Fibroids and Fertility: What to Know
Most women with fibroids can get pregnant, and where a fibroid sits matters more than whether you have one. Here is how location affects conception and miscarriage, what each treatment means for fertility, and what the evidence says about IVF.
TL;DR: Most women with fibroids can get pregnant. The location of the fibroid matters most: those growing into the womb cavity are the ones most clearly linked to lower fertility, those on the outside do not appear to affect it, and those in the wall are somewhere in between. Removing fibroids that distort the cavity may help, but evidence is limited. Not every treatment keeps pregnancy possible, so tell your doctor early if you want children.
Being told you have fibroids can feel like a door closing, especially if you have heard aunties, friends or even clinicians talk as if the two things cancel each other out. They do not. Fibroids are very common, and in one US ultrasound study, by age 50, more than 80% of Black women and nearly 70% of white women had developed them.
Our guide to fibroid symptoms and treatment covers the basics. This post looks only at fertility. For the wider picture, see our guides to fertility and periods.
Can you get pregnant with fibroids?
Yes, most women can. The US Office on Women's Health says infertility from fibroids is very rare and most women with fibroids have normal pregnancies, and the NHS also describes infertility and miscarriage as rare complications. The risk depends mostly on where the fibroid is.
A note on context: in a Nigerian teaching hospital study, primary infertility was the most common reason women with fibroids were admitted, at 22.9 percent. That reflects who reaches a hospital ward, not every woman with fibroids, but it shows how often the two are seen together here, and how much fear there can be around it.
Why the location of a fibroid matters
Doctors describe fibroids by where they grow in the womb. A systematic review in Fertility and Sterility looked at how each type affects fertility, in women who were already having trouble conceiving:
| Type | Where it grows | Effect on fertility | Does removal help? |
|---|---|---|---|
| Submucosal | Into the womb cavity | Lower pregnancy and implantation rates | Appears likely to help |
| Intramural | In the wall of the womb | Appears to lower fertility and raise pregnancy loss, but study quality is poor | Unclear |
| Subserosal | On the outside of the womb | No difference found | No benefit found |
The key question for your doctor is whether the fibroid distorts the cavity, the space inside the womb where an embryo implants. Size can also matter. One review reports that intramural fibroids over 3 cm can impair fertility even without distorting the cavity.
Ask for the location and size of each fibroid to be written down, because "you have fibroids" on its own does not tell you much.
Do fibroids cause miscarriage?
The evidence is mixed, but for most women the answer appears to be no. A meta-analysis of more than 20,000 pregnancies in general obstetric populations found no increased risk of miscarriage in women with fibroids (11.5 percent compared with 8.0 percent, a difference that was not statistically significant). The authors suggest earlier studies may have overstated the risk because they did not adjust for other factors.
Fibroids that distort the cavity may be different. The American Society for Reproductive Medicine found fair evidence that removing these by open or keyhole surgery reduces early pregnancy loss. If you have had repeated miscarriages, it is worth asking for a scan that checks the cavity.
What fibroids can mean later in pregnancy
If you do conceive, fibroids can raise the chance of some complications. The Office on Women's Health lists caesarean birth (about six times more likely), a breech baby, labour that does not progress, placental abruption and preterm birth. It also says most women with fibroids who become pregnant do not need a high-risk specialist, so this is about being aware and well monitored. Our guide to pregnancy covers your antenatal care.
How each treatment affects fertility
The NHS advises that some treatments can stop you having children or increase problems in pregnancy, so tell your doctor early if you want children, even if that is years away.
Watching and waiting. If your fibroids are not causing symptoms and are not distorting the cavity, you may not need treatment at all. Removing subserosal fibroids does not appear to help.
Myomectomy (surgery to remove fibroids, keeping the womb). This is the main option for women who want to get pregnant, and pregnancy is possible afterwards. The American Society for Reproductive Medicine found fair evidence that it improves pregnancy rates when fibroids distort the cavity, and says it may be considered even without symptoms. However, a Cochrane review of randomised trials rated the evidence as very low quality and could not say for certain whether it helps, so the decision is an individual one.
Surgery has its own risks. If fibroids were deeply embedded in the wall, a caesarean may be needed for birth, and new fibroids can grow later. In one Nigerian teaching hospital, abdominal myomectomy was the most common treatment, used in 90 percent of cases, so ask your surgeon about the approach they would use and how long to wait before trying to conceive.
Uterine artery embolisation (blocking the blood supply to the fibroid). This may be less suitable if you want to become pregnant. A Cochrane review found some indication of less favourable fertility outcomes than myomectomy, though from one small study of very low quality, and it should be read with caution. The Office on Women's Health lists women who do not want future children as good candidates.
Medicines. GnRH medicines can shrink fibroids and stop heavy periods, but the relief is temporary and fibroids often grow back quickly once you stop. They may be used to shrink fibroids before surgery. Progestogens do not shrink fibroids and have limited benefit for fibroid-related infertility. Ask about any medicine you take while trying to conceive.
Hysterectomy (removing the womb). This is the only sure cure, but you will no longer be able to get pregnant afterwards. Please make sure you are not being offered this without a full discussion of the alternatives if you still want children.
Fibroids and IVF
Fibroids can also affect IVF. A meta-analysis of 28 studies and 9,189 IVF cycles found that intramural fibroids that did not distort the cavity were linked to lower live birth rates and higher miscarriage rates than in women without fibroids. A more recent review found lower live birth rates with intramural fibroids of 2 to 6 cm, based on low-certainty evidence, with no significant reduction for those under 2 cm.
What this means for you is a conversation with your fertility specialist, because the evidence on removing intramural fibroids before IVF is thin. If a fibroid distorts your womb cavity, ask whether removing it before IVF is recommended for you.
When should I see a doctor about fibroids and fertility?
Do not wait a full year if you already know you have fibroids. The NHS says women aged 36 and over and anyone aware of possible fertility problems should see their GP sooner than the usual one year of trying. Our post on when to see a fertility specialist walks you through what to expect.
Questions to take to your appointment
- [ ] Where exactly are my fibroids, and how big are they?
- [ ] Do any of them distort the womb cavity?
- [ ] Could these be affecting my chances of getting pregnant?
- [ ] Would you recommend treatment, or waiting?
- [ ] Will this treatment affect my ability to carry a pregnancy?
- [ ] How long should I wait after surgery before trying?
- [ ] Should my partner be tested too?
That last question matters. Infertility can involve either partner, and fibroids should not automatically end the investigation. See our post on male fertility.
Tracking heavy bleeding, pain and your cycle over a few months gives your doctor something concrete to work with. You can log this in Asele and bring it to your appointment through the Health Brief.
This post is education, not medical advice. Please speak to a qualified clinician about your own situation.
References
- Baird DD, et al. High cumulative incidence of uterine leiomyoma in black and white women. Am J Obstet Gynecol. 2003. pubmed.ncbi.nlm.nih.gov
- US Office on Women's Health. Uterine fibroids. womenshealth.gov
- NHS. Fibroids. nhs.uk
- Obuna JA, et al. Uterine fibroids in a tertiary health centre South East Nigeria. Niger J Med. 2008. pubmed.ncbi.nlm.nih.gov
- Pritts EA, et al. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009. pubmed.ncbi.nlm.nih.gov
- Conservative management of uterine fibroid-related heavy menstrual bleeding and infertility. pmc.ncbi.nlm.nih.gov
- Sundermann AC, et al. Leiomyomas in pregnancy and spontaneous abortion: a systematic review and meta-analysis. Obstet Gynecol. 2017. pubmed.ncbi.nlm.nih.gov
- Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate. Fertil Steril. 2017. pubmed.ncbi.nlm.nih.gov
- Metwally M, et al. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2020. pubmed.ncbi.nlm.nih.gov
- Gupta JK, et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014. pubmed.ncbi.nlm.nih.gov
- NHS. Hysterectomy. nhs.uk
- The impact of noncavity-distorting intramural fibroids on IVF outcomes. Biomed Res Int. 2018. pubmed.ncbi.nlm.nih.gov
- The effect of 6 cm or smaller noncavity-distorting intramural fibroids on IVF outcomes. Fertil Steril. 2023. pubmed.ncbi.nlm.nih.gov
- NHS. Infertility. nhs.uk
- World Health Organization. Infertility fact sheet. who.int
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