Key Takeaway: Most women with uterine fibroids can still become pregnant. Learn how fibroid size, location and treatment options may affect fertility, and when it’s time to talk with your doctor.
If you’ve recently learned you have uterine fibroids, one question may have come to mind almost immediately: “Will this keep me from getting pregnant?” It’s one of the first questions many women ask, and it’s completely understandable to feel worried.
The reassuring news is that many women with fibroids conceive naturally and go on to have healthy pregnancies. Simply having fibroids doesn’t mean you’ll struggle to get pregnant.
Whether they affect your fertility depends on several factors, including their size, number and, most importantly, where they’re located within the uterus. Understanding those differences can help you feel more informed and confident as you think about starting or growing your family.
What Are Fibroids?
Fibroids are noncancerous growths that develop in or on the muscular wall of the uterus. They’re extremely common. In fact, by age 50, most women will develop fibroids at some point in their lives, although many never realize they have them.
Some fibroids are discovered during a routine pelvic exam or ultrasound. Others are found when a woman is evaluated for heavy or painful periods, pelvic pressure or difficulty getting pregnant.
Fibroids can range in size from as small as a seed to as large as a grapefruit. Some women have just one, while others have several. Many cause no symptoms at all, while others can lead to heavy periods, pelvic pain, frequent urination or pressure in the lower abdomen.
Because every woman’s situation is different, the way fibroids affect your health and your fertility can vary quite a bit.
How Can Fibroids Affect Fertility?
One of the biggest misconceptions is that every fibroid affects fertility. Fortunately, that’s simply not true.
For pregnancy to begin, a fertilized egg must implant in the lining of the uterus. Most fibroids never interfere with that process. Problems are more likely to occur when a fibroid changes the shape of the uterine cavity or affects the area where an embryo would normally implant.
In some cases, fibroids may also interfere with the movement of sperm or a fertilized egg through the reproductive tract or affect blood flow within the uterus. But these situations are much less common than many women fear.
The most important thing to remember is this: location matters much more than simply having fibroids. Two women can have fibroids that are the same size but have very different experiences when trying to conceive because the fibroids are growing in different parts of the uterus.
The good news is that most fibroids don’t prevent pregnancy, and many women with fibroids conceive without fertility treatment.
Which Fibroids Are Most Likely to Affect Fertility?
If you’ve looked at your ultrasound report, you may have seen terms like submucosal, intramural or subserosal. These names simply describe where the fibroid is growing.
- Submucosal fibroids grow just beneath the uterine lining and extend into the uterine cavity. Because they can change the space where an embryo implants, they’re the type most likely to affect fertility.
- Intramural fibroids grow within the muscular wall of the uterus. They’re the most common type. Smaller intramural fibroids often have little or no effect on fertility, while larger ones may distort the uterine cavity and interfere with implantation.
- Subserosal fibroids grow on the outside of the uterus. Because they grow away from the uterine cavity, they’re the least likely to affect your ability to become pregnant.
Can Fibroids Cause Pregnancy Complications?
Many women also wonder whether fibroids can affect pregnancy after they conceive.
While some fibroids may increase the risk of certain complications, it’s important to keep the bigger picture in mind: most women with fibroids have healthy pregnancies and healthy babies.
Depending on their size and location, fibroids may increase the risk of:
- Miscarriage, particularly if they significantly distort the uterine cavity
- Preterm labor or preterm birth
- Breech or other abnormal fetal positioning
- Cesarean delivery if a fibroid blocks the birth canal or affects the baby’s position
These complications don’t happen to everyone. Throughout pregnancy, your baby’s growth and development will be monitored, and any issues will be addressed by your obstetrician or midwife.
Fibroids and Family Planning: Why Timing Matters
If you’re thinking about getting pregnant — whether that’s in the next few months or a few years from now — it’s worth talking with your healthcare provider about your fibroids early.
This isn’t about rushing into treatment. It’s about understanding your options and making informed decisions based on your individual situation.
Timing can matter, especially if you’re planning a pregnancy later in your reproductive years. Fertility naturally declines with age, and fibroids can sometimes grow or change over time. Having a conversation before you’re actively trying to conceive can help you understand whether your fibroids are likely to affect pregnancy or whether they simply need to be monitored.
Whether you’re planning for your first child or hoping to grow your family, an early evaluation can help your care team develop a plan that’s tailored to your symptoms, fertility goals and overall health.
Should Fibroids Be Treated Before Trying to Conceive?
There’s no one-size-fits-all answer, and that’s actually good news.
Not every fibroid needs treatment. If your fibroids are small, aren’t causing symptoms and aren’t affecting the uterine cavity, your healthcare provider may simply recommend monitoring them over time.
If treatment is recommended, the best option depends on several factors, including the size, number and location of your fibroids, your symptoms and your family-planning goals. Treatment options may include:
- Medical management: Hormonal medications, such as birth control pills or hormonal IUDs, may help manage heavy bleeding and other symptoms. While these treatments don’t remove fibroids, they can provide relief for women who aren’t trying to become pregnant right away.
- Minimally invasive procedures: Depending on your individual situation, your physician may recommend procedures such as hysteroscopy, high-intensity focused ultrasound (HIFU), uterine artery embolization (UAE) or Sonata. Sonata uses radiofrequency energy to treat fibroids from inside the uterus without incisions. Performed as an outpatient procedure, it can relieve symptoms while preserving the uterus and typically offers a shorter recovery than traditional surgery for appropriately selected patients.
- Myomectomy: If fibroids are affecting fertility or significantly changing the shape of the uterine cavity, a myomectomy may be recommended. This procedure removes fibroids while preserving the uterus and has long been an important treatment option for women who hope to become pregnant.
The goal isn’t to treat every fibroid — it’s to determine whether treatment is likely to improve your symptoms, support a healthy pregnancy or increase your chances of conceiving. Together, you and your healthcare provider can choose the right approach.
When Should You See a Doctor?
It’s a good idea to schedule an evaluation if:
- You’ve been diagnosed with fibroids and are thinking about getting pregnant.
- You’ve been trying to conceive without success.
- You have heavy or painful periods, pelvic pressure or bleeding between periods.
- You know you have fibroids and are already pregnant.
- You simply want to understand how fibroids may affect your family-planning goals.
You don’t have to wait until you’re having trouble getting pregnant to start the conversation. Meeting with your healthcare provider early can give you clarity, answer your questions and help you make informed decisions about your reproductive health.
