Fibroids do not always affect fertility or pregnancy. Many people with fibroids conceive naturally and go on to have healthy pregnancies. Their impact depends mainly on the size, number and location of the fibroids, particularly whether they change the shape of the womb cavity.
Fibroids that project into or distort the womb cavity are more consistently associated with implantation difficulties, while fibroids in other locations may have little effect. Treatment is not always needed before trying to conceive or having IVF, as surgery can also carry risks. Your specialist will help you weigh the possible benefits against the risks based on your individual circumstances.
What Are Fibroids?
Fibroids are non-cancerous growths made from smooth muscle and fibrous tissue that develop in or around the womb. They may occur as a single growth or as several fibroids of different sizes.
Many fibroids cause no symptoms and are discovered incidentally during scans. However, some can cause heavy periods, anaemia, pelvic pressure, pain or bladder and bowel symptoms. Having a fibroid does not automatically mean it is affecting your fertility, as its size and location are important factors.
Which Types of Fibroids Can Affect Fertility?
The effect of a fibroid on fertility depends mainly on where it is located and whether it changes the shape of your womb cavity. The size of the fibroid alone does not always determine whether it affects your chances of becoming pregnant.
Submucosal fibroids, which grow into or distort the womb cavity, are the type most consistently associated with implantation difficulties and reduced fertility outcomes. Intramural fibroids, which grow within the muscular wall of the womb, may affect fertility if they significantly distort the cavity, while subserosal fibroids on the outer surface of the womb usually have less effect on fertility. Your specialist will consider the fibroid’s position alongside other fertility factors before recommending treatment.
| Fibroid location | Possible fertility effect |
| Submucosal | Most likely to affect implantation because it grows into the womb cavity |
| Intramural | Effect depends on whether it changes the cavity shape |
| Subserosal | Usually less likely to affect implantation |
Evidence Note:
Research suggests that fibroids that distort the womb cavity, particularly submucosal fibroids, are the type most consistently associated with reduced implantation and pregnancy rates. The impact of intramural fibroids that do not change the cavity shape remains more uncertain, which is why treatment decisions are usually individualised rather than based on fibroid size alone.
How Can a Fibroid Interfere with Conception?
A fibroid that changes the shape of your womb cavity may affect implantation by altering the surface where an embryo needs to attach. It may also influence the womb environment, blood supply and the conditions needed for successful implantation.
Having a fibroid does not always mean it is the reason you are finding it difficult to conceive. Your age, ovulation, fallopian tubes, endometriosis and your partner’s sperm health are also important factors. Your specialist will usually focus treatment on fibroids that clearly affect your womb cavity, while the effect of smaller fibroids that do not change the cavity remains less certain.
Does Fibroid Size Matter?
The size of a fibroid can matter, but its location is usually more important. A small fibroid inside the womb cavity may affect implantation more than a larger fibroid growing on the outside of the womb. Larger fibroids can sometimes distort the womb, affect nearby structures or make IVF procedures more difficult.
There is no single size threshold where every fibroid needs treatment. Your specialist will consider the fibroid’s position, effect on the womb cavity, your fertility plans and other factors before recommending surgery. Your scan should provide details about the fibroid’s size, location and whether it changes the shape of your womb.
Do Multiple Fibroids Make Pregnancy Less Likely?
Having several fibroids can make fertility assessment more complex, especially if one or more fibroids change the shape of your womb cavity. Multiple fibroids may also make treatment or surgery more complicated, but they do not mean that pregnancy is impossible.
The number of fibroids alone does not determine your chances of conceiving or having a healthy pregnancy. Your specialist will consider their size, location, effect on the womb cavity and any other fertility factors to decide which fibroids, if any, need treatment.
Can Fibroids Cause Miscarriage?
Fibroids have been linked with a higher risk of miscarriage in some studies, particularly when they distort the womb cavity. However, the effect depends on the fibroid’s location, size and how it affects the environment where an embryo implants.
Removing a fibroid does not guarantee that miscarriage will be prevented. Your specialist will consider the position of the fibroid alongside other factors, such as your age, chromosome-related causes, medical conditions and the shape of your womb, before recommending treatment.
What Are the Main Symptoms of Fibroids?
Many fibroids do not cause any symptoms. When symptoms do occur, they usually depend on the size, number and location of the fibroids within the womb.
- Heavy or painful periods: Menstrual bleeding may become heavier, last longer than usual, or be accompanied by more severe period pain.
- Pelvic pressure or discomfort: Fibroids can cause pelvic aching, a feeling of fullness, lower abdominal enlargement, or lower back pain.
- Bladder or bowel symptoms: Larger fibroids may press on nearby organs, leading to frequent urination, difficulty emptying your bladder, constipation, or bloating.
- Pain during sex or fertility concerns: Some fibroids can cause discomfort during sex or affect fertility, depending on their size and location.
Symptoms often develop gradually, so you may not notice how much they are affecting your daily life. If you have persistent heavy bleeding, pelvic pain, or symptoms that interfere with your normal activities, it is important to seek medical assessment.
Can Fibroids Affect IVF Success?
Fibroids may affect IVF outcomes, particularly when they change the shape of the womb cavity. Submucosal fibroids are considered the clearest concern because they may interfere with embryo implantation, while the effect of intramural fibroids that do not distort the cavity remains uncertain.
Your specialist will consider the fibroid’s location, size, your age, ovarian reserve and previous IVF outcomes before recommending treatment. In selected situations, your fertility team may discuss whether creating and freezing embryos before fibroid surgery is appropriate, particularly when age-related fertility considerations or ovarian reserve are important factors, or when delaying fertility treatment could be a concern. This decision depends on your individual circumstances and overall fertility plan.
Research Insight: Fibroids and IVF
Studies suggest that fibroids affecting the womb cavity are more consistently associated with reduced implantation and pregnancy outcomes than fibroids that do not alter the cavity. However, the impact of non-cavity-distorting intramural fibroids remains debated, which is why fertility specialists assess each case individually.
What Are IVF Success Rates When You Have Fibroids?
There is no single IVF success rate for people with fibroids, as outcomes depend on several factors, including your age, egg quality, ovarian reserve, sperm factors, embryo quality and the location of the fibroid. A fibroid affecting the womb cavity may have a different impact from one that does not change the cavity.
National IVF statistics provide average figures but do not predict your individual outcome. Your specialist should explain whether treating a fibroid is likely to improve implantation, make embryo transfer easier or provide little fertility benefit before you decide on treatment.
Should Fibroids Be Removed Before IVF?
Fibroid removal before IVF is usually considered when a fibroid affects the womb cavity. Submucosal fibroids that project into the cavity are the clearest example, as removing them may improve pregnancy outcomes in selected patients, although the effect can vary depending on individual fertility factors.
The decision is less straightforward for intramural fibroids that do not distort the cavity. Your specialist will balance the possible fertility benefit against the risks of surgery, delays to IVF, adhesions and womb scarring. The recommendation should consider your individual fertility history, ovarian reserve and the exact position of the fibroid rather than size alone.
How Do Fertility-Preserving Treatments Compare?
| Treatment | Potential fertility role | Important limitations |
| Monitoring | Appropriate when fibroids do not distort the cavity or cause significant symptoms | Fibroids may grow or symptoms may change over time |
| Hysteroscopic myomectomy | Removes submucosal fibroids through the cervix | Larger or deeper fibroids may require more than one procedure |
| Laparoscopic myomectomy | Removes selected intramural or subserosal fibroids through small abdominal incisions | Creates a uterine scar and may not be suitable for very large or multiple fibroids |
| Open abdominal myomectomy | Allows removal of large, numerous or deeply placed fibroids | Longer recovery, higher blood-loss risk and more extensive scarring |
| Uterine artery embolisation | Reduces blood supply to fibroids, causing them to shrink | Future fertility and pregnancy outcomes require careful discussion |
| Radiofrequency or focused ultrasound treatment | Preserves the womb and avoids conventional fibroid removal | Reproductive evidence is more limited than for myomectomy |
| Medical treatment | Can control bleeding or temporarily reduce fibroid size | Most hormonal treatments prevent pregnancy while used and do not permanently remove fibroids |
| Hysterectomy | Definitively treats uterine fibroids | Permanently removes the ability to carry a pregnancy |
NICE recommends that management decisions for fibroids should take into account symptoms, fibroid characteristics, reproductive plans and individual preferences. Ultrasound is used to assess fibroid location and size, while MRI may be considered when more detailed information is needed before treatment planning.
Myomectomy remains the most established womb-preserving operation when a fibroid is believed to affect fertility. Other treatments may be suitable for symptom control, but their effects on future pregnancy need careful discussion.
UK Guidance Note:
NICE recommends that treatment decisions for fibroids should be individualised according to symptoms, fibroid characteristics and reproductive plans. Imaging, including ultrasound and sometimes MRI, helps your specialist understand the location and impact of fibroids before discussing treatment options.
What Is Hysteroscopic Myomectomy?
Hysteroscopic myomectomy removes fibroids that grow into your womb cavity using a thin telescope and surgical instruments passed through your vagina and cervix. As no abdominal incision is usually needed, recovery is often quicker than with abdominal surgery.
The procedure may be completed in one session or planned in stages depending on the fibroid’s size, number and depth. It is the treatment with the clearest evidence for improving pregnancy rates in selected patients with submucosal fibroids that distort the womb cavity, although the effect on live-birth rates and miscarriage risk remains less certain.
What Is Abdominal or Laparoscopic Myomectomy?
A myomectomy removes fibroids while keeping your womb in place. Laparoscopic myomectomy uses small abdominal incisions, while open myomectomy uses a larger incision and may be recommended for larger or more complex fibroids.
The best approach depends on the size, number and location of your fibroids and how safely they can be removed. Myomectomy may improve fertility outcomes when a fibroid is affecting the womb cavity, but it also carries risks such as bleeding, adhesions and scarring. Your specialist will advise when it is safe to try for pregnancy based on the extent of your surgery.
Are UAE and Ablation Suitable When You Want a Baby?
Uterine artery embolisation (UAE) reduces blood flow to your fibroids, causing them to shrink. You may become pregnant afterwards, but the effects on fertility, the placenta and pregnancy outcomes are less certain than after myomectomy.
Other treatments, such as radiofrequency ablation and high-intensity focused ultrasound, preserve your womb but have more limited evidence when you are planning a pregnancy. If having a baby is important to you, discuss how each option may affect implantation, miscarriage risk, pregnancy complications and live-birth chances before making a decision.
How Can Fibroids Affect Pregnancy?
Most people with fibroids go on to have healthy pregnancies. However, fibroids may be associated with a higher likelihood of certain complications, including preterm birth, caesarean birth, abnormal placental position or separation, heavier bleeding after delivery and changes in your baby’s position. The level of risk depends on the size, number and location of your fibroids.
Fibroids may grow, stay the same size or become smaller during pregnancy. Treatment is not usually carried out during pregnancy because surgery can cause significant bleeding. Your maternity team may recommend extra monitoring if a fibroid is large, affects the placenta, is close to the cervix or makes it harder to assess your baby.
Can Fibroids Cause Pain During Pregnancy?
Fibroids can cause pain during pregnancy, especially if a fibroid grows quickly or develops degeneration because it is not receiving enough blood supply. You may notice localised abdominal pain, tenderness over the fibroid, nausea or discomfort that feels different from your usual symptoms.
However, not all pregnancy pain is caused by fibroids. If you have severe or persistent pain, vaginal bleeding, contractions, fever, leaking fluid, reduced fetal movements or feel unwell, seek medical advice promptly to rule out other causes that may need urgent treatment.
Can Fibroids Affect Labour and Delivery?
Fibroids can sometimes affect labour if they are large, located near the cervix or change the position of your baby. They are also linked with a higher chance of caesarean birth and heavier bleeding after delivery, but having fibroids does not automatically mean you will need a planned caesarean.
Your maternity team will consider your fibroid’s location, your baby’s position, your placenta and any previous fibroid surgery when planning your birth. Removing fibroids during a caesarean is not usually recommended because of the risk of significant bleeding, although it may be considered in selected cases.
What Happens in Pregnancy After a Myomectomy?
If you have had a myomectomy, tell your midwife and obstetrician early in pregnancy. Your previous operation details, including the type of surgery, depth of the fibroids removed and whether the womb cavity was opened, can influence how your birth is planned.
A myomectomy scar can rarely weaken or separate during pregnancy or labour, so some people may be advised to have a planned caesarean birth. Your obstetric team will also monitor for possible placental complications and advise you to seek urgent assessment for severe abdominal pain, bleeding or sudden symptoms around your previous scar.
Myth and Fact
| Myth | Fact |
| Having fibroids means you cannot become pregnant. | Many people with fibroids conceive naturally and have healthy pregnancies. The effect depends mainly on the fibroid’s location, size and whether it changes the womb cavity. |
| All fibroids need to be removed before trying for a baby. | Treatment is not always required before pregnancy. Removal is usually considered when a fibroid is affecting the womb cavity, causing significant symptoms or may influence fertility treatment outcomes. |
| The larger the fibroid, the greater the effect on fertility. | A smaller fibroid that affects the womb cavity may have more impact than a larger fibroid growing on the outside of the womb. |
| Fibroid removal guarantees a successful pregnancy. | Removing a fibroid may improve fertility outcomes in selected patients, but pregnancy success also depends on factors such as age, egg quality, sperm health and other fertility conditions. |
Key Takeaways
- Fibroids do not always affect your ability to conceive or have a healthy pregnancy.
- The location of a fibroid is often more important than its size when assessing fertility impact.
- Submucosal fibroids that affect the womb cavity are the type most consistently linked with implantation difficulties.
- Treatment decisions should be personalised and consider your fertility goals, symptoms and overall reproductive health.
- If you are planning a pregnancy or IVF, a specialist assessment can help you understand whether monitoring or treatment may be appropriate.
FAQs:
1. Can pregnancy occur naturally with fibroids?
Yes. Many people with fibroids conceive naturally without needing fertility treatment. The impact of fibroids on fertility depends mainly on their location, size and whether they distort the womb cavity. A specialist fertility assessment can help determine whether a fibroid is likely to be contributing to difficulties with conception.
2. Should fibroids always be removed before trying for a baby?
No. Fibroids do not always require treatment before pregnancy. Surgery is generally considered when a fibroid significantly affects the womb cavity, causes troublesome symptoms or is thought likely to influence fertility or IVF outcomes. Removing fibroids without a clear indication may expose you to surgical risks without providing a clear fertility benefit.
3. Can fibroids increase the risk of miscarriage?
Some fibroids, particularly those that project into or distort the womb cavity, have been associated with a higher risk of miscarriage. However, many people with fibroids have successful pregnancies, and miscarriage can occur due to many different factors. A specialist assessment can help determine whether the location of a fibroid is likely to affect pregnancy outcomes.
4. Can fibroids affect labour or increase the likelihood of caesarean birth?
Many people with fibroids can have a vaginal birth. However, large fibroids or those positioned near the cervix may affect the baby’s position or obstruct the birth canal, which can increase the chance of caesarean delivery. The recommended mode of birth depends on the fibroid location, pregnancy progress and other individual factors.
5. When is specialist fertility advice recommended for fibroids?
Specialist advice may be appropriate when conception has been difficult, recurrent miscarriage has occurred, IVF is being considered or imaging shows that a fibroid distorts the womb cavity. Earlier assessment may also be recommended for women aged 35 or over or when other fertility concerns are present, allowing treatment options to be discussed before pregnancy.
Final Thoughts: Understanding How Fibroids May Affect Fertility and Pregnancy
Fibroids do not always prevent you from becoming pregnant or having a healthy pregnancy, but their location, size and effect on the womb cavity can influence fertility and pregnancy planning. Understanding whether a fibroid is likely to affect implantation, IVF treatment or pregnancy outcomes can help you make informed decisions about whether monitoring or treatment is the right approach for you.
If you are considering fibroids treatment in London, our specialist team can provide a thorough assessment, review your scan findings and recommend the most appropriate investigations or treatment options based on your fertility goals and individual circumstances. At Gynaecology Clinic London, we tailor care to your symptoms, reproductive plans and overall health, helping you understand your options, weigh the benefits and risks of treatment, and make informed decisions while supporting your long-term fertility and gynaecological wellbeing.
References:
- NHS (2026) ‘Fibroids’. Page last reviewed 17 March 2026. Available at: https://www.nhs.uk/conditions/fibroids/
- National Institute for Health and Care Excellence (NICE) (2018, updated 2021; reviewed 2024) ‘Heavy menstrual bleeding: assessment and management (NICE guideline NG88)’. Available at: https://www.nice.org.uk/guidance/ng88
- Practice Committee of the American Society for Reproductive Medicine (2017) ‘Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline’, Fertility and Sterility, 108(3), pp. 416–425. Available at: https://www.asrm.org/practice-guidance/practice-committee-documents/removal-of-myomas-in-asymptomatic-patients-to-improve-fertility-andor-reduce-miscarriage-rate-a-guideline-2017/
- Metwally, M., Raybould, G., Cheong, Y.C. and Horne, A.W. (2020) ‘Surgical treatment of fibroids for subfertility’, Cochrane Database of Systematic Reviews, 2020(1), article CD003857. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6989141/
- Sunkara, S.K., Khairy, M., El-Toukhy, T., Khalaf, Y. and Coomarasamy, A. (2010) ‘The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis’, Human Reproduction, 25(2), pp. 418–429. Available at: https://pubmed.ncbi.nlm.nih.gov/19910322/
- Human Fertilisation and Embryology Authority (HFEA) (2026) ‘Fertility treatment 2024: trends and figures’. Published 16 June 2026. Available at: https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2024-trends-and-figures
- National Institute for Health and Care Excellence (NICE) (2010) ‘Uterine artery embolisation for fibroids (HealthTech guidance HTG240)’. Available at: https://www.nice.org.uk/guidance/htg240
- Akhatova, A. et al. (2023) ‘Reproductive and obstetric outcomes after UAE, HIFU, and TFA of uterine fibroids: systematic review and meta-analysis’, International Journal of Environmental Research and Public Health, 20(5), article 4480. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10001943/
- Li, H., Hu, Z., Fan, Y. and Hao, Y. (2024) ‘The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis’, BMC Pregnancy and Childbirth, 24(1), article 345. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11071265/
- Ramasauskaite, D., Purandare, N., Diaz, I., Kvederaite-Budre, G., Beyuo, T.K., Beyeza-Kashesya, J. and Jacobsson, B. (2026) ‘Fibroids and pregnancy’, International Journal of Gynecology & Obstetrics, 172(1), pp. 51–58. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12724024/