Fertility specialists typically assess the size, location, and impact of fibroids on fertility before deciding on surgical or medical management before in vitro fertilization (IVF). Here is how they determine the necessity for such treatments:

1. Size and Location of Fibroids: Larger fibroids or those located within the uterine cavity may impact fertility and the success of IVF. Specialists may consider surgical removal (myomectomy) to improve the chances of conception.

2. Symptoms: If fibroids cause symptoms like heavy menstrual bleeding, pelvic pain, or pressure symptoms, they may require intervention before proceeding with IVF.

3. Effect on Implantation: Fibroids can affect the blood supply to the uterus, potentially impacting embryo implantation. Surgical removal may be recommended in such cases.

4. Risk of Miscarriage: Fibroids have been associated with a higher risk of miscarriage. If a patient has a history of recurrent miscarriages and fibroids are identified, management before IVF may be necessary.

5. Response to Medications: Sometimes, medical management with medications to shrink fibroids (such as gonadotropin-releasing hormone agonists or selective progesterone receptor modulators) may be attempted before considering surgery.

6. Individual Patient Factors: Each case is unique, so specialists will consider the overall health of the patient, the specific characteristics of the fibroids, and the patient’s fertility goals before recommending surgical or medical interventions.

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