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Mr Parijat Bhattacharjee, Private Consultant Gynaecologist, Harrow, Brentford, Northwood, London, UK / Media / Videos » Fibroids & Fertility

Fibroids & Fertility

Fibroids & Fertility
Posted on: 03-Jul-2026

This video, titled "Fibroids & Fertility" by Gynae Consultant, reviews the classification of uterine fibroids, their controversial link to infertility and miscarriage, and how surgical versus non-surgical treatments affect a patient's ability to conceive.

Prevalence and Classification

  • High Prevalence: Uterine fibroids are the most common benign pelvic tumors in women. Approximately 30% of women over the age of 30 have them, rising to nearly 70% by age 50.
  • FIGO Classification (Types 0 to 7):
    • Submucosal (Types 0, 1, 2): Protrude inward into the uterine cavity to varying degrees.
    • Intramural (Types 3, 4): Grow entirely within the muscular wall of the uterus.
    • Subserosal (Types 5, 6): Protrude outward from the external surface of the uterus.
    • Pedunculated (Type 7): Grow on a distinct outer stalk.
    • Note: Parasitic and cervical fibroids also exist.

How Fibroids Impact Fertility

While 10% to 15% of women seeking fertility treatments have fibroids, they are the sole identifiable cause of infertility in only 2% to 3% of cases. They can disrupt reproduction in two main ways:

  • Anatomical Distortion: Submucosal fibroids distort the shape of the uterine cavity, while others situated near the fallopian tubes can physically block them.
  • Functional Disturbances: Fibroids can alter the uterine lining (endometrium), disrupt normal muscular contractions (myometrial peristalsis), alter local blood flow, and modify the hormonal environment, ultimately impeding the movement of sperm, eggs, or embryos.

Impacts on IVF and Miscarriage

  • Negative Outcomes: Meta-analyses show that submucosal fibroids, and to a lesser degree intramural fibroids, negatively impact clinical pregnancy rates and live birth rates while increasing miscarriage rates.
  • The Intramural Controversy: It remains medically controversial whether intramural fibroids that do not distort the cavity affect IVF success, as most supporting evidence comes from observational studies rather than randomized controlled trials (RCTs).
  • Miscarriage Risk: Observational data suggests multiple fibroids can nearly double first-trimester miscarriage rates compared to having a single fibroid. Historically, removing them (myomectomy) has been shown to reduce miscarriage rates from roughly 40% down to 20%.

Treatment Options and Fertility Outcomes

Surgical Management (Myomectomy)

  • Natural Fertility Boost: Historical and recent data reviews confirm that a myomectomy can increase natural pregnancy rates by roughly 40%. Choosing a laparoscopic or hysteroscopic approach over traditional open surgery shows no significant difference in final data outcomes.
  • Assisted Reproduction: Hysteroscopic removal of submucosal fibroids does not harm future embryo implantation. Furthermore, observational data suggests that removing any intramural or subserosal fibroid larger than 5 cm yields a positive impact on IVF outcomes.

Non-Surgical Management (Medical & Procedures)

  • GnRH Analogs: Used pre-operatively for about three months to shrink fibroids by inducing a temporary menopause-like state. Because they suppress reproductive hormones, they do not help a patient achieve pregnancy while actively taking them.
  • Selective Progesterone Receptor Modulators (e.g., Ulipristal Acetate): Also used pre-operatively, though recent safety controversies exist and they are not recommended for patients currently attempting to conceive.
  • Ablation & Ultrasound: Technologies like MRI-guided high-intensity focused ultrasound (HIFU) and gene therapy are newer options with very limited data regarding their impact on fertility.
  • Uterine Artery Embolization (UAE): Although common, UAE has documented negative effects on fertility. Retrospective data links it to lower clinical pregnancy rates, higher miscarriage rates, preterm labor, increased Cesarean section rates, and postpartum hemorrhage. Post-procedural evaluations frequently reveal uterine adhesions, necrotic tissue, and reduced monthly fecundity (by 2.1%), despite ovarian reserve remaining intact.