Many women with uterine fibroids conceive naturally and have healthy pregnancies. However, fibroids can sometimes affect fertility or increase certain pregnancy risks, depending on their size, number, and location. Understanding these factors can help you make informed decisions before and during pregnancy.
Planning a pregnancy with fibroids? Book a fertility-focused consultation with our gynaecology team at Treatment Range Hospitals.
Can Fibroids Affect Your Ability to Get Pregnant?
Fibroids do not always cause infertility. Many women with fibroids become pregnant without difficulty. However, fibroids can affect fertility when they:
- Distort the uterine cavity, making embryo implantation more difficult.
- Block the fallopian tubes or cervical canal.
- Alter uterine contractions or blood flow to the endometrium.
- Are large, multiple, or located in specific areas of the uterus.
The effect on fertility is strongly influenced by the fibroid’s location. Submucosal fibroids, which project into the uterine cavity, are most likely to reduce pregnancy rates and increase miscarriage risk. Intramural fibroids may also affect fertility, particularly when they are large or distort the cavity. Subserosal fibroids, which grow on the outer surface of the uterus, generally have minimal impact on fertility when they are small and do not affect surrounding structures.
If you have been trying to conceive for 12 months (or 6 months if you are over 35) without success, consult our fertility and gynaecology specialists for a comprehensive evaluation.
How Location & Size Matters for Fertility
Submucosal Fibroids
Submucosal fibroids develop just beneath the uterine lining and may project into the uterine cavity. They are most strongly associated with reduced implantation rates, lower clinical pregnancy rates, and higher miscarriage rates. Evidence suggests that removing cavity-distorting submucosal fibroids can improve pregnancy and live birth rates in women with infertility.
Intramural Fibroids
Intramural fibroids grow within the muscular wall of the uterus. They may affect fertility when they are large, multiple, or begin to distort the uterine cavity. Some studies suggest that intramural fibroids can reduce pregnancy and live birth rates, particularly in women undergoing assisted reproductive technology (ART), although the benefit of removing all intramural fibroids before pregnancy is not definitively proven and should be individualized.
Subserosal Fibroids
Subserosal fibroids grow on the outer surface of the uterus. Current evidence indicates that subserosal fibroids, especially when small, do not significantly affect fertility, implantation, or miscarriage rates. Removal is generally not recommended solely for fertility reasons unless they cause significant symptoms or complications.
Unsure which type of fibroid you have and how it may affect your fertility? Bring your ultrasound or MRI report to Treatment Range Hospitals for a detailed review.
Fibroids During Pregnancy: Risks to Watch
Most pregnancies with fibroids proceed without major complications. However, fibroids can sometimes cause issues during pregnancy, particularly when they are large, multiple, or located in specific areas.
Possible risks include:
- Fibroid growth: Some fibroids may enlarge during pregnancy due to hormonal changes, although many remain stable or even shrink.
- Pain: Fibroid-related pain can occur, especially in the second trimester, due to degeneration (when the fibroid outgrows its blood supply).
- Miscarriage: Some studies suggest a slightly increased risk of early pregnancy loss, particularly with submucosal or cavity-distorting fibroids.
- Preterm birth: There may be an increased risk of preterm labour or delivery in some cases.
- Placental problems: Fibroids may be associated with placenta previa or placental abruption in certain situations.
- Fetal position: Fibroids can sometimes contribute to abnormal fetal positions, such as breech presentation.
- Cesarean delivery: Women with fibroids may have a higher likelihood of requiring a cesarean section, depending on fibroid location and other obstetric factors.
It is important to note that many women with fibroids have uncomplicated pregnancies and deliver healthy babies. Regular antenatal care and monitoring are essential.
Already pregnant and concerned about your fibroids? Schedule an antenatal consultation at Treatment Range Hospitals for individualized monitoring and guidance.
Managing Fibroids Before & During Pregnancy
Before Pregnancy
If you are planning pregnancy and have known fibroids, your doctor may recommend:
- A detailed ultrasound to assess fibroid size, number, and location.
- Evaluation of symptoms such as heavy bleeding, pain, or anaemia.
- Discussion of whether fibroid removal (myomectomy) may be beneficial before attempting conception, particularly for submucosal or cavity-distorting fibroids.
Not all fibroids require removal before pregnancy. The decision depends on your symptoms, fibroid characteristics, age, and fertility history.
During Pregnancy
Management during pregnancy is usually conservative and focuses on:
- Regular antenatal check-ups and ultrasound monitoring.
- Pain management with pregnancy-safe medications.
- Monitoring for complications such as preterm labour, placental issues, or fetal growth concerns.
- Planning for delivery based on fibroid location, size, and obstetric factors.pmc.ncbi.nlm.nih+1
Surgery during pregnancy is rarely performed and reserved for exceptional circumstances, such as severe complications that cannot be managed medically.
Need help deciding whether to treat fibroids before trying to conceive? Our gynaecology team can provide personalized advice based on your scan and reproductive goals.
When Fibroid Removal Is Recommended Before Trying to Conceive
Fibroid removal (myomectomy) is not always necessary before pregnancy. It may be considered when:
- Submucosal fibroids distort the uterine cavity and are associated with infertility or recurrent miscarriage.
- Large intramural fibroids significantly distort the cavity or cause severe symptoms.
- Fibroids block the fallopian tubes or cervical canal.
- There is a history of recurrent pregnancy loss with fibroids as a likely contributing factor.
Myomectomy can improve fertility outcomes in selected patients, but it does not guarantee pregnancy. The procedure also carries risks, such as adhesions or uterine scarring, which should be discussed with your surgeon. Recovery time before attempting pregnancy varies depending on the type and extent of surgery.
Considering myomectomy before pregnancy? Book a pre-conception consultation at Treatment Range Hospitals to discuss the benefits, risks, and timing.
What to Expect During Delivery
Most women with fibroids can have a vaginal delivery. However, delivery planning may be influenced by:
- Fibroid location, particularly if a fibroid is low-lying and may obstruct the birth canal.
- Fibroid size and number.
- Previous obstetric history and any prior uterine surgeries.
- Fetal position and other pregnancy-related factors.
A cesarean section may be recommended if fibroids obstruct labour, if there are concerns about uterine integrity after previous myomectomy, or if other obstetric indications exist. In some cases, fibroids may be removed during cesarean delivery, but this decision is made carefully based on bleeding risk and surgical considerations.
Approaching your due date with fibroids? Discuss your delivery plan with our obstetric team to ensure a safe and well-prepared birth.
Frequently Asked Questions
1. Do fibroids need to be removed before getting pregnant?
Not always. Removal is typically considered for submucosal or cavity-distorting fibroids associated with infertility or recurrent miscarriage. Many women with small or asymptomatic fibroids can conceive without surgery. The decision should be individualized based on fibroid type, symptoms, and fertility history
2. Can fibroids grow during pregnancy?
Some fibroids may enlarge during pregnancy due to hormonal changes, particularly in the first trimester. However, many remain stable, and some may even shrink. Fibroid growth does not always cause complications, but it can sometimes lead to pain or other issues that require monitoring.
3. Do all fibroids cause infertility?
No. Many women with fibroids conceive naturally. Submucosal fibroids are most likely to affect fertility, while subserosal fibroids generally have minimal impact. Intramural fibroids may affect fertility when they are large or distort the uterine cavity
4. Can I have a normal delivery with fibroids?
Yes, many women with fibroids have successful vaginal deliveries. The mode of delivery depends on fibroid location, size, fetal position, and other obstetric factors. Your obstetrician will create a delivery plan tailored to your specific situation.
5. Will removing fibroids guarantee pregnancy?
Myomectomy can improve fertility in selected cases, particularly for submucosal fibroids, but it does not guarantee pregnancy. Other factors such as age, ovarian reserve, sperm quality, and tubal function also play important roles in conception.
Fibroids and pregnancy can coexist successfully with appropriate monitoring and care. While fibroids can sometimes affect fertility or increase certain pregnancy risks, many women conceive naturally and deliver healthy babies. Early evaluation, personalized management, and regular antenatal care are key to optimizing outcomes.
Planning a pregnancy with fibroids or already pregnant and concerned? Book a consultation with our gynaecology and obstetrics team at Treatment Range Hospitals for expert guidance and support throughout your journey.
