Many women with fibroids conceive without any special intervention, but the speed at which you get pregnant depends largely on where your fibroids are and whether they’re distorting the shape of your uterine cavity. Fibroids that push into or reshape the cavity where an embryo implants are the ones most likely to cause delays. The good news: once you know what you’re dealing with, there are clear steps to improve your odds.
Why Fibroid Location Matters More Than Size
Not all fibroids interfere with fertility. The critical factor is whether a fibroid distorts the endometrial cavity, the inner lining where an embryo needs to attach. Submucosal fibroids (which grow into the cavity) and large intramural fibroids (which grow within the uterine wall and push inward) are the types linked to lower pregnancy, implantation, and delivery rates. Subserosal fibroids, which grow on the outer surface of the uterus, generally don’t affect your ability to conceive.
Fibroids that distort the cavity can interfere with pregnancy through several pathways: they increase abnormal uterine contractions, alter blood flow to the lining, trigger chronic low-grade inflammation, and change the chemical signaling that helps an embryo implant. If your fibroids sit outside the cavity and aren’t especially large, they’re unlikely to be the reason you haven’t conceived yet, and other fertility factors deserve attention first.
Get the Right Imaging First
A standard ultrasound can identify fibroids, but it doesn’t always show whether they’re pressing into the cavity. A saline infusion sonogram, where sterile fluid is injected into the uterus during an ultrasound, gives a much clearer picture of the cavity’s shape. This distinction matters because it directly determines whether surgical removal would help. If your provider hasn’t done this type of imaging, it’s worth requesting. An MRI can also map fibroid locations precisely, which helps with surgical planning if removal is on the table.
When Removing Fibroids Speeds Things Up
The American Society for Reproductive Medicine recommends considering myomectomy (surgical fibroid removal) for cavity-distorting fibroids in women trying to conceive. Pregnancy and delivery rates improve after removing submucosal fibroids, especially when the fibroid is the only identifiable cause of infertility. For fibroids that don’t distort the cavity, surgery is generally not recommended to improve pregnancy outcomes, unless they’re severely distorting your pelvic anatomy in a way that complicates treatment like egg retrieval for IVF.
There are several surgical approaches, and the choice depends on fibroid size, number, and location:
- Hysteroscopic myomectomy is used for submucosal fibroids. A thin scope is inserted through the cervix with no abdominal incisions. Recovery is fastest with this approach.
- Laparoscopic myomectomy uses small abdominal incisions and a camera. A meta-analysis comparing it to open surgery found higher post-operative pregnancy rates: about 29% after laparoscopic versus 22% after open myomectomy.
- Open (abdominal) myomectomy involves a larger incision and is typically reserved for very large or numerous fibroids.
After any myomectomy, doctors typically recommend waiting 3 to 6 months before trying to conceive, giving the uterus time to heal fully. That waiting period can feel frustrating when you’re eager to start, but it reduces the risk of uterine rupture during a future pregnancy.
Avoid Fibroid Embolization If You Want to Conceive
Uterine fibroid embolization (UFE) is a procedure that shrinks fibroids by cutting off their blood supply. It’s effective for symptom relief, but the fertility outcomes are significantly worse than myomectomy. The estimated conception rate after UFE is around 38%, and post-UFE pregnancies carry a nearly threefold higher risk of miscarriage compared to the general population, along with increased rates of cesarean delivery and postpartum hemorrhage. One study comparing UFE to myomectomy directly found a 64% miscarriage rate after UFE versus 23% after myomectomy. If pregnancy is your goal, myomectomy is the safer path.
Medication to Shrink Fibroids Before Surgery
Your doctor may suggest a short course of hormone-suppressing medication for 3 to 4 months before surgery to shrink both the fibroids and overall uterine volume. This can make surgical removal easier, reduce blood loss during the procedure, and potentially allow a less invasive surgical approach. These medications can’t be used long-term because they induce a temporary menopause-like state with side effects including bone loss and hot flashes, but as a bridge to surgery they’re a useful tool.
Supplements That May Slow Fibroid Growth
Two supplements have the most clinical evidence for reducing fibroid size: vitamin D and green tea extract (EGCG).
In a clinical trial of women with fibroids larger than 2 centimeters and low vitamin D levels, high-dose vitamin D supplementation over 10 weeks led to measurable reductions in fibroid volume. Separately, a randomized trial found that 800 mg of green tea extract daily for four months produced a 32.6% reduction in fibroid volume. When vitamin D, green tea extract, and vitamin B6 were combined in other trials, fibroid volume decreased by roughly 35 to 38% over four months.
These are promising numbers, but they come with caveats. The vitamin D trial specifically enrolled women who were already deficient, so the benefit may be smaller if your levels are normal. And while shrinking fibroids is helpful, these supplements haven’t been directly studied as fertility treatments. They’re best thought of as a complement to your overall plan, not a replacement for addressing a cavity-distorting fibroid surgically. Talk to your provider about appropriate doses, especially for vitamin D, where high-dose supplementation needs monitoring.
Dietary Changes That Support Hormone Balance
Fibroids are estrogen-sensitive, meaning higher estrogen exposure can fuel their growth. Your diet plays a role in how your body processes and eliminates estrogen. Dietary fiber binds to estrogen in the digestive tract and helps remove it through regular bowel movements, which is one reason higher fiber intake is associated with lower fibroid risk.
Cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts contain natural compounds called indoles that help the body metabolize estrogen more efficiently. Flaxseeds are rich in lignans, plant compounds with anti-inflammatory and antioxidant properties that also influence estrogen metabolism. On the flip side, diets high in processed foods, refined carbohydrates, sugary drinks, and unhealthy fats are linked to higher fibroid risk. A fiber-rich diet built around vegetables, fruits, legumes, whole grains, and seeds supports the kind of hormonal environment that slows fibroid growth.
These dietary shifts won’t shrink an existing large fibroid overnight, but they create better conditions for conception and may prevent new fibroids from developing or existing ones from growing quickly while you’re trying to conceive.
A Practical Timeline to Work With
If you’re trying to conceive quickly with fibroids, here’s a realistic sequence. First, get imaging that clearly maps your fibroids relative to the uterine cavity. If your fibroids don’t distort the cavity, you can try conceiving right away while optimizing your diet, checking your vitamin D levels, and addressing any other fertility factors like ovulation tracking, thyroid function, or partner sperm quality.
If your fibroids do distort the cavity, the fastest path to pregnancy typically involves removing them. With a hysteroscopic approach for submucosal fibroids, recovery is relatively quick and you may be cleared to try within 3 months. For laparoscopic or open myomectomy, expect a 3 to 6 month waiting period before conceiving. While that feels like a delay, women who have cavity-distorting fibroids removed have meaningfully better implantation and delivery rates than those who try to conceive around them.
If you’ve been trying for 6 months or more without success (or 12 months if you’re under 35), a reproductive endocrinologist can evaluate whether fibroids are the primary issue or whether other factors are also at play. Fibroids are a contributing cause of infertility, but they’re rarely the only factor, and a comprehensive workup ensures you’re not spending months focused on fibroids while something else goes unaddressed.