Which doc to see next? Third opinion? Unicornuate uterus and scaring

[Anonymous]

IF veterans, advise me please. I'm not sure what step to take next.

I had a laproscopic myomectomy, that according to my surgeon, left me with Asherman's syndrome and only one functioning tube. The fibroid was a huge transmural one and she said that I was left with a much smaller cavity than before. She agreed that there was not much to be done to clean up the uterus because of time constraints and advised me to move forward with IVF.

Then, two failed IVF cycles (own eggs).

I've now switched clinics and the new doc says he sees no evidence of scar tissue but has diagnosed a unicornuate uterus. He can't explain why I have two tubes though, because apparently with that condition you only have one. This makes me doubt him. He also is happy to move forward with IVF (DE).

We are paying out of pocket.

I am trying to make sense of this contradictory information. It seems like everyone is very happy to move forward with taking my money but no one can get a fix on the state of my uterus.

Before we go dropping big money again I think I need to see someone else. Another RE for a third opinion? Back to the surgeon for her take on the new dx? I feel stuck.

[Anonymous]

I would recommend GW in this case (or possibly out of town, but may as well start local). After several 3 unsuccessful cycles, following a miscarriage and d&c, they did not recommend ivf until getting to the bottom of some pain my previous RE dismissed. They found, and with the help of their gyn dept treated, my Asherman's. I'm now 8 weeks pregnant.

[Anonymous]

I would go to a gyn surgeon. MacKoul is excellent.

[Anonymous]

One tube may not be attached or functioning unicorns ate uterus is usually diagnosed during laparoscopy the chances of preterm birth are higher because uterus cannot expand fully. You did not post how old you are, why are they suggesting de?

[Anonymous]

I am the pp obviously unicorns did not eat your uterus, stupid iPad correcting my spelling

[Anonymous]

op, with this condition you may have have 2 Fallopian tubes but only one horn of the uterus. One of the Fallopian tubes maybe rudimentary and is not communicating with uterus. did you have a hcg done?

[Anonymous]

OP here. I am now 44 and have been dealing with the whole fibroid thing and its repercussions for two plus years. This is also secondary IF. I carried to term a healthy child with no complications. I cannot make sense of why no one's pointed out the unicornuate uterus (my current RE says it's not hard to overlook but he can't explain the two tubes) and why two clinics have dismissed the post surgery report that diagnoses Asherman's, the importance of which I only recently realized. I have had three procedures at my new clinic to check for scar tissue incl an HSG and a sonohysterogram in 3d. I read through the other thread on scarring and am thinking of getting a third opinion with Sacks and also seeing Robinson at GW. I believe my surgeon at GW trained with him. Ugh so many appointments and that's even before I work my way through the pre-ivf checklist.

[Anonymous]

Anonymous wrote:OP here. I am now 44 and have been dealing with the whole fibroid thing and its repercussions for two plus years. This is also secondary IF. I carried to term a healthy child with no complications. I cannot make sense of why no one's pointed out the unicornuate uterus (my current RE says it's not hard to overlook but he can't explain the two tubes) and why two clinics have dismissed the post surgery report that diagnoses Asherman's, the importance of which I only recently realized. I have had three procedures at my new clinic to check for scar tissue incl an HSG and a sonohysterogram in 3d. I read through the other thread on scarring and am thinking of getting a third opinion with Sacks and also seeing Robinson at GW. I believe my surgeon at GW trained with him. Ugh so many appointments and that's even before I work my way through the pre-ivf checklist.

FWIW, Sacks missed my Asherman's. I did three unsuccessful IVF cycles with him post-D&C and even asked about scarring. He only did an HSG, which is not the optimal means of detecting Asherman's and will definitely miss it in some cases (like mine). The gold standard for diagnosis is Hysteroscopy, which Robinson does (I can't say for Sacks, since he did not do it for me). Robinson is generally wonderful (great doc and also treats patients well), and I credit him with saving my fertility. In your case, I would not recommend Sacks since his philosophy is to be less aggressive with testing in general. At your age, you want all the testing up front.

[Anonymous]

I have a unicornuate uterus, with 2 fallopian tubes. I was able to carry my 2 children full term. (I actually have one Fallopian tube now because the other one ruptured from an ectopic pregnancy)
I actually did go to dr. Robinson at gw and he confirmed with a hysteroscopy that I do have a unicornuate uterus.

[Anonymous]

OP here. Thanks pps, especially the last two, for your input. I have an appt scheduled with Robinson.