| Age | 38 years |
| Fertility History | 18 years of infertility |
| Prior Treatment | Multiple failed IUI and IVF cycles at other centers |
| Presenting Problem | Fibroids and adenomyoma — [size/location: e.g., X cm intramural fibroid, focal adenomyoma in Y location] |
| Treatment | Myomectomy + adenomyoma excision, followed by embryo freezing, then frozen embryo transfer |
| Outcome | Conceived on first embryo transfer following surgery; delivered a healthy baby |
Eighteen years of infertility, with multiple IVF cycles already failed elsewhere, is the kind of history that tends to get patients labeled — sometimes by themselves — as “poor responders” or told their chances are exhausted. But repeated cycle failure without ever identifying a specific anatomical explanation is itself a diagnostic clue: something in the uterine environment may be actively working against implantation, independent of embryo quality.
Fibroids and adenomyosis (or a localized adenomyoma) are common, frequently coexisting, and easy to under-treat — particularly when previous cycles focused on ovarian stimulation and embryo quality without addressing the cavity the embryo has to implant into.
Imaging confirmed [modality — e.g., transvaginal ultrasound / MRI] evidence of fibroid(s) and a focal adenomyoma at [location], of a size and position judged likely to be distorting the endometrial cavity or impairing implantation — the kind of lesion that can sit beneath the radar of a standard IVF workup focused on ovarian response.
This distinction matters clinically: submucosal fibroids that distort the uterine cavity are well established as reducing IVF implantation rates substantially, while non-cavity-distorting intramural fibroids remain more debated in the literature — evidence on whether they warrant removal is mixed, and the decision depends on size, location, and the patient’s treatment history.1 Adenomyosis carries its own independent evidence base: cohort data has associated adenomyosis with lower live-birth rates and higher miscarriage rates in IVF/ICSI cycles, particularly in patients aged 38 and above.2
Rather than attempting another fresh transfer around the existing anatomical problem, the sequence was reordered:
She conceived on the first embryo transfer following surgery — after 18 years of infertility and multiple prior failed cycles — and delivered a healthy baby.
This case illustrates a sequencing decision more than a new technology: when repeated IVF/IUI cycles fail without a clear embryo-quality explanation, the uterine cavity itself deserves a dedicated look — and, if structural pathology is found, treating it before the next transfer rather than around it. Freezing embryos ahead of surgery meant surgical recovery didn’t consume another attempt. This approach is consistent with the wider clinical view that symptomatic patients with repeated IVF/ICSI failure after good-quality embryo transfers are reasonable candidates for surgery rather than repeated hormonal escalation alone.2
Individual results vary based on the size, number, and location of fibroids/adenomyoma, and overall reproductive history. This case describes one patient’s outcome and is not a guarantee of results for any other individual.
Can fibroids cause IVF failure even if my embryos are good quality?
Yes. Fibroids and adenomyosis can distort the uterine cavity or impair blood flow to the endometrium, preventing an otherwise healthy embryo from implanting. Repeated failures without another clear cause warrant imaging to check for this.
Is it better to do surgery before or after embryo transfer?
When a fibroid or adenomyoma is likely affecting the cavity, treating it before transfer — rather than attempting a transfer around it — generally gives the embryo a better environment to implant in. Embryo freezing beforehand avoids losing a cycle to surgical recovery time.
Does age reduce the chances of success after this kind of surgery?
Age remains a factor in egg and embryo quality, but a structurally corrected uterus improves the chances that a good-quality embryo — frozen or fresh — is able to implant.
Do all fibroids need to be removed before IVF?
No. The evidence differs by fibroid type. Fibroids distorting the uterine cavity are more consistently linked to reduced implantation and are generally recommended for removal; smaller fibroids not affecting the cavity are often monitored rather than operated on, particularly if surgery would meaningfully delay treatment.
