Fibroids and Fertility: Can You Get Pregnant With Fibroids?

Being told you have fibroids can be frightening — especially when you are trying for a baby. Many women in Kenya hear the word and immediately fear the worst: that pregnancy is now impossible, or that the only answer is a hysterectomy. Neither is true. Fibroids are extremely common, most women with fibroids conceive without any treatment at all, and when fibroids do get in the way, they can usually be removed while keeping the womb — and your fertility — intact.

In this guide, the fertility specialists at Myra IVF Centre in Kenya, led by Dr. Sarita Sukhija, explain which fibroids affect fertility and which don't, when removing them genuinely improves your chances, the surgical options from hysteroscopic myomectomy to laparoscopy, how fibroids fit into IVF, and what to expect if you become pregnant with fibroids.

What Are Fibroids?

Uterine fibroids — medically called leiomyomas or myomas — are non-cancerous growths of the muscle tissue of the womb (uterus). They can be as small as a seed or as large as a melon, and many women have several at once. Their growth is driven by the hormones oestrogen and progesterone, which is why fibroids typically develop during the reproductive years, can grow during pregnancy, and usually shrink after menopause.

Fibroids are remarkably common. By the age of 50, around 70% of women have developed at least one — and the figure rises to over 80% among women of African descent, who also tend to develop fibroids at a younger age, in larger numbers and with more severe symptoms. For women in Kenya and across East Africa, fibroids are one of the most frequent gynaecological diagnoses, and often one that arrives just as they are planning a family.

Factors linked to a higher risk of fibroids include:

• African ancestry
• Age — fibroids are most common in the 30s and 40s
• Family history — if your mother or sister had fibroids
• Starting periods early
• Obesity and low vitamin D levels
• Never having been pregnant — pregnancy appears to have a protective effect

The Types of Fibroids — and Why Location Matters Most

Doctors classify fibroids by where they grow in the uterus, using a system developed by FIGO (the International Federation of Gynecology and Obstetrics). For fertility, location is far more important than size:

This is why two women with "a 3 cm fibroid" can receive completely different advice. A 3 cm submucosal fibroid inside the cavity is worth removing before trying to conceive; a 3 cm subserosal fibroid on the outside of the uterus is usually best left exactly where it is.

How Do Fibroids Affect Fertility?

Fibroids can interfere with conception and early pregnancy in several ways:

• Distorting the uterine cavity — submucosal and some intramural fibroids change the shape of the space where the embryo must implant.
• Affecting the womb lining — fibroids can alter blood flow and the signals that make the endometrium receptive to an embryo, even in parts of the lining away from the fibroid itself.
• Blocking the fallopian tubes — a fibroid near the upper corners of the uterus can press on the openings of the tubes (see our guide to blocked fallopian tubes).
• Obstructing the cervix — a cervical fibroid can make it harder for sperm to pass and can complicate IUI or embryo transfer.
• Disrupting uterine contractions — fibroids can interfere with the gentle, wave-like contractions that help sperm and embryos move to the right place.

The research on submucosal fibroids is clear. A major review of the evidence found that women with submucosal fibroids had roughly one-third the chance of implantation and live birth compared with women without fibroids, along with a higher miscarriage rate — and that removing these fibroids improved pregnancy rates. For subserosal fibroids, no such effect has been found.

Just as important is what fibroids usually don't explain. Fibroids are present in 5–10% of women with infertility, but they are the sole cause in only around 1–2% of cases. So if you are struggling to conceive and a scan shows a fibroid, it is essential to complete a full fertility work-up — ovulation, ovarian reserve (AMH), the fallopian tubes and a semen analysis — before assuming the fibroid is the problem. Surgery for a fibroid that was never the real cause costs months you may not have.

Symptoms: When to Suspect Fibroids

Many women with fibroids have no symptoms at all and only discover them on a routine scan. When symptoms do occur, the most common are:

• Heavy or prolonged periods, sometimes with clots — often leading to iron-deficiency anaemia, tiredness and breathlessness
• Pelvic pressure, fullness or a swollen lower abdomen
• Frequent urination or constipation, from a fibroid pressing on the bladder or bowel
• Lower back pain or pain during sex
• Difficulty conceiving or repeated miscarriage

Heavy bleeding that soaks through pads every hour, leaves you exhausted, or keeps you home from work is not something to simply endure. It deserves investigation — whether or not you are planning a pregnancy right now.

How Are Fibroids Diagnosed?

For fertility planning, the goal is not just to confirm that fibroids are present but to map them precisely — their number, size and exact relationship to the womb cavity:

• Transvaginal ultrasound — the first-line test: quick, painless and widely available. 3D ultrasound gives an even clearer picture of the cavity.
• Saline infusion sonography (SIS) — a small amount of sterile saline is placed in the uterus during the scan, outlining the cavity and showing exactly how far a fibroid protrudes into it.
• Hysteroscopy — a thin camera passed through the cervix looks directly inside the uterus. Submucosal fibroids can often be removed in the same procedure.
• MRI — used when there are many or very large fibroids, to plan surgery in detail.

Alongside fibroid mapping, we always recommend a complete fertility assessment for both partners, so that the treatment plan addresses every factor at once.

Treatment Options If You Want to Get Pregnant

The right treatment depends on the type, size and number of fibroids, your age and ovarian reserve, your symptoms, and whether you plan to conceive naturally or with IVF. These are the main options:

Two points about surgery are worth knowing. First, if a myomectomy involved deep cuts into the uterine wall, your doctor may recommend delivering future babies by planned caesarean section, to avoid the small risk of the scar opening during labour. Second, new fibroids can grow in the years after a myomectomy — one reason surgery is best timed close to when you plan to conceive, rather than years in advance.

Treatments to avoid if you want a baby. Some fibroid treatments are good for symptom relief but are not recommended for women planning a pregnancy. Uterine artery embolisation (UAE), which blocks the fibroid's blood supply, has been linked to higher miscarriage rates, and its pregnancy data is less reassuring than for myomectomy. Radiofrequency ablation and focused ultrasound (HIFU) have limited pregnancy data. Endometrial ablation and hysterectomy end the possibility of carrying a pregnancy. If you have been advised to have a hysterectomy for fibroids and still hope to have children, please get a second opinion from a fertility specialist first — in most cases, a womb-sparing option exists.

Surgery First or IVF First?

For women who need IVF anyway — because of age, low ovarian reserve, blocked tubes or male-factor infertility — the order of treatment matters:

• If a fibroid distorts the cavity: it is usually removed before embryo transfer, because a submucosal fibroid lowers the chance of implantation and raises the risk of miscarriage.
• If time is short: for women over 35 or with low AMH, one strategy worth discussing with your specialist is to stimulate the ovaries and freeze embryos first, have the myomectomy, then transfer a frozen embryo once the uterus has healed. This protects egg quality during the months of recovery (see frozen vs fresh embryo transfer).
• If intramural fibroids don't touch the cavity: management is individual. Larger intramural fibroids may modestly reduce IVF success, but surgery has its own costs in recovery time and scarring. Your specialist will weigh size, number and your timeline.
• If the uterus cannot safely carry a pregnancy: rarely — with very many or very large fibroids, or after multiple operations — pregnancy may not be safe. In these situations, gestational surrogacy using your own embryos can be an option.

Pregnancy With Fibroids: What to Expect

Most women with fibroids have healthy pregnancies and deliveries. Most fibroids stay about the same size during pregnancy; some grow, mainly in the first trimester. Possible issues to be aware of include:

• Pain from "red degeneration" — when a fibroid outgrows its blood supply. It is usually managed with rest and pregnancy-safe pain relief.
• A somewhat higher risk of miscarriage, preterm labour, the baby lying in a breech position, placental problems and caesarean delivery — particularly with large or multiple fibroids, or fibroids close to the placenta.
• Heavier bleeding after birth (postpartum haemorrhage), which your delivery team can plan for in advance.

If you have fibroids, tell your antenatal team early. An early scan that maps the fibroids in relation to the pregnancy and placenta allows any risks to be anticipated and monitored.

Fibroid Myths That Cost Women Time

Fibroid Care at Myra IVF Centre, Kenya

At Myra IVF Centre, women with fibroids receive fertility-first care, where every decision is made with your future family in mind:

• Precise fibroid mapping — detailed ultrasound and diagnostic hysteroscopy to classify every fibroid by type and position.
• Hysteroscopic myomectomy — removal of submucosal fibroids through the cervix, with no abdominal incision, as a day-case procedure.
• Laparoscopic myomectomy — keyhole removal of selected intramural and subserosal fibroids, with faster recovery than open surgery.
• A full work-up for both partners — so surgery happens only when it will genuinely help, and is timed around your natural conception or IVF plans.
• IVF, embryo freezing and surrogacy — when fibroids are one part of a bigger fertility picture.
• Three convenient locations — Nairobi, Mombasa and Kisumu.

With over 15 years of experience and a 79% overall IVF success rate, our team led by Dr. Sarita Sukhija helps women with fibroids build their families — keeping the uterus, and your options, intact wherever possible.

Conclusion

Fibroids are common, usually harmless to fertility, and — when they do get in the way — very treatable. The questions that matter are where your fibroids are, whether they reach the womb cavity, and what else is affecting your fertility. Answer those, and the right plan usually becomes clear: leave them alone, remove them with the least invasive surgery possible, or work around them with IVF.

If you have been diagnosed with fibroids and are hoping to conceive, don't wait for symptoms to get worse — and don't accept a hysterectomy without a fertility opinion. Speak with our specialists at Myra IVF Centre about a plan built around your future family.

Book a consultation today. Contact us at +254 786656236 or drsarita2007@gmail.com.