Gynecology · Uterine Leiomyoma

Navigating Fertility and Pregnancy with Uterine Fibroids

At a Glance

Fibroid location matters more than the diagnosis alone: those that bulge into the uterine cavity are most likely to affect implantation and early pregnancy loss. When treatment is needed for future pregnancy, myomectomy is generally preferred over uterine artery embolization.

For many people, the diagnosis of uterine fibroids comes at a time when they are also thinking about starting or growing a family. It is natural to feel a sense of urgency or concern about how these growths might affect your ability to conceive or carry a healthy pregnancy. Fibroids are only one possible contributor to infertility; age, tubal factors, ovulation, sperm factors, and ovarian reserve should all be evaluated rather than attributing infertility automatically to an imaging finding ^[1]. However, because fibroids can change the environment of the uterus, understanding their location and your treatment options is a vital part of your fertility journey.

How Location Impacts Fertility

When it comes to fertility, an important factor is the fibroid’s location—specifically its relationship to the endometrium (the inner lining of the uterus) ^[1]^[2].

Submucosal Fibroids (FIGO Types 0, 1, 2): These are the primary concern for fertility ^[2]. Because they bulge into or live entirely within the uterine cavity, they can interfere with how an embryo attaches (implantation) or increase the risk of early pregnancy loss ^[3]^[4].
Intramural Fibroids (FIGO Type 3 and 4): These live in the muscle wall. While they don’t always affect fertility, some studies suggest that larger intramural fibroids (e.g., over 3–4 cm) might be a possible factor in lowering IVF success if they distort the overall shape of the uterus, though this is not a universal rule ^[5]^[6].
Subserosal Fibroids: These grow on the outside of the uterus and generally have no measurable impact on your ability to get pregnant ^[2]^[1].

Choosing the Right Path for Conception

If fibroids are identified as a barrier to pregnancy, the standard approach is to remove them while keeping the uterus intact. This is known as a myomectomy ^[1].

The Gold Standard: Myomectomy

Myomectomy is the recommended treatment for those actively trying to conceive, especially if the fibroids are submucosal ^[7].

Hysteroscopic Myomectomy: For fibroids inside the cavity (Types 0–2), this “incision-less” procedure is often the first choice. Research shows it can significantly improve clinical pregnancy rates in people with otherwise unexplained infertility ^[7]^[8].
Laparoscopic or Abdominal Myomectomy: These are used for fibroids deeper in the muscle. While they require more recovery time, they are highly effective at restoring the uterine environment for a future pregnancy ^[9].

Why UAE is Generally Discouraged

While Uterine Artery Embolization (UAE) is an excellent option for managing heavy periods, it is generally not recommended for those who strongly desire a future pregnancy ^[1].

Miscarriage Risk: Studies have found higher rates of miscarriage and lower live-birth rates in pregnancies that occur after UAE compared to those after myomectomy ^[10]^[1].
Ovarian Reserve: There are concerns that UAE could potentially reduce blood flow to the ovaries, which might affect your “egg count” (ovarian reserve), particularly if you are over age 35 ^[1]^[11].

Being Pregnant with Fibroids

If you are already pregnant and have fibroids, your medical team will move into a phase of increased surveillance. While most pregnancies proceed without major issues, fibroids can introduce specific challenges.

Red Degeneration: Managing Pain

As a pregnancy progresses, the high levels of hormones can cause fibroids to grow rapidly. Sometimes, a fibroid grows so fast that it outstrips its own blood supply, leading to a process called red degeneration ^[12].

The Experience: This can cause acute, intense abdominal pain, sometimes accompanied by a low-grade fever ^[12].
The Management: Acetaminophen may be appropriate under clinician guidance, while NSAID use is gestational-age dependent. Severe or persistent pain, fever, bleeding, or reduced fetal movement requires prompt obstetric assessment to exclude other emergencies, as you cannot safely diagnose degeneration at home ^[13].

Potential Pregnancy Complications

Because fibroids take up space and can affect the blood flow to the placenta, they are associated with certain risks:

Fetal Position: Fibroids can make it harder for a baby to flip into the “head-down” position, increasing the chance of a breech presentation ^[14]^[15].
Preterm Birth: There is a slightly higher risk of the baby arriving before 37 weeks, especially if there are multiple or very large fibroids ^[14]^[16].
Placental Issues: Fibroids located near the cervix or the placental attachment site can increase the risk of placenta previa (where the placenta covers the cervix) or placental abruption (where the placenta detaches early) ^[17]^[18].

Planning for Delivery

If you have had a myomectomy or if you have large fibroids, your delivery plan may change.

The “Opened Cavity” Rule: If your surgeon made a deep uterine-wall incision that entered the endometrial cavity (often the case in abdominal or laparoscopic myomectomy), you will likely be advised to have a planned C-section for future deliveries to prevent the risk of uterine rupture ^[19]^[20]^[21]. A routine hysteroscopic procedure does not automatically mandate a cesarean delivery.
Postpartum Hemorrhage: Fibroids can prevent the uterus from contracting efficiently after birth, which increases the risk of heavy bleeding immediately after delivery (postpartum hemorrhage) ^[14]^[22]. Your care team will be prepared for this with medications that help the uterus firm up quickly ^[23].

Timing Your Pregnancy After Surgery

Healing takes time. There is no universally established minimum interval that guarantees scar strength. The timeline depends heavily on the surgical route, depth of incisions, complications, and your age ^[24]^[25]. Your surgeon will give you a specific timeline based on these individualized factors ^[26].

Common questions in this guide

Can uterine fibroids make it harder to get pregnant?

It depends mainly on where the fibroids are located. Submucosal fibroids that bulge into the uterine cavity are most likely to interfere with implantation and may increase the risk of early pregnancy loss; larger intramural fibroids that change the uterine shape may also affect IVF success. Subserosal fibroids on the outside of the uterus generally do not measurably affect the ability to become pregnant.

What type of fibroid surgery is used when I want a future pregnancy?

Myomectomy removes fibroids while leaving the uterus in place and is often recommended when fibroids are affecting fertility, particularly submucosal fibroids. Hysteroscopic myomectomy is commonly used for fibroids in the uterine cavity, while laparoscopic or abdominal myomectomy may be used for deeper fibroids in the uterine wall. The best approach depends on the fibroid’s size, number, location, and your reproductive goals.

Is uterine artery embolization a good option if I may want to become pregnant?

Uterine artery embolization can help control heavy periods but is generally discouraged when preserving future fertility is a major goal. Compared with myomectomy, pregnancies after embolization have been associated with higher miscarriage rates and lower live-birth rates, and there are concerns about effects on ovarian reserve. Discuss the trade-offs with a gynecologist or fertility specialist.

What risks should I know about if I am pregnant with fibroids?

Most pregnancies with fibroids do not develop major problems, but closer monitoring may be needed. Fibroids can increase the chance of breech presentation, preterm birth, placenta previa or placental abruption, and heavy bleeding after delivery. Risk depends in part on the fibroids’ size, number, and location.

What is red degeneration, and when should I seek care during pregnancy?

Red degeneration occurs when a fibroid grows faster than its blood supply and can cause sudden, intense abdominal pain with sometimes a low-grade fever. Severe or persistent pain, fever, vaginal bleeding, or reduced fetal movement needs prompt obstetric assessment because these symptoms can have other urgent causes. Acetaminophen may be appropriate under clinician guidance, while NSAID use depends on the stage of pregnancy.

How soon can I try to conceive after a myomectomy?

There is no single waiting period proven to guarantee that the uterine scar is strong enough. Your surgeon will consider the surgical route, depth and location of the incisions, complications, and your age when recommending when to try. Follow that individualized plan rather than relying on a fixed number of months.

Will I need a C-section after fibroid surgery?

A planned C-section may be recommended if a myomectomy involved a deep uterine-wall incision that entered the uterine cavity, because of concern about uterine rupture during labor. A routine hysteroscopic myomectomy does not automatically require a C-section. Your surgeon’s operative report and obstetric team should guide the delivery plan.

Curated prompts to bring to your next appointment.

1.Based on my imaging, are any of my fibroids classified as FIGO Type 0, 1, or 2, and how are they affecting my uterine lining?
2.If we decide on a myomectomy, what is the risk that you will need to make a deep incision in the uterine wall, and how would that affect my future delivery options?
3.How long do you recommend I wait to conceive after my surgery to ensure the uterine wall has healed?
4.If I become pregnant with my current fibroids, what specific additional monitoring will you provide?
5.In my case, why is myomectomy a safer or more effective choice for fertility than Uterine Artery Embolization (UAE)?
6.What is the plan for managing significant pain if it occurs during my second or third trimester?

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Key takeaways

Fibroid location matters for fertility: submucosal FIGO types 0–2 are most likely to affect implantation and early pregnancy loss.
For people who want a future pregnancy, myomectomy is generally preferred when fibroids interfere with the uterine cavity, while uterine artery embolization is generally discouraged.
Pregnancies with fibroids often need closer monitoring because of risks such as breech presentation, preterm birth, placental problems, and postpartum hemorrhage.
Red degeneration can cause sudden, severe abdominal pain and a low-grade fever during pregnancy, so severe or persistent symptoms need prompt obstetric assessment.
The recommended wait after myomectomy and the delivery plan depend on the depth of the uterine incisions; a deep incision entering the cavity may lead to a planned C-section.

References (26)

1
The management of uterine fibroids in women with otherwise unexplained infertility.
Carranza-Mamane B, Havelock J, Hemmings R, et al.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2015; (37(3)):277-285 doi:10.1016/S1701-2163(15)30318-2.
PMID: 26001875
2
Fibroids and natural fertility: a systematic review and meta-analysis.
Somigliana E, Reschini M, Bonanni V, et al.
Reproductive biomedicine online 2021; (43(1)):100-110 doi:10.1016/j.rbmo.2021.03.013.
PMID: 33903032
3
Management of fibroids prior to in vitro fertilization/intracytoplasmic sperm injection: A pragmatic approach
Sarıdoğan E, Sarıdoğan E
Journal of the Turkish German Gynecological Association 2019; (20(1)):55-59 doi:10.4274/jtgga.galenos.2018.2018.0148.
PMID: 30444214
4
Impact of fibroids on fertility, pregnancy loss, and preconception management.
Ezike O, Schneyer R, Wright K, Hamilton K
Current opinion in obstetrics & gynecology 2025; (37(4)):207-214 doi:10.1097/GCO.0000000000001033.
PMID: 40299726
5
The effect of ≤6 cm sized noncavity-distorting intramural fibroids on in vitro fertilization outcomes: a systematic review and meta-analysis.
Erden M, Uyanik E, Polat M, et al.
Fertility and sterility 2023; (119(6)):996-1007 doi:10.1016/j.fertnstert.2023.02.018.
PMID: 36813123
6
The impact of FIGO type 3 fibroids on in-vitro fertilization outcomes: A nested retrospective case-control study.
Bai X, Lin Y, Chen Y, Ma C
European journal of obstetrics, gynecology, and reproductive biology 2020; (247()):176-180 doi:10.1016/j.ejogrb.2019.12.018.
PMID: 32114322
7
Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline.
,
Fertility and sterility 2017; (108(3)):416-425 doi:10.1016/j.fertnstert.2017.06.034.
PMID: 28865538
8
European Society for Gynaecological Endoscopy (ESGE) Good Practice Recommendations on surgical techniques for Removal of Fibroids: Part 2 Hysteroscopic Myomectomy.
Clark TJ, Antoun L, Di Spiezio Sardo A, et al.
Facts, views & vision in ObGyn 2024; (16(4)):383-397 doi:10.52054/FVVO.16.4.054.
PMID: 39718323
9
Route of myomectomy and fertility: a prospective cohort study.
Wise LA, Thomas L, Anderson S, et al.
Fertility and sterility 2022; (117(5)):1083-1093 doi:10.1016/j.fertnstert.2022.01.013.
PMID: 35216832
10
Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes.
Zanolli NC, Bishop KC, Kuller JA, et al.
Obstetrical & gynecological survey 2022; (77(8)):485-494 doi:10.1097/OGX.0000000000001052.
PMID: 35932289
11
Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes.
Jegaden M, Bleas C, Debras E, et al.
Journal of minimally invasive gynecology 2023; (30(6)):494-501 doi:10.1016/j.jmig.2023.02.012.
PMID: 36813132
12
Fibroids-related complications in pregnancy: a twelve-year long experience at a maternal-fetal medicine referral center.
Lazzarin S, Ornaghi S, Roncaglia N, et al.
Minerva obstetrics and gynecology 2023; (75(6)):520-525 doi:10.23736/S2724-606X.22.05146-6.
PMID: 36193831
13
Preterm birth and uterine fibroid necrosis: The clinical presentation illustrated in a case series.
Don EE, Vissers G, Landman AJEMC, et al.
European journal of obstetrics, gynecology, and reproductive biology 2024; (299()):156-162 doi:10.1016/j.ejogrb.2024.06.002.
PMID: 38870742
14
Uterine fibroids and preterm birth risk: A systematic review and meta-analysis.
Pérez-Roncero GR, López-Baena MT, Ornat L, et al.
The journal of obstetrics and gynaecology research 2020; (46(9)):1711-1727 doi:10.1111/jog.14343.
PMID: 32633025
15
The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis.
Li H, Hu Z, Fan Y, Hao Y
BMC pregnancy and childbirth 2024; (24(1)):345 doi:10.1186/s12884-024-06545-5.
PMID: 38710995
16
Relationship between a uterine fibroid diagnosis and the risk of adverse obstetrical outcomes: a cohort study.
Karlsen K, Schiøler Kesmodel U, Mogensen O, et al.
BMJ open 2020; (10(2)):e032104 doi:10.1136/bmjopen-2019-032104.
PMID: 32071172
17
Uterine fibroids increase the risk of preterm birth and other adverse birth events: a systematic review and meta-analysis.
Wang X, Wang G, Han R, et al.
Translational pediatrics 2022; (11(6)):978-986 doi:10.21037/tp-22-215.
PMID: 35800281
18
Fibroids and pregnancy.
Ramasauskaite D, Purandare N, Diaz I, et al.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2026; (172(1)):51-58 doi:10.1002/ijgo.70612.
PMID: 41195598
19
Do myomectomies alter third-trimester complications compared with women without myomectomies and uterine fibroids in situ: A retrospective cohort study of an American population database.
Ginod P, Badeghiesh A, Baghlaf H, Dahan MH
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2025; (171(1)):310-316 doi:10.1002/ijgo.70211.
PMID: 40353825
20
Fibroids and infertility.
Mocanu E, Tarlatzis B, Feldberg D, et al.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2026; (174(1)):11-16 doi:10.1002/ijgo.71062.
PMID: 42104843
21
Uterine rupture in pregnancies following myomectomy: A multicenter case series.
Kim HS, Oh SY, Choi SJ, et al.
Obstetrics & gynecology science 2016; (59(6)):454-462 doi:10.5468/ogs.2016.59.6.454.
PMID: 27896247
22
Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries.
Zhao R, Wang X, Zou L, et al.
PloS one 2017; (12(11)):e0187821 doi:10.1371/journal.pone.0187821.
PMID: 29136018
23
Do Large Uterine Fibroids Impact Pregnancy Outcomes?
Al Sulaimani R, Machado L, Al Salmi M
Oman medical journal 2021; (36(4)):e292 doi:10.5001/omj.2021.93.
PMID: 34497721
24
Clinical features at the time of non-hysteroscopic myomectomy before pregnancy, which affect adverse pregnancy outcomes: a retrospective cohort study.
Kim YR, Na ED, Jung JE, et al.
BMC pregnancy and childbirth 2022; (22(1)):896 doi:10.1186/s12884-022-05240-7.
PMID: 36463110
25
Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review.
Orlando M, Kollikonda S, Hackett L, Kho R
Journal of minimally invasive gynecology 2021; (28(3)):598-618.e1 doi:10.1016/j.jmig.2020.10.006.
PMID: 33065260
26
Impact of Uterine Artery Embolization on Subsequent Fertility Outcomes: A Meta-Analysis of 20 Years of Clinical Evidence.
Bucuri CE, Mihu D, Măluțan AM, et al.
Journal of clinical medicine 2025; (14(20)) doi:10.3390/jcm14207205.
PMID: 41156073

This page is for informational purposes only and does not constitute medical advice about fertility or pregnancy. Your gynecologist, fertility specialist, and obstetric team should tailor treatment, medication, monitoring, and delivery planning to your situation.

Get notified when new evidence is published on uterine corpus leiomyoma.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

Guide Contents