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Infertility/Fertility/effect of myometium thickness on pregnaancy

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QUESTION: Hello SIR;
     I am 38.yrs old.I have been pregnant twice in the last two yrs but both the pregnancies ended in first trimester miscarriage after the cardiac activity was seen in sonography.Now i am pregnant again.
I had a sonography at 10wks5days.The report is as follows;
 ANTERIOR MAYOMETRIUM IN BODY AREA SHOW 3by2cm SIZE FOCAL THICKENING. rest everything is normal.
sir please tell how this can affect my pregnancy.what is the treatment for this problem ?
I have been taking Predenisolone 5mg twice a day starting from  6wks2days and today iam 11wks3days pregnant.my doctor has asked to
reduce the dose after 12 wks to 5mg once a day for a week then 5mg
every alternate day for aweek ,then stop completely aftr 14wks.
The other medicines i am taking are;baby aspirin;l.m.w.h 40mg inj
vaginal progesterone200mg,and ESTRADIOL VALERATE 2MG.

ANSWER: Hello Zarine from India,

The finding you describe is only a description.  It has no medical impact or consequences on pregnancy or anything else.  The most common reason for miscarriage after cardiac activity is noted is a genetic or anatomical abnormality in the fetus.  Based on your age, you are at increased risk for miscarriage due to spontaneous chromosomal abnormalities.  Eventually, you should have a fetus and embryo that are genetically normal, thereby leading to a successful pregnancy.  The only way to short cut that process is to do IVF and consider preimplantation genetic testing prior to embryo transfer.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: hello sir;
     Thanks for your reply sir.Its an honour and blessing to be able to communicate and get an opinion of an expert like you.
  sir as i have written my sonography report says
ANTERIOR MAYOMETRIUM IN BODY AREA SHOWS 3*2CM FOCAL THICKENING
my doctor says that normal anterior mayometrium measures 1.50cm  and since mine is 3*2cm it is a fibroid and progesterone may help in reducing it.i am 12 weeks2days pregnant already taking drydogesterone 10mg orally and
200mg vaginal progesterone.if i was your patient what treatment would you suggest?

ANSWER: Hello Again,

I do not agree with your doctor.  Fibroids are NOT diagnosed based on myometrial thickening.  They can be easily and clearly see with clear borders.  Considering that you are currently pregnancy, nothing can or should be done right now.  Also, the progesterone supplementation,which I presume your doctor gave to help support implantation, the early pregnancy and possibly prevent miscarriage, is NOT needed past 12 weeks gestational age.  By this time, the placenta is making its own progesterone.  In fact, I stop the progesterone at 10 weeks gestational age.  Again, I do not agree with your doctor on this.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: Thanks for your reply again sir and sorry to bother you again sir .
sir actually because of my age i.e 38yrs and past two miscarriages i am very nervous and thats why i am bothering you again.
sir yesterday i did some research on the net and came acrosss an article which said that the increased thickness of anterior mayometrium gives less space to the foetus to grow which may either cause deformities in the baby
or miscarriages and as mine was 3*2cm at 10weeks5days i am scared.
  sir about the progesterone supplement my doctor says that because of my
increased age i.e is 38yrs and previous 2 miscarriages i need to take vaginal progesterone and drydogesterone till 14 weeks and these progesterone supplement will help in reducing the anterior mayometrial thickness which is caused by excess of oestrogen.

Answer
The information you read is not correct.  The myometrium stretches out and thins out as the pregnancy progresses.  I don't know where that article came from but it is totally wrong.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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