Question

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

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

Answer 1

The Correct Option is B

In the scenario presented, the patient is experiencing primary infertility, with the presence of two fibroids located in the cornual region of the uterus, and both fallopian tubes are blocked. Despite normal ovulation and semen analysis, the treatment focus should address the structural impediments to fertility.

Given these conditions:

• Fibroids at the cornua: These can obstruct the path of the egg or embryo, particularly important when other routes like the tubes are not working.
• Tubal blockage on both sides: Prevents the meeting of sperm and egg within the fallopian tubes, essential for natural conception.
• Normal ovulation and semen analysis: Indicates that other factors related to infertility are not contributing to the problem.

The treatment option that would directly address the physical problem caused by fibroids, potentially improving the chances of fertility, is Lap Myomectomy. This procedure involves the surgical removal of the fibroids, thereby preserving the uterus and potentially removing the blockage at the uterus cornua which could improve uterine environment.

Let’s briefly consider the other options:

• ART (Assisted Reproductive Technology): While this can be an option for overcoming tubal blockage, addressing the fibroids might improve the outcomes of ART, thus making surgery a preparatory step.
• Hysterectomy: This option involves removing the uterus, which would eliminate the possibility of achieving pregnancy entirely.
• Uterine artery embolization: Typically used to shrink fibroids but may not adequately address the severity of blockage and may impair future fertility.

Therefore, Lap Myomectomy is the most appropriate treatment to alleviate the structural challenges posed by fibroids in this context of primary infertility.