Fibroids and Fertility: What You Need to Know
You found out about the fibroids during your fertility workup. Maybe your RE mentioned them casually, like they were a footnote. Maybe she paused at the ultrasound screen long enough that you knew something was there before she said it. Maybe you've known about them for years and never thought they mattered until you started trying to conceive and the question changed from "do I have fibroids" to "are they the reason this isn't working."
Now you're reading everything you can find. You're trying to figure out whether your fibroids are the kind that matter, whether they need to come out, whether surgery will help or set you back, whether there's something you can do that doesn't involve a scalpel or a waiting game.
The answer depends on the fibroids themselves, where they are, how large they are, and what they're doing to your uterine environment. It also depends on what's driving them, because fibroids don't develop in isolation. They grow in response to hormonal patterns, inflammation, and circulation issues that affect your fertility independently.
What Are Fibroids?
Uterine fibroids are noncancerous growths made of smooth muscle and fibrous tissue that develop in or around the uterus. They are among the most common gynecological findings in reproductive-age women. Research published in the American Journal of Obstetrics and Gynecology estimates that up to 70 percent of women will develop fibroids by age 50, though many will never know they have them because the fibroids remain small and asymptomatic.
Fibroids range from the size of a seed to the size of a grapefruit. They can appear as a single growth or as multiple masses. Some women carry fibroids for years without symptoms. Others experience heavy bleeding, pelvic pressure, pain, and cycle changes that significantly affect their quality of life. For more on the connection between heavy bleeding and fibroids, see our article onpainful periods.
The critical question for fertility is location.
Where Fibroids Are Determines How They Affect Fertility
Submucosal fibroids grow into the uterine cavity. These have the most significant impact on fertility because they directly affect the space where an embryo needs to implant. Research published in Fertility and Sterility found that submucosal fibroids reduce implantation rates by approximately 50 percent. Even small submucosal fibroids can distort the uterine lining, interfere with implantation, and increase the risk of miscarriage. Most reproductive endocrinologists recommend removal before attempting conception or IVF.
Intramural fibroids develop within the muscular wall of the uterus. Their impact on fertility is variable and depends on size and number. Research published in Human Reproduction found that intramural fibroids larger than 4 centimeters can reduce implantation and pregnancy rates, likely by affecting blood flow to the lining and altering uterine contractility. Smaller intramural fibroids may have minimal effect.
Subserosal fibroids grow on the outer surface of the uterus. These generally have the least impact on fertility because they don't affect the uterine cavity. They can cause pressure symptoms, bloating, and discomfort, but they rarely interfere with implantation or pregnancy.
If your RE has told you your fibroids are "not in a concerning location," she likely means they are intramural or subserosal and small enough that they are unlikely to affect conception. If they are submucosal or large intramural fibroids, the conversation about intervention before conception is warranted.
How Fibroids Affect the Fertility Picture
Fibroids can influence fertility through several mechanisms, and they often work in combination.
Implantation disruption. Fibroids that distort the uterine cavity change the environment where an embryo needs to attach. The lining may be uneven, blood flow may be reduced in the area around the fibroid, and the local inflammation can interfere with the delicate process of implantation.
Reduced uterine blood flow. Healthy blood flow delivers oxygen, nutrients, and hormones to the endometrium. Fibroids can compress blood vessels and redirect flow away from the areas where the lining needs to develop. This affects lining quality and receptivity.
Increased inflammation. Fibroids create localized inflammation that can affect the uterine environment. Research published in the Journal of Minimally Invasive Gynecology found that the inflammatory markers surrounding fibroids can impair implantation and increase the risk of early pregnancy loss. For more on how inflammation affects conception, see our article onendometriosis and fertility.
Hormonal patterns. Fibroids are estrogen-dependent. They grow in response to estrogen and tend to stabilize or shrink after menopause. The same estrogen dominance that feeds fibroid growth can also affect ovulation, cycle regularity, and progesterone production. Addressing the hormonal pattern addresses both the fibroids and the fertility picture simultaneously. For a deeper look at this hormonal pattern, see our article onestrogen dominance.
Why Do Fibroids Develop?
Hormonal influence. Fibroids are highly responsive to estrogen and progesterone. An environment where estrogen dominates, whether from anovulatory cycles, poor estrogen metabolism, environmental estrogens, or chronic stress depleting progesterone, creates the conditions for fibroid growth.
Genetics. If fibroids run in your family, your likelihood of developing them increases. The genetic component affects both the tendency to develop fibroids and how they respond to hormonal influences.
Inflammation and circulation. In Chinese medicine, fibroids are understood as accumulations that develop when blood and energy stagnate over time. The Western parallel is clear: poor circulation, chronic inflammation, and metabolic imbalance all contribute to an environment where fibroids can develop and grow.
Stress. Chronic stress affects hormonal balance, increases inflammation, and compromises circulation. All of these feed fibroid development. For more on how chronic stress affects your body, see our article onchronic stress and your body.
Why Standard Approaches Often Fall Short
If your fibroids are affecting fertility, your RE will likely recommend one of two things: surgical removal (myomectomy) or proceeding with IVF and monitoring the fibroids.
Myomectomy can be effective, particularly for submucosal fibroids where removal directly improves the uterine cavity. Recovery takes time, and there is a waiting period before you can attempt conception. New fibroids can develop after surgery because the underlying hormonal and inflammatory patterns that created them haven't changed.
The monitoring approach works when fibroids are small and in locations that don't affect the cavity. It becomes frustrating when months pass without answers and the fibroids are growing.
What both approaches miss is the internal environment that produced the fibroids. Estrogen dominance, inflammation, poor circulation, and stress all continue to operate whether the fibroid is removed or monitored. Addressing these patterns supports fertility directly and creates conditions where existing fibroids are less likely to grow and new ones are less likely to develop.
What Actually Helps
Acupuncture. Acupuncture improves blood flow to the uterus, reduces inflammation, regulates hormones, and calms the nervous system. In Chinese medicine, fibroids reflect blood stasis, and the treatment principle is to move blood and improve circulation. Over time, this can soften fibroid tissue and reduce symptoms. Acupuncture also supports the uterine environment for implantation, which is essential for women with fibroids who are trying to conceive. We recommend weekly treatment, timed to your cycle.
Chinese herbs. Herbal formulas for fibroids address the specific pattern driving them. A formula for blood stasis moves circulation and breaks up accumulation. A formula for qi stagnation addresses the stress and emotional constraint that often accompanies fibroid development. During pregnancy, specific formulas that are safe for use can support the uterine environment and reduce fibroid-related symptoms. The formula adjusts as your pattern shifts.
Supporting estrogen metabolism. Cruciferous vegetables, DIM, calcium D-glucarate, adequate fiber, and reducing alcohol all support the liver's ability to clear excess estrogen. Reducing environmental estrogen exposure from plastics, personal care products, and household chemicals lowers the total estrogenic load. This addresses one of the primary drivers of fibroid growth.
Anti-inflammatory nutrition. Reducing processed foods, sugar, excess dairy, and inflammatory oils lowers systemic inflammation. Increasing omega-3 fatty acids, vegetables, quality protein, and fiber supports the anti-inflammatory environment. Blood sugar stability matters because insulin spikes increase aromatase activity, which increases estrogen production.
Nervous system regulation. Stress drives the hormonal and inflammatory patterns that feed fibroids. Acupuncture, breathwork, somatic practices, and sleep optimization all support the nervous system shift that allows the body to move from survival mode into a state where reproduction is prioritized.
What This Looks Like in Practice
A woman came to us at 39 after one miscarriage and a diagnosis of multiple fibroids. Her RE had recommended a myomectomy before attempting IVF, but she wanted to explore other options first. Her periods were heavy with dark clots, lasting seven days. She had pelvic pressure and bloating that worsened premenstrually.
She brought a binder of ultrasound images to her first appointment with every fibroid measurement highlighted in yellow. She had researched everything. She told us she needed to understand exactly what was happening in her body before she could trust anyone to help her.
We started with weekly acupuncture focused on moving blood stasis, reducing inflammation, and supporting her hormonal balance. We prescribed Chinese herbs to address blood stagnation and support estrogen metabolism. She adjusted her diet, reducing inflammatory foods and increasing cruciferous vegetables and fiber.
Over three months, her periods shortened from seven days to five. The clotting reduced significantly. Her RE repeated her ultrasound and noted that the largest intramural fibroid had decreased in size.
She proceeded with IVF. One embryo was transferred. A few weeks later, she started bleeding. She called us terrified that the fibroid was ending her pregnancy. An ultrasound showed the intramural fibroid, but her RE was reassuring about its size and placement. We started a pregnancy-safe herbal formula and continued weekly acupuncture with points to support the pregnancy and address the stagnant blood.
Within a few weeks, the bleeding stopped. The fibroid shrank to the point where it was no longer perceptible on the scan. She had no further fibroid-related issues for the rest of her pregnancy. She delivered a healthy baby at 40.
Read stories from women we've worked with →
Frequently Asked Questions
Can fibroids prevent you from getting pregnant? It depends on the type and location. Submucosal fibroids, which grow into the uterine cavity, can significantly reduce implantation rates. Intramural fibroids may affect fertility if they are large. Subserosal fibroids generally do not impact conception. Many women with fibroids conceive naturally. Understanding your specific fibroid type and location is essential for determining the right approach.
Should I have fibroids removed before trying to conceive? This depends on the type, size, and location of your fibroids. Submucosal fibroids that distort the uterine cavity are typically recommended for removal before conception. Small intramural or subserosal fibroids may not require surgery. Your RE can advise based on imaging, and addressing the hormonal and inflammatory patterns that drive fibroid growth can support fertility regardless of whether surgery is pursued.
Can fibroids shrink naturally? Fibroids can reduce in size when the internal environment shifts. Addressing estrogen dominance, reducing inflammation, improving circulation, and supporting hormonal balance through acupuncture, herbs, and nutrition can all contribute to fibroid reduction. Some fibroids respond significantly to this approach. Even when fibroids don't fully resolve, improving the uterine environment can be enough to support conception.
Your Next Step
If you've been diagnosed with fibroids and you're trying to conceive, understanding your specific situation is the first step. The type, location, and size of your fibroids determine how they affect your fertility, and the hormonal and inflammatory patterns driving their growth are addressable.
Learn more about ourFertility & Health path or contact us at 212.432.1110 or info@fafwellness.com.
Keep Reading:
•Endometriosis and Fertility: What You Need to Know
•Recurrent Miscarriage: Understanding Why and What Can Help