Fibroids and fertility is a topic that raises many questions, especially when fibroids are discovered during a routine gynecological examination or fertility assessment.

One of the first questions many women ask is:

“Can I still get pregnant if I have fibroids?”

In most cases, having a fibroid does not mean that pregnancy is impossible. The effect of fibroids on fertility depends mainly on their size, number and location, particularly whether they affect the inside of the uterine cavity. Many women with fibroids become pregnant without needing treatment.

At Embryowish, we look at the complete fertility picture rather than assuming that a fibroid is automatically the cause of difficulty conceiving.

What Are Uterine Fibroids?

Uterine fibroids are benign growths that develop from the muscle tissue of the uterus. They are common during the reproductive years and can vary in size, number and location.

Depending on where they develop, fibroids may be:

• within the muscular wall of the uterus
• toward the outer surface of the uterus
• close to or affecting the uterine cavity

Their location is particularly important when considering fibroids and fertility, as not all fibroids have the same effect on reproductive health.

Can You Get Pregnant with Fibroids?

Yes.

Having a fibroid does not automatically mean that you are infertile.

The key question is whether the fibroid changes the shape of the uterine cavity or interferes with normal reproductive function.

A small fibroid that does not distort the uterine cavity may have little or no significant effect on fertility. On the other hand, a fibroid that grows into or significantly changes the uterine cavity may require closer evaluation.

This is why the presence of a fibroid should always be considered alongside other factors such as age, ovarian function, fallopian tube health and sperm quality.

How Can Fibroids Affect Fertility?

Not every fibroid affects fertility.

When a fibroid does have an impact, this may be related to changes in the anatomy of the uterus and the environment where embryo implantation takes place.

Depending on their characteristics, fibroids may:

• alter the shape of the uterine cavity
• affect the implantation environment
• be associated with certain pregnancy complications
• cause heavy or prolonged menstrual bleeding

Fibroids can also occur alongside other fertility factors. For this reason, it is important not to assume that a fibroid is the sole reason for difficulty conceiving without a complete fertility assessment.

Which Types of Fibroids Affect Fertility the Most?

The location of a fibroid is often more important than simply knowing that one exists.

Submucosal Fibroids

Submucosal fibroids develop in or protrude into the uterine cavity.

These fibroids are particularly relevant when assessing fertility because they can alter the cavity where implantation occurs.

In appropriate patients, treatment of fibroids that distort the uterine cavity may improve the chances of pregnancy.

Intramural Fibroids

Intramural fibroids develop within the muscular wall of the uterus.

Their potential effect on fertility depends on factors such as their size and whether they distort the uterine cavity.

Not every intramural fibroid requires treatment before pregnancy.

Subserosal Fibroids

Subserosal fibroids grow toward the outer surface of the uterus.

Because they generally do not affect the uterine cavity, they are less likely to have a direct impact on fertility. Treatment is therefore not automatically recommended simply because they are present.

How Are Fibroids Evaluated When You Are Trying to Conceive?

The evaluation usually begins with your medical history, a gynecological examination and imaging.

A transvaginal ultrasound can provide important information about the uterus and help determine the size and location of fibroids.

Depending on the findings, your doctor may recommend additional testing to obtain a clearer view of the uterine cavity.

If you are also experiencing difficulty conceiving, the evaluation should not focus only on the fibroid. A complete fertility assessment may also include:

• evaluation of ovulation
• ovarian reserve assessment
• fallopian tube evaluation
• semen analysis for the male partner

Looking at all these factors together provides a much clearer picture of your fertility.

Do Fibroids Need to Be Removed Before Pregnancy?

Not necessarily.

This is one of the most important things to understand.

Treatment decisions depend on the location and size of the fibroid, your symptoms, your age, your fertility history and your plans for pregnancy.

A fibroid that does not affect the uterine cavity may simply need monitoring. Surgery is not automatically necessary for every woman who wants to become pregnant.

When a fibroid significantly distorts the uterine cavity, however, treatment may be considered depending on the individual circumstances.

The decision should always be made after a detailed evaluation rather than simply because a fibroid has been found.

Fibroids and IVF

Having fibroids does not automatically prevent you from undergoing IVF.

Before starting fertility treatment, your doctor may assess whether the fibroid affects the uterine cavity or could influence implantation and the treatment plan.

In some cases, treatment may be recommended before IVF. In others, the fibroid may simply be monitored.

There is no single approach that is appropriate for every woman. The decision depends on the characteristics of the fibroid and the overall fertility picture.

Can Fibroids Affect Pregnancy?

Some fibroids may be associated with pregnancy complications, but this does not mean that every woman with fibroids will experience problems.

If you become pregnant with fibroids, your pregnancy may be monitored according to the size and location of the fibroid and your individual medical history.

Many women with fibroids have healthy pregnancies.

When Should You See a Fertility Specialist?

It may be helpful to speak with a fertility specialist if:

• you know you have fibroids and are planning a pregnancy
• you have been trying to conceive without success
• you have experienced a miscarriage
• you have multiple or large fibroids
• a fibroid appears to affect the uterine cavity
• you are considering IVF

An early evaluation can help determine whether the fibroid simply needs monitoring or whether treatment should be considered before trying to conceive.

Fibroids and Fertility: What Matters Most?

Having a fibroid does not automatically mean that you will have difficulty getting pregnant.

What matters is the location, size and effect of the fibroid on the uterus, together with your age, reproductive history, ovarian function, fallopian tubes and other fertility factors.

At Embryowish, Dr. Nikolaos Georgogiannis and our fertility team provide individualized fertility assessments to understand how fibroids may affect your reproductive plans and which options may be appropriate for you.

If you have fibroids and want to understand what they mean for your fertility, you can schedule a free initial fertility consultation with Embryowish.