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Is it possible for pregnancy with THYROID LEVEL, FIBROMYOMAS?

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Hello. I am 41 years old patientold and want to have a child. My day 3 hormonal test results were: E2- 38.58 FSH 5.3 LH 1.6 and AMH 2.045 ng/ml. My thyroid hormone levels were: TSH 2.48, T4 1.23 and T3 3.57. In your opinion, do I have chances of success with IVF or any other conception method, using my own eggs?
Also three small fibromyomas (less than 3 cm in diameter) were discovered in the uterus walls, which are giving me no problems so far. Do I need to remove them before conception, or the natural approach will be best?
Thank you for your help and advice!


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello,
Thanks for posting your query at DoctorSpring.com
Would you please mind uploading the exact test reports and imaging reports ?
This is because different labs have varying ranges of normal and abnormal, and interpreting just type written values is of not much use. So kindly upload the reports for me to infer.
Secondly, I would like to request a few more details-
What is your height and weight ?
Are your menstrual cycles regular ?
Have you ever conceived before , either naturally or with aid ?
Is your husband's / partner semen analysis carried out yet ?
Any other workup done at your end apart from the hormonal tests and the imaging ?
Please write back with these details.
Looking forward to hearing from you.
I will be glad to answer further queries,
Regards.


Patient replied :

Thank you doctor. Sorry I do not have a scanning device right now, but please let me describe my day 3 tests results in detail, which were as follows: Estradiol E2 38,58 pg/mL- Normal value Follicular phase: 19,5-144,2 FSH 5,3 mIU/mL - Normal value Follicular phase: 2,5-10,2 LH 1,6 mIU/ml - Normal value Follicular phase: 1,9-12,5 AMH 2,049 ng/ml- Females 3rd day of cycle 0-12,6 FT4 1,23 ng/dl - Normal value 0,89-1,76 (Direct Chemiluminometric immunoassay) FT3 3,57 pg/ml - Normal value 2,3-4,2 (Direct Chemiluminometric immunoassay) TSH 2,48 µIU/mL - Normal value 0,35 -4,78 (Direct Chemiluminometric immunoassay) My height is 175 cm and weight 105 kg. Menstrual cycles regular, every 26-29 days. Never conceived before either naturally or with aid. Husband's semen analysis not carried out yet. In addition, an abdominal ultrasound was conducted for me where the three fybromyomas, 2-3 cm in diamater, were discovered in my uterus walls. Thank you for your help and advice.


Expert:  Dr. Aarti Vazirani replied 3 Days.

Hello,
Thank you for the follow up.
I also apologise to you, for the exceptional delay in replying, as i was unavailable for some peronal work.
You definitely need to work on weight reduction, obesity adversely impacts fertility.
Also, your hormonal tests are fine, within normal range.
AMH is a very sensitive marker for predicting ovarian reserve, your capacity to form good quality and number of eggs.
I need to look at the scan report before predicting anything, however, you can go for a trial of IVF, before proceeding to the option of donor eggs.
That cycle of IVF would show you how you respond to stimulation.
There is no need to abandon hope, in my opinion, you should go for a trial of IVF for sure.
All the best, and prayers for you.
Regards.


Patient replied :

Thank you for your advice doctor. I would like to share with you the ultrasound scan. The report attached states: "Multiple uteri fybromyoma. Uterus of larger volume than the norm, because of the presence of several fybrous nodules (photos attached)." Uterus L-9.38cm, W-6.72cm, H-5.93cm, Volume-195.7cm3, Endo.Thickness-6.74cm. I was told to keep the myomas under control for possible growth. I am not sure how these can affect a possible pregnancy.Would really appreciate your opinion. Many thanks


Expert:  Dr. Aarti Vazirani replied 2 Days.

Hello,
Was this an abdominal scan ?
That does not really provide much information - a pelvic scan should be done transvaginally.
How myomas would affect a possible pregnancy depends on the location and size of the myomas mainly.
Myomas can be inside the uterine cavity, in the wall of the uterus or just studded on the periphery of the uterus.
Your report just does not clarify that.
I would like to advise a detailed pelvic scan for the myomas before commenting on that.
Regards.


Patient replied :

Yes, this was an abdominal scan. The myomas are described in the report as: fundal 33.7X31mm; interstitial anterior 27.2x27.2mm, and interstitial posterior 31.1x31.2mm.
Does "interstitial" mean that they are located in the wall of the uterus? What about "fundal"?
Many thanks.


Expert:  Dr. Aarti Vazirani replied 1 Day.

Hello again,
Please upload the report (take a high resolution pic) if possible instead of typing it in parts. It would give me much clearer picture.
Regards


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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