Advice needed: should I remove my pedunculated subserosal fibroid before embryo transfer?

[NervyJ]

Hi everyone. Hoping for some advice here as medical professionals are pretty much leaving this decision up to me!😱

I’ve got one frozen embryo following a difficult 3 rounds of IVF over the last year. I’m about to turn 42 and have very low AMH - so I know my chances of success are low.

My scans detected a large-ish fibroid which I had follow up scans for based IVF clinic advice. Subsequent MRI showed it to be a pedunculated subserosal fibroid, measuring 7.2cm.

I don’t really get symptoms from it - maybe some mild discomfort but honestly, I’d probably assumed that to be kidneys or something before and it hasn’t really caused problems. If it wasn’t for IVF scans, I’d have no idea it was there.

The consultant has said they can remove it if I want… the ivf doctor said the same. Helpful… It’s not essential to remove it - it may well cause no issues at all, but it could grow, twist or degenerate etc.

Part of me wants to remove all possible risks from the one shot we have. But it’s not a minor procedure - the consultant said it would be an open myomectomy - pretty much a C section.

I’m so torn about what to do. I don’t want to put myself through a big operation (which carries its own risks) if it’s not needed, but I don’t want to end up regretting that decision if it causes problems with any potential miracle pregnancy later down the line.

They also confused me around how long I’d have to wait post op to do the embryo transfer. Consultant suggested ~6-8 weeks but I’ve read online advice saying at least 6 months! I’m not getting any younger… especially as we may need to try further rounds of IVF still. The IVF clinic couldn’t offer any advice on it.

I don’t know where else to go for advice as the experts don’t seem to want to advise me in either direction, and I’m so confused. I’ve got the myomectomy booked soon and am desperately trying to decide if I should go ahead or cancel.

Anyone been in a similar position? Had experience of this? What did you do? Thank you for any responses 🙏

[Loveelou]

Hi

I removed two as one was in the way of my ovaries and could have impacted egg collection. That was June 2023 and I started IVF Feb 2024.

I would suggest it is a good idea as fibroids seem to respond to IVF meds and oestrogen and could grow further.

[Backagain987]

I had six rounds of IVF with 'several' fibroids in place that my consultant said wouldn't impact my fertility. I had multiple failed rounds and multiple miscarriages. I then went to a new clinic who refused to do a transfer with my fibroids, and referred me to a specialist about them.

Long story short I ended up having an open myomectomy. I was so frustrated as we had donor embryos ready to transfer and I was in my 40's and felt (like you) time was not on my side. It is a big op but the recovery was quicker than I had thought. I was advised to wait 6 months before transferring the embryo because there is a big incision in your uterus and it needs to strengthen again to carry a pregnancy. I had the op in February and had my transfer in August. I was lucky enough to get pregnant that transfer. The consultant was a bit concerned I had done the transfer so quickly, but my fibroid specialist had said it was ok. My daughter is now 18 months old. This was our first DE round, so that might have had something to do with the success, but I am 100% sure it was because my uterus was in tip top shape. I was 45 when I had the transfer and 46 when I had her.

If you have any questions about the op, my specialist (I went private but got it covered on health insurance) or anything else then don't hesitate to contact me x

[Newbeginnings24]

hi, this is certainly a tough decision. I have a similar size large sub serosal pedunculated fibroid and several others intramural (in the muscle). My consultant advised not to remove unless it was a sub mucosal (inside the cavity) >3cm. For the intramurals he said it would cause more scarring than benefit to remove and the subserosal wouldn’t have an impact.

It took 3 rounds of IVF to get pregnant between age 39-40 and now am 25 weeks. Every scan the sonographer makes comments like my uterus is ‘bulky’ but so far they haven’t caused a problem. In the final months I will have growth ultrasounds every 4 weeks to make sure the baby’s growth is ok. The consultant said 1/3 women have the fibroids shrink in pregnancy, 1/3 stay the same and 1/3 grow, so it’s hard to predict and can just monitor.

It seems that others here have had success removing them so it’s difficult to know. One of Dr.Tim Childs IG podcasts talks about fibroids so you could also check that one. Best of luck however you decide!

[Ree_Laine]

Hey,

So I can definitely relate. My 1st round of ivf I took my stims and meds as usual I had a 6cm pedunculated fibroid that no one was bothered about as it was outside of the uterus. HOWEVER what they failed to see was an even bigger fibroid 18cm that was on a stalk and wandering all around my abdomen 😩 (couldn’t see in the vaginal scans). Of course my transfer was halted and I had both of those monster fibroids removed. I had to wait 4 months to have the nhs remove them by open Myomectomy and had a further wait of 6 months to heal before having my frozen transfer. I’m glad they did it because from my mri it also showed I had severe endometriosis and one of my Fallopian tubes had to be removed because of it. It all happened for a reason as endometriosis on Fallopian tubes that are damaged can cause leaking of a harmful substance that affects and hinders implantation. I haven’t had a BFP yet, my infertility journey continues and I will do another FET in a few weeks time ..but I am thankful there’s nothing extra in my mind that makes me think I could have done more. I have the best shot knowing the surgeon has done everything they could to improve my chances and I may have a relatively lower risk pregnancy that isn’t more uncomfortable. I do still have very small fibroids but nothing as big as the previous. All the best lovely with whatever you choose to do xx

[Cornishgirl25]

HiSo I am in a very similar position, Im 42, I have a 9 cm subserosal fibroid not impacting my uterus. Im on a 12mth waiting list for surgery, but my gynea has said he doesnt have a problem with me having a FET whilst waiting. We have 3 embryos frozen so Ive decided to give it a try. Im anxious about the surgery and the FET. Cant win either way. But thr waiting around is also hard as Im not getting any younger. Sorry no advice but only sympathetic ear x good luck x

[NervyJ in reply to Cornishgirl25]

Thanks for your reply. I got a second opinion and decided to go ahead with the myomectomy in November. They managed to remove it with a smaller incision than originally thought which was good. I’ve recovered well and consultant has said she’s happy for me to proceed with a frozen transfer now. As the fibroid was on the outside of the womb and on a stalk, there was no damage done to the womb and healing time is quicker.

It might well have been fine to leave for a while, I’ll never know, but I’m glad I got it removed. They said it was bigger than expected from the scan, it was stuck to my womb and was really hard so likely would have caused issues at some point. They also discovered that I have endometriosis which I didn’t realise…

Now to continue with my next big step. Keeping everything crossed 🤞

Best of luck to you too x