Can Fibroids Affect Fertility?

The Relationship Between Fibroids and Fertility

Fertility is a concern for many women who are diagnosed with fibroids, particularly those in their reproductive years. The relationship between fibroids and fertility is nuanced — while most women with fibroids conceive without difficulty, certain types of fibroids can, in some cases, affect the ability to become pregnant or carry a pregnancy to term. For a broader overview of fibroids, visit our fibroids information page.

How Fibroids May Affect Conception

The impact of fibroids on fertility depends largely on their size, number, and — most importantly — their location. Not all fibroids affect fertility equally:

Submucosal Fibroids

These fibroids grow into the uterine cavity and are the type most strongly associated with fertility problems. They can interfere with the implantation of a fertilised egg by distorting the shape of the uterine cavity, disrupting the lining of the womb, or obstructing the passage of sperm to the fallopian tubes. Research suggests that submucosal fibroids may reduce fertility by as much as 50 to 70 per cent.

Intramural Fibroids

Fibroids that grow within the muscular wall of the uterus are the most common type. Their effect on fertility is less clear and depends on their size and position. Large intramural fibroids (typically greater than four centimetres) that distort the uterine cavity may have a similar impact to submucosal fibroids. Smaller intramural fibroids that do not distort the cavity generally have little or no effect on fertility.

Subserosal Fibroids

These fibroids grow on the outer surface of the uterus. They are generally considered to have minimal impact on fertility unless they are very large or located near the fallopian tubes.

Fibroids and Pregnancy Complications

Even when conception occurs successfully, fibroids can sometimes cause complications during pregnancy. These may include:

• Increased risk of miscarriage — particularly with submucosal fibroids
• Preterm delivery — fibroids may increase the risk of giving birth before 37 weeks
• Placental abruption — where the placenta separates from the uterine wall prematurely
• Malpresentation — large fibroids can prevent the baby from assuming the head-down position for delivery
• Caesarean section — the presence of large fibroids may make a caesarean delivery more likely
• Postpartum haemorrhage — fibroids may interfere with uterine contraction after delivery

It is important to emphasise that many women with fibroids have entirely uncomplicated pregnancies and deliveries. The risks above are increased compared with women without fibroids but remain relatively low overall.

What Can Be Done?

If you have been diagnosed with fibroids and are planning to conceive, it is advisable to discuss your fibroids with a specialist to understand whether treatment before pregnancy would be beneficial. The decision depends on the type, size, and location of your fibroids, as well as your overall fertility picture.

Treatment options that preserve fertility include:

• Myomectomy — surgical removal of fibroids while leaving the uterus intact. This is often the preferred option for submucosal fibroids that are clearly affecting fertility.
• Hysteroscopic resection — a minimally invasive technique for removing submucosal fibroids through the cervix
• Medication — certain medications can temporarily shrink fibroids, which may be useful as a bridge to pregnancy or prior to surgery

The role of Uterine Fibroid Embolisation (UFE) in women planning future pregnancy is currently an area of ongoing research. While there are reports of successful pregnancies following UFE, most specialists recommend that women who wish to become pregnant consider myomectomy as the first-line treatment where intervention is needed.

Seek Specialist Advice

If you are concerned about how fibroids may be affecting your fertility, the most important step is to seek specialist advice. A comprehensive assessment, including detailed imaging of the uterus, can help determine whether your fibroids are likely to be relevant to your fertility journey and, if so, what the best approach would be.

To discuss your individual situation with a specialist, book a consultation at the North London Fibroid Clinic. We are here to support you with expert, personalised advice.