Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Uterine leiomyomata
0%
0/83
Tubal blockage
36%
30/83
In utero exposure to diethylstilbestrol (DES)
Uterine retroversion
8%
7/83
Male factor infertility
18%
15/83
Select Answer to see Preferred Response
This patient presents with secondary infertility and an HSG that shows a T-shaped uterus. The most likely cause of this uterine abnormality is in utero exposure to DES. DES is a synthetic estrogen that was once prescribed for recurrent pregnancy loss and prematurity. It was discontinued when an association was found between in utero exposure to DES and mullerian anomalies such as a T-shaped uterus. Patients with T-shaped uterus may present with recurrent pregnancy loss themselves or have difficulty conceiving due to failed implantation. This can be confirmed on HSG. Of note, DES may also cause clear cell adenocarcinoma of the vagina in exposed daughters. Figure A shows an HSG with a T-shaped uterus and bilateral tubal patency. Incorrect Answers: Answer 1: Uterine leiomyomata can cause both spontaneous abortion and infertility especially if they are submucosal. Submucosal fibroids typically present with heavy or irregular bleeding and can be seen on both ultrasound and HSG, but these signs and symptoms are absent in this patient. Answer 2: Tubal blockage is a common cause of infertility and may be due to prior pelvic infection with sexually transmitted diseases. Although this patient has a history of gonorrhea, her HSG shows spillage of dye on both sides, confirming tubal patency. Answer 4: Uterine retroversion is a normal variant in which the uterus is tipped posteriorly. It can sometimes be “incarcerated” in this position due to endometriosis and subsequently be associated with infertility, but this patient does not exhibit any symptoms of endometriosis. Answer 5: Male factor infertility accounts for up to 40 percent of infertility. Risk factors include alcoholism, low testosterone, strenuous cycling, and hot tub use. Although it is possible that this patient’s husband is infertile, there is no reason to suspect this without additional evidence. Bullet Summary: In utero exposure to diethylstilbestrol (DES) is associated with uterine anomalies such as a T-shaped uterus which can cause recurrent pregnancy loss and infertility.
4.2
(5)
Please Login to add comment