Exploring the Impact of Uterine Polyps and Adenomyosis on Fertility: Diagnosis and Management – ARC Summit
Today, I’m discussing the identification and management of uterine polyps, adenomyosis, and intrauterine adhesions using HSG (Hysterosalpingography), which is crucial for initial assessments.
Polyps: During an HSG, identifying polyps is essential, and it can be subtle. I prefer office hysteroscopy over saline infusion sonograms because it provides clearer, more direct visualization, allowing for easier and more accurate diagnosis and treatment. While the literature on the necessity of removing polyps is mixed, I tend to remove them during the procedure because it is simple and quick, enhancing patient convenience and treatment outcomes.
Adenomyosis: This condition often masquerades as fibroids on imaging, making accurate diagnosis challenging. While there’s no definitive imaging for adenomyosis, ultrasound and MRI can provide suggestive evidence. If adenomyosis is suspected, conservative management is usually my approach unless the patient’s symptoms are severe or impacting fertility. Surgical intervention, when necessary, must be cautiously approached due to potential complications like excessive bleeding.
Intrauterine Adhesions: Often diagnosed during routine checks or following symptomatic complaints, these can significantly impact fertility and overall uterine health. For treatment, I typically perform an office hysteroscopy to assess the severity and extent of the adhesions. Post-surgical management involves placing an intrauterine balloon under ultrasound guidance to ensure correct placement, followed by estrogen therapy to promote healing. Subsequent hysteroscopy checks the effectiveness of the treatment.
For all conditions, especially when discussing potential surgeries or interventions, it’s critical to manage patient expectations regarding outcomes like pregnancy and miscarriage rates. Educating patients about the implications of their condition on fertility and the potential benefits and risks of treatment is a key part of their care process.
In conclusion, the use of precise diagnostic tools and thoughtful, patient-centric management strategies is essential in treating complex gynecological issues such as polyps, adenomyosis, and intrauterine adhesions. Each case should be approached with detailed diagnostic work to ensure tailored treatments that address both the medical and personal needs of the patient.
