Tuesday, June 28, 2011

IVF After A Myomectomy & Low Ovarian Reserve


Hello, Dr. Ramirez,

D. from VA here! I wrote to you a few weeks ago concerning my RE wanting to freeze my eggs, give me a myomectomy, then do implantation. You didn't understand why he wanted to do things in that order, and neither did I. He thought that my fibroids were blocking my left tube, and I also have hostile cervical mucus and low ovarian reserve. I want to thank you for your response to my question, it really made me think about things. I am having a myomectomy in a few weeks (by my gyno) and decided to hold off on any aspect of the IVF until later in the year, when I was fully recovered from the myomectomy (and had saved up some more money.) I do have a couple of questions.

First, is it a good idea to put off having the IVF, given all of my problems? Especially the low ovarian reserve. Part of me is hoping that by doing the myomectomy, I'll improve my chances of being able to get pregnant naturally. But because of the low reserve, I'm afraid if I wait too long I will have missed any chance of conceiving. Question #2: is there anything that can be done to improve cervical mucus? Or is the best option to bypass it with the IVF? Is intratubal insemination a good option? Thank you for any answers you can give me!


Hello D. from the U.S. (Virginia),

Low ovarian reserve is an indication that your ovaries might not stimulate well with the fertility medications and so less eggs will be retrieved. That is its ONLY implication. It does not mean that you cannot get pregnant or cannot get pregnant on your own. It is only important for IVF. Now, if you have to do IVF for specific indicated reasons, such as tubal blockage or sperm problems etc, then you will want to do it sooner than later because your ovaries might get to the point where they will not stimulate at all and that will decreased your chances of success with IVF.

In terms of your fibroids, it is not that uncommon for a patient to become spontaneously pregnant after a myomectomy. I am sure that every fertility doctor has had patients like this. As long as your ovaries are functioning then you have that possibility. Low ovarian reserve has nothing to do with spontaneous ovulation.

In terms of cervical mucous, if you are trying naturally (non-IVF), then you can try Robitussin taken daily to help thin the cervix or you can proceed to IUI (intrauterine insemination) where the sperm is injected into the uterus and thereby bypasses the cervix (there is no such thing as intratubal insemination).

Good Luck,

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

Monterey, California, U.S.A.


  1. Hello Dr Ramirez I have had a myemectomy and has healed, I have been trying to get pregnant naturally for 8 months now without any success what do you advice I do, am from west africa

  2. Hello,

    It's hard to give advice without additional information such as your age, FSH level, infertility evaluation, etc.

    In general, if you are trying for pregnancy, then you have to give yourself at least 1 year of trying before moving on to an infertility treatment. That is the standard for women trying for pregnancy (1year of trying) before they are recommended to start an infertility evaluation. Certainly this standard can change depending on any other issues that might be present, but this is the extent that I can advise without more information. If you are 35 years old or older, we only recommend 6 months of trying before doing an infertility evaluation.

    Keep in mind that it is controversial whether or not myomectomies are required in someone tryin for pregnancy or with a history of infertility. In general, it should only be done if there are other symptoms that are causing problems such as pain or abnormal bleeding. Usually infertility specialists will refrain from this surgery because it can lead to extensive scar tissue formation within the pelvis and cause infertility itself. If that happens, then often IVF will be the only option to achieve pregnancy.

    Good Luck.



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