This is a tricky question and I wouldn’t want to give a specific answer. I don’t like the put label on sizes because I have said many times, the most important thing is to take every couple as an individualized case. So you need to consider a lot of factors to answer that. The most important thing is not size, its position. So even if a fibroid is very small but it protrudes the whole of it or even part of it, it needs to be removed, as it can cause miscarriage, it can decrease the chance of implantation. Regarding fibroids that are 3-4 centimetres in size or 2-4 centimetres in size, and they are outside of the womb but very close to the endometrium, the most recent research says that they need to be removed because they can affect the blood flow in the endometrium. We need to take into consideration as well as other factors, f.e. the age of the woman if she had any previous surgeries, if she had failed IVF attempts or not, so there is no clear answer.
Regarding the fibroids that are outside the lining of the womb, and they are not close to the lining, they are more than 1-2 centimetres from there, so subserosal fibroids, I wouldn’t remove them unless they get too big. If they do get bigger, but they don’t cause problems, if they are subserosal that would depend if the woman is 25-30 and has a normal ovarian reserve, we can remove it but if someone is f.e. 42, possibly we would not want to lose time and get the eggs first.