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Dear Dr. Jacobs,
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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Personally, I try not to perform myomectomy. If the fibroid is distorting the uterine cavoty, the procedure will probably provide benefit. Otherwise, the data are not clear.
Good luck.
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