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SCOTT CORDTS, MD, RYAN LUCE, MD, AND REBECA NIEVES, MD

Am Fam Physician. 2026;113(4):388

Author disclosure: No relevant financial relationships.

CLINICAL QUESTION

Are uterine leiomyomas a risk factor for infertility?

EVIDENCE-BASED ANSWER

Patients with more than one untreated leiomyoma may have decreased fertility as measured by pregnancy and live birth rates. (Strength of Recommendation: B, meta-analysis of randomized controlled trials and cohort studies.) Patients with a single leiomyoma smaller than 5 cm may have a lower pregnancy rate than those without leiomyomas. The specific location of leiomyomas (ie, subserosal, submucosal, intramural, simultaneous submucosal and intramural) may be associated with lower birth rates.

EVIDENCE SUMMARY

A 2024 systematic review and meta-analysis of 13 mostly prospective and retrospective studies (N = 4,788) examined pregnancy and birth rates in patients with leiomyomas vs those without leiomyomas. Mean patient age was 33 years. Patients were included if they had intramural leiomyomas (most were smaller than 8 cm) and were undergoing assisted reproductive technology or attempting conception. Patients with leiomyomas smaller than 2 to 3 cm and patients with leiomyomas larger than 2 to 3 cm were compared with those who did not have leiomyomas in terms of the clinical pregnancy rate. Primary outcomes were the rates of clinical pregnancy and live birth.1

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Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

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This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

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