A 34-year old patient, G0P0, with primary infertility. The VHSG shows the presence of a subserous myoma on the left lateral and anterior wall of 5 × 5.5 × 8 cm that deforms the uterine silhouette, and a uterine cavity of normal morphology and regular outlines (Fig. 10.1). Its surgical removal is decided prior the start of the infertility treatment. The control VHSG carried out 2 months after the surgery shows a uterus of conservative size and normal morphology (Fig. 10.2).

A 29-year old patient, G1P1, with secondary infertility of 18 months. The VHSG exam shows a deformity in the uterine cavity at the level of the fundus, on the right horn, secondary to the presence of a posterior submucosal myoma of medium size (Fig. 10.3). Given these characteristics, and its potential influence in the success of the conception, it is proceeded with its removal via hysteroscopy (Fig. 10.4). The control VHSG after 3 months shows a uterine cavity of normal morphology with regular outlines, with no evidence of postsurgical sequels (Fig. 10.5).

A 36-year old patient, G0P0, with primary infertility and multiple symptomatic uterine myomatosis of 7 years of evolution. The presence of an intramural myoma on the right lateral uterine wall of 44 × 42 × 41 mm stands out, with an approximate volume of 39 cm³ (Fig. 10.6). The patient carried out medical treatment with agonists of the GnRh for 6 months, previous to the uterine embolization treatment, taking part of an immediate post-procedure without complications. A year later she returns for a reevaluation for her primary infertility. A control transvaginal ecography is done, identifying iso-hipoecogenic areas on the right myometrial wall in the location of the treated myoma, with thickening and endometrial liquid. Upon the 10th day, a conventional X-ray hysterosalpingography is done that shows passage of the instilled contrast through the external cervical os towards a pseudocavity located on the right uterine wall (Fig. 10.7). The exam is completed with the realization of a VHSG to value with higher precision the state of the endometrial cavity and plan the next procedure of assisted fertilization. The study shows the presence of fistula between the endometrial cavity and the residual post-embolization cavity, allowing the clear visualization of the diameter and length of the fistula trajectory, the parietal thickness of the residual pseudocavity and the absence of perforation towards the peritoneal cavity (Fig. 10.8).

A 24-year old patient, G3P0A3, with a history of spontaneous abortions during the first trimester. A diagnosis of a partial septated uterus is done (Fig. 10.9). As a therapeutic strategy, the removal via hysteroscopy of the uterine septum is decided. The VHSG study post-treatment shows a more ample uterine cavity, with a small indentation at the level of the fundus corresponding to the normal postsurgical remnant (Fig. 10.10).

A 25-year old patient, G2P0A2, with diagnosis of bicornuate uterus (Fig. 10.11). The patient is subject to a Strassman surgery as the reparation technique. In the post-treatment VHSG study carried out on the third month, a larger endometrial cavity could be appreciated, with a slight deformity at the level of the fundus, of regular margins and with no filling defects (Fig. 10.12).

A 29-year old patient, G2P0A2, with secondary infertility of 3 years of evolution, and a history of abortions with uterine curettage. As part of the diagnostic algorithm, the patient carries out a VHSG that demonstrates the presence of an irregular endometrial cavity, with lineal, irregular and thick filling defects that correspond to synechiae. The presence of a subserous myoma is also appreciated (Fig. 10.13). Treatment consists in the hysteroscopic removal of the synechiae and the laparoscopic resection of the myoma. The VHSG control carried out after 3 months shows the incomplete removal of the adherences, with a residual synechia around the right uterine horn. The subserosal myoma cannot be appreciated (Fig. 10.14).