Hormonal health

Fibroids and Fertility: When Fibroids Interfere

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Most fibroids do not cause infertility. The exception is a submucosal fibroid that pushes into the uterine cavity, which can lower the chance of pregnancy and raise miscarriage risk. Fibroids in the wall or on the surface usually matter less. Removing a cavity-distorting fibroid can improve conception odds; removing others often does not.

Last updated: July 2026

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Do fibroids usually cause infertility?

Fibroids are common, but they are an uncommon sole cause of infertility. Most women develop at least one fibroid by age 50, according to the Office on Women's Health, and the great majority conceive without difficulty 1. When a couple faces trouble conceiving, fibroids are only one possible factor, and other causes are found more often.

According to a comparative-effectiveness review, the evidence linking most fibroids to infertility is limited, and the clearest signal is for fibroids that distort the uterine cavity 3. Sorting fibroids from other explanations is why a fertility evaluation looks at ovulation, tubes, and sperm too — see the common causes of infertility.

Which fibroids actually affect conception?

Location decides whether a fibroid matters for fertility. Submucosal fibroids, which bulge into the uterine cavity, are the type consistently associated with lower pregnancy rates and higher miscarriage rates, according to the practice bulletin 2. Even a 1 to 2 cm submucosal fibroid can distort the cavity enough to matter, while intramural fibroids within the muscle wall have a less certain effect 2.

Subserosal fibroids on the outer surface, even larger ones over 5 cm, generally do not reduce fertility 2. A large fibroid can still deform the cavity or press on a fallopian tube 3. Because the same word on a scan can mean different things, reviewing how to tell if you have fibroids alongside your imaging clarifies the picture.

When does removing a fibroid improve pregnancy chances?

Surgery helps most when a fibroid distorts the cavity. Removing a submucosal fibroid — often through the vagina with a hysteroscope — is associated with improved conception in women who are otherwise unexplained, according to the guideline 2. Removing intramural or subserosal fibroids that do not touch the cavity has not been shown to reliably raise pregnancy rates, so it is not advised for fertility alone 23.

Myomectomy, the fibroid-preserving surgery, keeps the uterus and is the usual choice for someone hoping to conceive, though it can leave scar tissue weighed against the benefit 3. Healing, commonly about 3 to 6 months, before trying to conceive is generally advised. Talking through goals with a clinician who handles fibroid treatment options helps target only the fibroids that count.

How do fibroids affect pregnancy and change with age?

Fibroids can influence a pregnancy as well as conception, and their behavior shifts across life stages. During the reproductive years fibroids respond to estrogen and may enlarge, and some grow during pregnancy, occasionally causing pain or affecting the baby's position 1. In adolescence fibroids are rare, so trouble conceiving in a teenager usually points elsewhere.

Across the perimenopausal transition growth may speed up, and after menopause falling estrogen usually shrinks fibroids 1. Someone conceiving later in life may face both fibroids and age-related fertility decline at once — see how long it takes to conceive. Because fibroids grow more common with age, their presence alone does not explain a delay 1.

When should you see a fertility specialist?

A gynecologist or reproductive endocrinologist can judge whether a fibroid is truly the obstacle before recommending surgery. Bring your imaging and a timeline of trying to conceive, since the plan depends on fibroid location and your broader fertility picture 2. Useful questions cover whether the fibroid distorts the cavity, whether removal is likely to help, and how healing would affect timing.

If you have been trying without success, learning when to see a fertility specialist helps you act at the right time 3. For those with endometriosis too, endometriosis and pregnancy is a related read. Gale can help you prepare for that conversation.

Common questions

Usually yes. Most women with fibroids conceive without a problem. The main exception is a submucosal fibroid that pushes into the uterine cavity, which can lower the odds. A fertility evaluation looks at fibroids alongside ovulation, tubes, and sperm before blaming a fibroid.

Only some fibroids benefit from removal. Cavity-distorting (submucosal) fibroids are the ones most likely worth removing for fertility. Fibroids in the wall or on the surface usually do not need removal for conception, since taking them out has not reliably improved pregnancy rates.

Submucosal fibroids that distort the cavity are associated with higher miscarriage risk. Most other fibroids are not clearly linked to pregnancy loss. Because miscarriage has many causes, a clinician looks at the whole picture rather than assuming a fibroid is responsible.

Often they cause no trouble. Some fibroids grow during pregnancy and can cause pain or, less often, affect the baby's position or raise the chance of a cesarean. Many pregnancies with fibroids proceed normally, and your care team watches for the uncommon complications.

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When fibroids and fertility need a specialist

  • —Trying to conceive for 12 months without success (or 6 months if over 35) is a reason to seek a fertility evaluation.
  • —Heavy periods with fatigue or breathlessness can signal anemia and is a reason to seek prompt medical care.
  • —Recurrent miscarriage with a known fibroid is a reason to seek evaluation by a fertility specialist.
  • —Severe pelvic pain in pregnancy with a fibroid is a reason to contact your clinician or urgent care.

This article is general health education, not medical advice. Whether a fibroid is affecting your fertility, and whether removal would help, is a judgment for a gynecologist or reproductive endocrinologist who knows your full history.

References

  1. 1.Office on Women's Health (U.S. HHS) (2025). Uterine fibroids. Office on Women's Health (womenshealth.gov), U.S. HHS. link ✓Office on Women's Health overview establishing that fibroids are common by age 50, most women conceive despite them, fibroids can grow in pregnancy, and they usually shrink after menopause.
  2. 2.American College of Obstetricians and Gynecologists (2021). Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000004401 ✓ACOG practice bulletin establishing that submucosal (cavity-distorting) fibroids are associated with lower fertility and higher miscarriage risk, that removing them can improve conception, and that removing wall or surface fibroids is not advised for fertility alone.
  3. 3.Hartmann KE, Fonnesbeck C, Surawicz T, Krishnaswami S, Andrews JC, Wilson JE, Velez-Edwards D, Kugley S, Sathe NA (2017). Management of Uterine Fibroids (Comparative Effectiveness Review No. 195). Agency for Healthcare Research and Quality (AHRQ). PMID 30789683 ✓AHRQ comparative-effectiveness review supporting that evidence linking most fibroids to infertility is limited and that cavity-distorting fibroids are the clearest concern, framing myomectomy trade-offs.

3 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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