Which statement describes how fibroids can affect fertility?

• A. Submucosal fibroids can distort the uterine cavity and hinder implantation.
• B. Large intramural fibroids never impact implantation.
• C. Subserosal fibroids distort the cavity.
• D. Any fibroid improves implantation.

Answer: (A)

Fibroids affect fertility mainly by where they grow. Submucosal fibroids push into the uterine cavity and directly distort the endometrial lining, reducing a smooth, receptive surface for embryo implantation. This distortion can hinder the embryo’s ability to implant properly and can increase the risk of early pregnancy loss. Because they change the cavity where implantation occurs, these fibroids have a clear negative impact on fertility, even when they are not very large.

Subserosal fibroids, which grow on the outer surface of the uterus, typically don’t distort the uterine cavity, so they’re less likely to affect implantation. Large intramural fibroids can impair fertility if they distort the cavity or disrupt uterine blood flow and contractility, but that does not mean they never impact implantation. The idea that any fibroid would improve implantation is not correct. In many cases, removing submucosal fibroids via hysteroscopic myomectomy can improve fertility outcomes.