Uterine Fibroids & Infertility - Can Fibroids Affect Fertility?

Introduction

Fibroids are harmless (non-cancerous) growths that form in or around the wall of the uterus. They’re very common, as 7 out of 10 women will develop them by age 50, especially during the years when they can have children. Fibroids affect women in different ways. Some women never notice them, while others experience heavy bleeding, pelvic pain, or fertility issues. Asking whether fibroids can impact fertility is an important first step in getting timely help and exploring treatment options.

What Are Uterine Fibroids?

Fibroids, medically known as Leiomyomas or Myomas, are benign growths that develop in or around the uterus. They range in size from microscopic to large enough to alter uterine morphology. Fibroids are categorised into three primary types.

• Submucosal fibroids – just under the inner lining, sometimes sticking into the uterus.
• Intramural fibroids – growing inside the muscular wall.
• Subserosal fibroids – grow on the outside of the uterus and can sometimes push on nearby organs.

Fibroids can cause heavy periods, long cycles, pelvic pressure, needing to pee often, bloating, or pain during sex. But a lot of women don’t have any symptoms until they try to get pregnant or have pregnancy problems.

Fibroids and Pregnancy Complications

Fibroids make getting pregnant harder and can also affect your pregnancy. The risks depend on how big they are, how many there are, and where they are. Most women have healthy pregnancies, but some risks need watching.

• Miscarriage

  Women with fibroids, particularly those inside the uterus (submucosal), may have a higher chance of early miscarriage. The embryo might not attach well, or the fibroid could disrupt placental growth.

• Preterm Labour and Birth

  Big fibroids can irritate your uterus or take up space your baby needs to grow. This can trigger early contractions, sometimes leading to delivery before 37 weeks, which may cause low birth weight or breathing issues for the newborn.

• Abnormal Foetal Position

  Even if fibroids alter your uterus and make it harder for the baby to turn head-down, careful monitoring and planning can reduce risks like breech presentation and C-section delivery.

• Placental Abruption

  Fibroids can sometimes stop the placenta from sticking correctly, causing it to separate too soon. This can be very risky for both mother and baby.

• Intrauterine Growth Restriction (IUGR)

  Fibroids can crowd the uterus or reduce blood flow, which may make the baby grow more slowly. This is known as IUGR, and your doctor will closely monitor it.

• Obstructed Labour

  Rarely, large fibroids near the cervix can block the baby’s passage, so vaginal delivery isn’t possible. A C-section procedure is needed in these cases.

Diagnosis of Uterine Fibroids

Finding out whether fibroids are affecting fertility starts with a proper diagnosis. Because fibroids come in all shapes and sizes, doctors rely on your history, a physical exam, and imaging tests to see if they’re getting in the way of pregnancy.

• Clinical History and Physical Examination

  Fibroid diagnosis begins with a thorough consultation. The specialists review symptoms, including heavy menstrual bleeding, pelvic discomfort, urinary issues, and reproductive history. A pelvic exam may detect uterine enlargement or irregularity, allowing for precise assessment and planning.

• Ultrasound Imaging

  Your fibroid assessment often begins with a transvaginal ultrasound, which provides your doctor with a clear view inside. If fibroids are large, a transabdominal scan may be added. This simple, affordable test usually provides all the guidance needed for the next steps.

• Saline Infusion Sonography (Sonohysterography)

  Saline infusion ultrasound works by gently filling the uterus with sterile saline during the scan. This helps doctors see the endometrial lining more clearly and is especially useful for identifying fibroids that protrude into the uterine cavity and may affect implantation.

• Hysterosalpingography (HSG)

  Hysterosalpingography, or HSG, is an X-ray test that lets doctors see your uterus and fallopian tubes. It can detect fibroids that change the shape of the uterus or block the tubes, helping explain fertility challenges.

• Magnetic Resonance Imaging (MRI)

  Magnetic Resonance Imaging (MRI) provides superior accuracy in mapping fibroids, especially multiple or intramural types. MRI delineates fibroid size, anatomical location, and relation to adjacent organs, assisting in precise surgical planning.

Treatment Options for Fibroids and Infertility

Fibroid management can be adapted to individual fertility considerations, including age, reproductive history, and fibroid characteristics.

Doctors consider the size, number, and location of fibroids, as well as your age and overall health. Fibroids do not universally require treatment; however, in cases of infertility, procedures such as myomectomy have been shown to improve conception rates.

• Medications

  Hormonal treatments like the pill, hormone shots, or a progesterone IUD can make fibroids smaller and ease heavy bleeding. But they’re not meant to help you get pregnant because they stop ovulation, and help relieve symptoms.

• Hysteroscopic Myomectomy

  Hysteroscopy is the best option for fibroids that grow into the uterine cavity. It’s a small, minimally invasive procedure done through the vagina, no big cuts needed, and it restores the uterus so you have a better chance at pregnancy or IVF.

• Laparoscopic Myomectomy

  Laparoscopic myomectomy represents a minimally invasive surgical option for uterine fibroid removal, emphasising uterine preservation, reduced operative trauma, and accelerated postoperative recovery for fertility-minded patients.

• Open (Abdominal) Myomectomy

  If your fibroids are very large or there are many of them, open surgery might be recommended. Recovery takes longer, but it gives the surgeon the best access to handle complicated cases safely.

• IVF After Fibroid Removal

  After fibroid surgery, IVF can help many women take the next step toward pregnancy. Research shows that removing fibroids that distort the uterus increases implantation and live birth rates. Most doctors recommend waiting a few months, usually 3–6, to allow your uterus to heal fully.

• Other Options

  GnRH agonists are sometimes prescribed to shrink fibroids before surgery, but they are generally not recommended for women seeking pregnancy because of possible effects on uterine blood flow. MRI-guided focused ultrasound is a newer, non-invasive option, but we’re still learning how it affects fertility.

  The choice of treatment must balance fibroid removal with the patient’s fertility goals.

How Fibroid Removal Can Improve IVF Success

Having fibroids removed can significantly improve your chances of success with IVF. A healthier uterus makes it easier for embryos to stick, which means more successful pregnancies and fewer miscarriages.

Doctors usually suggest waiting 3–6 months after fibroid removal before trying to get pregnant or start IVF. This lets your uterus heal properly. With good timing, surgery can greatly improve your chances of conceiving naturally or through IVF.