Abdominals not cut, Myo not panacea for fertility problems

[Guest guest]

ABDOMINAL MUSCLES CUT DURING MYO

I was worried about my abdominal muscles being damaged during myo

(which have yet to undergo) and I asked the surgeon about it. She

told me that they do not cut the abdominal muscles, instead they just

push them to the sides, and I imagine they brace them there.

They do cut through some connective tissue and the abdominal fascia,

a membrane that holds your internal organs together, but they stitch

the fascia closed at the end of the procedure (I'm not sure if they

reconnect the connective tissue -- I haven't seen mention of that

anywhere) What Your Doctor May Not Tell You About Fibroids includes a

detailed description of the procedure that you may with to refer to.

MYO TO IMPROVE FERTILITY

The ability of myomectomy to improve fertility is not definative at

this point in time (this is confirmed in What Your Doctor...Fibroids

by Dr Brody, an ob/gyn and former RAND medical researcher).

There have been annectodal stories of success by patients and doctors

but current research has had flaws that limit its usefulness in

determining the appropriateness of this procedure to treat

infertility, especially if other factors exist that may be

contributing to the infertility (male factor, blocked tubes,

endocrine issues, etc.) This is partly why I have been reluctant to

undergo this procedure for my largely asymptomatic fibroid, we have a

known male factor.

Gynecologic Myomectomy

http://www.emedicine.com/med/topic3319.htm

" Myomectomy is also performed frequently in patients with infertility

with the presence of fibroids (Vercillini, 1998). Studies supporting

myomectomy as a fertility-enhancing procedure are uncontrolled and do

not use life-table analysis; nonetheless, a number of authors

recommend offering myomectomy to women who are infertile after other

causes of infertility have been eliminated (Hutchins, 1995;

Nachtigal, 1989; Verkauf, 1996).

Several papers suggest that patients with fibroids who are undergoing

assisted reproductive technology procedures may have lower success

rates compared to patients without fibroids. Stovall et al (1998)

noted decreased fertility rates in patients with any myomas

undergoing in vitro fertilization or zygote intrafallopian transfer.

Eldar-Geva and coworkers (1998) noted decreased success in patients

with intramural and submucosal myomas but not in those with

subserosal myomas. Ramzy et al (1998) noted no change in fertility,

but this study specifically excluded anyone with large, submucous, or

intramural myomas that distorted the endometrial cavity. Importantly,

note that no randomized studies document that removal of these myomas

improves success rates. "

TABLE 1 - ACOG CRITERIA FOR MYOMECTOMY IN INFERTILITY PATIENTS

Procedure:

Myomectomy* (68.29) (CPT Codes 56309 [laparoscopy with removalof

leiomyomata], 58140 [abdominal approach], or 58145 [vaginal approach]

Indication:

Leiomyomata (218.0-218.9) in infertility patients (628.3), asa

probable factor in failure to conceive or in recurrent pregnancy loss

(646.3)

Confirmation of Indication:

In the presence of failure to conceive or recurrent pregnancy loss:

1. Presence of leiomyomata of sufficient size or specific location to

be a probable factor

2. No more likely explanation exists for failure to conceive or

recurrent pregnancy loss

Actions Prior to Procedure:

1. Evaluate other causes of male and female infertility or recurrent

pregnancy loss

2. Evaluate the endometrial cavity and fallopian tubes, eg,

hysterosalpingogram

3. Document discussion that complexity of disease process may require

hysterectomy

--Ann