Question

H/o primary infertility, 2 fibroids in the cornua, and both sides tubal blockage, ovulation of women and semen analysis is normal. Treatment?

• A. ART
• B. Lap Myomectomy
• C. Hysterectomy
• D. Uterine artery embolization

Hint:

Consider whether removing the fibroid causing tubal blockage could restore natural fertility before proceeding to ART.

Answer 1

The Correct Option is B

Step 1: Understand the clinical scenario. The patient has primary infertility with two cornual fibroids and bilateral tubal blockage. Ovulation and semen analysis are normal, indicating the fibroids and tubal blockage are the likely causes of infertility.

Step 2: Understand the role of cornual fibroids. Fibroids located at the cornua (the junction of the uterine body and fallopian tubes) can mechanically compress or obstruct the interstitial portion of the fallopian tube, causing tubal blockage. Removing these fibroids can restore tubal patency.

Step 3: Evaluate treatment options.

• ART (IVF): Used when tubes cannot be salvaged. However, the first step should be to correct the reversible mechanical cause.
• Laparoscopic Myomectomy: Surgical removal of fibroids through small abdominal incisions. Removing cornual fibroids can relieve tubal obstruction and restore natural fertility. It is the preferred option in a woman desiring fertility.
• Hysterectomy: Not appropriate in a woman wishing to conceive.
• Uterine artery embolization: Contraindicated in women desiring future pregnancy as it can compromise uterine blood supply and cause premature ovarian failure.

Conclusion: Laparoscopic Myomectomy is the treatment of choice to correct the reversible cause of infertility before resorting to ART.