Need help with infertility results

[marksniles]

Hi! My wife and I have been trying to conceive for the past 3 years without success.  We finally decided to go see a infertility specialist.  We had blood work done, I provided a sample for analysis, and she had an HSG and a pelvic MRI done.  We are both 35 years of age. My wife also has a large fibroid that is sitting on the top of her uterus.  When the doctor first examined her she told us that she recommends taking out the fibroid because she doesn't think that she would be able to carry the baby to full term.  She said that she looks like she is already 3-4 months pregnant.  We got our results back last week.  I am fine and the HSG showed that everything was clear.  The fibroid was measured to have a diameter of 12 cm and a base of about 6 cm.  They also found 2 small ~2cm fibroids in the walls of the uterus.  Her FSH level was an 11.4.

The doctor recommends that we start a round of treatments to do a IUI.  She wants to skip the pill and start her right on the injections.  

Our concern is the statement she made about taking out the fibroid.  We understand that fibroids are dependent on her estrogen levels and can get much bigger with pregnacy.  We brought up her comment about taking the fibroid out first and she said not to worry about it -"Let's see what happens."  She explained that if you take the fibroid out then you can suffer from scar tissue.

We don't know what to do.  Should we go ahead with the IUI and hope for the best?  Should we take out the fibroid and then try the IUI?  From your experience - what would you recommend.

Thanks!

[DinaRose]

Hi Mark, I am 39 years old with a very large uterine fibroid.  My fertility specialist made the same recommendation and they are very reputable in our area.  This thing is so large it has made monitoing difficult at times.  I started infections/monitoring this month.  I will give it three months and see what happens. I am concerned about possible miscarriage or premature labor.  My doctor also told me if I would need IVF, I would have no other choice than to have the fibroid removed.  Yes, the having the fibroid removed put you at an increased risk for uterine rupture but I can tell you my sister, who had her fibroid removed several years ago, just gave birth via C-section, and was fine.  My other sister had a large fibroid when she got pregnant.  It did grow with pregnancy and she did have premature labor, approx. 35-36 weeks and she and baby were fine!  Good luck....maybe we can stay in touch since we are embarking on this journey at the same time.  -Dina

[John Kim, M.D.]

When a fibroid is not impinging into the uterine cavity or is not blockiing the fallopian tubes then you can leave it alone. However, there is an exception and that is if the fibroid is particularly large and the cut off size is contoversial but around 10cm, then doctors suggest removing it before pregnancy because of the potential for obstetrical complications.
However, I think it is not unreasonable to try injectables with IUI 2-3 times and if not pregnant then you may consider surgery and then IVF.
Alternatively, you can have surgery first but it could delay trying to get pregnant for several months.
Your doctor will have a better idea than me of determining whether or not the fibroid may present future problems in pregnancy.