Practice Uncertainties Page

Do uterine fibroids cause infertility and should they be removed to increase fertility?

BMJ 2009; 338 doi: (Published 16 January 2009) Cite this as: BMJ 2009;338:b126
  1. Cynthia Farquhar, postgraduate professor of obstetrics and gynaecology
  1. 1Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
  1. c.farquhar{at}

    Twenty to fifty per cent of women are estimated to have fibroids, and the incidence increases with age until menopause.1 Whether fibroids cause infertility is the subject of considerable speculation; fibroids are estimated to be the sole cause of infertility in less than 3% of cases.2

    The impression that fibroids contribute to infertility has arisen from several case series, mostly without controls, where a varying proportion of previously infertile women conceived after their fibroids had been removed.3 4 However, case series are generally not considered strong evidence of causation, so whether fibroids do cause infertility, and therefore whether they should be removed, is still uncertain.5

    What is the evidence of the uncertainty?

    A systematic review of 22 observational studies and one randomised controlled trial has recently reported reduced fertility in women with fibroids, mostly in association with assisted reproductive technology cycles.6 The review suggests that the location of the fibroids may matter: women with subserosal fibroids do not seem to be less fertile than women with no fibroids; however, women with submucosal fibroids (with or without intramural fibroids) had decreased fertility and increased pregnancy loss compared with women with no fibroids.

    There are several reasons to be …

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