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Unable to conceive. Have multiple fibroids. IVF without myomectomy advisable?

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Infertility Specialist
Practicing since : 2002
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hi, many thanks for taking time to read our concern and provide your advice. We are married for 13 years and unable to conceive - reason unexplained infertility. i am now 38 yrs and my husband is 46 yrs, i have now been diagnosed with multiple fibroids (total 5 and the biggest is 8 cms) but none inside the uterus, 4 months back i had consulted a doctor who suggested myomectomy and post myomectomy to try for IVF. Recently 3 weeks back i did a repeat scan with a different dr, both the sonologist and the gyneacologitst suggested that i should go for IVF without Myomectomy, i am now confused and need an expert advice pls
Posted Sun, 25 Aug 2013 in Infertility Problem
 
 
Answered by Dr. Dattaprasad 37 minutes later
Hi,
Welcome to XXXXXXX
If fibroid is intramural & more than 5cms, or if there is any submucous fibroid or if there are multiple fibroids large enough to distort cavity, they should be removed to improve chance of pregnancy before IVF.
As I don't know the report of your second scan, I can't advise regarding surgery.
If your ultrasound report fits to one of the senarios described above, you can go for myomectomy.
Second option is to get one more scan done& then decide for myomectomy.
If you don't want surgery at any cost, you can go ahead with IVF with risk of 50% reduction in IVF success rate. (If its 45% after myomectomy, it will be 22.5% without surgery).
You can upload your second scan report for exact advice.

Let me know if you have other concerns.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Unable to conceive. Have multiple fibroids. IVF without myomectomy advisable? 1 hour later
Thank you for the reply, i am writing to u now from office and my reports are at home, can i scan and send them to u on Mon 5 Aug.

My sonologist was telling that the cavity is not distorted but the uterus is displaced. the largest fibroid is palpable and is of the size of a 18 - 20 weeks foetus.

in fact initially i was preparing myself to go for myomectomy followed by an IVF. However the recent consultation with an infertility specialist suggested that Myomectomy is not required and we can try for an IVF directly. My concern is, if i goahead with the IVF prior to Myomectomy and conceive will their be any risk to the foetus with the growing fibroid around it. Anitmulleral Harmone (AMH test was also done and the reports are normal)

I shall forward u my reports on Monday.
 
 
Answered by Dr. Dattaprasad 40 minutes later
Hi,

Welcome back.

Fibroid of 18-20weeks size definitely needs removal before IVF, unless it is totally subserous(outside uterus).
Regarding effect on pregnancy fibroids(except subserous fibroids) can cause abortion, premature delivery, bleeding during or after delivery.

Again I repeat fibroid of 18-20 weeks size needs removal before IVF unless its totally outside uterus.

Let me know if you have other concerns.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Unable to conceive. Have multiple fibroids. IVF without myomectomy advisable? 2 days later
Dear Doctor,

I have uploaded the ultrasound scan reports taken in XXXXXXX 2013 & subsequently in July 2013, attached pls find the same. I seek your clarification on the following

although my largest fibroid is as big as a 18 - 20 weeks it is outside the uterus and all the fibroids are outside the uterus, therefore the gyneacologist suggested to go for an IVF without doing Myomectomy - your take on this pls.

my concern is if i go ahead for IVF without myo will the growing fibroid hamper the growth of the foetus (if i conceive) - doctor i am totally confused whether to go for an IVF with Myo or post Myo - i need your suggestion / guidance pls.

Also if you could pls advice a good IVF centre in Bangalore pls. I also wanted to inform you that i am working as an executive assistant to the vice chairman, during IVF cycle will i be able to work or do i have to apply leave?
 
 
Answered by Dr. Dattaprasad 4 hours later
Hi,

Welcome back.

I have gone through both of reports. In my opinion 8cm intramural fibroid displacing endometrial cavity (although not distorting it) definitely needs removal before IVF. (Evidence from multiple large studies says that any intramural fibroid of more than 5 cm size should be removed before IVF to improve outcome).

Regarding your second query, you need two days of leave minimum, one on the day of egg retrieval & another on the day of embryo transfer if there is no complication.

Let me know if you have other concerns.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Unable to conceive. Have multiple fibroids. IVF without myomectomy advisable? 1 hour later
Thank you so much for taking time and replying to my queries, i was also thinking of doing Myomectomy followed by IVF. how much gap should be given between Myomectomy and IVF pls.

would u pls suggest good IVF centres in Bangalore
 
 
Answered by Dr. Dattaprasad 6 minutes later
Hi,

There should be 3 months gap between myomectomy & IVF, although duration can vary depending on surgical findings.

You can do IVF with Dr XXXXXXX XXXXXXX or Dr Korula George(Baptist Hospital, Hebbal).

Wish you good luck.

Regards.
Above answer was peer-reviewed by
 
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