Key takeaways

• Fibroids can affect fertility depending largely on their size and location, especially when they distort or enter the uterine cavity.
  

• Many people with fibroids can still become pregnant, particularly when the fibroids are outside the uterine cavity.
  

• Intracavitary or cavity-distorting fibroids are more likely to interfere with implantation and increase miscarriage risk and are often removed before an embryo transfer.
  

• Fibroids can also affect pregnancy, with risks varying based on size, number, and location.
  

• The timing of pregnancy after fibroid removal depends on the type and extent of surgery.
  

When you are trying to build your family, being told you have fibroids can immediately raise a bigger question: what does this mean for my fertility?

The answer depends heavily on where the fibroids are located, how large they are, whether they distort the uterine cavity, and whether they are causing symptoms. To better understand how fibroids can affect conception, implantation, pregnancy, and fertility treatment, we spoke with Dr. Deepti Nahar, a highly esteemed OB-GYN in the Bay Area with expertise in complex gynecologic conditions and minimally invasive surgery, along with Collab Fertility founder and reproductive endocrinologist Dr. Thalia Segal.

Can fibroids cause infertility?

Yes. Fibroids can directly cause infertility, especially depending on their location.

Fibroids that are within the uterus, whether it’s partially or completely, we call these type 0, type 1, or even type 2 FIGO grading fibroids. Those can impact fertility directly because they’re taking up the same space that a baby would try to go into.

It’s decreasing the fertile space where implantation can occur because if there’s a fibroid there, the endometrial lining can’t grow, and implantation either will be more limited or the risk of miscarriage increases.

Can you get pregnant with fibroids?

Yes. Dr. Segal explains that pregnancy is often possible when fibroids are outside the uterine cavity. At Collab Fertility, if a fibroid is not in the cavity and is not otherwise creating a significant concern, patients can often move forward with an egg retrieval and embryo banking. If a fibroid is intracavitary or distorts the uterine cavity, removal is generally recommended before an embryo transfer because these fibroids are more likely to interfere with implantation and increase miscarriage risk.

Size and location still matter during pregnancy. Fibroids can grow during pregnancy and may increase the risk of complications, including:

• Miscarriage, particularly with submucosal or cavity-distorting fibroids

• Pain or fibroid degeneration, especially with larger fibroids

• Preterm contractions and preterm delivery, particularly with multiple or large fibroids

• Fetal malpresentation, especially with large or lower-uterine-segment fibroids

• Placental abruption, with risk potentially greater for retroplacental fibroids

• Placenta previa

• Cesarean delivery due to malpresentation, labor dystocia, or obstruction

• Postpartum hemorrhage due to impaired uterine contractility

Evidence around fetal growth restriction is mixed. Most fibroids do not significantly impair fetal growth, although very large or multiple fibroids may increase risk.

Dr. Nahar similarly notes that small fibroids can often be monitored during pregnancy, while larger fibroids may grow, lose blood supply and cause significant pain, or create other pregnancy-related concerns. The decision to remove a fibroid before pregnancy or embryo transfer depends on its size, location, symptoms, and how it affects the uterine cavity.

Can fibroids affect implantation or contribute to failed embryo transfers?

Yes, particularly when fibroids distort the uterine cavity. Dr. Nahar also shared the example of a patient who had experienced infertility despite having euploid embryos available for transfer.

“She’s had several embryos that are euploid and has had three failed transfers already. Everything else is fine. Every other workup has been fine, but she just had a whole bunch of fibroids.

I ended up taking out seven or eight fibroids. Nothing was in the cavity, but they ranged from three or four centimeters all the way to seven or eight centimeters, multiple of them.

We’re curious to see if this is going to help. She’s just healing, and I’m like, ‘Okay, let’s see, maybe in three to four months. Talk to your REI and let’s see if it works.’”

This is an individual clinical example rather than proof that non-cavity-distorting fibroids caused the failed transfers. It illustrates why size, number, symptoms, and location all matter when deciding whether removal may be appropriate.

Dr. Segal also shared an example that illustrates why fertility planning before fibroid surgery can matter. One patient came to Collab after experiencing multiple pregnancy losses. Evaluation identified an approximately six-centimeter fibroid that was not inside the uterine cavity but was distorting it. Recurrent pregnancy loss was the patient’s only apparent symptom.

Because the patient needed fibroid surgery, the Collab team first helped her bank euploid embryos. She then returned to her gynecologic surgeon for fibroid removal. After allowing time for the uterus to heal, she came back to Collab for a frozen embryo transfer and went on to have a successful live birth.

This is one individual clinical example and does not mean every fibroid requires surgery. It demonstrates how the sequence of fertility preservation, surgery, recovery, and embryo transfer can be personalized around a patient’s age, ovarian reserve, fibroid characteristics, and family-building goals.

Why might hysteroscopy be recommended before an embryo transfer?

A hysteroscopy allows the physician to look directly inside the uterine cavity and identify intracavitary fibroids or other abnormalities that could interfere with implantation.

Dr. Nahar explains that even when there is not a distinct lesion, hysteroscopy can sometimes reveal an irregular lining, with some areas appearing thicker or thinner. In fertility treatment, evaluating the uterine cavity can help clarify whether there is anything that should be addressed before embryo transfer.

How soon can you get pregnant after fibroid removal?

“It depends where the fibroids are and how extensive the surgery is.

If the surgery is hysteroscopic, meaning it’s through the vagina into the cervix, there are no other incisions on the uterus, so usually it’s a quicker recovery. They usually say, ‘Wait until you get your next normal period,’ and then discuss with your REI specialist what the plan is, whether they’re doing medicated cycles, non-medicated, monitoring, or whatever it may be.

The challenge becomes a little bit more if we’re removing fibroids where we have to cut into the uterus.

Depending on where that fibroid is, how much of the uterus I have to cut into, and how much of the uterus I have to repair is going to tell us how long of a recovery time they may need.

Sometimes it may be up to six months, especially if they had multiple fibroids that were in the muscle part of the uterus. The uterus needs time to heal and repair.

Getting pregnant too early after fibroids are removed from the muscle part of the uterus may cause those stitches to burst open, and it can cause what’s called a uterine rupture.”

Depending on the type of surgery performed, that history may also affect delivery planning.

“Sometimes we recommend them to actually have a C-section for delivery because it’s the force of the labor contractions that puts a lot of strain on the uterus and can cause that rupture to happen.”

When should you see a fertility specialist for fibroids?

If you have known fibroids and are thinking about pregnancy, a fertility evaluation can help determine whether their size or location may affect conception, embryo transfer, or pregnancy.

Dr. Nahar recommends checking in if you are experiencing symptoms such as irregular bleeding, bleeding between periods, pelvic pressure, or if you have been trying to conceive without success. A basic fertility and uterine evaluation can help determine whether fibroids may be playing a role.

Dr. Segal also recommends seeing a fertility specialist before major fibroid surgery, particularly if you are older or have diminished ovarian reserve. If surgery is likely to delay attempts at pregnancy, embryo banking before surgery may allow you to preserve embryos created with eggs at your current age.

Major fibroid surgery and the time needed for uterine healing can delay pregnancy efforts by approximately six to nine months, depending on the procedure and the individual patient. Discussing fertility preservation before surgery can therefore be especially important when age or ovarian reserve is already a concern.

Understanding the full fertility picture

Fibroids affect every patient differently. Their location, severity, symptoms, reproductive goals, and previous fertility history can all influence whether treatment is recommended and when.

At Collab Fertility, we take an individualized approach to understanding the factors that may be affecting your ability to conceive and determining the next steps that make sense for your goals. 

We have firsthand experience working with patients who have undergone fibroid removal surgery before going on to welcome healthy babies. Stories like these can offer real hope and show that, with the right evaluation and individualized treatment plan, addressing underlying reproductive health conditions may help improve the chances of a healthy pregnancy.

If you are experiencing painful or irregular periods, have been diagnosed with fibroids, or have questions about how they may affect fertility treatment, schedule a consultation with Collab Fertility.

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