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Fibroids and IVF: When Fibroids Matter and When They Do Not

Dr. Senai Aksoy · · Updated · 8 min read
Medically reviewed on 9 October 2026 - Dr. Senai Aksoy
Medical illustration of the uterus showing submucosal, intramural, and subserosal fibroid locations

Key Takeaways

Fibroids do not affect IVF in the same way for everyone. Fibroids that distort the uterine cavity have the clearest effect, and removing them before transfer is usually considered. Intramural fibroids that leave the cavity intact are linked with lower live-birth rates in observational studies; whether removing them helps is uncertain, because there are no randomized trials and non-randomized studies disagree. Short ovarian stimulation does not appear to make small fibroids grow.

Key evidence: ASRM guideline on removal of myomas to improve fertility (2017) Intramural fibroids and fertility: systematic review and meta-analysis (Obstet Gynecol 2024) IVF stimulation and the size of small fibroids (Fertil Steril 2011)

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Fibroids and IVF

Fibroids are common, and many women with them still go on to have healthy pregnancies, naturally or through IVF. If you have just seen the word “fibroid” on your scan report, the useful question is rarely “is it a problem?” The more helpful questions are: where is it, how big is it, and does it distort the cavity or get in the way of treatment?

Two women with the same diagnosis can receive very different advice. A small fibroid in the outer wall of the uterus may barely matter for IVF. A submucosal fibroid pushing into the cavity can have a much clearer effect on implantation.

Which Fibroids Matter Most for IVF?

Fibroids are grouped by where they sit. The FIGO classification numbers them from type 0 (entirely inside the cavity) to type 8, but three broad groups are enough for most decisions:

Submucosal fibroids matter most. In a systematic review, submucosal fibroids were linked with lower fertility and their removal appeared to help, while subserosal fibroids did not affect fertility.

Intramural fibroids are the debated group. When they distort the cavity, they behave much like submucosal fibroids. When they leave the cavity intact, the picture is less clear:

These studies are observational, so they show an association, not proof that the fibroid itself caused the lower rate.

The same 2024 analysis found no improvement in clinical pregnancy rates after removing intramural fibroids (OR 1.10, 95% CI 0.77–1.59). By contrast, a 2026 review of seven non-randomized studies (1,644 women) found higher ongoing-pregnancy or live-birth rates after myomectomy (RR 1.64, 95% CI 1.15–2.33), but fibroid classification and outcomes were reported inconsistently. The two reviews measured different outcomes, and no randomized trial has settled the question. There is no agreed size threshold for surgery.

FIGO type 3 fibroids are a special case. They lie within the uterine wall and touch the endometrium without necessarily changing the shape of the cavity, so the simple question “is the cavity distorted?” can miss them. In a meta-analysis of 1,020 women, untreated type 3 fibroids were linked with lower implantation, clinical pregnancy and live-birth rates, and the effect grew with fibroid size and number; the 2023 meta-analysis above found the same for type 3 fibroids of 2 to 6 cm. Whether removing them improves live birth is still uncertain.

How Fibroids Can Affect IVF

Here is what fibroids can do during an IVF cycle:

This does not mean every fibroid needs surgery before IVF. Fibroids should be assessed in context, starting with transvaginal ultrasound. A standard scan may not show exactly how close a fibroid comes to the endometrium. When that could change the decision, saline infusion sonography can outline the cavity more clearly: in a review of studies in subfertile women, it detected abnormalities inside the uterine cavity, of all types, with a sensitivity of 0.88 and a specificity of 0.94 compared with hysteroscopy. MRI is used in selected cases when the anatomy is unclear.

The ASRM guideline makes three points:

Many women also ask whether IVF medication will make their fibroids grow. In a study of 72 women with small intramural or subserosal fibroids, fibroid size did not change over an IVF cycle. In a later study by the same group, clear growth was seen only in women who became pregnant, in early pregnancy.

Fibroids and miscarriage are a related worry. In a meta-analysis of more than 20,000 pregnancies in the general obstetric population, fibroids were not associated with a higher risk of miscarriage.

When Surgery May Help

Surgery is more often considered when:

Dr. Aksoy’s Approach: The question I ask in clinic is never “does she have a fibroid?” — it is “what is this fibroid doing to the cavity?” A 4 cm fibroid growing outward and a 4 cm fibroid bulging into the cavity are different problems, even though the scan reports the same number. That distinction is usually what decides whether surgery actually helps before IVF. But I also pay attention to intramural fibroids that sit very close to the endometrium without visibly distorting the cavity. They may matter even when the scan looks reassuring. That does not automatically make surgery the right answer.

The goal is not to remove every fibroid at any cost. It is to improve the uterine environment when the expected benefit outweighs the surgical burden. In the Cochrane review of surgery for fibroids in subfertile women, the randomized evidence was of very low quality. For patients planning IVF treatment in Istanbul from abroad, deciding whether a fibroid needs treatment first is part of preparing the cycle before travel.

Which Procedures Are Used?

The procedure depends mainly on fibroid location.

Hysteroscopic Resection

If a fibroid protrudes into the cavity, hysteroscopy is usually the preferred approach. The surgeon passes a thin camera through the cervix and removes the cavity-distorting tissue without abdominal incisions. The deeper a submucosal fibroid extends into the muscle wall (FIGO types 1 and 2, called G1 and G2 in the hysteroscopic classification), the more demanding hysteroscopic removal becomes, and the technique is chosen according to that extension.

Laparoscopic Myomectomy

For selected intramural or subserosal fibroids, laparoscopic myomectomy may be used. Recovery is usually shorter than after open surgery. In the Cochrane review, fertility outcomes did not differ clearly between laparoscopic and open myomectomy.

Open Surgery

Open myomectomy may still be needed when fibroids are very large, numerous, or positioned in a way that makes minimally invasive surgery unrealistic or unsafe.

After Myomectomy: Waiting and Pregnancy Safety

There is no proven minimum interval between myomectomy and pregnancy. In a systematic review, about a third of women were advised to wait 3 to 6 months and another third 6 to 12 months, and the authors concluded that the data are insufficient to advise a minimum time. I explain my own approach to timing in the questions below.

Surgery on the uterine wall also matters for later pregnancy. In a systematic review of pregnancies after myomectomy, uterine rupture occurred in about 0.6% to 0.9%, depending on the studies included. Among women who laboured it was 0.47%; most ruptures happened before 36 weeks and before labour began. Ask your surgeon to record how deep the incision went and whether the cavity was opened, because this information shapes later pregnancy and delivery planning.

Questions to Ask Before IVF

When fibroids are found before IVF, useful questions include:

Bring these questions to your appointment. They turn a vague worry into a concrete plan.

Frequently Asked Questions for Dr. Aksoy

Do IVF medications make fibroids grow, and what do you do if you see growth?

Fibroids are sensitive to oestrogen and progesterone, so it is thought that IVF medications could make them grow. However, there is no strong evidence that short ovarian stimulation causes meaningful fibroid growth. I do not postpone a patient’s IVF just because she has fibroids. If I notice growth during treatment, I first compare with earlier scans to see whether it is a measurement difference or real growth. If the fibroid has started to affect the uterine cavity, or is causing pain or bleeding, I review the transfer plan. A change of a few millimetres on its own is not a reason for surgery or for cancelling treatment.

Can IVF be done with fibroids, and which fibroids do you remove?

Yes. Many women with fibroids can have IVF without surgery. For me, the most important criterion is the fibroid’s relationship with the uterine cavity. I usually prefer to remove submucosal fibroids that distort the cavity, and intramural fibroids that press on the cavity, before transfer. I usually leave alone subserosal fibroids that grow toward the outside of the uterus, as long as they cause no symptoms and do not make egg collection difficult.

The truly debated group is intramural fibroids that do not distort the cavity. Some studies show they can lower IVF success, but it has not been clearly shown that removing them increases the live-birth rate. So I do not routinely operate on a small, for example 2 to 3 cm, fibroid that does not affect the cavity. For fibroids of 4 to 5 cm or more, especially if they are very close to the endometrium, if there are several, or if there have been repeated failures with good-quality embryos, I consider surgery more seriously. But these sizes are not absolute limits for surgery. The patient’s age, ovarian reserve, surgical risk and the time lost to surgery change my decision.

How long do you wait after myomectomy before embryo transfer, and do you freeze embryos before surgery?

I set the waiting time according to the type of operation and how deep the damage to the uterine wall is. After hysteroscopic removal of small submucosal fibroids, transfer can usually be planned within one or two menstrual cycles once healing is confirmed. After wider resections, I may wait longer to allow the endometrium to heal and to check that no adhesions have formed.

After laparoscopic or open myomectomy, especially if the muscle was cut deeply, many fibroids were removed or the cavity was opened, I usually consider a healing period of three to six months. It should be said, though, that this is not a scientifically proven fixed interval for everyone.

Especially in an older patient or one with low ovarian reserve, I may prefer to collect eggs and freeze embryos before the operation. That way we do not lose time in terms of ovarian age while the uterus heals. What matters to me is not doing the transfer at the earliest possible date, but being sure the uterus has healed well enough to carry a pregnancy safely.

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Dr. Senai Aksoy

Dr. Senai Aksoy studied and trained in France before returning to Turkey, where he was a member of the ICSI team at Sevgi Hospital, Ankara — the country's first ICSI centre (1994-95) — and a co-author on the first Turkish ICSI publications produced in collaboration with the Brussels Van Steirteghem group (Human Reproduction, 1996; PMID 8671323). He helped build the IVF programme at the American Hospital Istanbul and has been running his own fertility practice since 1998.

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