Can Fibroids Cause Infertility?

You hear the word 'fibroid' at your ultrasound appointment and suddenly the room feels smaller, your heart pounds, and all you can think is: does this mean I cannot have a baby? If you have been trying to conceive, that single word can stir up fear, frustration, and a thousand anxious questions. You are not alone in this. At Malpani Infertility Clinic, we have met countless women who have faced these same doubts and found answers, support, and hope. Let us talk about what fibroids really mean for your fertility, without sugar-coating or false alarms.

What Exactly Are Fibroids?

Fibroids are non-cancerous growths made of muscle and fibrous tissue that develop in the uterus. Doctors also call them uterine leiomyomas or myomas. They are incredibly common: by age 50, up to 70 percent of women will have fibroids, and many will never even know it.

Why do they happen? The exact cause isn’t fully understood, but hormones like estrogen and progesterone play a role, and your genes can tip the odds. If your mother or sister had fibroids, you are at higher risk. Lifestyle factors such as being overweight can also encourage fibroid growth.

Most importantly, having fibroids does not mean you cannot have a baby. Most women with fibroids get pregnant naturally and carry healthy pregnancies. The real question is: do your fibroids matter for your fertility?

Watch Dr. Malpani explain fibroids and fertility in this short video: here.

Different Types of Fibroids: Which Ones Matter for Fertility?

Your uterus has three layers. Where a fibroid grows determines whether it can affect your ability to conceive:

• Submucosal fibroids: Grow just under the lining of the uterus (the endometrium) and stick into the uterine cavity. These are the most important when it comes to fertility, but they are also the rarest.
• Intramural fibroids: Found within the muscular wall (myometrium). These make up about 40 percent of all fibroids. Large ones can sometimes affect fertility.
• Subserosal fibroids: Grow on the outside surface of the uterus, under the outer covering (serosa). These are the most common type—about 55 percent—and rarely cause fertility issues.

Some fibroids are attached directly to the uterus, while others dangle by a stalk (called pedunculated fibroids).

Fibroids inside the uterine cavity (submucosal type) are the ones most likely to block implantation and cause infertility.

How Can Fibroids Impact Getting Pregnant?

While most fibroids do not prevent pregnancy, there are situations where they can get in the way. Here is how fibroids might affect fertility:

• Altering the shape of the cervix, which can make it harder for sperm to enter the uterus
• Blocking the fallopian tubes, so the egg and sperm cannot meet
• Distorting the uterine cavity, making it difficult for the embryo to implant
• Reducing blood flow to the uterine lining, which can stop an embryo from growing properly

Submucosal fibroids are the biggest troublemakers: their position inside the cavity acts like a physical barrier, making it hard for an embryo to find a good spot to settle. Large intramural fibroids (over 6 cm) can sometimes reduce fertility, but this is debated among doctors. If fibroids block your fallopian tubes, natural conception becomes very difficult.

Still, in the vast majority of cases, fibroids are simply bystanders. If you are struggling to get pregnant, do not panic or rush into surgery. It is crucial to rule out other, far more common causes of infertility first.

What If You Get Pregnant With Fibroids?

If you are already pregnant and have fibroids, you are probably wondering what to expect. Most fibroids do not grow during pregnancy, but some can get bigger, especially in the first trimester. Here is what you might face:

• Miscarriage: There is a slightly higher risk, but most women go on to have healthy pregnancies.
• Preterm delivery: The baby could arrive before 37 weeks, but this is still uncommon.
• Breech presentation: The baby may be feet-first instead of head-first.
• Placental abruption: The placenta may separate too early, but this is rare.
• Cesarean section: Women with fibroids are more likely (up to six times) to need a C-section.
• Pain: Occasionally, fibroids can outgrow their blood supply and cause pain (called red degeneration).
• Frequent urination: Large fibroids may press on the bladder.

Despite these risks, most women with fibroids have smooth pregnancies and healthy babies. Medical monitoring and individual care make all the difference.

How Do Doctors Diagnose Fibroids?

Many women discover fibroids during a routine pelvic exam or ultrasound—sometimes they are so small, they cause no symptoms at all. When fibroids are suspected to impact fertility, more detailed tests help us understand their size, number, and exact location:

• Ultrasound: The first test, shows fibroids and where they are inside or on the uterus.
• Hysterosonogram (saline infusion sonogram): A special ultrasound where saltwater is placed in the uterus to show if fibroids are bulging into the cavity.
• Hysterosalpingogram (HSG): Uses dye and X-rays to check for blockages or distortions in the uterine cavity.
• Hysteroscopy: A thin telescope lets the doctor see directly inside the uterus—this is the gold standard for checking fertility-impacting fibroids.
• MRI: Gives very detailed images but is rarely needed due to cost.

If you have symptoms like heavy periods, pelvic pain, or unexplained infertility, these tests can pinpoint what is happening—and whether your fibroids are just an innocent bystander or the main culprit.

When Should Fibroids Be Treated for Fertility?

This is where many women are given misleading advice. The truth is: most fibroids in women trying to conceive do not need treatment. Unnecessary surgery can actually harm your fertility by causing scar tissue or damaging the uterus.

• Submucosal fibroids: If they are inside the uterine cavity or badly distort it, removal is strongly advised. The best and least invasive way is through hysteroscopic myomectomy—removing the fibroid through the vagina without any cuts on your belly.
• Large intramural fibroids: If bigger than 6 cm, and especially if you have had failed IVF or miscarriages, surgical removal might be considered after weighing risks and benefits.

Treatments include:

• Hysteroscopic myomectomy: Ideal for submucosal fibroids. No external incisions, quick recovery, and preserves fertility.
• Myomectomy (open, laparoscopic, or robotic): Removes fibroids from the wall or outer surface. Minimally invasive techniques mean less pain and faster healing, but are only needed in selected cases.
• Hormonal therapy (like GnRH agonists): Can shrink fibroids before surgery but is not a permanent solution.
• Birth control pills or IUDs: Help with heavy bleeding, not fertility.
• Anti-inflammatory drugs: Relieve pain.
• Uterine artery embolization: Blocks blood flow and shrinks fibroids, but its effect on future fertility is unclear—this is rarely recommended if you want children.

After surgery, your doctor will usually advise waiting at least one menstrual cycle before trying to conceive, to let your uterus heal. Sometimes, a planned C-section is recommended for delivery, depending on the surgery type.

Removing the wrong fibroid—or operating when it is not needed—can do more harm than good.

Living With Fibroids: What Can You Do?

Fibroids are often part of your life for many years. While you cannot always prevent them, you can manage symptoms and support your fertility:

• Eat well: More fruits, vegetables, and whole grains. Limit red meat. A healthy diet can help control hormones that influence fibroid growth.
• Stay active: Regular exercise helps maintain a healthy weight, which can reduce hormone levels that fuel fibroids.
• Track your symptoms: Keep a diary of bleeding, pain, or pressure. This helps your doctor understand what is changing.
• Regular checkups: Especially after fibroid surgery, pelvic exams and ultrasounds are important. For fertility planning, schedule exams before ovulation (around day 12 of your cycle).

Fibroids can sometimes return after treatment. New ones might grow, but not all will need another procedure. The key is ongoing monitoring and honest conversations with your doctor about your symptoms and your fertility goals.

Get Honest, Expert Guidance

If you have been told that fibroids are the reason you are not getting pregnant, do not accept that answer blindly. At Malpani Infertility Clinic, we believe in looking at the whole picture, not just blaming the first thing we see on a scan. Sometimes fibroids are the cause, but often they are not—and unnecessary surgery can delay what you want most: a healthy baby in your arms.

Our mission is to give you clear answers, comfort, and a plan that truly fits your situation. If you are worried about fibroids and your fertility—or if you just want straight, no-nonsense advice—speak to an expert fertility advisor for personal guidance on your next steps.