Challenges of Uterine Fibroid Surgery Before IVF: What You Need to Know

Uterine fibroid surgery issues?

I recently underwent an egg retrieval procedure because I want to pursue in vitro fertilization (IVF), and I am scheduled for surgery to remove uterine fibroids.
However, during my recent follow-up appointment, my doctor informed me that a new regulation was implemented last week, prohibiting laparoscopic surgery.
Instead, I can only have an open abdominal surgery to remove the fibroids.
The reason seems to be the concern that if the fibroids are fragmented, any potential cancer cells could spread.
Is there any possibility for reconsideration? I really do not want to undergo open surgery for the fibroids.
Additionally, if I do proceed with the traditional open surgery to remove the fibroids, will I still be able to attempt IVF for twins afterward? Note: I have about four to five fibroids, with the largest being nearly five centimeters, and my doctor believes there isn't enough space for implantation, so the fibroids need to be removed first.

S, 40~49 year old female. Ask Date: 2020/05/12

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if you have fibroids, you may need to wait a longer time before trying to conceive, and considering your age, I suggest directly pursuing in vitro fertilization (IVF).
You can discuss this with your doctor.
Wishing you good health.

Reply Date: 2020/05/12

More Info

When considering the challenges of uterine fibroid surgery before undergoing in vitro fertilization (IVF), it is essential to understand the implications of both the surgical procedure and the fibroids themselves on fertility. Uterine fibroids, which are benign tumors of the uterus, can affect a woman's ability to conceive and maintain a pregnancy, depending on their size, location, and number. In your case, with multiple fibroids, including one close to five centimeters, your doctor has recommended surgical intervention to improve your chances of successful implantation during IVF.

The recent regulatory change that restricts the use of laparoscopic (minimally invasive) techniques for fibroid removal is indeed concerning. Traditionally, laparoscopic surgery is preferred due to its shorter recovery time, reduced postoperative pain, and minimal scarring compared to open abdominal surgery. However, the concern about potential cancerous cells being disseminated during the morcellation process (the fragmentation of fibroids) has led to increased scrutiny and regulation of this technique.
If your doctor has deemed that an open abdominal procedure is necessary, it is crucial to discuss the specific reasons for this decision. Factors such as the size and location of the fibroids, your overall health, and the potential risks associated with laparoscopic surgery should be considered. It may be worthwhile to seek a second opinion from another specialist in reproductive surgery or a fertility clinic that has experience with fibroid management in the context of IVF.

Regarding your concern about the possibility of having twins after undergoing traditional fibroid surgery, it is important to note that the surgical procedure itself should not inherently affect your ability to conceive multiples. The likelihood of having twins during IVF is primarily influenced by the number of embryos transferred and the specific protocols used by your fertility clinic. If you are considering transferring multiple embryos, this could increase your chances of having twins, regardless of the fibroid surgery.

However, it is essential to ensure that your uterus is in optimal condition for implantation and carrying a pregnancy to term. After fibroid removal, your doctor will likely monitor your recovery and assess the uterine environment before proceeding with IVF. Factors such as uterine scarring, healing, and overall uterine health will play a significant role in your fertility outcomes.

In summary, while the transition from laparoscopic to open surgery may feel daunting, it is crucial to prioritize your health and the potential for successful IVF. Open communication with your healthcare provider about your concerns, the risks and benefits of the surgical approach, and your fertility goals will be vital in navigating this process. Additionally, consider discussing the implications of fibroid surgery on future pregnancies and the potential for multiple births with your fertility specialist. This comprehensive approach will help you make informed decisions as you move forward with your family planning journey.

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