During routine investigation for infertility a HSG shown a hypoplastic uterus and absent right rule explore the management option.
A detailed history of the LMP, menarche, cycle regularity, spontaneous or induced, contraception. Previous pregnancies. Previous treatments for infertility, recurrent urinary problem and medication taken. A previous history of surgery for any mass or anatomical correction. A history of any radiation of chemotherapy for her mother when she was pregnant is adducted.
The general examination of the woman noting the height, secondary sexual development and features of Turner?s syndrome is observed. Abdominal examination for any mass suggesting undescended testes is noted. Local examination for any clitoromegaly, enlargement of labia majora, or sign of estrogenzation noted. A bimanual pelvic examination to confirm the uterine size, mobility presence of any adnexal mass is done.
The following tests are offered explaining the option of why it is being done. As she has come with infertility, an ultrasound to confirm the size of the uterus presence of normal ovaries and any adnexal mass. Simultaneously any renal tract anomalies can be ruled out. A diagnostic laprascopy to visualize directly the uterus, its size any adhesion posteriorly causing the distorted size, presence of one or both tubes. Its patency should be checked using dye insuffulation since the HSG finding suggests a blocked right tube. The presence of normal ovaries or follicular cysts is noted. Ovarian drilling with monopolar cautery, 40V, and 4 places for 4 secs gives an ovulation of 80% and pregnancy of 40-70%. It also corrects the hormonal imbalance. A repeat HSG is advised if the laprascopy shows absence of dye from the left tube. This enables the exact location of the block to be identified. It the diagnostic laprascopy reveals a hypoplastic uterus with absent on streak ovaries then the patient is offered a karyotyping. If it is 46xy the abnormal gonad & searched for and gonadectomy done. In case of 46 x 0 suggesting a Turner?s or 46xx a Turners mosaic or a developmental anomaly the woman is informed about the rare probably of spontaneous pregnancy. She is given the option of Oocyte retrieval and in vitro fertilization
