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If not, we can always inject a sperm directly into an egg (ICSI). Old data suggests that 60% of naturally fertilized eggs fail to become pregnancies.In our IVF program last year, more than 70% of patients (all ages) had positive pregnancies tests, but only half of those had ongoing or delivered pregnancies. The best example is the closed hydrosalpinx containing fluid, which runs back into the uterus and changes the uterine environment.
Others showed that this surgery (removing the tube) doubled or tripled the pregnancy rate with IVF.With my concerns about age, I try to avoid most myomectomies.There is some data suggesting a fertility benefit by removing polyps greater than 1/2 cm.The data is weak, but the surgery is easy and with low likelihood of complications.Some fibroids and some polyps likely cause problems in achieving pregnancy.The best study on fibroids out of Johns Hopkins was randomized and showed a fertility benefit from myomectomy.
Most reproductive endocrinologists would recommend myomectomy only for the larger fibroids and those fibroids located near and especially distorting the endometrial lining.
One significant cost of treating fibroids is the time such treatment takes.
We know that on average 90% of all sperm studied are chromosomally normal.
It is rare to have a normal man with a large quantity of chromosomally abnormal sperm.
If you do an IUI with a decent sperm count, you can be assured that at least some chromosomally normal sperm will get to the egg.
Most men will have at least some sperm that can bind to and penetrate the zona pellucida around the egg and enter the egg.