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I received this email from a patient

 My husband and I have been trying to conceive for more than a year. I have low AMH which is 0.2 ng/ml and my FSH fluctuates from a value of 7 to 18 IU. I have been through one hysteroscopy for polyp removal. We did one IUI and now we are going through Natural cycle IVF. My question is related to a lesion in my uterus. My current doctor thinks it could be a fibroid or a polyp but more likely a fibroid. It is on the fundus of the uterus and on the left side. It is 5mm in to the cavity so it is not likely to affect implantation of an embryo. She thinks that if it is a fibroid and we try to remove it then it is most likely to form scar tissue in that area and prevent implantation. I have attached saline sonogram report and HSG report. We would like your opinion whether we should remove this fibroid or not before embryo transfer?

This is a tough call, because both options are equally good, and there is no evidence that removing such a small polyp will help to improve pregnancy rates. The truth is that many medical problems are not black or white - they are shades of grey, and patients need to decide for themselves.

A good doctor will explain the options, but will leave the final decision to the patient, when he feels both are equally good.

Yes, it's a hard spot for a patient to be in, because most patients want an authoritative doctor who will tell them what to do ! They are confused when the doctor asks them to decide for themselves ! Isn't the doctor the expert ? Shouldn't he be telling them what to do ? If the doctor is confused, imagine the plight of the poor patient !

Yes, it can be hard to make a call, and a useful rule to follow is to " take the path of least regret".

Think of the following scenarios.

Suppose you choose not to remove the fibroid, and go ahead with the embryo transfer . If you don't get pregnant, how much will you kick yourself for not insisting on having the fibroid removed ?
On the other hand, suppose you do the hysteroscopy and find the cavity is normal, how much will you regret wasting the money on an unnecessary intervention ?
This is a very personal decision, which only patients can make for themselves, based on their individual philosophy . There are no generic right answers - just the answer which is right for you!

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

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