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Do fibroids or adenomyosis affect fertility, and do they need treating before IVF?

6 November 2026, by Dr. Navdeep Singh Pannu

Do fibroids or adenomyosis affect fertility, and do they need treating before IVF?

It depends on where the fibroid is. Fibroids that bulge into the womb's cavity (submucosal) lower the chance of pregnancy, and removing them through a hysteroscope is usually advised. Fibroids on the outside of the womb rarely matter. For fibroids within the wall, the evidence is mixed and guidelines differ. Adenomyosis is linked to lower IVF success, but no treatment has yet been proven to improve it.

This page explains what guidelines say and where the evidence is still uncertain, so you can talk it through with your specialist. The sources are listed at the end.

What are fibroids and adenomyosis?

Fibroids (fibroid rahim or ketumbuhan fibroid) are non-cancerous growths of the muscle of the womb. They are very common: FIGO, the international federation of gynaecologists, puts the lifetime risk at about three in four women, and most cause no symptoms. Many women only find out they have one during fertility tests.

Adenomyosis (adenomiosis) is when tissue like the womb lining grows into the muscle wall of the womb. It can cause heavy or painful periods, pain during sex and difficulty getting pregnant. It can be spread through the wall (diffuse) or form a lump (focal, or an adenomyoma). Doctors still don't agree on a single way to describe and grade it: ESHRE, the European fertility society, is preparing good practice recommendations on adenomyosis with two other societies to address this, and as of November 2026 these are still in draft.

Which fibroids affect fertility?

Doctors describe fibroids by where they sit, using FIGO numbers from 0 to 8:

  • Inside the cavity (submucosal, types 0, 1 and 2). These lower the chance of pregnancy and raise the risk of miscarriage.
  • Within the wall (intramural, types 3 and 4). Type 3 touches the lining without bulging into the cavity. Reviews suggest these can lower IVF success, but it is not clear that removing them helps.
  • On the outside (subserosal, types 5, 6 and 7). These don't appear to affect fertility.
  • Type 8 covers fibroids elsewhere, such as in the cervix.

Some fibroids span two zones and get two numbers, such as "2–5". Size and number matter as well as position.

How are fibroids found?

A pelvic ultrasound is the usual first test (see fertility testing). The key question for fertility is whether a fibroid touches or bulges into the cavity, and an ordinary scan can miss that. Australian and New Zealand guidance (RANZCOG) names MRI, a saline scan (sonohysterography) or a hysteroscopy as the better tests for this. NICE, the UK's guideline body, advises an ultrasound before a myomectomy or embolisation, and an MRI if more detail is needed.

Do fibroids need removing before IVF?

Submucosal fibroids: usually yes. NICE's heavy menstrual bleeding guideline advises considering hysteroscopic removal for submucosal fibroids. The American Society for Reproductive Medicine (ASRM, 2017) found fair evidence that hysteroscopic removal improves pregnancy rates, and FIGO (2026) recommends that infertile women with fibroids affecting the lining be offered surgery. In a hysteroscopy, a thin camera passes through the cervix, so there are no cuts on the tummy. See keyhole surgery.

Intramural fibroids: guidelines differ. ASRM says removal is generally not advised to improve pregnancy outcomes when the cavity is not distorted. FIGO's 2026 guidance suggests considering removal of a type 3 fibroid larger than 5 cm close to the lining, and of larger fibroids in the wall, especially if there are several. A Cochrane review (2020) found very little good-quality evidence either way: only one small trial compared surgery with no surgery. RANZCOG lists repeated failed IVF cycles with intramural fibroids as one reason to consider surgery.

Subserosal fibroids: usually no, unless they are large or cause symptoms.

Any fibroid that blocks access to the ovaries may need removing before IVF, because the eggs are collected through the vagina. ASRM and FIGO both make this exception.

Heavy bleeding, anaemia or pressure symptoms can be reasons for treatment in their own right, whatever the effect on fertility.

What about HIFU, embolisation and medicines?

  • Uterine artery embolisation (UAE) blocks the fibroid's blood supply. FIGO (2026) says it is not recommended if you want to become pregnant, because of the risk to the ovaries. NICE's heavy menstrual bleeding guideline is less strict and says UAE or myomectomy "may potentially" allow women to keep their fertility.
  • HIFU (high-intensity focused ultrasound) aims ultrasound energy at the fibroid from outside the body. RANZCOG advises that focused ultrasound, radiofrequency ablation and embolisation be used for women with infertility only within approved clinical trials. FIGO describes only "modest evidence" on pregnancy after HIFU. A 2025 review found poorer reproductive outcomes after HIFU than after myomectomy, and said the quality of HIFU studies leaves much room for improvement.
  • Hormone treatments can control bleeding, but RANZCOG points out that they delay trying for a baby, and does not recommend them as a fertility treatment. A short course of a GnRH analogue is sometimes used before surgery to shrink a fibroid or correct anaemia.

How long should I wait after a myomectomy?

There is no agreed answer. A 2021 systematic review found too little data to set a minimum interval. FIGO's 2026 guidance recommends a three-month healing period after a fibroid is removed through the abdomen (by keyhole surgery or an open cut). That advice is about abdominal surgery, so ask your surgeon how long to wait after a hysteroscopic removal.

Waiting has a cost if you are older or your egg reserve is low. Ask your specialist how to order surgery and IVF in your case, including whether it makes sense to collect and freeze embryos first. See fertility after 35 and low AMH.

Will a myomectomy affect how I give birth?

Possibly. The womb can rarely tear (uterine rupture) in a pregnancy after myomectomy, and it can happen before labour. FIGO advises considering a caesarean birth when the full thickness of the womb wall was cut. Ask your surgeon for the operation note and keep it: your obstetrician will need to know where the fibroids were, how deep the cut went and whether the cavity was opened. Tell your doctor straight away about severe tummy pain in pregnancy.

Does adenomyosis affect IVF?

Probably. A 2022 review of studies found that women with adenomyosis had lower live birth rates and more miscarriages after IVF than women without it. Many of the studies did not separate focal from diffuse adenomyosis, so the size of the effect is uncertain.

Hormone treatment before a frozen transfer. Some clinics give a few months of a GnRH agonist injection to shrink adenomyosis before a frozen embryo transfer. The evidence is weak and conflicting. One 2025 review found more pregnancies with fresh transfers but no difference in live births. Another, of eight retrospective studies, found no benefit before a frozen transfer. Ask your specialist why they suggest it for you, and what it adds in time.

Surgery (adenomyomectomy). Removing adenomyosis while keeping the womb is a major operation. A 2026 review advises keeping it for women with severe symptoms or repeated failed IVF, because later pregnancies carry a real risk of uterine rupture and of the placenta growing too deeply (placenta accreta). A planned caesarean birth is advised after it.

HIFU for adenomyosis. You may be offered HIFU as a way to treat adenomyosis without surgery. The evidence on pregnancy afterwards comes from small studies, mostly without comparison groups. A 2024 review called it "very weak". For now, treat HIFU for fertility as unproven, and ask what evidence the clinic is relying on.

Pregnancy with fibroids or adenomyosis

Most pregnancies with fibroids go smoothly. FIGO notes slightly higher risks of early miscarriage, preterm birth, the baby lying in an unusual position and the placenta separating early, and a higher chance of caesarean birth.

Adenomyosis has been linked with pre-eclampsia, preterm birth, the placenta lying in an abnormal position, a small baby and heavier bleeding after birth. The evidence is of low certainty, but it is a good reason to tell your obstetrician you have it. If you have had repeated miscarriages, see repeated miscarriages: which tests help.

Where to start in Malaysia

If you have heavy periods, pain or trouble conceiving, a klinik kesihatan or your GP can arrange an ultrasound and refer you to a gynaecologist. If you are already having IVF, ask your fertility specialist whether any fibroid or adenomyosis seen on your scans needs treating first, and why. See also endometriosis and after a failed IVF.

Sources

This page is general information, not medical advice for your situation.

This article is for general education only and does not take your personal circumstances into account. Please speak to your doctor for a diagnosis and treatment that are right for you. Disclaimers