Question

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

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

Hint:

Consider whether removing the fibroid causing tubal blockage could restore natural fertility before proceeding to ART.

Answer 1

The Correct Option is B

Clinical reasoning: Primary infertility + bilateral tubal blockage + 2 cornual fibroids + normal ovulation + normal semen analysis.

Key insight: Cornual fibroids physically obstruct the interstitial/cornual segment of the fallopian tube. Surgical removal can relieve this obstruction and restore tubal patency, enabling natural conception.

Evaluation of options:
- ART (IVF): Bypasses tubes entirely -- appropriate only if tubes cannot be salvaged or if myomectomy fails.
- Laparoscopic Myomectomy: Minimally invasive removal of fibroids; preferred when fertility preservation is desired.
- Hysterectomy: Removes uterus -- never appropriate in a woman seeking conception.
- Uterine artery embolization: Risk of premature ovarian failure and uterine ischemia; contraindicated in those desiring pregnancy.

In a young woman with primary infertility due to a correctable mechanical cause (cornual fibroids causing tubal obstruction), Laparoscopic Myomectomy addresses the root cause and is the first-line surgical intervention.

\[\boxed{\text{Laparoscopic Myomectomy}}\]