Not all fibroids cause fertility problems. Submucosal fibroids (inside the uterine cavity) most significantly impair implantation and should be removed before trying to conceive or before IVF. Intramural fibroids affecting the cavity may also require treatment. Subserosal fibroids rarely affect fertility. A fertility specialist assessment determines whether treatment is needed.
Introduction
Uterine fibroids are the most common benign tumours in women of reproductive age, affecting an estimated 20–40% of women. In South Africa, fibroids are particularly prevalent — affecting a disproportionately higher number of Black African women. If you have fibroids and are trying to conceive, the critical question is not whether you have fibroids, but where they are and whether they are affecting the uterine cavity. This guide explains everything you need to know. For specialist fertility clinic listings in South Africa, see the Fertility Solutions directory.
What Are Uterine Fibroids?
Fibroids (leiomyomas or myomas) are non-cancerous growths of the uterine muscle (myometrium). They range in size from a few millimetres to several centimetres and can be single or multiple. Fibroids are oestrogen-sensitive and grow during the reproductive years, typically slowing after menopause.
Types of Fibroids and Their Fertility Impact
Submucosal Fibroids (Type 0, 1, 2)
These fibroids project into the uterine cavity. Even small submucosal fibroids can significantly impair implantation by distorting the endometrial surface, creating mechanical disruption, and altering the biochemical environment. Studies consistently show reduced pregnancy rates and higher miscarriage rates with submucosal fibroids. Removal is generally recommended before trying to conceive or before IVF.
Intramural Fibroids (Within the Uterine Wall)
Intramural fibroids that distort the uterine cavity (cavity-distorting intramural fibroids) have similar effects to submucosal fibroids and warrant treatment. Intramural fibroids that do not reach the cavity have a more debated impact on fertility — many studies show modest effects on IVF success at sizes above 4–5cm.
Subserosal Fibroids (On the Outer Surface)
Subserosal fibroids do not typically affect the uterine cavity and generally do not significantly impair fertility. They may cause mechanical symptoms (pressure, pain, urinary frequency) but removal for fertility purposes alone is usually not indicated unless very large.
How Fibroids Affect Fertility
- Distortion of the uterine cavity: prevents normal embryo implantation
- Altered endometrial blood flow: fibroids can reduce blood supply to the endometrium in the adjacent area
- Inflammatory changes: alter the local endometrial environment
- Mechanical obstruction: very large fibroids can obstruct the fallopian tube openings
- Uterine contractility: fibroids may cause abnormal contractions that impair sperm transport or embryo implantation
Symptoms
Many fibroids cause no symptoms. When symptoms occur:
- Heavy or prolonged menstrual bleeding
- Pelvic pain or pressure
- Urinary frequency or difficulty emptying the bladder
- Constipation
- Enlarged abdomen
- Pain during intercourse
Diagnosis
- Transvaginal ultrasound: first-line investigation — identifies fibroids, their size and location
- Saline sonohysterogram (SHG): saline injected into the cavity during ultrasound — best for assessing cavity involvement
- Hysteroscopy: direct visual assessment of the uterine cavity; allows simultaneous treatment of submucosal fibroids
- MRI: gold standard for mapping multiple fibroids before myomectomy
Treatment: Myomectomy
Hysteroscopic Myomectomy
For submucosal fibroids (Type 0 and 1 fully or mostly inside the cavity), hysteroscopic resection is the gold standard. A thin camera and resection instrument are passed through the cervix — no incisions. Day procedure under sedation or general anaesthesia. Recovery: 1–2 days. Studies show significant improvement in pregnancy rates after removal.
Laparoscopic Myomectomy
For intramural and subserosal fibroids requiring removal, laparoscopic (keyhole) surgery is preferred. Smaller incisions, faster recovery than open surgery. Hospital stay typically 1–2 days. Allow 3–6 months before trying to conceive to allow uterine wall healing.
Open (Abdominal) Myomectomy
For very large or multiple fibroids, open myomectomy may be required. Longer recovery (4–6 weeks). Caesarean section is usually recommended in subsequent pregnancy due to uterine scar.
IVF with Fibroids
For women with fibroids who also need IVF, the decision on whether to remove fibroids before IVF depends on cavity involvement, fibroid size, and location. The general principle: any fibroid distorting the cavity should be removed before embryo transfer. Non-cavity-distorting intramural fibroids below 4cm are generally observed rather than treated. Your fertility specialist will assess your specific fibroid map and advise accordingly. See the IVF South Africa guide for full IVF process and cost information.
South African Context
Fibroids are particularly prevalent in South African women of African descent. Fertility specialists and gynaecologists across Johannesburg, Cape Town, Pretoria, Durban, and Gqeberha are experienced in fibroid assessment and surgical management. Medical aid may cover myomectomy under relevant PMB codes — review the medical aid fertility coverage guide for details.
Related Articles
- Fibroids and Pregnancy: Fertility Guide
- IVF in South Africa: Complete Guide
- HSG (Hysterosalpingogram)
- Uterine Polyps and Fertility
- Uterine Polyps and IVF
- Trying to Conceive with Adenomyosis
- Medical Aid Coverage for Fertility Treatment
- NHS Fibroids Overview
Frequently Asked Questions
Do all fibroids need to be removed before trying to conceive?
No — only fibroids that distort or intrude into the uterine cavity (submucosal or cavity-distorting intramural fibroids) require removal before attempting conception. Your specialist will assess your specific fibroid type and location.
Can I get pregnant naturally with fibroids?
Many women with fibroids conceive naturally. The impact depends entirely on fibroid location. Subserosal fibroids rarely affect fertility. Submucosal fibroids have the greatest negative effect and should generally be removed.
Will fibroids grow during pregnancy?
Fibroids are oestrogen-sensitive. Some may grow during pregnancy due to elevated hormone levels; others remain stable. Fibroids growing in pregnancy can occasionally cause pain or complications — your obstetrician will monitor them.
Can fibroids cause miscarriage?
Submucosal fibroids are associated with higher miscarriage rates. Removing them before conception may reduce miscarriage risk. If you have experienced recurrent miscarriage, uterine cavity assessment is an important investigation.
How long after myomectomy can I try to conceive?
After hysteroscopic myomectomy: typically 1–2 menstrual cycles. After laparoscopic or open myomectomy: usually 3–6 months to allow uterine wall healing. Your surgeon will advise specifically.
Does IVF work with fibroids?
IVF success depends significantly on fibroid type. Removing cavity-distorting fibroids before IVF improves implantation rates. Non-cavity-distorting intramural fibroids below 4cm have less impact on IVF outcomes.
Is there a non-surgical treatment for fibroids?
Uterine fibroid embolisation (UFE) and focused ultrasound can shrink fibroids but are not generally recommended for women who wish to conceive, as effects on future pregnancy are uncertain. Surgical removal remains standard for fertility purposes.
Are Black African women more likely to have fibroids?
Yes — fibroids are significantly more prevalent and tend to be larger and more numerous in women of African descent. This is a well-documented epidemiological finding. Awareness and earlier investigation are important in this population.
Do fibroids affect IVF success rates?
Submucosal and large cavity-distorting intramural fibroids reduce IVF success. Removal before IVF is recommended. Small intramural fibroids not touching the cavity have a less certain effect.
Where can I find a fibroid specialist in South Africa?
Fertility Solutions lists reproductive gynaecologists with fibroid surgery expertise across South Africa.
Key Takeaways
- Not all fibroids affect fertility — location is the critical factor
- Submucosal fibroids most significantly impair implantation and should be removed
- Hysteroscopic myomectomy is the gold standard for submucosal fibroid removal
- IVF with fibroids is possible; cavity-distorting fibroids should be removed first
- South African fertility specialists are experienced in fibroid assessment and treatment
Closing Thoughts
Fibroids are common and manageable. With the right assessment and, where needed, the right surgical intervention, most women with fibroids achieve healthy pregnancies. Do not let a fibroid diagnosis discourage you — let it drive you to get the right information and the right specialist. Find a specialist near you through Fertility Solutions.
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before making decisions about fertility treatment.
About the Author
Leigh-Ann Geydien is the founder of Fertility Solutions, South Africa’s only dedicated fertility directory. With a deep commitment to patient advocacy, she built the platform to bridge the gap between those navigating fertility challenges and the clinics and reproductive health specialists best placed to help them.
