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Infertility

Infertility

06/17/2009

Question:

Dear Doctor, I am 26 years old. I have always had long but regular cycles, 45-50 days (Menarche at 13yr). Ultrasound shows hyperfollicular ovaries, about 4x2cm of size. There is a subserosal myoma in the uterus (2x2cm), it has not grown since September 2008. My basal body temperature chart shows temperature elevation on about 30-32nd day, it stays elevated for two weeks, then it drops and the period starts. My hormones are in normal limits, except a little bit elevated prolactin. My doctor recommends laparoscopy in order to check the tubes, perform ovarian electrocautery and myomectomy altogether. My questions are: 1) Does this BBT pattern mean that ovulation occurs? 2) If it does, then why should I undergo ovarian drilling? 3) Do I need myomectomy? 4) Is the risk of infertility higher with subserosal myomas or after the surgery? 5) What else could be the cause of infertility? Thank You very much!

Answer:

1) Your biphasic BBT pattern and your 46-day cycles suggest you are ovulating, but fairly late in the cycle. We would routinely treat your elevated prolactin with bromocriptine to see if this would shorten your cycle. If it did not, we would also use clomiphene citrate or injectable FSH.

2) We perform ovarian drilling only as a last resort, since it often causes extensive pelvic adhesions.

3) and 4) A 2 cm subserosal myoma is unlikely to have anything to do with your infertility. Removing it will increase your risk of pelvic adhesions without increasing your fertility

5) In addition to hyperprolactinemia and ovulation dysfunction, you could have a male factor problem, and thus a semen analysis should be check. You could also have tubal blockage, and thus a hysterosalpingogram should be performed to verify that your tubes are open. Prior to undergoing surgery, you should consider getting a second opinion from a specialist in reproductive endocrinology and infertility.

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Response by:

William W Hurd, MD William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University