Uterine fibroids are common, but when you are trying to conceive, they can bring up a lot of questions.

Can I still get pregnant?

Will fibroids affect implantation?

Could they increase miscarriage risk?

Will they grow during pregnancy?

Do I need surgery first?

The reassuring truth is this:

Many people with fibroids conceive and deliver healthy babies.

But fibroids can also create unique fertility and pregnancy challenges depending on their size, number, location, and whether they affect the uterine cavity.

That is why understanding your specific fibroid situation matters.

Not all fibroids are the same.

Some may have little to no impact on fertility. Others may interfere with implantation, increase pregnancy risks, or affect delivery planning.

Here are seven things no one tells you about getting pregnant with fibroids, plus what to ask your provider so you can move forward with more clarity and confidence.

This article is for educational purposes only and is not intended to provide medical advice. Always consult your OB-GYN, reproductive endocrinologist, fertility specialist, maternal-fetal medicine specialist, or qualified healthcare provider for personalized diagnosis, treatment, pregnancy planning, and fertility guidance.

Uterine fibroids, also called leiomyomas, are noncancerous growths that develop in or on the uterus.

They can vary widely in:

Fibroids are very common. Many people have them without knowing it.

Some fibroids cause no symptoms at all.

Others may cause heavy bleeding, pelvic pressure, painful periods, anemia, difficulty conceiving, or pregnancy complications.

Fibroids may cause:

The key is not just whether you have fibroids.

The key is what type of fibroids you have and where they are located.

Fibroid location matters a lot.

Submucosal fibroids grow into the uterine cavity.

These are the fibroids most likely to interfere with fertility because they can affect the space where implantation occurs.

They may also increase miscarriage risk.

Intramural fibroids grow within the muscular wall of the uterus.

Their impact depends on size and whether they distort the uterine cavity.

Larger intramural fibroids may affect blood flow, uterine shape, implantation, or IVF outcomes in some cases.

Subserosal fibroids grow on the outside of the uterus.

These are usually less likely to affect fertility unless they are very large, cause pain, press on nearby organs, or distort pelvic anatomy.

One of the most important things to know is that fibroids do not automatically mean infertility.

Many people with fibroids conceive naturally.

Fibroids are more likely to create fertility challenges when they:

If your fibroids are small, outside the uterus, or not affecting the lining, they may not interfere with conception at all.

A fibroid diagnosis can sound scary, but the diagnosis alone does not tell the full story.

You need to know:

Many pregnancies with fibroids progress normally.

But some fibroids may increase miscarriage risk, especially when they affect the uterine cavity.

Submucosal fibroids are often the biggest concern because they grow into the space where an embryo needs to implant and develop.

Submucosal fibroids may:

Because of this, doctors may recommend removing submucosal fibroids before pregnancy or embryo transfer.

If a submucosal fibroid is present, your doctor may discuss a hysteroscopic myomectomy.

This is a procedure where the fibroid is removed through the cervix using a camera and surgical instruments.

Not every fibroid needs removal, but fibroids that distort the cavity are often treated more seriously in fertility planning.

Fibroids can be sensitive to hormones, especially estrogen and progesterone.

Because hormone levels rise during pregnancy, some fibroids may grow.

This is more likely to happen in the first or second trimester, though not all fibroids grow.

Some stay the same size.

Some shrink after delivery when hormone levels drop.

If fibroids grow during pregnancy, they may cause:

Sometimes a fibroid outgrows its blood supply during pregnancy.

This can cause pain, tenderness, cramping, or localized discomfort.

It can be scary, but your provider can help determine whether pain is from fibroids or something else that needs urgent attention.

It is easy to assume that the biggest fibroids cause the biggest problems.

But with fertility, location often matters more than size.

A small fibroid inside the uterine cavity may cause more fertility trouble than a larger fibroid on the outside of the uterus.

These are most likely to affect implantation, miscarriage risk, and fertility treatment success.

These may affect fertility if they are large or distort the uterine cavity.

These are usually less likely to affect fertility unless they are very large or create pelvic pressure or distortion.

A report that says “fibroids present” is not enough information.

You need to know whether the fibroids are affecting the uterine cavity.

That is the part most directly related to implantation and pregnancy development.

If you are doing IVF, fibroids may or may not affect your success.

It depends on the type and location of the fibroids.

Submucosal fibroids and some large intramural fibroids may reduce implantation, clinical pregnancy, or live birth rates.

Subserosal fibroids usually do not affect IVF outcomes unless they distort anatomy or cause symptoms.

Before embryo transfer, many fertility clinics want to make sure the uterine cavity is normal.

They may recommend:

This helps identify fibroids, polyps, scar tissue, or other issues that could interfere with implantation.

Your provider may recommend fibroid treatment before transfer if the fibroid:

Having fibroids does not automatically mean you will need a C-section.

Many people with fibroids deliver vaginally.

But certain fibroids may increase the chance of cesarean delivery.

This is more likely if fibroids are large, low in the uterus, near the cervix, or affecting the baby’s position.

Delivery planning may need to be more individualized if fibroids are large or strategically located.

Your provider may monitor fibroid position and baby’s position later in pregnancy.

Fibroids are common, but not every provider approaches them the same way.

Some fibroids are watched.

Some are treated.

Some matter a lot for fertility.

Some do not.

That is why your questions matter.

Your experience may be very different from someone else’s.

Ask your provider to explain:

A second opinion may be helpful if:

You deserve individualized care.

Your concerns are valid.

Bring these questions to your next appointment:

Getting pregnant with fibroids can feel overwhelming, especially when you are not sure whether they matter for your fertility.

But fibroids are not always a roadblock.

Many people with fibroids conceive naturally, carry healthy pregnancies, and deliver healthy babies.

The most important thing is understanding your specific situation.

What type of fibroids do you have?

Where are they located?

Do they affect the uterine cavity?

Are they causing symptoms?

Could they change your fertility or pregnancy plan?

Once you have those answers, you can make better decisions with your provider.

Fibroids may add extra questions to your fertility journey, but they do not erase your hope.

With the right information, monitoring, and care plan, you can move forward with more confidence.