroids are the hindrance.
- Laparoscopic Myomectomy (Keyhole Surgery): For fibroids that are intramural or subserosal (within the wall or on the outside of the uterus), a laparoscopic myomectomy is often the preferred approach if the fibroids are moderate in size and number. Laparoscopy is another minimally invasive surgery, done through small (usually 0.5-1 cm) incisions in the abdomen. Through one incision, a tiny camera (laparoscope) is inserted, allowing the surgeon to see the pelvic organs; through other incisions, specialized instruments are used to cut out fibroids from the uterus. The surgeon carefully removes each fibroid and stitches the uterine muscle back together. Because the incisions are small, laparoscopic surgery usually means less pain and quicker recovery compared to traditional fertility-preserving surgery. Many patients go home the same day or after one night. From a fertility standpoint, laparoscopic myomectomy is highly effective at relieving symptoms and restoring normal uterine anatomy while minimizing scar tissue formation. It’s a popular choice for women who need fibroids removed but want to avoid a large incision.
- Abdominal Myomectomy (Open Surgery): If you have very large fibroids or numerous fibroids, sometimes an open surgery may be needed. This is called an abdominal myomectomy. While it is more invasive than laparoscopy, it allows the surgeon to remove multiple fibroids and feel the uterus directly to ensure all problematic fibroids are taken out. Abdominal myomectomy is still a uterine fibroid surgery that preserves the uterus, but recovery is longer (several weeks) due to the larger incision. Doctors might opt for an open approach if, for example, you have more than, say, 5 or 6 fibroids of various sizes, or an extremely large fibroid (over 10 cm). In those cases, a laparoscopic removal might be too time-consuming or risky, and an open approach can be safer to reconstruct the uterus fully. Fertility outcomes after abdominal myomectomy are comparable to laparoscopic outcomes – the main difference is the recovery time and a slightly higher risk of adhesions (scar tissue) because of the open incision. Still, many women successfully conceive after an abdominal myomectomy once they’ve healed. Your doctor will consider factors such as fibroid size, number, and location to determine the optimal surgical method for you.
Regardless of the surgical method, myomectomy is aimed at removing fibroids while leaving the uterus intact. After a myomectomy, most women are advised to wait a few months before trying to conceive to allow the uterus to heal correctly.
Non-Surgical and Medical Treatments
There are therapies like medications to shrink fibroids or procedures like uterine artery embolization that cut off the blood supply to fibroids. However, these are generally not ideal for women who still want to have children. Hormonal treatments (for example, GnRH agonists or newer pills that lower estrogen) can temporarily shrink fibroids or reduce bleeding, but they also prevent pregnancy while you’re on them and don’t provide a long-term solution – fibroids often regrow once medication is stopped. Such medications might be used for a short period to shrink fibroids before surgery or to improve anemia, but they are not a stand-alone fertility treatment.
Uterine artery embolization (UAE), a radiologic procedure, can effectively shrink fibroids by blocking their blood flow, but it is usually not recommended for women desiring future pregnancy. This is because UAE may compromise the uterine lining and ovarian reserve, and studies have found that pregnancy rates after UAE are lower and miscarriage rates are higher compared to surgical myomectomy. Other newer procedures like MRI-guided focused ultrasound or radiofrequency ablation exist to destroy fibroid tissue; while promising for symptom relief, they also lack sufficient data on safety and success in subsequent pregnancies. For these reasons, if fertility is your priority, doctors typically stick with myomectomy as the tried-and-true myomectomy for fertility enhancement.
Managing Uterine Fibroids While Trying to Conceive
Every woman’s situation with fibroids is unique. Some individuals may not require any intervention and can proceed with trying to conceive naturally or with assistance, while others may greatly benefit from treating a fibroid first. Effective management of uterine fibroids when you want a baby involves a personalized plan. Here are a few tips:
- Watchful Waiting (when fibroids are mild): If your fibroids are small and not affecting the cavity, and you are otherwise healthy, your doctor may suggest simply trying to conceive on your own for a certain period while “watchfully waiting.” During this time, you’d monitor for any fibroid symptoms. Fibroids tend to grow slowly, and many do not grow much at all, especially in your 30s and beyond. You might never need treatment if pregnancy occurs without issue. However, you should be monitored during pregnancy because fibroids can sometimes grow due to pregnancy hormones.
- Preconception Fibroid Check: If you know you have fibroids, it’s wise to have a thorough evaluation before pregnancy. This might involve an ultrasound or hysteroscopy to map out any fibroids. If any fibroid looks concerning, addressing it before you conceive can save you from potential complications. For example, removing a fibroid that’s largely inside the uterine cavity can prevent miscarriages and even improve the lining for better implantation. Think of it as optimizing the “soil” before planting the seed.
- Fibroids discovered during pregnancy: Sometimes, fibroids are only discovered when you become pregnant. In pregnancy, fibroids are managed conservatively – we do not remove fibroids during pregnancy due to the risk of bleeding. Instead, the doctors will monitor you. Many women with fibroids in pregnancy go on to have healthy babies. Depending on the fibroid location, there could be an increased chance of needing a C-section or other complications, like the baby being breech or preterm labor. But these are just possibilities, not certainties.
- Lifestyle and general health: While there is no miracle diet to cure fibroids, maintaining a healthy weight and a balanced diet might help slow fibroid growth (obesity and high estrogen levels can promote fibroid growth). Some studies suggest that vitamin D deficiency is linked to fibroids, so maintaining a good level of vitamin D could be beneficial. These measures are not treatments per se, but rather part of the management of uterine fibroids and preparation for pregnancy.
Successful conception and a healthy pregnancy with fibroids are often achievable with careful monitoring and individualized care.
Consultation and Finding the Right Specialists
Fibroids are a bridge between general gynecology and fertility medicine, so it often helps to consult a specialist who understands both worlds. This is where fertility clinics with surgical expertise are particularly helpful. It’s worth it to find fibroid specialists who have experience in fertility-preserving fibroid treatments. At IVF Center Hawaii, our team comprises reproductive endocrinologists who are not only skilled in IVF and fertility treatments but also in the surgical management of fibroids when needed. We routinely perform evaluations like hysteroscopies and laparoscopies to ensure that fibroids won’t impede our patients’ fertility plans. Essentially, we offer a one-stop approach: evaluating the fibroid, discussing whether it’s affecting your fertility, and if so, planning the optimal way to remove it while safeguarding your fertility. When you schedule a fibroid treatment consultation, come prepared with any prior imaging or records. The doctor will review your history, possibly perform an ultrasound, and give an honest opinion on whether treating the fibroid is likely to improve your chances of pregnancy. You’ll discuss the risks and benefits of surgery in your particular case.
Consider the emotional aspect: coping with fibroids and infertility can be stressful. Surround yourself with supportive healthcare providers and possibly support groups. Remember that you are not alone. Fibroids are extremely common, and many women have walked this path and come out the other side with healthy babies. Modern fertility science is on your side. By addressing fibroids when needed, you are removing a potential obstacle on your journey to parenthood. Many of our patients express relief after fibroid treatment, knowing they’ve done everything they can to optimize their uterus for pregnancy.
Many women with fibroids go on to have healthy pregnancies. By staying proactive and informed, you increase your odds of joining that group. So take heart: a fibroid diagnosis is not the end of your dream to conceive. With proper management, you can often overcome this hurdle. If you have questions or require individualized guidance, consider scheduling a consultation. The journey might involve a few extra steps, but the destination is attainable.
Sources:
- Rezk A., Kahn J., Singh M. Fertility Sparing Management in Uterine Fibroids. StatPearls (NCBI Bookshelf), 2023ncbi.nlm.nih.govncbi.nlm.nih.gov
- Turkgeldi E., et al. Uterine fibroids & infertility: which fibroids should be removed? Gynecol Pelvic Med, 2024gpm.amegroups.org
- Freytag D. et al. Uterine Fibroids and Infertility. J Clin Med, 2021; 10(17): 3900pmc.ncbi.nlm.nih.gov
- Darmon E. et al. Uterine Leiomyomas and Infertility: A Comparison of National and International Guidelines, 2023pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
- The IVF Center (Florida). Uterine Fibroids Can Impact Your Fertility, 2020theivfcenter.com