Uterine Fibroids, Polyps, and Fertility: What Actually Matters
Learn which uterine conditions affect fertility and what to do about them — for anyone navigating unexplained failures or losses.
Fibroids, polyps, a uterine septum, and intrauterine adhesions can all affect fertility — but not equally, and not always. The uterine factor story is mostly one of precision: the diagnosis matters less than where it is and how severe. Most of what's found is treatable, often with a minor outpatient procedure, and the key is finding it before it causes repeated losses or failed transfers.
Do fibroids affect fertility?
Not all fibroids affect fertility — location and size matter more than the diagnosis itself. A fibroid's impact depends almost entirely on its relationship to the uterine cavity. Submucosal fibroids, which grow inside the cavity, are the type most associated with implantation problems and pregnancy loss. Intramural fibroids, which sit within the uterine wall, may have no effect on fertility at all — or may matter, depending on their size and proximity to the cavity. A diagnosis of "fibroids" alone doesn't tell you much; the specific type and location do.
What type of fibroids have the most impact on pregnancy?
Submucosal fibroids — those that distort or protrude into the uterine cavity — are the type with the clearest impact on fertility and pregnancy outcomes. Even small submucosal fibroids can interfere with implantation and increase miscarriage risk. Intramural fibroids and subserosal fibroids (on the outer surface of the uterus) are less likely to affect fertility directly, though large intramural fibroids may still be a consideration depending on size. If you have fibroids, the most important question is which type you have and where they are — not how many.
What is a uterine polyp and does it need to be removed before trying to conceive?
Uterine polyps are small, soft growths on the inner lining of the uterus. They're common and almost always benign, but they can interfere with implantation — particularly in the context of IVF or repeated failed cycles. Removal is a minor outpatient procedure, typically done by hysteroscopy, and is often recommended before starting IVF. If you've had unexplained implantation failures or are preparing for a transfer, it's worth asking whether a uterine cavity evaluation has been done and whether any polyps were identified.
What is a uterine septum and how is it treated?
A uterine septum is a wall of tissue that divides the uterine cavity. It's a structural abnormality present from birth, often entirely undiagnosed until a person starts trying to conceive or investigates recurrent pregnancy loss. The septum is associated with miscarriage because tissue at the septal midline has poor blood supply, making it a difficult site for successful implantation. Surgical correction is straightforward — it's done by hysteroscopy, typically as an outpatient procedure — and is generally recommended when a septum is identified during a fertility workup.
What is Asherman's syndrome?
Asherman's syndrome is a condition in which scar tissue — intrauterine adhesions — forms inside the uterine cavity, usually as a result of prior uterine surgery. Common causes include a dilation and curettage (D&C) after pregnancy loss or scarring from a cesarean section. These adhesions can reduce the functional surface area of the uterine lining, potentially interfering with implantation. Severity varies widely: mild adhesions may have minimal effect on fertility, while more extensive Asherman's significantly reduces the available lining and typically requires surgical treatment.
Does removing fibroids improve fertility outcomes?
For submucosal fibroids, which are most directly associated with implantation problems and pregnancy loss, surgical removal — typically hysteroscopic myomectomy — is generally recommended before fertility treatment. Most uterine factors, once identified, are treatable with minor outpatient procedures. The clinical rationale is consistent: finding and addressing the problem before repeated failed cycles or losses is almost always the better path. Whether and how urgently to treat depends on the specific type, location, and your full clinical picture — a conversation for your provider.
What is the best test to diagnose uterine problems affecting fertility?
A standard transvaginal ultrasound may miss problems inside the uterine cavity. Two better options are the saline infusion sonogram (SIS) and hysteroscopy. An SIS involves filling the uterine cavity with saline during an ultrasound, which outlines the cavity and makes polyps, fibroids, and adhesions much easier to see. A hysteroscopy goes further — a small camera is passed into the uterus to view the cavity directly, and is both diagnostic and, in many cases, immediately therapeutic. If you've had failed transfers or unexplained pregnancy losses, a cavity evaluation beyond a standard ultrasound is a reasonable question to raise.