Yes, you can still get pregnant with fibroids. Most women who have them conceive without any trouble. Fibroids are diagnosed in about 5 to 10% of women evaluated for infertility, but they’re estimated to be the sole cause of infertility in only 2 to 3% of cases. That means the vast majority of women with fibroids have other factors at play, or no fertility problem at all.
What matters most is where the fibroid is, how big it is, and whether it’s changing the shape of your uterine cavity. Those details determine whether fibroids are just along for the ride or actively getting in the way.
Why Location Matters More Than Size
Fibroids are classified by where they grow in the uterus, and that location has a dramatic effect on pregnancy chances. There are three main types: submucosal (growing into the uterine cavity), intramural (embedded in the muscular wall), and subserosal (growing on the outer surface).
In one well-known study of women undergoing fertility treatment, pregnancy rates per embryo transfer told a clear story. Women with subserosal fibroids had a 34.1% pregnancy rate, nearly identical to the 30.1% rate in women with no fibroids at all. Women with intramural fibroids dropped to 16.4%, and women with submucosal fibroids had just a 10% pregnancy rate. Implantation rates followed the same pattern: 15.1% for subserosal, 6.4% for intramural, 4.3% for submucosal, and 15.7% for no fibroids.
The takeaway is straightforward. Fibroids on the outer wall of the uterus don’t appear to affect your chances. Fibroids that push into or distort the inner cavity, where an embryo needs to implant, are the ones that cause problems. Intramural fibroids lowered pregnancy and implantation rates even when they didn’t visibly deform the cavity, suggesting they may interfere in subtler ways.
How Fibroids Interfere With Conception
Submucosal fibroids cause the most trouble because they press directly against the uterine lining and alter the shape of the cavity. This changes the environment where an embryo would normally attach and grow. Large submucosal fibroids can also disrupt the rhythmic contractions of the uterine wall that help move sperm toward the egg. In some cases, fibroids near the cervix or fallopian tube openings can physically block sperm from reaching the egg at all.
Intramural fibroids, even when they don’t obviously distort the cavity, may affect the blood supply to the lining or change how receptive it is to an embryo. The exact mechanism is still debated among researchers, but the reduced pregnancy rates are consistent across studies.
Most Fibroids Don’t Need Treatment
Fibroids are extremely common. Roughly 35% of women of reproductive age have them, with the rate climbing as you get older and peaking around ages 45 to 49. A majority of women with fibroids have no symptoms and need no intervention.
If you’re trying to conceive, treatment decisions depend on your specific situation. A small subserosal fibroid is unlikely to warrant any action. A submucosal fibroid distorting your uterine cavity is a different story entirely. When fibroids are causing abnormal bleeding, pelvic pain, or pressure symptoms, treatment is typically guided by the fibroid’s characteristics alongside your fertility goals.
Surgical removal (myomectomy) is the most common approach for fibroids that are affecting fertility. This preserves the uterus while removing the fibroid itself. For submucosal fibroids, the procedure can often be done through the cervix without any abdominal incision. For larger intramural fibroids, it may require an abdominal or laparoscopic approach, with recovery ranging from a few weeks to a couple of months depending on the technique used.
What to Expect If You Get Pregnant With Fibroids
Many women carry pregnancies successfully with fibroids still present. But fibroids can increase certain risks during pregnancy, particularly when they’re large (bigger than 5 cm), when there are more than three, or when they’re located behind the placenta.
The complications linked to these higher-risk fibroids include miscarriage, preterm labor, placental abruption (where the placenta separates early), the baby settling into an unusual position, and heavier bleeding after delivery. Cesarean delivery is also more likely. One study found that women with large fibroids had a higher miscarriage rate, which researchers attributed to distortion of the uterine cavity.
That said, the numbers are more reassuring than alarming for many women. In one study of 41 pregnancies with fibroids, preterm labor occurred in 7.3% of cases, well below the 16 to 27% range reported in earlier research. Individual risk varies widely based on the specific characteristics of your fibroids.
The Big Picture for Fertility Planning
If you’ve been diagnosed with fibroids and want to get pregnant, the single most useful step is getting clarity on the type, size, and location of your fibroids through imaging. A detailed ultrasound or MRI can show whether any fibroid is pressing into your uterine cavity, which is the key factor in whether it’s likely to affect conception or pregnancy.
For women with small, subserosal, or intramural fibroids that aren’t distorting the cavity, there’s no reason to delay trying to conceive. For women with submucosal fibroids or large intramural fibroids that are changing the cavity’s shape, removal before conception tends to improve outcomes. The timing of surgery matters too, since the uterus typically needs three to six months to heal before it’s safe to carry a pregnancy.
Fibroids are one of the most common reproductive findings in women, and the vast majority of women who have them go on to conceive and deliver healthy babies. Having fibroids puts you in a very large club, not a high-risk category by default.