A 30-year-old married woman came for an infertility evaluation. On performing further investigations, intramural fibroids of sizes 7x5cm and 5x3cm were seen at the right and left cornual ends of the uterus. Her husband’s semen analysis was found to be normal. What is the appropriate management of this case?
A. Uterine artery embolization
B. Myomectomy
C. Artificial reproductive techniques
D. GnRH analogues
In the case of a 30-year-old woman with infertility and significant intramural fibroids, the appropriate management would focus on addressing the fibroids, as they can impact fertility by altering the uterine environment. The options provided include:
A. Uterine artery embolization: This is generally used to control symptoms like heavy menstrual bleeding or pelvic pain in women who are not seeking to become pregnant, as it can potentially affect future fertility and pregnancy outcomes.
B. Myomectomy: This surgical procedure removes fibroids while preserving the uterus. It is often recommended for women who are experiencing infertility due to fibroids, particularly when the fibroids are large or intramural and distorting the uterine cavity, as in this case.
C. Artificial reproductive techniques: These techniques (like IVF) can be considered, but if the fibroids are causing significant distortion of the uterine cavity, they could still impair implantation and pregnancy success. It would typically be considered after addressing the fibroids.
D. GnRH analogues: These medications can shrink fibroids temporarily by creating a hypoestrogenic state, but they are usually not a long-term solution for infertility and the fibroids often regrow after discontinuation of the medication. They might be used preoperatively to reduce the size of fibroids before a myomectomy.
Given the size and location of the fibroids (7x5 cm and 5x3 cm at the cornual ends of the uterus), and their potential impact on fertility, B. Myomectomy would be the most appropriate initial management option. This approach addresses the mechanical issues caused by the fibroids, potentially improving the chances of a successful pregnancy either naturally or with assisted reproductive techniques later on.
So, the correct answer is: B. Myomectomy.