Fibroid Types (FIGO) — Which Ones Matter for IVF

Key Takeaways

• Not all fibroids impact fertility—location matters more than size.
• Fibroids touching or distorting the uterine cavity (FIGO 0–2) most strongly reduce implantation and pregnancy rates.
• FIGO 3–4 fibroids may require removal depending on symptoms, size, and IVF history.
• FIGO 5–8 fibroids typically do not affect embryo implantation unless extremely large.
• Understanding fibroid type helps determine whether removal is needed before IVF or FET.

Fibroids are common benign uterine growths that affect up to 70–80% of women by age 50. While many fibroids are harmless, some can significantly interfere with fertility, implantation, and IVF outcomes. The internationally accepted FIGO classification system helps fertility specialists decide which fibroids matter, which need removal, and when IVF treatment can safely proceed.

This blog breaks down each FIGO type and provides clear guidance on how different fibroid locations impact IVF, embryo transfer, and overall fertility success.

Understanding the FIGO Classification System

The FIGO (International Federation of Gynecology and Obstetrics) classification divides fibroids into nine types (0–8) based on their relationship to the uterine cavity and wall.

Why FIGO Matters in Fertility

• It predicts whether a fibroid distorts the cavity.
• It guides whether hysteroscopy, laparoscopy, or monitoring is appropriate.
• It helps avoid unnecessary surgery while ensuring nothing reduces the chances of implantation.

FIGO Fibroid Types & Their Impact on IVF

FIGO 0 — Pedunculated Submucosal

• Inside the cavity, attached by a thin stalk
• High negative impact on IVF
• Must be removed before IVF/FET
• Very easy to remove hysteroscopically

FIGO 1 — <50% Intramural, Mostly in Cavity

• Projects into cavity
• Strongly affects implantation
• Removal recommended before transfer

FIGO 2 — ≥50% Intramural, But Still Distorting Cavity

• Deep within the wall but distorting cavity
• Reduces IVF success
• Hysteroscopic removal possible but may require staged procedures

FIGO 3 — 100% Intramural Touching the Cavity

• Does not distort the cavity but touches the lining
• Controversial
• May reduce implantation if >2–3 cm
• Removal considered for repeated failed cycles

FIGO 4 — Fully Intramural (Centered in the Muscle)

• Largest group of “silent” fibroids
• If >4–5 cm, may affect blood flow, uterine contractility, receptivity
• Removal depends on symptoms + IVF history

FIGO 5 — Subserosal ≥50% Intramural Extension

• Mostly external but partly in muscle
• Rarely affects IVF
• Removal only if very large or causing pressure symptoms

FIGO 6 — Subserosal <50% Intramural Extension

• Almost entirely external
• No impact on implantation
• Typically ignored for IVF planning

FIGO 7 — Pedunculated Subserosal

• On a stalk outside uterus
• Not relevant for fertility
• Removal only if torsion risk or symptoms

FIGO 8 — “Other” Fibroids (Cervical, Parasitic)

• Impact depends on location
• Cervical fibroids may interfere with embryo transfer catheter
• Decisions individualized

Which FIGO Types Matter the Most for IVF?

High Impact — Removal Needed

• FIGO 0, 1, 2 (cavity-distorting)
  Direct evidence shows these reduce implantation, increase miscarriage, and dramatically lower IVF success.

Moderate Impact — Case-by-Case

• FIGO 3 & 4
  Depends on size, symptoms, and past failed cycles.

Minimal or No Impact

• FIGO 5, 6, 7
  Unless extremely large, these do not affect IVF outcomes.

Situational

• FIGO 8
  Depends on location.

When to Remove Fibroids Before IVF

General Guidelines

• Distortion of cavity = remove
• Large intramural (>4–5 cm) = consider removal
• Multiple failed transfers = evaluate carefully
• Symptoms (pain, pressure, heavy bleeding) = stronger case for surgery

Timing

• Remove fibroids 1–3 months before starting FET or IVF
• Uterus heals fully before transfer
• Egg retrieval can often be done before surgery if timing is tight

Diagnostic Tools to Classify FIGO Types

• 3D Pelvic Ultrasound — first-line, highly accurate
• SIS (Saline Infusion Sonography) — best for cavity distortion
• MRI — gold standard for complex mapping, multiple fibroids, or surgical planning

Case Study: FIGO 2 Fibroid Behind Two Failed Transfers

Patient: 35-year-old woman
History: Two failed IVF cycles with high-quality embryos
Tests: Standard ultrasound showed “normal uterus”
Next Step: SIS revealed a FIGO 2 fibroid slightly distorting the cavity
Treatment: Hysteroscopic removal
Outcome: Successful pregnancy on next FET

Lesson: Even subtle cavity distortion can profoundly affect outcomes.

Testimonials

1. Meera, 33

“I didn’t realize my intramural fibroid was causing issues. Understanding its FIGO type helped me make the right decision before IVF.”

2. Tanya, 41

“My doctor recommended MRI to map my fibroids. We discovered a FIGO 1 fibroid affecting implantation. After removal, my FET worked!”

3. Leena & Vikram

“Multiple clinics told us different things. The FIGO classification finally gave clarity about which fibroids mattered for IVF.”

Expert Quote

“Fibroids don’t all behave the same. It’s their location—not their size—that determines whether they impact implantation. FIGO classification is essential before IVF.”
— Dr. Rashmi Gulati

Related Links

• Imaging Pathway — SIS, HSG, 3D Ultrasound, MRI
• Polyp Removal Before IVF — When to Proceed
• Cervical Factors — When Access Is the Issue
• Endometritis — Diagnosis and Treatment Basics

Glossary

Fibroid: Benign muscular growth in the uterus.
FIGO Classification: System categorizing fibroids based on location.
Submucosal Fibroid: Fibroid growing into the uterine cavity.
Intramural Fibroid: Fibroid within the uterine muscle.
Subserosal Fibroid: Fibroid on the outer surface of the uterus.
Hysteroscopy: Procedure to remove fibroids inside the cavity.
Myomectomy: Surgical removal of fibroids.
Endometrial Cavity: Space where embryo implants.
Distortion: Change in normal shape of cavity.
Receptivity: Uterus’s ability to accept an embryo.

FAQ 

Q. Do all fibroids need to be removed before IVF?

Ans. No. Only those that distort the cavity (FIGO 0–2) and large intramural fibroids (FIGO 3–4) that impact uterine function usually require removal. Most subserosal fibroids don’t affect IVF.

Q. Which fibroid types most strongly affect implantation?

Ans. Submucosal fibroids (FIGO 0–2) have the highest negative impact because they disrupt the cavity, alter blood supply, and interfere with the embryo-endometrium interface.

Q. Can intramural fibroids (FIGO 3–4) reduce IVF success even if they don’t distort the cavity?

Ans. Yes, especially if they are >4 cm. They can alter uterine contractility, reduce blood flow, and impact hormonal signaling. Removal may be advised in women with multiple failed transfers.

Q. Are subserosal fibroids (FIGO 5–7) harmful for IVF?

Ans. In most cases, no. These fibroids are located outside the uterus and do not affect implantation. They are removed only for symptoms or if they grow extremely large.

Q. How do I know which FIGO type I have?

Ans. Your doctor will determine it through imaging:

• 3D ultrasound
• SIS
• MRI (for complex mapping)
  Accurate classification is essential before deciding on surgery.

Q. Should I delay IVF if a fibroid is found?

Ans. If the fibroid distorts the cavity or is large intramural (>4–5 cm), delaying IVF for removal is recommended. For non-impactful fibroids, IVF can proceed without delay.

Q. What size fibroid requires removal before IVF?

Ans. Those are:

• Submucosal: any size
• Intramural: >4 cm
• Subserosal: only if symptomatic or huge

Q. What is the recovery time after myomectomy before IVF?

Ans. Depends on surgical type:

• Hysteroscopic: 2–4 weeks
• Laparoscopic: 6–8 weeks
• Open surgery: 3–6 months
  Your doctor will guide embryo transfer timing to ensure proper healing.

Q. Can fibroids reoccur after removal?

Ans. Yes, recurrence rates are 15–30% depending on age and hormone levels. Regular monitoring is advised, especially before future pregnancies.

Q. Do fibroids increase miscarriage risk?

Ans. Submucosal and large intramural fibroids can increase miscarriage risk because they alter the uterine cavity and blood flow. Removing them reduces this risk.

Q. How are fibroids removed safely before IVF?

Ans. Depending on type:

• FIGO 0–2: hysteroscopic resection
• FIGO 3–4: laparoscopic or robotic myomectomy
• FIGO 5–7: rarely needed

Minimally invasive options are often preferred.

Q. Can I do egg retrieval before fibroid removal?

Ans. Absolutely. Many women freeze eggs or embryos first and undergo fibroid removal later, allowing them to start IVF without losing time.