30-year-old woman

Endometrial cavity distortion due to fibroid uterus desiring fertility.


Symptoms

  • Infertility
  • Heavy menses
  • Increased urinary frequency
  • Pelvic pressure

Ultrasound

Uterus with multiple fibroids, large fibroid compressing endometrial cavity

Examination

14-week-size fibroid uterus

Recommendations

Expectant management (no treatment) or myomectomy. Discussion of decreased pregnancy rate and increased miscarriage rate due to compression of endometrial cavity where embryo implants

Treatment

Patient underwent uncomplicated myomectomy through mini-laparotomy incision. Large central fibroid plus other smaller ones removed. Minimal blood loss. Patient advised that she will require cesarean deliveries in future due to incisions > 50% of myometrial wall thickness. Patient discharged on post-op day #1.