Some people with uterine fibroids have difficulty getting pregnant or carrying a baby to term. Evidence shows that certain types of fibroids may be more strongly linked to infertility than others, depending on where they are located. Learn about how different kinds of fibroids impact fertility, and what you can do to improve your chances of conceiving, carrying, and safely giving birth.* 

What the researchers did

Fibroids are estimated to directly cause infertility in up to 3% of women. Depending on where the fibroids are located, they can also cause spontaneous abortions, also known as miscarriages. 

Fibroids can vary in size, location, number, and whether or not they cause symptoms, but they are often categorized by location. Based on where they develop, they are typically grouped into four different types:

• Cervical (in the cervix)
• Submucosal (extending into the uterine cavity)
• Subserosal (bulging outward from the uterus)
• Intramural (within the muscle of the uterine wall)
• Pedunculated (grow on stems that can be attached either to the inside or outside of the uterus)

In a 2021 study published in the scientific journal Diagnostics, a group of researchers collected evidence from nine different fibroid/fertility studies and organized the data based on where the fibroids were located. 

What they found

Their data showed that the location of a fibroid may be relevant to whether someone is able to conceive and carry a pregnancy to term.

The researchers found that patients with subserosal fibroids had similar pregnancy rates, live birth rates, and miscarriage rates as people without fibroids. The scientists concluded that subserosal fibroids are not likely linked with infertility.

Fibroids that interfered with the shape of the uterine cavity, however, including intramural and submucosal fibroids, were linked with poorer pregnancy outcomes. Among women undergoing in vitro fertilization (IVF), patients with intramural or submucosal fibroids experienced lower pregnancy, implantation, and live delivery rates compared to those whose infertility was not due to fibroids. 

The findings also showed, however, that removing the fibroids can improve someone’s chances of getting pregnant and safely carrying and delivering the baby.

What it means

As the evidence suggests, you are more likely to have difficulty having a successful pregnancy if your fibroids are bulging into and distorting the shape of your womb. The reasons for this are not completely clear, but experts suspect it may be a combination of factors, including:

• Increased contractions of the uterus,
• Abnormal blood vessel development, and
• Chronic inflammation.

If you are dealing with infertility because of fibroids, speak with your doctor. The size and location of your fibroid(s) will influence your treatment options. 

• Myomectomy, the surgical removal of fibroids, can be done several different ways, including vaginally and hysteroscopically. 
• Non-surgical options may include:
  • uterine fibroid embolization (UFE), 
  • radiofrequency ablation (RA), and 
  • MRI-guided focused ultrasound (MRgFUS). 

Knowing how the location of your fibroid may be affecting conception can help guide you and your healthcare provider in choosing the best treatment to help you achieve your pregnancy goals.

*Freytag, D., Günther, V., Maass, N., & Alkatout, I. (2021). Uterine Fibroids and Infertility. Diagnostics, 11(8), 1455. https://doi.org/10.3390/diagnostics11081455