Concluded Case

Subserosal fibroid with primary infertility

23 Years, Female Chief Complaints 1.Pain in lower mid abdomen during menstruation 2. Primary infertility History ✓ Past history of PCOD treatment (2 Yrs ago) ✓ No other known medical or surgical history. ✓ Patient is neither obese nor thin. ✓ No known diseases of husband. ✓ Married 4 years ago. Vitals Vitals stable Physical Examination NAD Investigations Attached. Diagnosis Subserosal fibroid with primary infertility. Management Suggest management approach.

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Subserosal fibroid arising from fundus need not hamper infertility Go for proper USG to confirm whether it is submucosal or subserosal!! How is her menstural cycle??? Is pain severe enough to alter her lifestyle.? Hormonal assessment?? Thyroid will not suffice?? Ovulation study??

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Golum Mortuza, First, I would like to say that you've improved your case presentation. When you attach reports, cut the unwanted report and post . Regarding this case, Primary infertility with fibroid. Do detailed investigation of both husband and wife. To know the exact location of fibroid, go for 3D SCAN OR MRI. Treatment of fibroid depends on the location FIGO CLASSIFICATION OF UTERINE FIBROIDS. Here, FIGO classifies fibroids into 8 types. TYPE 0 : PEDUNCULATED , INTRACAVITARY. TYPE I : SUB MUCOSAL < 50% INTRAMURAL TYPE II : SUB MUCOSAL >50% INTRAMURAL. TYPE III : 100% INTRAMURAL CONTACT WITH ENDOMETRIUM TYPE IV : INTRAMURAL. TYPE V : SUB SEROSAL , >50% INTRAMURAL. TYPE VI : SUBSEROSAL, <50% INTRAMURAL. TYPE VII : SUB SEROSAL, PEDUNCULATED. TYOE VIII : CERVICAL / PARASITIC FIBROIDS.

Subserosal fibroid arising from fundus need not hamper infertility Go for proper USG to confirm whether it is submucosal or subserosal!! How is her menstural cycle??? Is pain severe enough to alter her lifestyle.? Hormonal assessment?? Thyroid will not suffice?? Ovulation study??

• Subserosal from one of the two USGs. • Menstrual volume, duration, cycle all are normal but painful in first two days where pain is moderate to severe. Hypogastrium is mild tender. • FSH, LH done which are normal in value and in ratio. TSH normal. • Menstruation is regular so didn't workout for ovulation. My questions are .... ✓ May I prescribe Clomiphene citrate now or first we need to treat fibroid ? ✓ If she becomes pregnant, will the fibroid make any problem ? ✓ Has the conservative management any role in treating fibroid specially in this case ?
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Subserosal fibroid needs surgically remove. I think consult with an Gynaecologist for the better treatment and management.

Thank you Sir@Md Altaf Hussain .
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May require endoscopic approach in removal of fibroid. Also see for hypothyroidism in association.

Fibroid should be removed surgically Ref to gynaecologist

panchkarma-abhyang,swedan,then uttar basti orally-herbs

Try to post clear imgaes sir

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