What Are Fibroids?
Fibroids (also called leiomyomas or myomas) are non-cancerous growths of the muscular wall of the uterus. They can range from microscopic to the size of a grapefruit or larger, and women can have one or many. Fibroids are classified by location: submucosal (inside the uterine cavity), intramural (within the uterine wall), and subserosal (on the outer surface). The location matters more than the size when it comes to fertility — submucosal fibroids have the biggest impact, while subserosal ones often cause no fertility problems at all.
How Fibroids Can Affect Fertility
Distortion of the uterine cavity: Submucosal fibroids can prevent embryo implantation by physically interfering with the uterine lining.
Blocked fallopian tubes: Large fibroids near the tubal openings may prevent sperm meeting the egg or stop a fertilised egg reaching the uterus.
Altered blood flow: Fibroids can disrupt blood supply to the uterine lining, affecting its receptivity to an embryo.
Inflammation: Some fibroids create a pro-inflammatory environment that may impair implantation and early pregnancy.
Increased miscarriage risk: Fibroids that distort the cavity are associated with higher rates of early pregnancy loss.
Pregnancy complications: Even fibroids that allow conception can increase risks of preterm birth, abnormal placental position and caesarean delivery.
Treatment Options When Trying to Conceive
Watchful waiting: Small, asymptomatic fibroids that do not distort the uterine cavity may simply need monitoring.
Hysteroscopic myomectomy: Day-case removal of submucosal fibroids through the cervix using a telescope. Best preserves fertility and recovery is fast.
Laparoscopic or open myomectomy: Surgical removal of intramural or subserosal fibroids while preserving the uterus. Recovery is longer and pregnancy may need to be delayed 6-12 months.
Uterine artery embolisation (UAE): Generally not recommended if you want children, as it can affect ovarian blood supply.
MRI-guided focused ultrasound: Newer non-invasive option, but data on subsequent fertility is limited.
Medication: GnRH agonists shrink fibroids temporarily but cannot be used long-term and fibroids regrow when stopped.
When to Seek Specialist Advice
You have been trying to conceive for 6-12 months without success and have known fibroids
You have heavy or painful periods alongside difficulty conceiving
You have had recurrent miscarriage and fibroids have been identified
A fibroid is found on ultrasound that distorts the uterine cavity
You are over 35 with fibroids and considering trying for a baby