June 06, 2013
Mrs XXXX
Age: 29yrs
Married life: 7yrs
A case of primary infertility with past h/o of bilateral laparoscopic ovarian cystectomy (dec/2011) with 2 failed IUI in dec/2012 ,jan/2013.
Ultrasound Done- Shows all the parameters within normal limit
Planned For Diagnostic and Operative Hysteroscopy and Laparoscopy (06/06/2013)
INTRA-OPERATIVE FINDING
1.Adenomyotic cyst present on posterior wall of uterus near to right ostia : Adenomyotic cyst opened and excised
2.Cavity size reduced due to lateral wall and fundal wall adhesion : Lateral wall and fundal wall metroplasty done
PRACTICAL POINTS
1.Adenomyotic cyst can be cause of failed ivf/implantation
2.Adenomyotic cyst might not be visualized on ultrasound and may appear has subendometrial haemorrhagic area ( as in these case ,such area should be probed hysteroscopically in order to diagnose and treat the cyst)
3.Adenomyotic cyst should be opened and resected out ,this can be done using office hysteroscopy with hysteroscopic scissor more than adequately as shown in the clip
4.Adenomyotic cyst not always indent the cavity and hence might be missed at times . visualize cues like
- a) Sub endometrial haemorrhage
- b) Abnormal vascularity on the surface
c)Ultrasound diagnosis of adenomyotic area /cyst are helpful method to diagnosis and hence treat.