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Review
. 2003 Sep 27;327(7417):721-4.
doi: 10.1136/bmj.327.7417.721.

Unexplained infertility, endometriosis, and fibroids

Roger Hart  1
Affiliations
Review

Unexplained infertility, endometriosis, and fibroids

Roger Hart. BMJ. .
No abstract available

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Figures

Figure 1
Figure 1
Unexplained subfertility can be a frustrating diagnosis for any couple trying to conceive
Figure 2
Figure 2
Cumulative live birth rate and prognostic influence of history and findings in couples not conceiving in the first year of trying
Figure 3
Figure 3
Laparoscopy of an enlarged ovary containing an endometriotic cyst leaking “chocolate” fluid (arrow). These endometriomas develop as endometriotic implants that may bleed slowly into the ovary over months. This patient complained of worsening left sided pain. A small rupture was found and there was a small amount of blood in her abdomen. The cyst was removed and the normal ovarian tissue was saved
Figure 4
Figure 4
Mild pelvic endometriosis seen at the time of diagnostic laparoscopy. Arrows show typical endometrioic deposits
Figure 5
Figure 5
Magnetic resonance scan showing a bright endometrioma (A) with a dependent clot. The arrows show small intramural fibroids
Figure 6
Figure 6
Uterus containing multiple fibroids, which may interfere with fertility even after surgical myomectomy because of distortion of the uterus
Figure 7
Figure 7
Intracavity fibroid seen by hysteroscopy
Figure 8
Figure 8
Hysteroscopic resection of an intracavity fibroid, with part of the diathermy cutting loop visible
Figure 9
Figure 9
Fibroid embolisation—both uterine arteries are occluded using a transfemoral approach. Small polyvinyl alcohol beads obstruct the blood supply to the fibroids, causing necrosis and shrinkage
See this image and copyright information in PMC

References

    1. Royal College of Obstetricians and Gynaecologists. Evidence based guidelines. The management of the infertile couple. London: RCOG Press, 1998.
    1. Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999;14: 698-703. - PubMed
    1. Marcoux S, Maheux R, Berube S. Canadian Collaborative Group on Endometriosis. Laparoscopic surgery in infertile women with minimal or mild endometriosis. N Engl J Med 1997;337: 217-22. - PubMed
    1. Hart R, Khalaf Y, Yeong CT, Seed P, Taylor A, Braude P. A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception. Hum Reprod 2001;16: 2411-7. - PubMed
    1. Hart R, Molnar BG, Magos A. Long term follow-up of hysteroscopic myomectomy assessed by survival analysis. Br J Obstet Gynaecol 1999;106: 700-5. - PubMed