Fibroids and Fertility
Why This Matters
If you've been told you have fibroids and you're hoping to have a baby, it's natural for your mind to jump to the worst-case scenario.
You may be wondering:
Will I ever get pregnant?
Will I need IVF?
Will I lose my baby?
Should I have my fibroids removed before trying to conceive?
These are understandable questions, but it's important to know that many women with fibroids conceive naturally and go on to have healthy pregnancies.
The impact fibroids have on fertility depends largely on their size, number and, most importantly, their location within the uterus.
Understanding how fibroids can affect fertility will help you have informed conversations with your healthcare team and understand which treatments, if any, might be beneficial.
Quick Summary
Most women with fibroids can become pregnant.
Many fibroids do not affect fertility.
Fibroids that distort the inside of the uterus are the most likely to reduce fertility.
The size, number and location of fibroids all matter.
Fibroids may sometimes increase the risk of miscarriage or pregnancy complications.
Treatment is only recommended when fibroids are thought to be contributing to fertility problems or causing significant symptoms.
Every woman's situation is different.
Can Fibroids Cause Infertility?
The answer is sometimes—but not always.
Fibroids are very common, and many women never realise they have them until they become pregnant or have a scan for another reason.
In fact, many women with fibroids conceive naturally without any difficulty.
However, certain fibroids can interfere with fertility by affecting the normal function of the uterus.
Whether a fibroid affects fertility depends on:
where it is located
how large it is
whether there are several fibroids
whether it changes the shape of the uterine cavity
Why Does Location Matter?
The location of a fibroid is often more important than its size.
Submucosal Fibroids
These grow just beneath the lining of the uterus and bulge into the uterine cavity.
They are the type most strongly associated with reduced fertility because they can:
reduce the space available for an embryo
interfere with implantation
increase the risk of miscarriage
affect the blood supply to the lining of the uterus
Even relatively small submucosal fibroids may affect fertility.
Intramural Fibroids
These grow within the muscular wall of the uterus.
Small intramural fibroids often have little or no effect on fertility.
However, larger intramural fibroids—particularly those that distort the uterine cavity—may reduce pregnancy rates and increase miscarriage risk.
Research is ongoing, and not all studies agree on the degree of their impact.
Subserosal Fibroids
These grow on the outside of the uterus.
Because they do not usually change the inside of the uterus, they rarely affect fertility.
They may still cause symptoms such as pelvic pressure or discomfort, but they are generally considered less likely to interfere with conception.
Pedunculated Fibroids
These are attached by a stalk.
Whether they affect fertility depends entirely on where they arise.
Most have little effect unless they distort the uterine cavity.
How Can Fibroids Affect Fertility?
Researchers believe fibroids may reduce fertility in several ways.
They may:
change the shape of the uterus
interfere with implantation
reduce blood flow to the uterine lining
block the fallopian tubes (rarely)
alter normal uterine contractions
create inflammation within the uterus
affect the environment needed for embryo development
Not every woman with fibroids experiences these problems.
Fibroids and IVF
Fibroids can also affect assisted conception.
Studies suggest that fibroids which distort the uterine cavity may reduce the success of IVF treatment.
For this reason, fertility specialists sometimes recommend removing certain fibroids before IVF.
However, many women undergo successful IVF without requiring fibroid surgery.
The decision depends on:
fibroid location
size
previous fertility history
age
other fertility factors
Treatment is always individualised.
Should Fibroids Be Removed Before Trying for a Baby?
Not always.
Surgery is usually only considered when fibroids are thought to be affecting fertility or causing troublesome symptoms.
For example, your doctor may recommend treatment if:
a fibroid is distorting the uterine cavity
repeated miscarriages may be related to the fibroid
IVF has been unsuccessful and the fibroid is thought to be contributing
the fibroid is causing severe symptoms
Removing fibroids also carries risks, including scar tissue formation and, in some cases, weakening of the uterine wall.
For this reason, surgery should be carefully balanced against the potential benefits.
Can Fibroids Cause Miscarriage?
Some fibroids—particularly those that distort the uterine cavity—may increase the risk of miscarriage.
However, many women with fibroids have completely normal pregnancies.
Your overall risk depends on:
fibroid location
size
number of fibroids
your age
other medical conditions
Can You Have a Healthy Pregnancy with Fibroids?
Yes.
The majority of women with fibroids have healthy pregnancies and healthy babies.
Some women may experience:
increased discomfort
pain if a fibroid outgrows its blood supply (known as degeneration)
a slightly increased risk of preterm birth
breech presentation
Caesarean birth
Your maternity team will monitor you if necessary.
What Does This Mean for You?
Finding out you have fibroids while trying for a baby can feel overwhelming.
It's easy to assume that fibroids automatically mean infertility, but that simply isn't true.
Many women with fibroids conceive naturally, while others may benefit from treatment before trying to become pregnant.
The most important thing is understanding your individual situation.
Your doctor will consider:
where your fibroids are
how large they are
whether they affect the uterine cavity
your age
how long you've been trying to conceive
any other fertility factors
Remember, fertility is rarely determined by one factor alone.
You Are Not Alone
Many women blame themselves when pregnancy doesn't happen as quickly as they hoped.
If you've been diagnosed with fibroids, you may be wondering whether you've missed your chance to become a mother.
Please remember that fibroids are only one piece of the fertility puzzle. Many women with fibroids go on to have healthy pregnancies—naturally or with fertility treatment.
If you're struggling to conceive, ask your healthcare team to assess all possible causes, not just your fibroids. Looking at the bigger picture gives you the best chance of finding the right path forward.
Key Takeaways
Most fibroids do not cause infertility.
The location of a fibroid is often more important than its size.
Submucosal fibroids have the greatest impact on fertility.
Many women with fibroids become pregnant naturally.
Some fibroids may reduce IVF success rates.
Surgery is not necessary for every woman with fibroids.
Decisions about treatment should always be individualised.
Frequently Asked Questions
Can I get pregnant naturally if I have fibroids?
Yes. Many women with fibroids conceive naturally and have healthy pregnancies.
Which fibroids are most likely to affect fertility?
Submucosal fibroids, because they distort the inside of the uterus.
Should all fibroids be removed before pregnancy?
No. Treatment is usually recommended only when fibroids are causing symptoms or are thought to be affecting fertility.
Can fibroids cause miscarriage?
Some fibroids may increase the risk, particularly those that distort the uterine cavity, but many women with fibroids never experience miscarriage.
Can IVF still work if I have fibroids?
Yes. Many women have successful IVF despite having fibroids. Your fertility specialist will advise whether treatment of the fibroids is likely to improve your chances.
References
National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management (NG88).
Royal College of Obstetricians and Gynaecologists (RCOG). Fibroids: Information for You.
American College of Obstetricians and Gynecologists (ACOG). Uterine Fibroids.
European Society of Human Reproduction and Embryology (ESHRE). Fertility guidance and scientific literature on uterine fibroids.
Stewart EA, et al. Uterine Fibroids. Nature Reviews Disease Primers.
Bulun SE. Uterine Fibroids. New England Journal of Medicine.