I have a big dilemma about how to proceed in terms of IVF and fibroid management and would be grateful for any advice from people more experienced in these matters. My situation has a few separate components.
I am 41, nearly 42, and belatedly have decided to try and conceive. I've actually wanted to try for years but various factors made that tricky.
Anyway... ahead of trying I got rapidly referred for an NHS ultrasound to rule out ovarian cancer after a weird set of symptoms (bloating, bleeding, pain etc). Thankfully fine on that front but they told me I have a pretty hefty intramural posterior fundal fibroid (7cm). I asked if it was the kind that would make pregnancy impossible and the sonographer casually said yes...
I did loads of reading as soon as I got home and it seems fibroids don't rule out pregnancy but some can impact conception/ retention depending on size and location. A significant percentage of women have them and most cause zero problems, particularly if they are subserosal (on the outside) or otherwise small and not within the uterine cavity.
I quickly booked a private appointment with a consultant for a second opinion and it turns out I also have a small submucosal fibroid. Wonderful! She confirmed that this one could cause issues with implantation and the large intramural one could cause issues with retention. I asked if it would be more likely than not that I would miscarry but she sort of shrugged at that and couldn't give a percentage chance. I asked what she would do in my shoes any she said remove. But she is not a fertility expert so I need to probably seek another opinion from a consultant who does both IVF/ pregnancy management and fibroid surgery. Open to suggestions if anyone has seen anyone good!
Cost to remove both: around 10k. Ouch. And then there's risks of uterine rupture during pregnancy, scar tissue complications etc. (And worst of all... hysterectomy. Only about 1% chance but bloody hell). Plus the recovery time of about 3 months. All a nightmare curveball to consider at the point I'm finally trying to get a move on! I've had an urgent NHS referral to Imperial while I try to work out what to do. My appointment is in June but I'll try to bring it forward.
Some glimmers of hope:
- My antral follicle count is 20 (10 on each ovary). This seems oddly good for my age.
- My AMH is 12.5 which seems acceptable
Things to check again:
- My day 21 progesterone test was 27.1 nmol/L, which is under the 30 level to indicate definite ovulation but the doctor said it was likely and maybe I tested a day or two out. I have regular cycles and always get high/peak smiley faces for an LH surge and EWCM.
- My baseline FSH was 2.6 which seemed suspiciously low/good for my age and I now wonder if this was taken on day 1 rather than 3 (because of fibroid bleeding, the true period start can be difficult to gauge). I did an internet order test on what may have been day 4/5 and FSH had gone up to over 8. Still probably fine but it threw the ratio with LH.
I'm considering banking embryos over three cycles while I have a good AFC and sending them for testing. This would be to play the numbers game of hopefully at least a few being normal and provide some security if I have several months of recovery from surgery or miscarriage issues. However it would be expensive and I wouldn't be able to use an Access package. It would be difficult to afford both IVF and fibroid surgery.
I've never actually tried to conceive naturally! Well, other than last month in a roll of the dice. And this one (now 4 days past ovulation). If naturally worked it would save a fortune but then there's the risk of time consuming recurrent miscarriages because of age.
My sister is a year younger and had a healthy baby in December, albeit after several miscarriages over a year. (Her numbers were FSH 17 and AFC 7).
CENTRAL ISSUES:
What do I do first here? Where do I focus my budget? What makes most sense in terms of timeline?
Do I do the embryo banking first and then consider surgery? Or have the surgery first and then bank while recovering? Or should I forget myomectomy because it presents too many possible complications?
Should I just go for it now in terms of fresh transfers via Access (I'd still likely need the submucosal one removed via hysteroscopy but that one would be cheaper with little recovery time)?
Or do I try naturally for a few more months in hope of a miracle? By which time the NHS fibroid treatment offer may have arrived.
Do I bother applying for my one round of NHS funded IVF?
Big solidarity to everyone on here. This makes zero sense given my age but I was oddly complacent I would be able to conceive at the drop of a hat until this all kicked off two months ago. Partly because I feel so young. Partly because I'm one of five children and my grandmother had my mum when she was 45. I have a newly acquired respect and empathy for everything women go through on this journey.
Thanks for reading if you got this far!