When Fibroids, Polyps, or a Septum Get in the Way

Can Fibroids and Polyps Cause Infertility?

Yes, in some cases — though it depends heavily on where the growth sits, not just whether it's there. Fibroids, endometrial polyps, and a uterine septum are grouped together under the umbrella of uterine factor in a fertility workup, because all three can distort the space an embryo needs to implant. A fibroid on the outer surface of the uterus behaves very differently than one bulging into the cavity.

Fibroids are benign muscle growths classified by location: submucosal fibroids bulge into the uterine cavity, intramural fibroids sit within the muscular wall, and subserosal fibroids grow on the outer surface. It's generally the cavity-distorting ones that draw the most attention when fertility is the concern. Polyps are growths of the uterine lining itself, usually benign, and a septum is different from either — a band of tissue left over from how the uterus formed before birth, dividing part of the cavity in two. Uterine structural issues are one entry on the list of common causes of female infertility, alongside ovulation disorders and blocked fallopian tubes, which is why imaging of the cavity is a standard part of a workup rather than an unusual add-on.

How These Are Found

A structural cause like this is usually first suspected on a pelvic ultrasound, then confirmed with a more detailed look: a saline-infusion sonogram, which fills the uterine cavity with sterile fluid to outline its shape, or a hysteroscopy, where a thin camera goes directly into the cavity to see, and sometimes treat, what's there in the same visit.

Neither test requires the cycle-day precision that a hormone blood draw does, though many clinicians prefer to schedule imaging for the first half of the cycle, after bleeding has stopped and before ovulation, simply because the lining is thinnest and easiest to see through at that point.

What Happens If One Is Found?

Not every fibroid or polyp found on imaging needs to come out. Many reproductive endocrinologists reserve treatment for growths that distort the uterine cavity or are unusually large, and leave smaller, non-distorting fibroids alone while a couple continues trying or moves toward treatment. When removal is recommended, it is often done hysteroscopically — through the cervix, without an abdominal incision — for polyps and cavity-bulging fibroids, while a larger or deeper fibroid may need a more involved surgical approach.

A septum is treated differently again: because it is a band of tissue rather than a growth, correcting it usually means a hysteroscopic procedure to divide it, distinct from removing a fibroid or polyp.

Recovery and timing for trying again also depend heavily on which procedure was done. A hysteroscopic polypectomy or fibroid removal, done entirely through the cervix, generally allows a shorter wait before resuming attempts than a procedure that requires an incision into the uterine wall, since a surgical entry point into the muscle itself needs more time to heal before it is safe to carry a pregnancy. A clinician who performed the procedure is the right person to set that specific timeline, since it depends on exactly what was found and how it was removed.

Uterine Factor Is Only Part of the Picture

A structural finding in the uterus is one piece of a larger evaluation, not the whole story. Guidelines call for evaluating the male partner at the same time as the female partner, rather than waiting to see what the uterine imaging shows, and note that male-factor issues can sometimes point to a health condition worth addressing in its own right 1Ref 1American Urological Association / American Society for Reproductive Medicine (2020).Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I.Supports that guidelines call for evaluating the male partner concurrently with the female partner, and that male infertility can itself signal an underlying health condition worth addressing.. A complete male fertility workup runs in parallel for exactly this reason.

On the female side, hormonal causes are checked alongside structural ones — high prolactin and trouble getting pregnant is its own common thread, distinct from anything a fibroid or polyp would explain — and modifiable exposures like smoking and marijuana use are worth addressing regardless of what imaging shows, since both are linked to lower success with fertility treatment 2Ref 2Practice Committee of ASRM (2024).Tobacco or marijuana use and infertility: a committee opinion.Supports that smoking and marijuana use are linked to reduced fertility-treatment success, relevant as a modifiable factor to address alongside any structural finding.. Age still matters more than any single structural finding. Guidelines describe female age as the single most important predictor of fecundity, with relative fertility roughly halved by 40 compared with the late-20s to early-30s peak — a decline that runs alongside whatever a fibroid, polyp, or septum contributes, not in place of it 3Ref 3Practice Committee of ASRM and the Society for Reproductive Endocrinology and Infertility (2022).Optimizing natural fertility: a committee opinion.Supports that female age is the single most important predictor of fecundity, with relative fertility roughly halved by 40, and that evaluation is recommended after 12 months of trying (6 months if the female partner is 35 or older)..

When Should This Evaluation Happen?

The same timing guidance that applies to a full female fertility workup applies here: evaluation typically starts after 12 months of regular, unprotected intercourse without pregnancy if the female partner is under 35, or after 6 months if she is 35 or older 3Ref 3Practice Committee of ASRM and the Society for Reproductive Endocrinology and Infertility (2022).Optimizing natural fertility: a committee opinion.Supports that female age is the single most important predictor of fecundity, with relative fertility roughly halved by 40, and that evaluation is recommended after 12 months of trying (6 months if the female partner is 35 or older)..

Certain situations move imaging up sooner regardless of that timeline — a history of heavy or prolonged periods, previously diagnosed fibroids, recurrent pregnancy loss, or a uterine anomaly noted on a prior scan are all reasons a clinician might order pelvic imaging before the standard 6- or 12-month mark.

What If Imaging Finds Nothing?

A clear scan doesn't end the workup — it moves it into a different category. When ovulation, tubal patency, semen parameters, and uterine anatomy all check out, the diagnosis becomes unexplained infertility, and there is real evidence comparing what to do next 4Ref 4Practice Committee of ASRM (2020).Evidence-based treatments for couples with unexplained infertility: a guideline.Supports the evidence-based treatment comparisons available once a couple's workup — including uterine anatomy — is complete and no structural or other cause is found, i.e., unexplained infertility..

One randomized trial found that couples who moved to IVF after three cycles of ovarian-stimulation medication with IUI reached a pregnancy faster, had more live births, and spent less money overall than those who followed the conventional, slower stepwise path 5Ref 5Reindollar RH, Regan MM, Neumann PJ, et al. (2010).A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial.Supports the FASTT trial finding that moving to IVF after three cycles of gonadotropin/IUI produced faster pregnancy, more live births, and lower cost than the conventional stepwise path in unexplained infertility.. Reading about whether your unexplained infertility workup was actually complete is worth doing before accepting that label, since a missed or incompletely characterized uterine finding is one of the more common reasons the 'unexplained' category turns out not to be the end of the story. For couples who do reach the point of considering IVF, ivf insurance coverage varies enormously depending on where you live, which is worth checking early rather than late.