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Abstract: The patient, Ms. Deng, presented to our hospital because she had been sexually active for 3 years without contraception and infertile for more than 1 year. I suspected that the patient had infertility through medical history consultation. After the patient was admitted to the hospital, through the perfection of hysterosalpingography, it was clear that the primary infertility was caused by the sequelae of pelvic inflammatory disease, which required surgical treatment. 5 months after the surgical treatment, the pregnancy was successful, and I was sincerely happy for the patient.
Basic information】Female, 28 years old
Type of disease】Infertility (primary infertility)
Hospital】Hunan Women’s and Children’s Hospital, Hunan Province, specializing in gynecological oncology and cervical lesions
Date of consultation】June 2021
Treatment plan】Laparoscopy + hysteroscopy
Treatment Period】5 days of inpatient treatment and 6 months of outpatient follow up
Results】After surgery, she was advised to try to conceive, and the pregnancy was successful after 5 months.
I. Initial consultation
Ms. Deng came to our hospital because she had been sexually active for 3 years and had not been pregnant without contraception for more than 1 year. She reported that she used to have regular menstruation, 7-8/27-32 days, with medium volume, no dysmenorrhea or blood clots. She had a normal sexual life, with condom contraception until early 2021, after which she had no pregnancy. There was no hirsutism and overflow of breast milk, hot flashes and night sweats, intercourse during menstruation, and no abdominal pain, abdominal distension and anal swelling. The patient had not undergone tubal lavage and had ovulation monitored by ultrasound, with dominant follicles and ovulation. The male partner had undergone semen examination in May, and the examination results showed no significant abnormality. The male partner had undergone a semen test in May and the test results showed no significant abnormality. So she came to our clinic today and wanted further examination and treatment. Based on the patient’s medical history, she was initially diagnosed with infertility and was recommended to undergo tubal angioplasty after hospitalization to clarify her specific condition.
II. Treatment history
After admission, a hysterosalpingogram was performed. The uterus was found to be normal in size, but it was suspected that the tubes were not open bilaterally, with the middle and distal segments of the left tube being S-shaped and twisted at an angle, and the middle and distal segments of the right tube being S-shaped and twisted at an angle in a spiral pattern. The patient expressed her agreement to the treatment plan. The hysteroscopy showed regular morphology of the uterine cavity, and the laparoscopy showed distorted and fluid-filled fallopian tubes. The operation went smoothly, and ceftriaxone sodium for injection was given to prevent postoperative infection routinely. The patient had no postoperative complications and was discharged 5 days later.
III. Treatment effect
The patient had been infertile without contraception for 1+ years. After examination, the patient was considered to be suffering from pelvic inflammatory disease, and a tubal plastic stoma had been performed during the operation. Fortunately, after 5 months, the patient came to the hospital for examination and was clearly 2 weeks pregnant, and the patient was instructed to just perform regular obstetric examinations.
IV. Precautions
When the patient was discharged from the hospital, she was worried that she still could not get pregnant easily. I reassured the patient that she should pay attention to relaxing and avoiding excessive stress on a daily basis. After the operation, I suggested ultrasound monitoring of ovulation to guide the timing of intercourse, actively trying for pregnancy for 6 months, and assisted reproduction if necessary. In addition, tub bathing and sexual intercourse were prohibited for 2 weeks after surgery. After discharge, if there is severe lower abdominal pain, the tubal effusion may rupture and should be closely observed. If internal bleeding is suspected, ultrasound examination or posterior fornix or lower abdominal puncture can be done to clarify the diagnosis and deal with it actively.
V. Personal insight
Female patients who develop infertility are usually caused by pelvic diseases or ovulation disorders, as in the case of the patient in this case, where there is no abnormal ovulation but there are sequelae of pelvic inflammatory diseases, thus leading to poor tubal passage and thus causing primary infertility. For infertility caused by such conditions, surgical treatment is required in most cases, with specific results varying from person to person, and active attempts to conceive after surgery are also required under the guidance of a physician.