Endo, submucosal fibroid, trying to conceive..

I am 38yrs old with endometriosis history, was operated yrs ago and now I have it again. Endometrioma but not very big, probably tubes not open etc. Rectovaginal was never operated, so endo has grown. I also have about 3x3 submucosal fibroid that affects the cavity.
My question is, should I have surgery before trying to conveice? My ovaries do not work properly anymore, not producing a lot of follicles..My FSH is elevated, on the other hand, how much does endo influence the FSH? I'd like the fibroid to be removed, then it will surely not help implanting.
My doc says I may try to get pregnant, I may go to surgery, maybe we should start with IVF as soon as she knows if I react well to stimulation..I don't know what is the right choice for me, as endo and definitely the fibroid will not help getting pregnant.
IVF will maybe also not work for us due to these reasons, so would the chances grow if I had the surgery at first (with 1month healing if the fibroid was left on its place)? If they shaved the fibroid, would that help?

[Elaine Brown, MD]

Hi!
If you were my patient, I would be inclined to do some "housekeeping"  before going to IVF.  I would probably offer you a hysteroscopy laparoscopy combination to clean up and remove as much endometriosis as possible, and also to remove the fibroid hysterescopically if possible.  

If your tubes are not open, going to IVF is really the only way to go, and the sooner the better.  If your FSH is over 9, you may not respond well to stimulation, although there are some protocols for "the more mature" customers.

How is your partner?  
Any male factor?


Good Luck!
Dr B