infertility

35 year old G2 P1 L1 LCB 13 years with two months amenorrhoea. ultrasound sowed a 7 weeks live intra uterine pregnancy associated with intra mural fibroid of 6*5 cms. patient c/o bleeding pv . per speculam examination showed a fibroid polyp as shown. what is the line of management.

45yrs old para 3 presented with H/o excessive and irregular bleeding PV since 2yrs and pain and off an off 1yr.on exam P/s cervical polyp protruding through is usg showed Bil TO MASS. MRI Pelvis showed bil hydrosalpinx. LAVH Planned and done after investigation. Hydrosalpinx refers to Fallopian tube that’s blocked with watery fluid. Causes are ST infections endometriosis PID ruptured appendicitis or any and surgery. Symptoms are and or pelvic pain unusual watery discharge or infertility. Treatment is surgery to remove the affected tube. Treat endometriosis treat PID with antibiotics. Sclerotherapy usg needle is used to draw fluid out of affected tube and special chemical is used called sclerosing agent that is injected to prevent the fluid building up again.

33 yrs old lady treated for primary infertility. Reported on 02_07 with bleeding PV. At present she is 23 wks. Placenta ant grade 2. All blood reports r normal. Let's discuss the etiology of bleeding PV . She is tted with vit k,progesterone & duvadilon . Settled & discharged on 05_07.

what management will be needed for this person with TSH level 4.95

HSG FINDINGS IN GENITAL KOCHS : Female genital tuberculosis is a major cause of tubal obstruction leading to infertility , especially in developing countries. Genital tuberculosis is difficult to diagnose. DEFINITIVE DIAGNOSIS OF GENITAL TUBERCULOSIS IS MADE BY 1 ) POSITIVE MYCOBACTERIUM CULTURE IN ENDOMETRIAL TISSUE . 2 ) HISTOLOGICAL DIAGNOSIS OF TUBERCLES / GRANULOMAS . HYSTEROSALPINGOGRAM IS THE GOLD STANDARD IMAGING PROCEDURE IN EVALUATING THE INTERNAL ARCHITECTURE OF THE FEMALE GENITAL TRACT. The radiographic features of genital tuberculosis is described in two parts 1 ) PART I / SPECIFIC FEATURES : Related to tubes . BEADED TUBE. PIPESTEM TUBE . GOLF CLUB TUBE . COBBLE STONE TUBE . LEOPARD SKIN TUBE . 2 ) PART II : Related to endometrium. This describes the adverse effects of tuberculosis on the structure of endometrium. DWARFED UTERUS WITH LYMPHATIC INTRAVASATION AND OCCLUDED TUBES "T" SHAPED UTERUS . PSEUDOUNICORNUATE UTERUS. COLLAR STUD ABSCESS. HSG FINDINGS : 1 ) CALCIFICATION OF FALLOPIAN TUBES ,OVARY .Tubal calcification is usually seen in the form of small linear streaks in the course of tubes. 2 ) HYDROSALPINX : HSG shows dilated fallopian tube filed with contrast and absence of free spillage of dye. 3 ) TUBAL OCCLUSION : Distal tubal occlusion causes hydrosalpinx and in proximal tubal occlusion, dye fails to enter the tubes and therefore tubes are not visualized. 4 ) TUFTED LIKE APPEARANCE / ROSETTE LIKE APPEARANCE : Caseous ulceration of tubal mucosa creates an irregular, ragged or diverticular appearance on the contour of tubal lumen in HSG These diverticular cavities surrounding the ampulla produced by caseous ulceration gives the tubal outline "tufted like appearance / rosette like appearance. 5)TB-SIN : TUBERCULOSIS-SALPINGITIS ISTHMICA NODOSA : Penetration of contrast medium between the mucosal folds due to ulceration of tubal mucosa causes diverticular - like outpouchings. 6 ) COTTON WOOL PLUG APPEARANCE: Distribution of contrast medium in a reticular pattern produces cotton wool plug appearance. 7 ) SAW TOOTHED APPEARANCE: when the tubal lumen is filled with putty like caseous material, the HSG outline is irregular with pockets or Laguna giving a saw toothed appearance. 8 ) BEADED TUBE : Multiple constrictions along the fallopian tubes gives a beaded appearance. 9 ) PIPE STEM TUBE : Absence of normal tortuosity and curved / straight pipe like rigid appearance in fibrotic stage of tubercular salpingitis causes pipe stem appearance. 10 ) LEOPARD SKIN TUBE : Multiple rounded filling defects following intra luminal granulomas formation within the hydrosalpinx gives leopard skin appearance . 11 ) GOLF CLUB TUBE : Sacculation of tubes in distal portion with an associated hydrosalpinx gives a golf club like appearance. 12 ) COBBLE STONE APPEARANCE : Intra luminal scarring gives rise to cobble stone pattern which indicates intra luminal adhesions . 13 ) TOBACCO POUCH APPEARANCE : Eversion of fimbria secondary to adhesions with a patent orifice produces tobacco pouch appearance.