Uterine septum hysteroscopy followed by IUI or IVF

Hello doctor,

                My husband and I had been trying to conceive for about a  year now with no success. On discusisons with our Reproductive Endocrinologist and follow up HSG, Ultrasound & MRI, it was discovered I have a Uterine Septum that extends about 1/3 into the Uterus and an Intramural and a  Pedunculate Fibroid. I have read online that either of these Fibroids do not pose danger to a  pregnancy because of their placement. I am due for a  Hysteroscopy for my Septum in 3 weeks  now, and though have been advised to do both a  Myomectomy for the Fibroid .I believe I should not do the Myomectomy as this will definately affect my Uterine wall, and may definately lead to a  C-section surgery or pre-term labour which I want to avoid. Is this a correct decision to make?

I am also thinking about going through an IUI or IVF. I don't tknow the sucess rates for these? Could you help me with any information. My husband was detected with a  low sperm count around 7.9 million and the morphology of % Normal Oval was below average ( aound 0.5) . We feel helpless at the moment and feel IVF may be our only chance..

I do want to get a  second opinion on the Semen Analysis test as I understand it is a  manual test and may be prone to error. Are we jumping into IVF too early? Is that what most doctors recommend easliy today?  With the septum surgery, my chances at fertility may increase, so I have no problem doing that.. my concern is about the Myomectomy and the push to do IVF. We are confused and tired of the Infertility Depression Syndrome, if there is anything like thay :-(

[Elaine Brown, MD]

Hi!
If you were my patient, I would remove the fibroid only if it extended into the endometrium/uterine cavity.  I would scrape it out with the hysteroscope while I was in there removing the septum, but I would not do a separate surgery or incision into your uterus to remove it if it is deep in the muscle wall and not visible from inside the uterus.
I am assuming of course that it is a small fibroid.  If it is a large one, 3-4 cm or bigger, it could cause problems with the pregnancy, and probably should be removed.

If your tubes are patent (open) there is no reason NOT to try IUI.  It is much cheaper and less invasive than IVF.  If it is going to work, it will work within 3 cycles.  There is no reason to do more than 6 cycles.  If it doesn't work within 2-3 cycles. you could go to IVF at that point.  It is much costlier, but may give you better results since you have a complex case.  If you do IVF, you should plan to do ICSI (intracytoplasmic sperm injection) since there are some problems with your husband's SA.

You are correct though, that the test is quite variable, and we almost always do more than one semen analysis before declaring that there is a problem.

By the way, I like your terminology--Infertility Depression Syndrome.  There definitely IS anxiety and depression associated with infertility!

Good luck!
Dr B