“Myomectomy Followed By IVF With ICSI Result In Pregnancy After 10 Years Of Infertility"

For over 10 years Scott and Vickie Fee wanted a family. But with her history of irregular, heavy periods, conceiving was difficult. "I was seeing our family doctor for help with my periods, not infertility," explained Fee. "I figured if I could get my periods under control, then I would be able to get pregnant." But her menstrual cycle continued to be erratic and painful, and for many disappointing years the Fees tried unsuccessfully to have a baby.

In the world of reproductive health, the Fee's case is actually quite common. "The diagnosis and treatment of the root cause of a fertility problem can be quite difficult," said Dr. Jaime Vasquez, medical director for the Center for Reproductive Health in Nashville, TN. "Often, when patients first come to our office, we find that only the symptoms have been treated." Opened in 1995, the center specializes in fertility and related treatments, and other women's health services including treatment for endometriosis and related problems and menopause therapies.

In April 1996, the Fees were referred to Dr. Vasquez. He performed a complete battery of fertility tests including semen analysis, blood work, biphasic temperature charts, and a Doppler imaging study with contrast enhancements to document any abnormalities, such as an unusually shaped uterus, tumors, scar tissue or blockages in the fallopian tubes. The doppler study, a procedure developed by Dr. Vasquez and his associate, Dr. Arthur C. Fleischer, is performed at the Center for Reproductive Health and does not require a hospital visit.

The doppler documented multiple leiomyomata, or fibroid tumors, in Fee's uterus. Fibroids are common, usually benign tumors, which develop in the muscle tissue of the uterus. Some develop outside the uterine wall, while others can be located in the uterine cavity itself. Even small fibroid tumors can produce severe symptoms - heavy bleeding, pain, and fatigue. In Fee's case, the fibroids also contributed to her infertility.

According to national statistics, in over 80 percent of fibroid cases, a hysterectomy was the recommended course of treatment, but Vickie Fee didn't even consider a hysterectomy. "I wanted to get pregnant," she explained. Instead, she had a laparoscopic myomectomy performed, which removed the benign tumors and left her uterus intact.

Myomectomy is a popular and safe alternative to hysterectomy for women like Fee who develop uterine fibroid tumors but would still like to have families, stated Dr. Vasquez. Depending on the location and size of the fibroids, a myomectomy can be performed in one of two ways - using laparoscopy or hysteroscopy.

Laparoscopy, the procedure performed on Fee, involves making several Band-Aid incisions to place a narrow, fiber optic telescope and the surgical tools to remove the fibroids. Using a laser, argon beam coagulator or other electrosurgery devices, the fibroids are removed and the uterine wall repaired. Hysteroscopy is performed through the cervical canal; a resectoscope cuts away the fibroids or electric current evaporates them.

Dr. Vasquez carefully documented the exact location and size of each fibroid so the uterine cavity wouldn't be damaged during the myomectomy. "Any damage could weaken the uterine wall and mean later pregnancies would require delivery by Cesarean section," he explained. In Fees case, damage to the uterine cavity could have affected her ability to conceive at all. In addition to revealing the fibroids, the fertility tests had also documented a male factor problem, very poor sperm motility. Dr. Vasquez recommended in vitro fertilization (IVF) to the couple.

The laparoscopic myomectomy was performed on an outpatient basis in June 1996. Fee says she was fully recovered within two weeks. The Fees underwent IVF with intracytoplasmic sperm injections (ICSI) in August that year. Vickie Fee delivered a healthy, six-pound, 15-ounce baby girl in April 1997, just 11 months after her myomectomy. Dr. Vasquez, who has performed hundreds of these procedures, says most of his patients (without other fertility problems) have become pregnant within a year of the procedure.

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