By Dr. Álvaro Díez Álvarez (Gynecologist – License No. 282865580).
Uterine fibroids are one of the most common gynaecological conditions in women of reproductive age. It is estimated that up to 70-80% of women may develop them at some point in their lives, but most will be asymptomatic and not all will require treatment.
Although in many cases they do not present symptoms, they may raise doubts in women who intend to become pregnant.
Also called fibroids or leiomyomas are benign tumours that grow in the uterus. They develop from uterine smooth muscle and their growth is influenced by hormones, especially oestrogen and progesterone.
There are different types, depending on their location in the uterus.
Subserosal fibroids develop on the outside of the uterus and, in principle, do not affect fertility, although if they are very large, their removal should be considered.
Intramural fibroids grow inside the muscular wall of the uterus and can affect the implantation of the embryo and cause abundant bleeding.
Submucosal fibroids, which should always be removed, are found in the uterine cavity and can directly interfere with implantation and the development of the pregnancy; both subserosal and submucosal fibroids can be pedunculated and are attached to the uterus by a stalk that can twist and cause pain.

Not only is it possible, but many women with fibroids achieve pregnancy naturally. However, the impact of fibroids on fertility depends on their size, number and even their location. It is important to note that large subserosal or submucosal fibroids can compromise embryo implantation or increase the risk of miscarriage.
In addition, some fibroids can cause menstrual irregularities, heavy bleeding and pelvic pain, which can affect a woman's fertility.
Fertility treatments, such as in vitro fertilisation (IVF), can be affected by the presence of fibroids. In particular, submucosal fibroids and large intramural fibroids can reduce embryo implantation success rates. In these cases, it is recommended to evaluate the possibility of removing the fibroids by open or closed surgery (myomectomy) or hysteroscopy before starting treatment.
There are different treatment options for fibroids depending on their impact on fertility and symptomatology, ranging from active surveillance (if they do not cause symptoms or affect fertility), to surgery to remove them, preserving the uterus. In addition to surgery, there are other treatments such as uterine artery embolisation, although this technique is not always recommended for women who wish to become mothers.
Hormonal treatments can reduce the size of fibroids, although they are not recommended in the long term for women seeking an immediate pregnancy. If you have fibroids and want to become a mother, it is essential to consult a fertility specialist to evaluate their impact and plan the best treatment. Although in some cases they can make conception difficult, with the right approach many women achieve pregnancy, either naturally or through assisted reproduction.