QuestionHello,
I am 41 yrs. old and had never been pregnant after 8 years of marriage. I have a uterine fibroid that is 'not blocking the cervix'. 2 different Infertility MDs said that I don't need a myomectomy.My infertility is unexplained as all my hormones are normal and my husband has no sperm problems. However , after a failed Clomid with IUI and Gonadotropins with IUI my second doctor has now changed his opinion and said I will now need myomectomy. I had 2 hysterosalpingograms which showed a normal uterine cavity with both fallopian tubes open. What is your opinion about fibroids and is this the only way I can get pregnant? IVF is not an option for me as I am catholic. Thank you very much.
AnswerHello Marie,
There is controversy regarding uterine fibroids. There have been some studies showing that fibroids anywhere in the uterus can decrease pregnancy rates,other studies showing that only fibroids in the uterine cavity decrease pregnancy rates and some studies showing that fibroids have no effect at all. Most fertility specialists are reluctant to do a myomectomy because the surgery can lead to pelvic scar tissue formation and hence, infertility. I usually only do the myomectomy in this case if the patient is willing to undergo IVF, which is the treatment of choice for pelvic scar tissue. However, it is also a treatment of last resort, as in your case. If everything else is normal, and the treatments have failed, then I would also recommend a myomectomy. However, has a laparoscopy been done? Another disease, endometriosis, can also be the culprit in patients that test completely normal otherwise. This can only be diagnosed by laparoscopy. If you surgeon is good enough, then the myomectomy can be done at the same time by the same technique.
I was sorry to hear that you would not do IVF. There is another overwhelming factor now, which is your age. Your chances of a natural pregnancy (non-IVF) is only 10% per year of trying or less than 1% per month. With IVF you would have a 27% chance of pregnancy per try. I am Catholic myself, and my wife and I have undergone IVF to get our daughter. I have also had many couples who have used IVF who are Catholic. Have you spoken to your priest about this? I don't think that it is disallowed, but I could be wrong, in the strictest teaching. But God loves children and wants children to be born. He has endowed me with the ability to help couples achieve this goal. Why would he not want you to have a child? However, you do know that the Italians do IVF as well?
Sorry for the philosophizing. I hope this answers your questions.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
