Fibroids and Fertility

March 3, 2005 - Thursday
2:14 PM to 3:14 PM (EST)
Guest Speakers: David W. Schmidt, MD, The Center for Advanced Reproductive Medicine - Hamden, CT

Categories
Donor Egg • Fertility • IVF • PCOS

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Lori_Masi AFA_Patient_Advocate	Welcome Dr Schmidt!
Dr._Schmidt	Thank you Lori.
Dr._Schmidt	I need just a few minutes before we start, if that's o.k.
Lori_Masi AFA_Patient_Advocate	Lisa was unable to attend this evening but I will be here with you to moderate. Would you please post your contact info several times over the hour for everyone!
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Lori_Masi AFA_Patient_Advocate	That's fine - take your time
Dr._Schmidt	Thank you.
Lori_Masi AFA_Patient_Advocate	Everyone we are very fortunate this evening to have Dr David Schmidt with us to discuss this very important topic and help to rest your fears and answer your questions
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Lori_Masi AFA_Patient_Advocate	Welcome again Dr Schmidt and everyone!
sblm	hello everyone
Lori_Masi AFA_Patient_Advocate	We will begin in a few minutes
claudia	hello everyone
Lori_Masi AFA_Patient_Advocate	Welcome Claudia
claudia	hi
Lori_Masi AFA_Patient_Advocate	Welcome Justine and anyone that I may have missed! We are happy to have you here
Lori_Masi AFA_Patient_Advocate	This is a very important topic!
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Lori_Masi AFA_Patient_Advocate	Welcome All! Please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Schmidt	Good evening everyone. Sorry for the delay. I'd be happy to take any questions now.
Lori_Masi AFA_Patient_Advocate	Welcome Meg
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Lori_Masi AFA_Patient_Advocate	Dr Schmidt is it always mandatory to have a myomectomy with 1 or more fibroids?
Lori_Masi AFA_Patient_Advocate	Can you explain to everyone what a myomectomy is
Dr._Schmidt	David W. Schmidt, M.D. The Center for Advanced Reproductive Services 2080 Whitney Ave. Suite 250 Hamden, CT 06518 Phone: (203) 230-4400
Lori_Masi AFA_Patient_Advocate	The room is starting to fill up, so please everyone start posting your questions for Dr Schmidt!
claudia	Can I ask you a question about PCOS?
Dr._Schmidt	Claudia. That is fine if it's o.k. with Lori. Go ahead.
Lori_Masi AFA_Patient_Advocate	Should they always be removed? Or sometimes they might not interfere with implantation depending on the above circumstances?
Lori_Masi AFA_Patient_Advocate	Thant's fine Claudia
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justine	Hello Dr Schmidt and everyone...I am 41 years old. I just bot my 2nd failire at a donor egg cycle on Monday. First was a 2 blast transfer. Now a 2 3-day transfer. Doctor at Cornell sys it must be something uterine. I have fibroids - uterine leiomyomata including a 6.5 x 4.6 cm right fundal exophytic myoma, a 4.3 x 4.4 cm left mid fundal subserous myoma, and a 2.3 x 3.1 cm left anterior fundal subserous myoma. The adnexae are unremarkable. There is no pelvic ascites. (This info is from a CT scan done MArch 2003. My Dr Chung at Cornell never said they were a problem, but a dr at AFS (dr Husami) said fibroids always lesson your chance of preg. What do you think?
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Dr._Schmidt	Lori: As far as removal, not all fibroids need to be removed. From a fertility standpoint, it is usuall recommended to remove fibroids that are partially within the uterine cavity, or distort the cavity. This is only after all other types of infertility have been ruled out.
Happy	Type here Hi! Dr. Schmidt, I know the topic is on Fibroids, but my main concern is that I am 31 years old, I had three IVF cycles. The first one nothing happened, The second one I had a positive result, and then the numbers dropped. Then I had a third cycle and it was negative. I used to different reproductive facilities.Should I continue with more cycles, or just hope a miracle happen or change facilities. Do I just give up hope and stay childless with my husband. I am not considering adoption.
Lori_Masi AFA_Patient_Advocate	Can you please talk about for us the different methods of removal that you mentioned?
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SasnBrassy33	Hi, I have a had total of 3 fibroids and 2 myomectomies. Unfortunately, during the last surgery both tubes were taken. NOw, I think I have another one. What do you suggest I do this time? I have had only 1 IVF and want to try again
Lori_Masi AFA_Patient_Advocate	Why don’t you type your questions in a word document, in case you need to retype then you can just copy and paste.
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Dr._Schmidt	Justine; I think for the most part, fibroids don not soley have a large cause of infertility (usually 2-10% dependingon the studies you look at). But they can impact patients undergoind IVF, particularly if they are large intramural or intracavitary fibroids. Of the ones you mentions, the subserous fibroids may have an impact on IVF success rates, only if they are large enough to distort the cavity or have a intracavitary component. It is worth looking into if you've had a few failled cycles.
Lori_Masi AFA_Patient_Advocate	Welcome Merlin and everyone! The room is busy and the posting seems to be slow tonight so might I suggest that eveyone type and save your questions in a word document and then you can copy and paste if you need to repeat. Thanks!
Dr._Schmidt	Happy; It is hard to answer that question without a thorough review of those cycles, but I would not give up. The fact that you did get pregnant, but it resulted in a 'biochemical' pregnancy or a misscarriage, may have been due to random aneuploidy (random genetic mistake with fertilization). It is useful to have those cycles reviewed thoroughly, regardless of waht doctor or IVF clinic you feel comfortable with.
Happy	Thank you doctor. From Happy.
Lori_Masi AFA_Patient_Advocate	How long after a myomectomy should you wait to cycle?
Dr._Schmidt	SasanBrassy33: I think a careful look at the size and location of that new fibroid is important. This can be done with a simple office procedure called a Sonohystogram, in which some sterile saline is placed into the cavity during an ultrasound to detail the location of the fibroid, and if it may impact implantation of an embryo during an IVF cycle. It may not be something to worry about, but it should not be ignored before starting your next IVF cycle. Good Luck!
SasnBrassy33	Thanks very much::smile
justine	Dr Schmidt: Do my fibroids sound intramural?? Doctor Chung as done a saline u/s and has said that they do not look like they are intruding on my cavity. He did a hysteroscopy in Feb 2003. And all the failed cycles since then. (with my eggs and with 2 donors’ eggs). Should I get another hysteroscopy? Does the hysteroscopy see more than the saline u/s. What do you recommend as follow up given my 3 fibroid sizes and kinds as I described (6.6x4.6 right fundal exophytic myoma, 4.3 x 4.4 cm left mid fundal subserous muoma and a 2.2 x 3.1 left anterior fundal subserous myoma.)
Dr._Schmidt	Lori and everyone: There are several ways to remove fibroids that depend on your surgeon's expertise and the location and size of the fibroid. Various surgical procedures include: laparotomy, or open myomectomy, laparoscopic removal, or hysteroscopic removal.
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Lori_Masi AFA_Patient_Advocate	Welcome Marsha! We are very fortunate tonight to have Dr David Schmidt with us. The room is busy and posting seems to be slow - so pleas type your question for Dr Schmidt and then save it in a word document in case you need to re send it.
Lori_Masi AFA_Patient_Advocate	Welcome Yolanda!
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yolandamachado	Thank you
yolandamachado	my question: can large fibroids be removed thru laparoscopic surgery
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marsha	Do fibroids affect fertility? If so then how? Thanks a lot, Doc
Lori_Masi AFA_Patient_Advocate	Yolanda the doctor may have missed your question because he got knocked off so please retype it
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Lori_Masi AFA_Patient_Advocate	Everyone - Dr Schmidt seems to be having trouble logging back on, so please have your questions ready to resend, when he gets back. Thanks!
meg_coyne	Meg- Thanks
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Lori_Masi AFA_Patient_Advocate	Yolanda your question seems to have been cut off please re send it! Thanks!
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Dr._Schmidt	Hello Everyone: I am sorry, but I think I was disconnected.
Lori_Masi AFA_Patient_Advocate	Welcome Back Dr Schmidt - I'm sorry you are having trouble
Dr._Schmidt	Did everyone get my replies?
Lori_Masi AFA_Patient_Advocate	Everyone please repost your questions
justine	Dr Schmidt: Do my fibroids sound intramural?? Doctor Chung did a saline u/s and has said that they do not look like they are intruding on my cavity. He did a hysteroscopy in Feb 2003. And all the ivf cycles failed since then. (failed with my eggs and with 2 donors’ eggs). Should I get another hysteroscopy? Does the hysteroscopy see more than the saline u/s? What do you recommend as follow up given my 3 fibroid sizes and kinds as I described (6.6x4.6 right fundal exophytic myoma, 4.3 x 4.4 cm left mid fundal subserous muoma and a 2.2 x 3.1 left anterior fundal subserous myoma.) ?
Lori_Masi AFA_Patient_Advocate	I'm not sure but I see you now
Dr._Schmidt	O.k. Thanks.
Lori_Masi AFA_Patient_Advocate	Dr Schmidt can you see Justine's question?
Lori_Masi AFA_Patient_Advocate	Yolanda please repost your question
yolandamachado	I have fibroids do size have a problem with what kind of surgery could be done , abdominal incision or laparascope, I've been told It needs to be thru incision.
Lori_Masi AFA_Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Schmidt	Yolandamachado: They can be done laparoscopically, but the long term outcomes from this approach are not well known. This technique is also very dependent on your surgeon's abilities and experience with this procedure. If they are large and in the wall of the uterus, the open procedure is more commonly performed.
yolandamachado	thank you very much dr. Schmidt
justine	Thanks for your response. Is it worth doing a hysteroscopy or does the saline u/s show just as much? What does "subserous fibroids" mean?
Dr._Schmidt	You're welcome yolandamachado!
Lori_Masi AFA_Patient_Advocate	Everyone we have about 10 minutes left so please post your remaining questions for Dr Schmidt
marsha	Whate tests do you use to evaluate fibroids? Whate treatment do you advocate for fibroids that produce excessive menstral bleeding? Does diet have an effect on fibroid formation?
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Lori_Masi AFA_Patient_Advocate	Dr Schmidt when you have a chance please re post yourcontact info for eveyone
Dr._Schmidt	Justine: The 'sensitivity' of a sonohystogram for detecting a fibroid's location is reportedly 100%. In other words, an office hysteroscopy may not provide any added benefit over the sonohystogram. If however, your physician is planning on removing a submucosal fibroid (into the cavity), then hysteroscopy is often done. A subserous, or subserosal fibroid in in the 'outer' portion of the uterus and usually does not implact IVF outcomes, as it is further away from the cavity. There are exceptions if they are very large and span the wall.
Lori_Masi AFA_Patient_Advocate	Justine did you get Dr Schmidt's answer because you got knocked off just as his answer posted?
Dr._Schmidt	Marsha; Fibroids are thought to be from a mutated single muscle cell of the uterus. It may be partly genetic, but we don't know all factors that contribute to their growth. We do know that hormones such as estrogen can contribute to their growth and perhaps even progesterone. Diet may play a role. Certain foods may effect these factors, but this is not clearly understood, and certainly estrogen plays a clear role, as they often regress after menopause.
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Lori_Masi AFA_Patient_Advocate	WelcomeLisaZ we have about 7 minutes left - please post your question for Dr Shmidt
Dr._Schmidt	Yolandamachado: A hysterectomy is always a small risk when performing surgery on the uterus for any reason. Fortunately, the risk is small and would only be done for your safety if a complication were to occur. Again, this is rare for the most part. Your physician will give you the chance of this in reviewing the procedure and obtaining your consent.
yolandamachado	yes
Lori_Masi AFA_Patient_Advocate	Justine did you see Dr Schmidt's answer?
justine	Yes, thanks you for your 2nd answer. 1.) Do fibroids grow duing pregnancy? 2.) May mine cause a problem given there size and type? My friend's friend had fibroid that pushed the fetus up into the mother's diaphram and the baby got less oxygen and then was born brain damaged. I want to avoid any harm.
marsha	Does the fertility enhancing drug Cloumid have any effect on fibroids? Can it trigger their development?
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Lori_Masi AFA_Patient_Advocate	We only have about 5 minutes so pleas post your final quesetions!
Lori_Masi AFA_Patient_Advocate	He got knocked off again
lisaz	I'm pregnant after extensive fertility treatments. I also have questions about fibroids and pregnancy. I had fibroids removed during my "workup" prior to fertility cycles, then during this pregnancy, my OB said I had a fibroid growing. Will it shrink by itself, or am I going to require more surgery? We want to try for #2 right away due to my age (43). Thank you.
Lori_Masi AFA_Patient_Advocate	Lisa type your question but wait to send it until he logs back on so you are sure he will see it
justine	During this last IVF cycle, I had horrbile pain on my left side and I still do now even though I just got my period today after the failre. I was on estogen patches and progesterone. Do you think that caused them to grow over the cycle and thus my left side of my uterus is in pain?
Dr._Schmidt	Justine;;;; I'm sorry, I typed a reply and got disconnected. Just one minute and I'll retype a shorter version.
Lori_Masi AFA_Patient_Advocate	Dr Schmidt we don't want to keep you too long so please just answer the few remaining questions and we will let you go
lisaz	I'm pregnant after extensive fertility treatments. I also have questions about fibroids and pregnancy. I had fibroids removed during my "workup" prior to fertility cycles, then during this pregnancy, my OB said I had a fibroid growing. Will it shrink by itself, or am I going to require more surgery? We want to try for #2 right away, due to my age (43).
Lori_Masi AFA_Patient_Advocate	Folks in all fairness to Dr Schmidt lets say good night in 5 minutes so please post you final question
Dr._Schmidt	Fibroids do not have to be operated on unless they are causing symptoms, or have a potential to impact fertility. Your fibroids and their location are not likely to cause complications in pregnancy. They can grow, but recent evidence suggests they do so in the 1st trimester and may even srink later in pregnancy.
Dr._Schmidt	Lisaz. size and location will decide that, and what happens to the fibroid during this pregnancy. Have the fibroid closely monitored during the pregnancy, but it may even shrink (see last answer). If you have any signs of preterm labor or early leakage of fluid, let your physician know. The chance of this is small, about 10-15%
Lori_Masi AFA_Patient_Advocate	Don’t Forget to please call the AFA Toll Free Support/Referral Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
yolandamachado	Thank You Dr. and thanks everyone. Was a pleasure to participate in this meeting
Lori_Masi AFA_Patient_Advocate	Thank you Dr Schmidt! Good Night All!
Dr._Schmidt	Thank you all! I hope that I've helped answer some questions. Lori asked for me to post my office contact information to follow:
lisaz	Thank you!
vacation	Hi- is the chat still on?
Dr._Schmidt	David W. Schmidt, M.D. The Center for Advanced Reproductive Services 2080 Whitney Ave Suite 250 Hamden CT 06518 Phone 203-230-4400
Lori_Masi AFA_Patient_Advocate	Sorry vacation it is from 8-9 pm EST and we are running late now
Dr._Schmidt	Have a good night everyone!
Lori_Masi AFA_Patient_Advocate	Good Night Doctor and thanks!
justine	Thank you Dr Schmidt for all your advice. Thank you Lori for organizing. And good luck to all....
Dr._Schmidt	You are all very welcome. Goodnight!
vacation	Will the text be posted?
Lori_Masi AFA_Patient_Advocate	Vacation the transcript will be up on the web site in a week or two
Lori_Masi AFA_Patient_Advocate	Good Night All!
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