Fibroids are rarely the sole cause of infertility, but their size and location can influence reproductive outcomes. Submucosal fibroids, which grow inside the uterine cavity, can interfere with embryo implantation, increasing the risk of miscarriage in the first trimester. Larger fibroids outside the uterus (subserosal or intramural) can sometimes compress the fallopian tubes, making it harder for sperm and egg to meet, though this is less common.  

Which Fibroids Require Surgical Treatment?  

Submucosal fibroids that distort the uterine cavity are the most concerning for fertility. These are typically removed through hysteroscopic surgery, a minimally invasive procedure performed under general or local anesthesia.  

Fibroids that cause severe symptoms—such as pressure on the bladder or urinary tract, heavy bleeding leading to anemia, or significant pain—may also require surgery, even if they do not affect fertility. These procedures are often performed via laparoscopy (minimally invasive surgery) or, in some cases, laparotomy (an open surgical approach, similar to a C-section incision).  

A non-surgical alternative, uterine artery embolization (UAE), is sometimes used to shrink fibroids by blocking their blood supply. However, this procedure can reduce ovarian reserve, potentially affecting fertility and response to future ovarian stimulation for assisted reproduction.  

Learn. Improve. Maintain.  

Fibroids don’t always require treatment, but understanding their impact on fertility is essential. Learning about their effects, improving monitoring through regular medical evaluations, and maintaining a personalized approach to treatment can help women make informed reproductive choices.