Fibroids vs. Low Morphology
4 Replies
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Hi Dr. Smith,
When you have a patient who has a uterine fibroid, how do you determine if it is causing fertility problems? I have a subserous fibroid (~5cm). At first my RE was unconcerned about it, but when he looked at it on US he said it is pretty deep into the wall. We did an HSG and my tubes and uterus looked good on that. We've done 3 stimulated IUI cycles with no success. So, my RE is having me come in to take another look at it to see if we should remove it. This would be my second myomectomy (the first was 5 years ago for a pedunculated fibroid). What complicates things in my mind is that my husband has morphology issues (1%) and his sperm count is borderline (ranges between 12 and 37 million). So, I'm just wondering which thing is the bigger issue? Should we move on to IVF? Or does the fibroid need to come out first? I know you probably can't give me a specific answer, but I'd just like to hear your general thoughts on this. Thanks so much!
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You're right, I'm not a physician, so I better not answer your question. However, I will forward your question to Dr. Miller and she will answer in the near future.
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Hello,
The fibroid is of a substantial size and may pose problems as the uterus grows during pregnancy. If the fibroid is within 4 mm from the endometrial cavity (as measured on sono) it needs to come out. If it is further away it will not affect implantation but may grow during pregnancy, cause major discomfort, and even bleed. Your difficulty conceiving is multifactorial. In my opinion the 1% normal sperm morphology is an indication for IVF/ICSI. I am surprized that that was not the recommendation when you started treatment.
Good luck,
Dr. Miller
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Thanks for the information. I really appreciate it!
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