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Ask Dr. Tim, MD Your Own Question
Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 1627
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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Second Opinion I had an open myomectomy in May 2016. I am

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Second OpinionHello. I had an open myomectomy in May 2016. I am now undergoing ivf and want to have 2 embryos transferred but my consultant is against this. I am almost 42 and do not want to PGS testing. Please advise. I am happy to have regular scans and testing or reduce my hours at work to ensure my safety.
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I on take vitamins
JA: Is there anything else the Doctor should know before I connect you? Rest assured that they'll be able to help you.
Customer: I have one miscarriage at 3months in April 2018
Detail Required: HIGH
Dr. Tim, MD

Hello and I would be happy to help. Here is what I think that your doctor is worried about:

1. In women who have had a prior myomectomy (that involves cutting into the muscle wall of the uterus)
2. The muscle wall is 'compromised'. In most cases, these patients are not allowed to labor - they are scheduled for C-sections
3. A certain, and not insignificant, number of women will have 'rupture' of the uterus before the onset of labor. This risk is increased in the setting of prior C-sections, and certainly with prior myomectomies
4. Putting back two embryos that might result in twins (or even triplets) would increase these risks dramatically

So, I agree with your doctor. Weighing the risk of twins and uterine rupture with potential loss of life of the twins (and you) against what would already be a higher risk pregnancy as a singleton is heavily in favor of the single embryo transfer.

Does this makes sense?
Dr. Tim

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Customer: replied 1 year ago.
this makes sense. Is there anything I can do to reduce the risk if I desperately wanted to go ahead with 2 embryo transfer?
Customer: replied 1 year ago.
Also, what would I do I got pregnant with twins naturally?

The only thing that would INCREASE the risk is having a shorter interval from the myomectomy to eventual C-section (less that 18 months between surgery and delivery). After that point, there is nothing that would further reduce the risk.

Based on the limited amount of information that I have available, I would agree with your doctor. In someone like you, I would STRONGLY suggest a second opinion. This does not have to be a fertility specialist. If you have a regular OB/GYN that still does Obstetrics, schedule a visit with them and see what they think.

Dr. Tim

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Customer: replied 1 year ago.
I will do that. hank you for your time.

You are very welcome. Please take a moment to rate my answer (5 stars). This is greatly appreciated.

Dr. Tim

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