Fertulity IVF
Fertulity IVF

Fibroids & Fertility

Many women trying to conceive are faced with the unexpected diagnosis of fibroids, without knowing how significantly they can affect their fertility. Fibroids, especially when located inside the endometrial cavity, can block embryo implantation or cause miscarriages. Timely diagnosis and targeted fibroid removal before IVF significantly increase success rates and offers many women the opportunity to have a child.

What are fibroids?

Fibroids, also known as myomas or leiomyomas, are benign tumors that develop in the muscular wall of the uterus. They are one of the most common conditions of the female reproductive system, with occurrence rates reaching up to 70% of women before menopause. Although non-cancerous, they can significantly affect quality of life and fertility, depending on their size, number, and location within the uterus.

Types of Fibroids

Fibroids are classified mainly based on their location in relation to the uterine wall and cavity

Submucosal fibroids

Develop just beneath the inner lining of the uterus (endometrium) and protrude into the endometrial cavity. Although usually smaller in size, they have the greatest impact on fertility as they can distort the uterine cavity, affect embryo implantation, and cause bleeding or miscarriage. Hysteroscopic removal is the treatment of choice for these fibroids.

Intramural fibroids

Located within the muscular wall of the uterus and are the most common. Depending on their size, they can cause menstrual disorders, pain, and pressure symptoms. When larger than 3 centimeters or when they alter the anatomy of the endometrial cavity, they may negatively affect fertility and the success of treatments such as IVF.

Subserosal fibroids

These fibroids develop on the outer surface of the uterus, projecting into the peritoneal cavity. They usually do not directly affect fertility unless they grow very large and exert mechanical pressure on the fallopian tubes or nearby organs. Their removal is mainly suggested when they cause symptoms or interfere with the functionality of the reproductive organs.
Proper identification of the type and location of fibroids is a fundamental step for the appropriate therapeutic approach, especially when there is a goal of childbear

How do they affect fertility?

The presence of fibroids can affect a woman's fertility in various ways, primarily depending on the location, size, and number of tumors. Not all fibroids impact conception or IVF success the same way. However, when fibroids alter the normal anatomy of the uterus or block embryo implantation, the chances of conception are significantly reduced.

Fibroid location and fertility

Fibroid size and number

Statistics and implantation failure risks

The location of fibroids is perhaps the most important factor regarding their impact on fertility:

Submucosal fibroids

Cause temporary menopause and fibroid shrinkage but are not suaHave the most negative impact. Even small ones can distort the endometrial cavity and block embryo implantation, reducing the success rates of both natural conception and IVF. Their removal via hysteroscopy significantly improves outcomes.itable for long-term use due to side effects.

Intramural fibroids

When larger than 3–4 cm or located near the endometrial cavity, they can also negatively affect fertility by causing an inflammatory microenvironment, changes in blood flow, or mechanical pressure.

Subserosal fibroids

Rarely associated with fertility issues, unless they become large and obstruct fallopian tube movement or press against adjacent organs.
Size also plays an important role
Fibroids over 4–5 cm, even if not submucosal, may alter the endometrium or uterine contractions, affecting embryo receptivity. Additionally, the presence of multiple fibroids increases the likelihood of disrupting the uterus' morphology and creating a non-conducive environment for conception.
Research data has shown that:
Women with submucosal fibroids have up to 70% lower implantation rates in IVF cycles compared to women without fibroids.
Removal of fibroids, particularly submucosal or large intramural ones, can double the chances of successful implantation.
In cases of multiple or large fibroids, pregnancy chances are significantly reduced, even after repeated IVF attempts.
Each case must be evaluated individually, based on medical history, age, fibroid characteristics, and the woman's reproductive plan. Collaboration with a fertility specialist can determine the best strategy for managing fibroids and optimizing pregnancy chances.
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Symptoms & When to See a Specialist

Fibroids often cause no obvious symptoms, especially when small. However, in many cases, they can significantly impact a woman’s daily life and become a barrier to childbearing. Timely recognition of symptoms is crucial for diagnosis and appropriate therapeutic intervention.

Common fibroid symptoms

Prolonged and/or heavy menstrual bleeding (menorrhagia)
Intermenstrual bleeding
Severe menstrual pain (dysmenorrhea)
Pressure or heaviness in the pelvis or bladder
Frequent urination or incomplete bladder emptying sensation
Constipation or intestinal discomfort
Pain during intercourse (dyspareunia)
Difficulty conceiving or delayed pregnancy
Recurrent miscarriages or implantation failures in IVF
It is worth noting that symptom severity is not always related to fibroid size. Even small lesions can cause serious problems when located in critical areas within the uterus.

When to consult a specialist

If you notice any of the above symptoms or if you have been trying to conceive unsuccessfully for more than 6 months, it is important to be evaluated by a gynecologist specialized in fertility. Timely diagnosis and a personalized therapeutic approach can improve pregnancy rates and prevent complications.
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Fibroid Diagnosis

Accurate fibroid diagnosis is a key step in planning the right treatment approach, especially when pregnancy is the goal. The choice of diagnostic method depends on symptom type, fibroid location, and the woman's reproductive planning.
The most reliable diagnostic techniques include:

Ultrasound

Transvaginal ultrasound is the first-line method for fibroid diagnosis. It is non-invasive, readily available, and provides valuable information about the size, morphology, and location of fibroids in relation to the uterine cavity. In some cases, saline infusion sonography (sonohysterography) is also used to better assess the endometrial cavity and identify possible submucosal fibroids.

Hysteroscopy

Hysteroscopy is an endoscopic method that allows direct visualization of the endometrial cavity through a thin optical tube inserted through the cervix. It is the most accurate method for identifying and evaluating submucosal fibroids, offering a 3D view of the uterine interior. It can be diagnostic and therapeutic if fibroid removal is possible during the same session.

MRI (Magnetic Resonance Imaging)

MRI is mainly used in complex or multiple fibroid cases when detailed uterine anatomical mapping is needed before surgery. It offers excellent precision in determining fibroid location, depth of infiltration, and relationship with surrounding organs. It is particularly useful for women planning IVF or close to reproductive age and requiring full uterine preservation.
Choosing the appropriate diagnostic approach is always based on each woman’s individual needs and history. Proper diagnosis lays the foundation for successful, personalized treatment.

Treatment Options

Treatment for fibroids depends on various factors such as size, location, number, age, presence of symptoms, and future pregnancy plans. Available options range from conservative medication to advanced uterus-preserving surgical techniques.

Medication & hormonal management

Drug treatment aims to reduce symptoms and fibroid size, mainly in women not planning pregnancy soon.
It includes:

GnRH agonists

Cause temporary menopause and fibroid shrinkage but are not suitable for long-term use due to side effects.

Combined contraceptive pills

Help control bleeding but do not significantly reduce fibroid size.

Levonorgestrel-releasing IUDs (e.g., Mirena)

Reduce blood loss.

New agents (e.g., ulipristal acetate)

Used under strict medical supervision, mainly as pre-surgical preparation.
Medical management is not a definitive solution and is usually recommended as pre-surgical preparation or for women near menopause.

Hysteroscopic myomectomy (day-clinic)

Hysteroscopic myomectomy is the most appropriate method for removing submucosal fibroids that distort the endometrial cavity. The procedure is incision-free, using a camera inserted through the cervix, and shows excellent results for women with fertility issues.

Laparoscopic / Robotic myomectomy

Laparoscopic myomectomy is used for deeper or larger fibroids. It is a minimally invasive procedure where fibroids are removed through small abdominal incisions guided by a camera. Robotic myomectomy is an advanced version offering more precision and stability, especially in complex cases with multiple or hard-to-reach fibroids. Both techniques minimize recovery time and preserve uterine fertility.

Uterine artery embolization (UAE) – Pros & Cons

UAE is a non-surgical technique where fibroid blood supply is cut off by injecting microscopic beads into uterine arteries, causing fibroid necrosis and shrinkage.
Advantages
No general anesthesia required
Short hospital stay
No surgical incision
Disadvantages
Not suitable for women desiring pregnancy, as it may affect endometrial blood flow
Risk of recurrence
Possible complications like pelvic pain and inflammation
This method is mainly suggested for women who do not plan future pregnancies or have contraindications for surgery.
Selecting the most suitable treatment is always based on individualized evaluation by specialized medical personnel, with a focus on preserving fertility and uterine health.

Fibroids & IVF (In Vitro Fertilization)

The presence of fibroids is a common concern for women preparing for IVF. Although not all fibroids affect the process equally, certain types — especially those that distort the endometrial cavity — may significantly reduce implantation and pregnancy chances. Proper evaluation and removal where necessary before IVF are critical for optimizing outcomes.

When removal is recommended before IVF

The decision to remove fibroids before an IVF cycle mainly depends on their location and characteristics. Surgery is generally recommended in these cases:

Submucosal fibroids

Even small, as they distort the endometrial cavity and hinder embryo implantation.

Intramural fibroids

Larger than 3–4 cm, especially if they affect the cavity geometry or cause symptoms.

Multiple fibroids

That cause increased inflammation or disrupt uterine blood flow.

Fibroids

Associated with implantation failures or recurrent miscarriage, even after successful embryo transfer.
The decision is always personalized, in collaboration with a fertility gynecologist, considering the number and quality of embryos, the woman’s age, and her reproductive history.

Success rates after surgery

Studies show that removing submucosal fibroids via hysteroscopic myomectomy can increase implantation rates by 30–70%, depending on the woman’s age and IVF cycle parameters. Likewise, removing large intramural fibroids laparoscopically or robotically has been linked with higher clinical pregnancy rates, especially after previous failed attempts. The endometrium regains normal shape and improved blood flow, making the environment more receptive to implantation.
Overall, proper fibroid management before IVF does not guarantee success, but may double pregnancy chances in selected cases, providing better conditions for embryo implantation and development.
Talk to an IVF specialist

Frequently Asked Questions About Fibroids

Can fibroids grow during pregnancy?

Yes, the increase in estrogen and progesterone during pregnancy can accelerate fibroid growth, especially in the first trimester. In some cases, they may cause pain or complications, though most pregnancies proceed normally.

Can I have a vaginal delivery with fibroids?

In many cases, yes. It depends on the fibroid’s location and size. If they are near the cervix or obstruct fetal descent, a C-section may be recommended for safety.

Do fibroids recur after removal?

Unfortunately, there is a chance of recurrence, especially in women not close to menopause. The risk depends on age, fibroid type, and hormonal influences.

Is IVF possible without fibroid removal?

In some cases, yes – especially when fibroids are small, peripheral, and don’t distort the endometrial cavity. The doctor carefully assesses if removal is necessary.

Are there natural remedies to shrink fibroids?

So far, no scientifically proven natural therapies reduce fibroid size or number. Diet and lifestyle may help regulate hormones but do not replace medical intervention.

Does menopause “eliminate” fibroids?

With declining estrogen in menopause, most fibroids stop growing and gradually shrink. However, this isn’t always the case, and some women continue to have symptoms.

Do fibroids increase cancer risk?

No. Fibroids are benign tumors and rarely become cancerous. The so-called leiomyosarcoma is extremely rare and does not develop from pre-existing fibroids.

Are there exercise restrictions with fibroids?

Usually not. Most women can continue exercising unless fibroids cause pain or bleeding. Light exercise may help regulate hormones and promote well-being.

Our Doctors

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Maria Oikonomou Obstetrician – Gynecologist

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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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