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Re: GYN: fibroids/future fertilityFrom: George M. Grunert (grunert@icsi.net)Sat Feb 28 18:01:22 1998
> Today, she had an irregular fibroid uterus at exam under anesthesia, a > large (3 or 4 cm) fibroid that filled most of the uterine cavity at > hysteroscopy, and several large intramural and subserosal fibroids from > 2 to 5 cm distorting the uterus. She had one spot of endo over the > right ureter on the sidewall, and gelatinous goop reminiscent of old PID > hanging from both ovaries, which were otherwise ok (no endo). There was > minimal adhesive disease between the ovaries and the ovarian fossae, > easily broken up with flipping the ovaries, and one tube easily filled > and spilled (the right), and the left was occluded distally with > clubbing. Incidentally, I could see only the left tubal ostium by > hysteroscope. > > So, she needs an open myomectomy, I think, and a goop cleanup at the > same time, as she wishes pregnancy this summer. What should I do, if > anything, with the clubbed tube? I'd put her on a long-acting GnRH agonist (Lupron Depot) and follow the size of the fibroids. They should decrease in size (quite variable from patient to patient) and stabilize in 2 to 3 months. If the intracavitary one responds very well, you might consider hysteroscopic remova, but it sounds like you're goling to be doing a lap for her multiple other myomata. While you're there, do a cuff salpingostomy or fimbrioplasty depending on the condition of her tube. If it's a large, poor prognosis hydro, I'd remove it. The endo may or may not respond completely. I'd also take advantage of the amenorrhea to give her iron and correct her anemia.
-- George M. Grunert, M.D. Director ART Program, Woman's Hospital of Texas 7550 Fannin Houston, TX 77054 713-512-7851 fax 713-512-7853 grunert@icsi.net
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