This is a case of 38 year old married lady, complaining of lower abdomen pain from last 7 days. LMP 2 Aug. Past history of two miscarriage after taking treatment for IVF. Also suffering from Migraine, presently talking no treatment. Non Diabetic and NonHT. Had pulmonary Koch's 14 years back took complete course of ATT Any advice from esteemed members ??

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38 yr old / recurrent abortions /had IVF /pulmonary koch's treated/two subserosal fibroids /endometriosis. may be she has no living children. investigate both husband and wife. husband : * semen analysis. * semen c/s. * hb %, tc dc, esr. * rbs. * vdrl, hiv, Hbsag, hcv. wife. * hb %, tc dc, esr. * rbs. * tft. * rft, lft. * scan total abdomen. * vdrl, hiv, Hbsag, hcv. take up the patient for hysterolaparoscopy. take endometrial scrapings for hpe and TB PCR. remove the fibroids. endometriotic deposits are excised /cauterised /vaporised. you can induce ovulation and do IUI for 3 cycles. if she fails to conceive, go for IVF.

Thanks Is subserosal fibroid a problem. Should that be removed before IUI
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Case of subfertility and abortions may be because of multiple reasons 1. Endometriosis 2. Koch : it is pulmonary but may be associated with genital too 3. Fibroids though subserosal Treatment may be laparoscopy and hysteroscopy. On laparoscopy removal of endometroitic cyst along with myomectomy. On hysteroscopy just check endocervical and endometrial cavity and take a biopsy for TB-PCR or AFB smear and culture. Also get HPE tissue of endometrial, cyst and fibroid as per protocol. Tubal patency can also be checked during hysterolap but because of endometriosis her normal anatomy will be disturbed, so I think IUI will not be successful. Her age is also a factor Immediate after endometroitic cyst removal is a best chance for IVF success .

Very fine. I totally agree with you Dr Kaur
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As pt is In reproductive age group n probably desirable of pregnancy So admit n put her on Watchful expectancy management As of now we can first focus on lf . Ovarian mass ...treating it conservatively with Iv.antibiotics placentrx And Sos surgical intervention

That mass is a hemorrhagic mass. Should it not dissolve in few weeks without medicine. She does not have fever and is actively mobile. Thanks DR Sangita
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difficult to comment without real-time ultrasound...the ovary is not separately seen...is the mass stuck to the post wall of uterus ovarian in origin?

Kindly see the Typed report on the side.
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She needs myomectomy of multiple uterine fibroids in varying sizes with removal of left ovarian chocolate cyst. This may relieve her pain in the lower abdomen.

hysterolaproscopy to be done. fibroid remaval

look for recent infection then look for endometriosis and R /O abdominal TB, after cure of abdominal pain she can go for infertility work up and ART

subserosal fibroid not a problem. but the ovarian lesion looks like a chocolate cyst. needs removal as it is a cause of infertility

laparoscopy and proceed accordingly

good course of antibiotics. Hysterolaparoscopy for tubal patency and to know pelvic pathology and treat accordingly.

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