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Fibroids and fertility: which fibroids matter
Fibroids are non-cancerous growths of the womb muscle, and they are common. Whether a fibroid affects fertility depends mostly on where it is. Fibroids that bulge into the womb cavity matter most; many fibroids on the outside of the womb do not affect the chance of pregnancy at all.
Types of fibroids by position
- Submucous fibroids grow into the womb cavity, where the embryo implants. They are the type most clearly linked with difficulty conceiving and with miscarriage.
- Intramural fibroids sit within the wall of the womb. Small ones often do not matter; larger ones, or ones that press on the cavity, may.
- Subserosal fibroids grow on the outside of the womb and usually do not affect fertility.
How fibroids are found
An ultrasound usually shows the number, size and position of fibroids. When a fibroid may be touching the cavity, a hysteroscopy, or sometimes an MRI, helps decide exactly where it lies.
When is removal advised?
- Submucous fibroids are usually removed through a hysteroscopy, with no cut on the abdomen.
- Large intramural fibroids, or fibroids that distort the cavity, may be removed by laparoscopy or open surgery (myomectomy) after the pros and cons are weighed.
- Small fibroids away from the cavity are often left alone, especially when time and egg reserve matter.
After a myomectomy, a waiting time is usually advised before trying to conceive, so the womb can heal. Your doctor will tell you how long, and whether a caesarean may be advised later in pregnancy.
Fibroids, IVF and pregnancy
Symptoms of fibroids
- Heavy or long periods, sometimes with clots, which can lead to anaemia.
- Pain or pressure in the lower abdomen.
- Passing urine often, or constipation, when a fibroid presses on the bladder or bowel.
- Often there are no symptoms at all, and the fibroid shows up only on a scan.
Medicines for fibroids
Some medicines can control heavy bleeding or shrink fibroids for a while. Most of them also stop ovulation or are not suitable in pregnancy, so they are not used during the months you are trying to conceive. They are sometimes given for a short time before surgery, to shrink a fibroid and correct anaemia. Iron tablets are often needed when periods have been heavy.
Recovery after fibroid surgery
How long recovery takes depends on how the fibroid is reached. When it is removed from inside the womb with a telescope, there is no cut on the abdomen and most women go home within the day. Keyhole and open operations need a short hospital stay and some weeks of rest at home, longer after an open operation. Your doctor will tell you how long to wait before trying to conceive or starting IVF, and whether a caesarean is advised later.
Can fibroids come back?
Yes, new fibroids can grow after a myomectomy, because the tendency to form them stays. This is one reason the timing of surgery is planned around when you want to conceive.
Heavy periods and anaemia
Losing a lot of blood every month can drain the body's iron stores slowly, so you may feel weak, short of breath on stairs, or unusually tired. Your haemoglobin is checked, and if it is low it is brought up with iron or other treatment before surgery or pregnancy.
Fibroids found during fertility tests
Fibroids are often seen for the first time on a scan done for fertility. Finding one does not always mean surgery. The doctor looks at the number, size and position, your symptoms, your age and your egg reserve, and then advises whether to remove it, watch it, or go ahead with treatment. A hysteroscopy may be done to see the inside of the womb clearly. If you are unsure, it is reasonable to ask for the scan pictures and a clear explanation before deciding.
If IVF is planned, fibroids are assessed beforehand, because a fibroid in the cavity can lower the chance of an embryo implanting. During pregnancy, most fibroids cause no trouble; some grow or cause pain, and a few are linked with early labour. Pregnancies with large fibroids are watched more closely; see our page on high-risk pregnancy care.
Questions about fibroids and pregnancy
Can I get pregnant with fibroids?
Often, yes. The position of the fibroid is the key point: a fibroid inside the cavity is the one most likely to matter, while many on the outer surface make no difference.
Do all fibroids need to be removed before IVF?
No. Fibroids inside the cavity are usually removed, while small fibroids away from the cavity are often left alone. The decision depends on size, position and your age.
How is a fibroid inside the womb removed?
Usually by hysteroscopy: a slim camera is passed into the womb through the vagina and the neck of the womb, so the abdomen is not cut.
How long after fibroid removal can I try to conceive?
A waiting time is usually advised so the womb can heal; your doctor tells you how long based on the surgery done.
Can fibroids cause miscarriage?
Fibroids that bulge into the womb cavity are linked with miscarriage. Fibroids elsewhere are less likely to be the cause.
Are fibroids cancer?
Fibroids are non-cancerous growths. Very rarely a growth that looks like a fibroid is something else, which is why any fast-growing lump is checked.
Can fibroid medicines help me get pregnant?
Most fibroid medicines stop ovulation or are not suitable in pregnancy, so they are used only for a short time before surgery, not while trying to conceive.
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What you read here explains fertility care in general terms and cannot replace a consultation. Decisions about your own care should be made with a doctor who knows your history and has seen you. We do not carry out or offer sex determination of any kind, which is prohibited by law in India under the PCPNDT Act.