Can You Conceive with Uterine Fibroids? Fertility, Pregnancy Risks, and What to Expect

What are Uterine Fibroids?

Uterine fibroids are non-cancerous growths that develop from the muscle layer of the womb. Also known as leiomyomas or myomas, they are one of the most common gynaecological conditions in people of reproductive age.

Fibroids can be single or multiple and vary greatly in size, from very small nodules to large masses that enlarge the uterus. They are usually classified by where they sit in the womb:

• Subserosal (on the outer surface of the uterus)
• Intramural (within the muscle wall)
• Submucosal (bulging into the uterine cavity)

Most fibroids do not turn into cancer, and some cause no symptoms at all. However, some can lead to heavy periods, pelvic pain, or a feeling of pressure on the bladder or bowel, and in certain cases, they may affect fertility or pregnancy.

Can You Conceive Naturally With Uterine Fibroids?

Many people with fibroids can still conceive naturally and have healthy pregnancies. For a large number, fibroids are an incidental finding during scans and do not significantly interfere with ovulation, fertilisation, or implantation.

Whether fibroids affect your ability to conceive depends largely on:

• Their location in relation to the uterine cavity
• The size of fibroids
• How many fibroids are present
• Whether they distort the internal shape of the womb or block the fallopian tubes

Small fibroids that sit on the outside of the uterus and do not distort the cavity (subserosal fibroids) generally have little effect on natural conception. Fibroids that change the cavity shape or are very large are more likely to be linked with difficulty conceiving or recurrent pregnancy loss.

How Do Fibroids Affect Fertility?

Fibroids can affect fertility in several ways, although not every fibroid will have these effects. The impact tends to be more significant when fibroids distort the cavity where a pregnancy would grow.

Possible mechanisms include:

• Cavity distortion: Fibroids bulging into the uterine cavity (submucosal) can interfere with embryo implantation.
• Tube blockage: Fibroids near the fallopian tube openings can partially or completely prevent sperm and egg from meeting.
• Cervical changes: Fibroids near the cervix may alter the canal, making it more difficult for sperm to enter.
• Blood flow changes: Large intramural fibroids may affect blood flow to the uterine lining, which could influence implantation or early pregnancy development.

If you are wondering whether you can conceive with uterine fibroids, a key question is whether your fibroids distort the cavity or block the tubes. Imaging such as ultrasound, saline sonography or MRI can help clarify this.

Which Fibroids Are Most Likely To Cause Problems?

Not all fibroids carry the same risk for fertility and pregnancy. Their size, number, and especially their position make a big difference.

Fibroids more likely to affect fertility include:

• Submucosal fibroids: These protrude into the uterine cavity, and they are more likely to impact fertility and result in miscarriages.
• Intramural fibroids that distort the cavity: Larger fibroids within the muscle wall can push into the cavity and cause similar problems to submucosal fibroids.

Fibroids that are less likely to affect fertility include:

• Small intramural fibroids that do not distort the cavity
• Subserosal fibroids on the outside of the uterus, which usually do not affect implantation or the passage of sperm

Your gynaecologist or fertility specialist can explain which category your fibroids fall into and how likely they are to interfere with conception.

What Are the Pregnancy Risks If You Have Fibroids?

If you become pregnant with fibroids, most pregnancies will still be successful, but certain complications are more common than in pregnancies without fibroids. The overall risk depends on the size, number and location of the fibroids.

Possible pregnancy‑related risks include:

• Pain: Fibroids can outgrow their blood supply during pregnancy, causing degeneration and significant pain.
• Miscarriage: Women with fibroids may have a higher risk of miscarriage, particularly when they distort the uterine cavity.
• Bleeding in early or late pregnancy: Fibroids can be linked with bleeding episodes.
• Preterm labour and birth: The chance of going into labour early is increased in some cases.
• Placental problems: Fibroids may increase the risk of placental complications, including placenta previa, which is characterised by the positioning of the placenta in the lower part of the uterus, and placental abruption.
• Malpresentation: Fibroids can sometimes affect how the baby is positioned in the womb, making breech or sideways (transverse) positions more likely.
• Caesarean birth and postpartum haemorrhage: Fibroids are associated with higher rates of caesarean section and heavy bleeding after delivery.

Despite these increased risks, many people with fibroids have uncomplicated pregnancies with appropriate monitoring and care.

When Should Fibroids Be Treated Before Pregnancy?

Fibroid treatment before trying to conceive is not always necessary. Decisions are usually based on your symptoms, age, previous pregnancy history, and the characteristics of your fibroids.

Treatment may be considered if:

• You have submucosal fibroids or intramural fibroids that clearly distort the uterine cavity.
• You have been trying to conceive for a year or more without success, and other causes have been excluded.
• You have had repeated miscarriages, and fibroids are thought to be a contributing factor.
• Fibroids are large and cause severe symptoms such as heavy bleeding, pain, or pressure.

Surgical removal of fibroids (myomectomy) is often the preferred option when fertility is a priority. Other treatments, such as uterine artery embolisation or focused ultrasound, may affect the uterine blood supply and are usually considered more cautiously in those who still wish to have children.

Can Assisted Reproduction Help If You Have Fibroids?

Methods of assisted reproduction, including intrauterine insemination or IVF, can help some people with fibroids conceive. However, this is applicable only in cases where additional problems, such as age or male factors, come into play.

If your fibroids do not significantly distort the cavity and your tubes are open, you may be able to try assisted reproduction without fibroid surgery, depending on your overall situation. If fibroids are clearly affecting the uterine cavity, your specialist may recommend treating them first to improve implantation and lower the risk of miscarriage, in line with ESHRE recommendations.

Assisted reproduction does not address the structural impact of fibroids inside the womb, but it can help bypass other barriers to conception, such as tubal problems or ovulation issues.

What Should You Expect During Pregnancy With Fibroids?

If you become pregnant and have fibroids, your care team is likely to suggest closer monitoring. This is to watch both your baby’s growth and any changes in your fibroids.

During pregnancy, you can expect:

• More frequent ultrasound scans to check the baby’s growth and placental position.
• Monitoring of fibroid size and number, especially large or multiple fibroids.
• Discussion of pain management strategies if fibroid degeneration occurs.
• A birth plan that considers the size and position of fibroids, particularly if they are near the cervix or lower uterine segment.

In most cases, fibroids are not removed during pregnancy because surgery carries a higher risk of heavy bleeding. Any necessary myomectomy is usually planned before pregnancy or after delivery, unless there is an emergency.

How Can You Prepare If You Are Planning A Pregnancy?

If you are planning a pregnancy and know you have fibroids, there are practical steps you can take to feel more in control.

You can:

• Undergo a thorough pelvic ultrasound (and possibly an MRI) to determine the size and position of your fibroids.
• Discuss with a gynaecologist or fertility specialist whether any fibroids should be removed or monitored before trying to conceive.
• Improve your overall health by managing conditions such as anaemia, thyroid disease, or diabetes.
• Focus on lifestyle measures that support fertility, such as maintaining a healthy weight, not smoking, moderating alcohol, and managing stress.

If you are concerned about whether you can conceive with uterine fibroids, a personalized consultation that reviews your scans, your age, and your fertility history will give the clearest answer for your situation.

Conclusion

Uterine fibroids are common, and having them does not always mean that you will necessarily face problems conceiving and carrying your baby safely throughout pregnancy. In many cases, women who have uterine fibroids conceive without difficulty and give birth to healthy babies, especially if the fibroids are small in size and do not distort the cavity of the uterus.

If you are concerned about conceiving with uterine fibroids, the most important step is to understand the pattern of your fibroids and how they relate to the womb’s lining and fallopian tubes. With careful assessment, some people can try to conceive with monitoring alone, while others may benefit from fibroid treatment or assisted reproduction before pregnancy. Working closely with your doctor can help you plan the next steps in a way that supports your fertility goals, manages symptoms, and keeps both you and your baby safe.