Fibroids and infertility.

The presence of uterine fibroids impacts fertility through multiple mechanisms. While subserosal fibroids have minimal impact, especially when of reduced size, the presence of intramural fibroids impacts both the likelihood of pregnancy and its outcomes. Submucosal fibroids significantly reduce the chance of pregnancy and increase pregnancy complications. While noninvasive techniques can treat fibroids and appear safe, surgical management of FIGO Type 0, 1, 2, and 3 fibroids remains the gold standard in women desiring pregnancy. Uterine artery embolization is not recommended. Where the ovaries are not visible due to the presence of large fibroids, assisted reproduction and transvaginal oocyte pick-up become a challenge and consideration for myomectomy should be given. A cesarean section should be performed for women where the uterine cavity has been opened at the time of myomectomy.