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Uterine fibroids and infertility frequently coexist, creating significant challenges for women desiring pregnancy. These benign tumors impact reproductive outcomes through various mechanical and molecular mechanisms. Specifically, the location of the fibroid determines its clinical significance. While subserosal fibroids generally have minimal impact, intramural and submucosal types often impair conception. Consequently, clinicians must accurately classify these lesions to provide optimal care.
Surgical management remains the gold standard for FIGO Type 0, 1, 2, and 3 fibroids in women seeking to conceive. Furthermore, myomectomy offers better fertility outcomes compared to non-invasive alternatives. Notably, medical experts do not recommend uterine artery embolization for patients prioritizing future fertility. This procedure may compromise ovarian reserve or uterine blood flow. Therefore, surgical intervention provides the most reliable pathway for restoring the uterine cavity.
Large fibroids can physically obstruct the ovaries. This displacement makes transvaginal oocyte pick-up exceptionally difficult for fertility specialists. In such cases, surgeons should consider myomectomy prior to starting assisted reproduction cycles. Additionally, if the surgeon opens the uterine cavity during myomectomy, the patient must deliver via Cesarean section. This precaution prevents uterine rupture during future labor. Ultimately, personalized surgical planning ensures the safety of both the mother and the infant.
Submucosal fibroids (FIGO Types 0-2) have the most significant negative impact because they distort the uterine cavity. They reduce implantation rates and increase the risk of miscarriage.
No, uterine artery embolization is generally not recommended for women desiring pregnancy. Surgical myomectomy remains the preferred treatment to preserve uterine integrity and ovarian function.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Refer to the latest local and national guidelines for clinical practice.
References
1. Mocanu E et al. Fibroids and infertility. Int J Gynaecol Obstet. 2026 May 09. doi: 10.1002/ijgo.71062. PMID: 42104843.
2. Practice Committee of the American Society for Reproductive Medicine. Uterine myomas and infertility: a guideline. Fertil Steril. 2026.
3. Munro MG et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding. Int J Gynaecol Obstet. 2011;113(1):3-13.
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