Uterine factors can be found in only 2 to 3% of infertile women, but intrauterine lesions are much more common in this setting (40–50%). These lesions can compromise spontaneous fertility as well as reduce pregnancy rates in assisted reproduction. Published observational studies suggest increased pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum, or intrauterine adhesions, which can be found in 10% to 15% of women seeking treatment for subfertility.
Several studies have shown that submucous fibroids are associated with infertility, probably as a result of decreased implantation. Some studies have also shown that submucous fibroids are associated with recurrent spontaneous abortions. However, in many cases the infertility preceded the fibroids and the fibroids have grown because of incessant ovulation. There may also be abnormalities of tubal motility or tubal obstruction based on the location of the fibroid.