Wednesday, September 29, 2010

37 Yr. Old Australian Woman With Complex Hyperplasia With Atypia Does Not Want Hysterectomy: Wants To Conceive


I am a 37 yr old woman who has been trying to get pregnant since I was 16. I have never fallen pregnant that I know of. I have had a Laparoscopy to see if i have a blockage in my tubes-there was not. Last year I had mid cycle bleeding for a few months & went to doctors who did a LLETZ procedure and found I had complex hyperplasia with atpia. I was told to have a hysterectomy, but declined & said I would like to see if I can get pregnant through a Natropath here in Australia, because she has a 87% success rate of clients falling pregnant.

The findings from my last hysterscopy, dilation & curetteage & polypectomy were, cervix healthy, consistent with previous LLETZ. Uterus bulky 8 week size, cavity 10cms, endometrial polyp and hyperplastic endometrium, both ostia seen, Adenexa NAD.

What does all this mean? Could I still fall pregnant?. Can I die from having complex hyperplasia with atpia? Do I really need to have a hysterectomy or can it be left until after I fall pregnant? I am so confused & very distressed that I may never have children of my own. I have asked my surgeon that performed the lasts LLETZ procedure and all he said was he wants me to have a hysterectomy, I don't want to have one, because I think he is being a little knife happy. What would you suggest? Thank you. D. From Australia


Hello D. from Australia,

Complex hyperplasia with atypia is an endometrial diagnosis and not a cervical diagnosis. It is a worrisome diagnosis because of the possibility that it could develop into a uterine cancer. It needs to be treated and in a woman who wants to maintain her fertility potential, is usually treated with depo provera injections for a 6 month period. Rebiopsy is then done to make sure that it is resolved. This diagnosis does NOT require a hysterectomy necessarily. If it is successfully treated with progesterone, that is all that is required. Another possible treatment option is D&C to clear the endometrial tissue. I would not simply ignore it.

At your age, if you want pregnancy and have never been able to achieve it, you should be under the care of an infertility specialist, who is also a gynecologist and should be able to care for both problems. I do not know of any physician in anywhere in the world who can claim an 87% pregnancy rate. If that were indeed true, people would be flocking to see her from all over the world and forsaking us infertility specialists! NO treatment is that good, and such a claim is highly suspicious. I hope you do not waste your time because age is a critical factor for you and your chances are decreasing rapidly.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

Comment: Thank you so much for giving me a direct answer. The surgeon I had wouldn't give me a direct answer.You have been very helpful. I have been to the Monash Ivf Clinic but there findings after all the tests were that I have unexplained infertility, which is very frustrating, That is why I thought I would try a natropath. But I still have my fingers crossed that one day I will have a baby. Thank you again.

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