A 32-year-old woman with primary infertility for 3 years is found on saline infusion sonography to have a 2.5 cm FIGO Type 0 submucosal fibroid. The myometrium is otherwise normal. She has regular cycles and normal hormonal profile. Her husband's semen analysis is normal. Which mechanism BEST explains how this fibroid impairs fertility?
- A Mechanical obstruction of the tubal ostia
- B Chronic anovulation due to endometrial inflammation
- C Distortion of the endometrial cavity interfering with embryo implantation ✓
- D Impaired sperm transport through the cervical canal
Correct answer: C. Distortion of the endometrial cavity interfering with embryo implantation
Explanation
FIGO Type 0 submucosal fibroids are entirely within the endometrial cavity. They impair fertility primarily by mechanically distorting the endometrial cavity and disrupting the implantation window, reducing endometrial receptivity markers such as HOXA10 and integrins. Tubal obstruction is seen with cornual intramural fibroids, not submucosal ones. Cervical impedance is not relevant for intracavitary fibroids. Ovulation is typically unaffected.
Reference: Te Linde's Operative Gynecology, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.