Categories: Uterine Fibroids

Uterine Fibroids & Fertility: Understanding Their Impact on Reproductive Health

Today, I want to address these concerns head-on, providing clear, evidence-based information about fibroids and fertility. Whether you’re actively trying to conceive, planning for future pregnancy, or simply wanting to understand your reproductive health better, this guide is for you.

Understanding Fibroids: The Basics

Uterine fibroids (also called leiomyomas) are non-cancerous growths that develop in or around the uterus. They’re incredibly common—approximately two-thirds of women will develop fibroids by age 50. They can range from tiny seedlings, undetectable to the human eye, to bulky masses that can distort and enlarge the uterus.

As a women’s health physician in central Indiana, I’ve seen the entire spectrum of fibroid presentations, from women with no symptoms whatsoever to those experiencing significant pain, heavy bleeding, and fertility challenges.

Can You Get Pregnant with Fibroids?

Let me start with the most common question I hear: “Can I get pregnant if I have fibroids?”

The short answer is yes, absolutely.

Many women with fibroids conceive naturally and have healthy pregnancies with no complications. However, depending on the size, number, and location of your fibroids, you may face some additional challenges when trying to conceive or during pregnancy.

Here in our Westfield practice, we evaluate each woman’s situation individually. Not all fibroids impact fertility, and not all require treatment before pregnancy. The key factors we consider include:

Location Matters

The location of your fibroids is often more important than their size when it comes to fertility impact:

Submucosal fibroids (those that grow into the uterine cavity) are most likely to affect fertility, as they can interfere with implantation or block the fallopian tubes.
Intramural fibroids (those within the uterine wall) may impact fertility if they’re large or if they distort the uterine cavity.
Subserosal fibroids (those on the outside of the uterus) typically have minimal impact on fertility unless they’re extremely large or block the fallopian tubes.

Size and Number Matter Too

Very large fibroids or multiple fibroids can:

Distort the shape of the uterine cavity
Interfere with sperm movement
Block the fallopian tubes
Affect blood flow to the uterine lining
Interfere with implantation of a fertilized egg

How Fibroids Might Affect Your Pregnancy

If you do become pregnant with fibroids, there are several ways they might affect your pregnancy:

Potential Pregnancy Complications

First Trimester: Some women experience more pain as fibroids may grow rapidly due to hormonal changes
Growth During Pregnancy: Fibroids can either grow or shrink during pregnancy—there’s no way to predict which will happen
Placental Issues: Fibroids can affect where the placenta attaches or develops
Fetal Growth: Very large fibroids can restrict space for the baby to grow
Delivery Considerations: Fibroids near the birth canal may necessitate a C-section

Many of my patients in the Westfield and Carmel areas have had successful pregnancies despite having fibroids. However, we typically recommend more frequent monitoring during pregnancy for these women.

Treatment Options: When to Consider Intervention

When a patient with fibroids is trying to conceive or planning for future pregnancy, we carefully weigh the pros and cons of treatment. Here’s my approach at Via Women’s Health Collective:

When Treatment May Be Recommended Before Pregnancy

Submucosal fibroids that distort the uterine cavity
Multiple or large fibroids that significantly alter uterine structure
History of miscarriage potentially related to fibroids
History of fertility challenges with no other identified cause

Treatment Options to Consider

Myomectomy: Surgical removal of fibroids while preserving the uterus. This is often the preferred option for women planning future pregnancy.
Hysteroscopic Myomectomy: A minimally invasive procedure for removing submucosal fibroids.
Uterine Artery Embolization (UAE): While effective for symptom relief, this is generally not recommended for women planning future pregnancy as it can affect ovarian function and uterine health.
Medication Options: Certain medications can temporarily shrink fibroids or manage symptoms, though these are typically short-term solutions.

Many of my patients here in Hamilton County express concerns about recovery times from fibroid treatments. For surgical options like myomectomy, I typically recommend waiting 3-6 months after surgery before attempting pregnancy to allow the uterus to fully heal.

When Surgery Might Not Be the Answer

It’s important to note that not all fibroids require surgical intervention before pregnancy. In our practice, we consider several factors:

Asymptomatic Fibroids: If they’re not causing symptoms and are in a location unlikely to affect pregnancy, we may recommend a watchful waiting approach.
Very Large or Numerous Fibroids: Sometimes, the surgical risks outweigh the benefits. In these cases, we discuss alternative options.
Coexisting Medical Conditions: Some medical conditions may make surgery higher risk.

Birth Control and Fibroids: Finding the Right Balance

For women with fibroids who aren’t currently trying to conceive, birth control decisions can be complicated. The relationship between hormonal contraceptives and fibroids varies:

Some hormonal methods may contribute to fibroid growth due to their estrogen content
Progestin-only options may be better choices for some women with fibroids
Non-hormonal IUDs can be excellent options, providing contraception without hormonal effects

At our Westfield clinic, we work with each patient to find the contraceptive method that best balances effective pregnancy prevention with fibroid management.

Planning for the Future: Proactive Steps

If you have fibroids and are planning for future pregnancy, here are my recommendations:

Get a Detailed Evaluation: Understanding the exact location, size, and number of your fibroids will help guide decision-making.
Consider Timing: If fibroid treatment is recommended, factor in recovery time before attempting pregnancy.
Optimize Overall Health: Focus on maintaining a healthy weight, managing stress, and following a nutritious diet—all of which may help manage fibroid symptoms.
Track Your Symptoms: Keep a record of any fibroid-related symptoms to help identify if they’re worsening over time.
Regular Follow-ups: Even if you’re not currently trying to conceive, regular monitoring of fibroid growth can help with future planning.

Finding Support in Our Community

Navigating fibroids and fertility concerns can feel overwhelming. Here in central Indiana, we have several support resources, including:

Support groups for women with fibroids
Fertility specialists who work specifically with fibroid-related challenges
Mental health professionals who specialize in reproductive health concerns

At Via Women’s Health Collective, we believe in providing comprehensive care that addresses both the physical and emotional aspects of reproductive health challenges.

The Bottom Line

If you have fibroids and are concerned about fertility, remember these key points:

Many women with fibroids conceive naturally and have healthy pregnancies
The impact of fibroids on fertility depends largely on their location, size, and number
Treatment options exist that can preserve fertility while addressing fibroid-related concerns
Individualized care is essential—what’s right for one woman may not be right for another

If you’re in the Westfield, Carmel, Noblesville, or surrounding areas and have concerns about fibroids and fertility, I invite you to schedule an appointment at Via Women’s Health Collective. Together, we can create a plan that supports your reproductive health goals.

Dr. Taylor Hahn is a board-certified OB/GYN specializing in women’s sexual health and menopause care at Via Women’s Health Collective. She is passionate about empowering women through education and compassionate care.

Dr. Taylor Hahn, MD, FACOG, MSCP