Uterine Fibroids and Fertility: Impact, Symptoms & Treatment

For many individuals and couples planning a family, a diagnosis of uterine fibroids brings a wave of questions about their reproductive future. Understanding the relationship between uterine fibroids and fertility is essential for making informed decisions and choosing the right path toward pregnancy. This guide explains how these common growths affect conception, how they are diagnosed, and the treatment options available. At Yaal Fertility Centre in Chennai, Dr. Rukkayal Fathima and the team look at fibroids as one part of the whole fertility picture, not in isolation.

What Are Uterine Fibroids?

Uterine fibroids, medically known as leiomyomas or myomas, are non-cancerous (benign) growths of the uterus that typically develop during the childbearing years. They are made of the same smooth muscle tissue as the uterine wall (myometrium) and vary widely in size, shape and number, from tiny seedlings to bulky masses that distort the uterus. When fibroids enlarge the womb, a scan report may simply say "bulky uterus".

Fibroids are not associated with an increased risk of uterine cancer and almost never turn cancerous. Many women have fibroids without knowing it, because they cause no symptoms. They are often found incidentally during a pelvic exam or a routine ultrasound.

The Three Main Types: Submucosal, Intramural, and Subserosal

Specialists classify fibroids by where they sit in the uterine wall:

• Submucosal fibroids grow just beneath the uterine lining (endometrium) and project into the cavity. Even when small, they can change the internal shape of the womb, which makes them the type most likely to interfere with conception and pregnancy.
• Intramural fibroids develop within the muscular wall. If large enough, they can stretch or distort the cavity or the outer wall, and may affect fertility depending on their size and closeness to the lining.
• Subserosal fibroids project outward from the surface of the uterus. Because they grow away from the cavity, they rarely affect fertility unless they become very large and press on neighbouring organs.

How Common Are Fibroids in Women of Reproductive Age?

Fibroids are very common. Studies estimate that up to 70–80% of women develop them by age 50, and a meaningful proportion of women between 20 and 40 have fibroids large enough to matter clinically. Because fibroids respond to estrogen and progesterone, they tend to grow during the childbearing years, which is why they so often coincide with plans to conceive.

How Do Uterine Fibroids Affect Fertility and Conception?

Many women with fibroids conceive and deliver healthy babies without any treatment. But certain fibroids can create physical and biological barriers to conception. The effect depends on the size, number and precise location of the growths.

Anatomical Changes and Blocked Fallopian Tubes

• Cervical distortion: a fibroid near the cervix can change its shape or position and interfere with the passage of sperm.
• Tubal obstruction: fibroids near the point where the fallopian tubes join the uterus can block the tubal opening, stopping the egg and sperm from meeting. You can read more about tubal problems in our guide to blocked fallopian tubes.
• Cavity distortion: larger intramural or submucosal fibroids can change the shape of the uterine cavity and make it harder for sperm to travel towards the tubes.

Impact on Uterine Blood Flow and Implantation

An embryo needs a well-vascularised, nutrient-rich lining to implant. A fibroid — particularly a submucosal or large intramural one — can disturb local blood supply and cause inflammation in the surrounding endometrium, which reduces the lining's receptivity. This can raise the risk of implantation failure or early miscarriage. If you have had repeated failed transfers, see our guide to recurrent implantation failure.

Recognizing the Symptoms of Uterine Fibroids

Symptoms depend on size, number and location. Some women have severe symptoms; others have none.

• Heavy menstrual bleeding: the most common symptom. Periods may last more than seven days, include large clots, or cause anaemia.
• Pelvic pressure and pain: a persistent feeling of heaviness or fullness in the lower abdomen.
• Pressure on other organs: frequent urination or difficulty emptying the bladder; constipation.
• Backache and leg pain: from pressure on pelvic nerves.
• Pain during intercourse: especially with fibroids near the cervix.

Many women with unexplained infertility have no symptoms at all, which is why a fertility evaluation should include pelvic imaging. See unexplained infertility for more on this.

How Uterine Fibroids Impact IVF Success Rates

For people having IVF, the location of a fibroid matters far more than its mere presence.

Submucosal fibroids are widely recognised as a major obstacle to IVF success, because they distort the site where the embryo is placed. Removing them before an IVF cycle improves the chance of pregnancy. Whether to treat intramural fibroids is a more nuanced decision, and your specialist will weigh size, position, your age and your history. The aim is the same in every case: to give a good-quality embryo the best possible uterine environment. See our IVF treatment page for how a cycle is planned.

How Are Uterine Fibroids Diagnosed?

• Pelvic exam and transvaginal ultrasound: the usual first step. An enlarged or irregular uterus can often be felt, and ultrasound shows the fibroids in detail.
• Saline infusion sonography (SIS): a small amount of sterile saline is placed in the cavity during ultrasound so that any fibroid bulging into the cavity shows up clearly.
• MRI: for multiple or very large fibroids, MRI gives a detailed map of the pelvis and helps plan surgery.
• Diagnostic hysteroscopy: a thin, lighted telescope passed through the cervix lets the specialist look directly at the lining and confirm any cavity-distorting fibroid. Read more in our hysteroscopy guide.

When Is Surgical Removal of Fibroids Necessary?

Not every fibroid needs surgery. When you are trying to conceive or preparing for fertility treatment, the decision depends on:

• your age and ovarian reserve;
• the size and growth rate of the fibroids;
• whether any fibroid distorts the cavity (any submucosal component);
• a history of recurrent miscarriage or failed IVF.

Hysteroscopy vs. Laparoscopy for Fibroid Removal

When surgery is advised, minimally invasive techniques are preferred to limit tissue trauma and protect future fertility.

• Hysteroscopic myomectomy is the standard for submucosal fibroids. The surgeon works through the cervix, so there are no abdominal incisions and recovery is quick. See our hysteroscopy service.
• Laparoscopic myomectomy is used for intramural or subserosal fibroids. Instruments and a camera are passed through small keyhole incisions, the fibroid is removed, and the uterine wall is carefully repaired in layers. See our laparoscopic surgery service.

The Role of Myomectomy in Preserving Fertility

Unlike a hysterectomy, a myomectomy removes only the fibroids and leaves the healthy uterus in place. It is the surgical option for women who want to preserve fertility. Careful, multi-layer repair of the uterine wall is essential so that the uterus can safely support a future pregnancy.

Pregnancy After Fibroid Treatment: What to Expect

• Recovery time: after a hysteroscopic myomectomy, many women can try to conceive after one or two cycles. After a laparoscopic or open myomectomy, where the muscle wall was cut, specialists usually advise waiting around three to six months. Your surgeon will give you an individual timeline.
• Mode of delivery: if the surgery went deep into the muscle wall, your obstetrician may recommend a planned Caesarean section to protect the scar.
• Outcomes: removing cavity-distorting fibroids is associated with better pregnancy rates and a lower risk of miscarriage in women who struggled to conceive.

When to See a Fertility Specialist

If you have fibroids and want to build a family, getting advice early saves time. Consider seeing a specialist if:

• you are under 35 and have been trying for 12 months;
• you are 35 or older and have been trying for 6 months;
• you have fibroids and have had two or more miscarriages;
• you have severe pelvic pain, very heavy periods or anaemia.

Our guide on when to see a fertility specialist explains the timelines in more detail. A free fertility assessment is a good first step: it looks at ovarian reserve, the tubes, your partner's fertility and the uterus together, rather than looking at fibroids in isolation.