The relationship between uterine fibroids and a woman's reproductive health is heavily dependent on the fibroid's location, making Fertility Impact a primary factor in treatment choice. Submucosal fibroids, which distort the uterine cavity, are the most detrimental, as they are strongly linked to impaired embryo implantation, higher rates of miscarriage, and infertility. Large intramural fibroids (those within the wall) may also compromise fertility by affecting endometrial blood flow or cavity shape, whereas subserosal fibroids (on the outer surface) generally have little to no effect.

For women actively seeking to conceive, myomectomy remains the gold standard procedure, as surgical removal of the offending fibroids can significantly improve pregnancy rates when the uterus is preserved and the cavity restored. Conversely, while UFE is often successful at managing symptoms, its potential effect on endometrial receptivity or ovarian reserve is less established, making myomectomy the prioritized route for fertility preservation. Furthermore, all treatments must account for potential risks during pregnancy, such as preterm labor and uterine rupture after extensive myomectomy incisions.

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