Case presentation-

INFERTILITY
Dr. Sindhuja.B
Final year PG
SRIHER
Case History
24years, Mrs.S ,
Residing at Karapakkam,Chennai
Education- B.Com.,
Socioeconomic status- Class II
Home-maker
W/O Mr. R ,29years, driver by occupation.
Chief complaints:
 Pain during menstruation, since 2years
 Anxious to conceive
 Married for the past 4years, living with husband
History of presenting illness:
 H/O increased pain during mentrual cycles, since 2years
 No H/O abdominal distension, WDPV, menstrual irregularities
 No H/O bladder, bowel disturbances
 No H/O secretions from breast
 No H/O loss of weight or appetite

Menstrual history:
 Attained menarche at 13years of age
 Regular menstrual cycles- 5-6/27-30days
 LMP: 03/12/18
 H/O congestive dysmenorrhoea, triple dysmenorrhoea + (pain reduced
with medications)
Marital history:
 Married since 4years (June 2014), non-consanguinous marriage
 1st marriage for both partners
 Living with husband
 No H/O contraceptive use

Obstretic history- Nulliparous

Coital history:
 Regular unprotected intercourse- 3-4/week
 H/O deep dysparunia +
 No H/O coital difficulties, premature or retrograde ejaculation
 No H/O use of lubricants or post- coital douching
 Wife is aware of fertile period
Past medical history:
 No H/O DM/ HT/ thyroid disorder/ asthma/ heart disease/ renal
disease/ epilepsy/ hyperprolactinemia/ prolonged medications
 No H/O TB/ STD/ recurrent UTI/ PID

Past surgical history:

 H/O laproscopic ovarian cystectomy done for left endometriotic cyst
in Nov 2017, in a private hospital.

Personal history:
 Consumes mixed diet
 No H/O tabacco, betel-nut, smoking, alcohol intake
Family history:
 She is the elder sister
 No H/O malignancy, infertility, TB, premature ovarian failure, early
menopause
Andrological history:
 Mr. R, 29years, driver by occupation
 No H/O UTI, urethral discharge
 No H/O coital difficulties, premature or retrograde ejaculation
 No H/O DM, HT, TB, prolonged medications, mumps
 No H/O previous surgeries
 Not a known smoker, occassional alcoholic
 H/O semen analysis done in Feb 2018- told to be normal
Treatement history:
 Has undertaken treatement irregularly for the past 2.5years
 In 2016 Feb- was diagnosed with small endometriotic cyst, was not
advised any medications
 Underwent 3cycles of OI in june- august 2016
 Tried alternative (homeo) medicines for 6months in 2017
 Diagnosed with increase in size of endometriotic cyst and hence
underwent endometriotic cystectomy in Nov 2017- Both fallopian
tubes were said to be patent.
 H/O OI+ TI for 3cycles in 2018, No IUI was done- was told the growth
of follicles was not adequate
Examination
Height- 158cm
General: Weight- 56.8kg
 Moderately built and nourished BMI- 22.72kg/m2
 Afebrile
 No pallor, icterus, clubbing, cyanosis, lymphadenopathy, pedal edema
 No hirsutism
 Thyroid- clinically normal
 Bilateral breasts- normal, no discharge
 Spine, gait- normal
Systemic Examination:
 CVS- S1 S2 heard,no murmurs
 RS- VBS heard, no added sounds
 CNS- no focal neurological deficit noted
Abdominal Examination:
Inspection:
 All quadrants move equally with respiration
 No distension
 Umblicus normal in position
 Laproscopic scar noted, healthy
 No sinuses, visible pulsations, dilated veins
 Hernial orifices free
Palpation:
 Inspection findings are
confirmed
 Soft, no tenderness, no
organomegaly, no palpable
mass
Examination of the external
genitalia:
 Normal in appearance, normal
pubic hair distribution
 Ruptured hymen
 Vulva, urethra appears normal
Speculum examination:
 Vagina- normal
 Cervix appears healthy, no
discharge
Bimanual pelvic examination:
 Uterus normal size, anteverted,
mobile, no forniceal fullness or
tenderness
Per rectal examination:
 No nodularity noted in POD
 Summary
24years, Nulliparous Mrs.S, W/O Mr.R, married and staying
together for 4years, with no marital or coital disturbances, a
known case of endometriosis, H/O endometriotic cystectomy
done a year back in 2017, H/O irregular treatment for
infertility, with normal examination findings, anxious to
conceive.

Primary infertility with endometriosis , for

further management
Thank you.