Fibroids and conception: Why Size and Location Matter

Finding a fibroid while trying to conceive does not automatically mean it is the reason pregnancy has not happened. Fibroids are common noncancerous growths in or around the womb. Their relationship to the womb cavity, associated symptoms and the rest of your fertility assessment help determine what to do next.

Ask for a description of the location

A submucosal fibroid projects toward the inner cavity. An intramural fibroid sits within the muscle wall, while a subserosal fibroid grows toward the outside. The fibroid types guide explains these terms in more detail.

Ask whether the fibroid changes the shape of the cavity where a pregnancy would implant. That can be more informative for fertility planning than hearing its measurement alone. Size and number still matter when assessing symptoms and possible procedures, but there is no single measurement that proves a fibroid is causing infertility.

Clarify what the scan can answer

Ultrasound can show the size, number and position of fibroids. Further imaging or examination of the cavity may be useful when the relationship to the lining is unclear. A saline ultrasound, for example, uses fluid to make the cavity easier to assess.

Ask for the written report and whether another investigation would change the recommendation. The fibroid diagnosis guide can help you prepare for this conversation. Fertility assessment should still consider ovulation, sperm and other relevant factors rather than stopping at the first scan finding.

Compare symptom relief with fertility benefit

Removing a fibroid that distorts the cavity may be considered to improve pregnancy chances. Evidence is less clear for removing fibroids that do not affect the cavity when there are no symptoms. Removing a fibroid on the outer surface has not been shown convincingly to improve fertility.

An operation may still be considered for heavy bleeding, pressure or another specific problem. Ask which outcome is the reason for recommending it. Evidence about becoming pregnant is not identical to evidence about live birth or preventing miscarriage.

Make pregnancy goals part of treatment planning

Myomectomy removes fibroids while keeping the womb and may be an option when treatment is needed and pregnancy is desired. Other procedures can prevent pregnancy or have uncertain implications for future pregnancy, so make your plans explicit before choosing treatment.

Ask about complications, recovery, the possibility of new fibroids and the recommended timing of attempts after your particular procedure. If observation is suggested, agree what symptoms or changes should trigger review. You should leave knowing why the fibroid does or does not need treatment now, rather than feeling that every scan finding must be removed before you can try.