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Video: How Are Fibroids Diagnosed and Treated?

Dr. Jenna McCarthy, a fertility doctor with South Florida Institute of Reproductive Medicine, explains what fibroids are and how they are diagnosed and treated.

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0:00:00.000,0:00:03.000 (text on screen): Fertility Authority. Your Most Trusted Source 0:00:03.000,0:00:05.000 Ask the Experts 0:00:05.000,0:00:10.000 How are fibroids diagnosed and treated? 0:00:10.000,0:00:14.000 Dr. Jenna McCarthy, South Florida Institute for Reproductive Medicine: Most of the time, fibroids are initially diagnosed on ultrasound. 0:00:14.000,0:00:23.000 And then they can be definitively diagnosed from a fertility standpoint by either a saline infusion sonogram, or an HSG. 0:00:23.000,0:00:28.000 If the fibroid is well away from the cavity, and it's not changing the shape of the cavity at all, 0:00:28.000,0:00:32.000 and it's not causing you any other symptoms, there's no reason you need to have it taken out. 0:00:32.000,0:00:37.000 So, doctors typically will recommend that you have the fibroid taken out if it's changing the shape of the cavity, 0:00:37.000,0:00:41.000 or if it's causing some of the other symptoms. 0:00:41.000,0:00:43.000 Fibroids are typically removed one of two ways. 0:00:43.000,0:00:47.000 You can either have them removed by having a surgery, either laparoscopically 0:00:47.000,0:00:52.000 or an open surgery where they make an incision in the belly, and have the fibroids removed. 0:00:52.000,0:00:57.000 Alternatively, fibroids that are completely within the cavity can sometimes be removed vaginally. 0:00:57.000,0:01:03.000 It depends on where the fibroid is. So, let's start with a large fibroid that's large enough that it's changing the shape of the cavity. 0:01:03.000,0:01:10.000 That type of fibroid might be removed laparoscopically, which is a couple of small incisions on the belly, nothing big. 0:01:10.000,0:01:15.000 The procedure is usually performed as an outpatient procedure, which means that you can go home the same day, 0:01:15.000,0:01:20.000 sleep in your own bed, take your pain medicines yourself, instead of having to be in the hospital. 0:01:20.000,0:01:26.000 The healing time from that is typically two to six weeks, depending on the woman and how active she is. 0:01:26.000,0:01:30.000 And then we usually ask you to wait three months before trying to get pregnant. 0:01:30.000,0:01:35.000 Some doctors will err on the side of caution and say as much as six months before trying to get pregnant. 0:01:35.000,0:01:41.000 And then, typically, if the fibroid that was removed was large enough that we actually went all the way through the wall 0:01:41.000,0:01:45.000 of the uterus to take it out, we'll recommend a c-section for delivery, 0:01:45.000,0:01:51.000 to help prevent the chance that the scar that's left in its place doesn't pop open during labor. 0:01:51.000,0:01:57.000 The other way to remove fibroids is hysteroscopically, or vaginally. Those are fibroids that are completely within the cavity. 0:01:57.000,0:02:02.000 So, basically, they can put a little camera inside the uterus and look around; you can see the whole fibroid. 0:02:02.000,0:02:08.000 Those, the recovery time is even faster. The surgery itself, again, is outpatient. You go home the same day. 0:02:08.000,0:02:11.000 The pain is much, much less associated with it. 0:02:11.000,0:02:15.000 Most women are back to work within a week to two weeks. Some women don't even need that much time. 0:02:15.000,0:02:19.000 And we usually don't ask you to wait more than one normal period before you try and get pregnant. 0:02:19.000,0:02:26.000 And neither of the two surgeries make it so that you can or cannot have fertility treatments. 0:02:26.000,0:02:29.000 Some gynecologists are extremely skilled at removing fibroids. 0:02:29.000,0:02:37.000 Other gynecologists prefer to refer those patients to either a reproductive endocrinologist or a minimally invasive surgeon. 0:02:37.000,0:02:45.000 The advantage to doing that is most REs and minimally invasive surgeons are trained in doing laparoscopic myomectomies. 0:02:45.000,0:02:50.000 The difference between a laparoscopic myomectomy and an abdominal myomectomy is the recovery time. 0:02:50.000,0:02:55.000 With a laparoscopic, most women, really, are up and around and doing for themselves in about two weeks. 0:02:55.000,0:03:00.000 It may be six weeks before they feel 100 percent, but they're usually at 80 percent or better by two weeks. 0:03:00.000,0:03:05.000 With an abdominal myomectomy, you've actually gone through the big muscles of the abdominal wall, 0:03:05.000,0:03:12.000 so, just like a c-section or any other major abdominal surgery, it takes you that full six to eight weeks to feel like yourself again. 0:03:12.000,0:03:14.000 (text on screen): Fertility Authority. Your Most Trusted Source
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Video: Can Women Improve Their Fertility As They Age?

While "40 may be the new 30" in some instances, it doesn't pertain to your fertility. Dr. Kimberly Thompson, with South Florida Institute of Reproductive Medicine explains.

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0:00:00.000,0:00:03.000 (text on screen): Fertility Authority. Your Most Trusted Source 0:00:03.000,0:00:05.000 Ask the Experts 0:00:05.000,0:00:10.000 Can women improve their fertility as they age? 0:00:10.000,0:00:13.000 Dr. Kimberly Thompson, South Florida Institute for Reproductive Medicine: Many times nowadays, women think 0:00:13.000,0:00:22.000 because they are healthy and active, exercising and taking their vitamins, that that means they're going to be more fertile. 0:00:22.000,0:00:28.000 And the reality is that, yes, if they don't smoke, that will improve their chances of being able to get pregnant, 0:00:28.000,0:00:32.000 because smoking does diminish our egg supply. 0:00:32.000,0:00:40.000 But as far as we can tell, there is nothing about these other healthy lifestyle choices that truly saves the number of eggs that we have. 0:00:40.000,0:00:46.000 We hear a lot nowadays about "40 being the new 30," and these sorts of things, 0:00:46.000,0:00:52.000 but it's been studied and there doesn't seem to be a real difference. 0:00:52.000,0:00:55.000 The main thing we can do, as I said, is not smoking. 0:00:55.000,0:01:02.000 But otherwise, being healthy in other ways may help a woman get through pregnancy healthy 0:01:02.000,0:01:09.000 (not develop gestational diabetes or high blood pressure), so I don't mean to knock being in good health. That's still important. 0:01:09.000,0:01:14.000 But it doesn't seem to protect the actual eggs from what we can tell. 0:01:14.000,0:01:17.000 (text on screen): Fertility Authority. Your Most Trusted Source
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Video: How Does Smoking Affect Fertility?

Dr. Kimberly Thompson, with South Florida Institute of Reproductive Medicine explains that smoking does negatively impact fertility.

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0:00:00.000,0:00:03.000 (text on screen): Fertility Authority. Your Most Trusted Source 0:00:03.000,0:00:05.000 Ask the Experts 0:00:05.000,0:00:10.000 How does smoking affect a woman's fertility? 0:00:10.000,0:00:12.000 Dr. Kimberly Thompson, South Florida Institute for Reproductive Medicine: Smoking seems to diminish 0:00:12.000,0:00:18.000 the egg supply that a woman has. Women who smoke tend to go into an earlier menopause. 0:00:18.000,0:00:25.000 So, by not smoking or quitting as soon as possible, the woman improves the chances that she will have more eggs, 0:00:25.000,0:00:30.000 lasting for longer, so that she's able to have her family when she wishes to. 0:00:30.000,0:00:34.000 How much a woman smokes does seem to affect the age at which she goes into menopause. 0:00:34.000,0:00:41.000 Someone who is smoking a half pack a day or full pack per day for many years is more prone to having an earlier menopause. 0:00:41.000,0:00:49.000 There are other factors also. There is a genetic component to the age of menopause, so a woman who might otherwise have been 0:00:49.000,0:00:59.000 destined for menopause at a more average age of approximately 51 might move her menopause up a few years to 47 or 48. 0:00:59.000,0:01:06.000 But if she was a woman who was, perhaps, genetically more prone to a menopause at 44, and she smokes, 0:01:06.000,0:01:12.000 then she could be moving into very early '40s, and depending on her life situation and social circumstances, 0:01:12.000,0:01:18.000 when she's ready to pursue having a family, it could make her life more difficult conceiving then. 0:01:18.000,0:01:21.000 (text on screen): Fertility Authority. Your Most Trusted Source
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Video: Do Fibroids Cause Infertility?

Fibroids can cause infertility, Dr. Jenna McCarthy of South Florida Institute of Reproductive Medicine explains. It depends on their size, where they are located, and whether they are changing the shape of the uterine cavity.

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0:00:00.000,0:00:03.000 (text on screen): Fertility Authority. Your Most Trusted Source 0:00:03.000,0:00:05.000 Ask the Experts 0:00:05.000,0:00:10.000 Do fibroids cause infertility? 0:00:10.000,0:00:12.000 Dr. Jenna McCarthy, South Florida Institute for Reproductive Medicine: Fibroids can cause infertility. 0:00:12.000,0:00:18.000 It depends on where they're located in the uterus. If they change the shape of the cavity where the baby implants, 0:00:18.000,0:00:24.000 then they can prevent a woman from getting pregnant, or increase her chances of having a miscarriage when she does get pregnant. 0:00:24.000,0:00:29.000 Fibroids that are outside of the cavity, that are in the wall of the uterus or hanging off the back of the uterus, 0:00:29.000,0:00:31.000 don't seem to cause those problems. 0:00:31.000,0:00:37.000 Recurrent pregnancy loss would be one reason to take a look at the cavity and see if there's a fibroid in there. 0:00:37.000,0:00:43.000 Heavy bleeding with your periods. Pain or pressure in the pelvis. Frequent urination. 0:00:43.000,0:00:46.000 All of those can be symptoms of fibroids. 0:00:46.000,0:00:52.000 If the fibroid changes the shape of the cavity, then we do see a decrease in her chances of getting pregnant, 0:00:52.000,0:00:57.000 particularly if she's trying to get pregnant using assisted technologies like IVF. 0:00:57.000,0:01:01.000 And then we also see a substantial increase in her miscarriage rate. 0:01:01.000,0:01:06.000 But women who have fibroids can still get pregnant on their own and they can carry to term. 0:01:06.000,0:01:08.000 And so it's not a hundred percent. 0:01:08.000,0:01:13.000 What we're trying to do when we help; when we offer to help women by removing a fibroid 0:01:13.000,0:01:17.000 is we're trying to improve their chances of getting pregnant and taking home a healthy baby. 0:01:17.000,0:01:24.000 Nothing when it comes to women getting pregnant is a hundred percent, and I never tell women that they can never get pregnant. 0:01:24.000,0:01:29.000 But, you know, there are things that we can do that are going to improve their chances of getting pregnant, 0:01:29.000,0:01:33.000 and that's what myomectomy, or removal of the fibroid, is for. 0:01:33.000,0:01:36.000 (text on screen): Fertility Authority. Your Most Trusted Source
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What Is the Correlation Between a Woman's Age and Her Fertility?

There is a direct link between a woman's age and her fertility including the quantity and quality of her eggs and the ability to get pregnant. Dr. Kimberly Thompson, with South Florida Institute for Reproductive Medicine explains.

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0:00:00.000,0:00:03.000 (text on screen): Fertility Authority. Your Most Trusted Source 0:00:03.000,0:00:05.000 Ask the Experts 0:00:05.000,0:00:10.000 What is the correlation between a woman's age and her fertility? 0:00:10.000,0:00:11.000 Dr. Kimberly Thompson, South Florida Institute for Reproductive Medicine: Age impacts fertility 0:00:11.000,0:00:16.000 primarily by affecting the number and quality of eggs that a woman has. 0:00:16.000,0:00:20.000 Over time, the woman loses more eggs. 0:00:20.000,0:00:23.000 We're born with all the eggs we're ever gonna have; many women don't realize that. 0:00:23.000,0:00:28.000 So, over time, we have fewer eggs until we finally run, out and that is menopause. 0:00:28.000,0:00:34.000 Over time, as the eggs age, more of them also develop susceptibility to abnormalities. 0:00:34.000,0:00:42.000 So, more of the eggs, even if they're fertilized by a sperm, may not grow enough to implant; to give a positive pregnancy test. 0:00:42.000,0:00:49.000 We also see more miscarriages as a woman ages, because of genetic abnormalities that show up later. 0:00:49.000,0:00:57.000 It's also recommended for a woman to consider doing an amniocentesis if she's over 35, or chorionic villus sampling, 0:00:57.000,0:01:04.000 some form of additional testing as she gets older, because there are more chances of a genetic abnormality in the baby 0:01:04.000,0:01:07.000 since only some of them will miscarry on their own. 0:01:07.000,0:01:13.000 Women have their optimal fertility when we're in our later teens, early 20s. 0:01:13.000,0:01:17.000 Even as soon as 30, you can start to measure some decline in fertility. 0:01:17.000,0:01:22.000 Over 35 is in particular when we get more concerned that it starts vary much more 0:01:22.000,0:01:28.000 whether a woman will have difficulty getting pregnant, or become more susceptible to a miscarriage. 0:01:28.000,0:01:34.000 Women, in particular, over 40, have much lower chances of conceiving or can take much longer to get pregnant 0:01:34.000,0:01:42.000 On average, a woman who's young, who's perhaps 30 years old, will have about a 20 percent chance of conceiving 0:01:42.000,0:01:44.000 if she has unprotected intercourse in a cycle. 0:01:44.000,0:01:52.000 Once a woman is 40, even if everything is working properly in her system and in the man's reproductive system, 0:01:52.000,0:01:57.000 the chances of conceiving in a particular month go down to approximately 10 percent. 0:01:57.000,0:02:01.000 By age 42, it drops to closer to 5 percent per month. 0:02:01.000,0:02:08.000 Over 42, it's hard to even get specific numbers, because the pregnancy rate per month is quite low. 0:02:08.000,0:02:14.000 Obviously, over many months, that can still add up to a very real chance that a woman could get pregnant. 0:02:14.000,0:02:20.000 But since the numbers of good eggs continue to decline over time, that probability of conceiving is getting lower. 0:02:20.000,0:02:30.000 And some women can have menopause as soon as early 40s, and that's actually still considered just the early end of normal range. 0:02:30.000,0:02:36.000 So, many women will have trouble if they are waiting into their later 30s or early 40s. 0:02:36.000,0:02:42.000 Not many women are really aware of how much age affects fertility, and we spend so much of our young years 0:02:42.000,0:02:49.000 trying to avoid getting pregnant at the wrong time, and avoiding catching any infections. 0:02:49.000,0:02:54.000 And when it's suddenly time, where the woman's in the right circumstance to have a baby, 0:02:54.000,0:03:01.000 she can really be having difficulty and be caught quite by surprise that she has no idea that her egg supply has been declining. 0:03:01.000,0:03:06.000 And, obviously, there are only certain times when a woman may be ready to have a baby in her life. 0:03:06.000,0:03:16.000 But, definitely, the younger that we have children (later teens; early 20s), is actually when nature designed us to have the best fertility. 0:03:16.000,0:03:22.000 But socially, now, life is complicated with school and work and being with the right person, 0:03:22.000,0:03:26.000 or deciding to do it on a woman's own terms as a single mom, 0:03:26.000,0:03:33.000 that it's not always easy just to follow what nature designed our best fertility as. 0:03:33.000,0:03:35.000 (text on screen): Fertility Authority. Your Most Trusted Source
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How Does Embryo Transfer in an IVF Cycle Affect Pregnancy Rates?

Dr. Juergan Eisermann with South Florida Institute of Reproductive Medicine explains the importance of the embryo transfer process and its influence on IVF success rates.

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0:00:00.000,0:00:03.000 (text on screen): Fertility Authority. Your Most Trusted Source 0:00:03.000,0:00:05.000 Ask the Experts 0:00:05.000,0:00:10.000 How does embryo transfer in an IVF cycle impact pregnancy rates? 0:00:10.000,0:00:12.000 Dr. Juergen Eisermann, South Florida Institute for Reproductive Medicine: Embryo transfer is a technical step 0:00:12.000,0:00:17.000 that involves various components. 0:00:17.000,0:00:25.000 It has nothing to do with how we prepare the endometrium or select patients based on their uterine anatomy and so forth. 0:00:25.000,0:00:31.000 It has something very much to do with on-site, at the moment of having the embryo ready for transfer, 0:00:31.000,0:00:36.000 doing the best you can in order to get the embryo to where it needs to be in the safest way. 0:00:36.000,0:00:42.000 The dynamics of large group practices are such that often one single physician 0:00:42.000,0:00:46.000 will do all of the transfers at any given day or week or time interval. 0:00:46.000,0:00:53.000 And one would hope that within the department one could shift the responsibilities 0:00:53.000,0:00:59.000 towards those that are talented and have the better pregnancy rates, versus leaving those out that, 0:00:59.000,0:01:07.000 or reducing their volume, or do some other internal adjustment towards those that may not be so good at it. 0:01:07.000,0:01:19.000 Unfortunately, the criteria as to who gets to decide those things are not always simply established on performance rates alone. 0:01:19.000,0:01:30.000 The chief of the department versus the director of the department versus somebody with certain background and reputation 0:01:30.000,0:01:37.000 may be the preferred transferrer based on the patient's request, who may not know, internally, 0:01:37.000,0:01:41.000 what is happening in terms of the success rates, based on the transfer alone. 0:01:41.000,0:01:46.000 The patient has, usually, very little input on that. 0:01:46.000,0:01:54.000 Because that's not part of any published data of any clinic or; you have to assume, basically, if you go to a program, 0:01:54.000,0:01:59.000 and multiple physicians are involved, their pregnancy rates are quoted as a group. 0:01:59.000,0:02:06.000 The question that, as a patient, I would recommend should come up, is, 0:02:06.000,0:02:16.000 "How much importance do you put on the actual embryo transfer? Where do you do the procedure? And who does the procedure? 0:02:16.000,0:02:27.000 And do you keep track of embryo transfer technique-related statistics?" 0:02:27.000,0:02:32.000 One could ask that, as a patient. "Do you use ultrasound for embryo transfer?" 0:02:32.000,0:02:35.000 (text on screen): Fertility Authority. Your Most Trusted Source
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