Uterine Fibroids and Fertility: Not All Fibroids Are Created Equal

The First Thing I Tell Fibroid Patients

“Not all fibroids need to be removed.”

I say this because I regularly see women who’ve been told they have fibroids and need surgery before trying to conceive — without anyone explaining that the impact of a fibroid on fertility depends entirely on where it is and how big it is. Some fibroids have no effect whatsoever on fertility. Others absolutely do.

Let me explain the difference.

Types of Fibroids: Location Is Everything

Submucosal Fibroids — The Problem Ones

These grow inside or into the uterine cavity — the space where an embryo needs to implant. Even a small submucosal fibroid can significantly impair implantation and increase miscarriage risk. These need to be removed before fertility treatment — full stop. The good news: removal via hysteroscopy is straightforward, effective, and requires no external incisions.

Intramural Fibroids — It Depends

Growing within the muscle wall of the uterus. Small ones (under 3–4 cm) that don’t distort the cavity usually don’t need removal before trying to conceive. Larger ones that push into the cavity need to be assessed carefully — some need removal, others don’t.

Subserosal Fibroids — Usually Fine

These grow outward from the uterus and generally have no impact on fertility unless they’re very large or pressing on the fallopian tubes. Most can be left alone.

When I Recommend Fibroid Removal Before Treatment

I recommend surgery when:

• The fibroid is submucosal (inside the cavity)
• A large intramural fibroid is clearly distorting the uterine cavity on scan
• There have been unexplained IVF failures with otherwise good embryos
• There’s recurrent miscarriage with no other cause found

I don’t recommend routine surgery for fibroids that are unlikely to be affecting fertility — unnecessary myomectomy carries its own risks, including reduced blood supply to the ovaries and scar tissue formation.

How Fibroids Are Removed

Hysteroscopic Myomectomy

For submucosal fibroids — a camera and instrument through the cervix, no external cuts, day procedure, back to normal in 1–2 days. The gold standard.

Laparoscopic Myomectomy

For intramural or subserosal fibroids requiring removal — keyhole surgery through 3–4 small incisions. Preserves the uterus completely. Recovery 5–7 days.

Do Fibroids Come Back After Removal?

Fibroids can recur, but the recurrence rate is much lower when removed before they’re very large, and when conception happens within a reasonable timeframe after surgery.

Let’s Look at Your Specific Case

At Punit Fertility, Kandivali Mumbai, every fibroid patient gets an individual assessment. We don’t recommend surgery unless it’s genuinely likely to improve outcomes.

👉 Book a fibroid assessment at Punit Fertility today