Spontaneous Fertility Following Conservative Surgical Management of Persistent Müllerian Duct Syndrome: A Case Report.

Persistent Müllerian duct syndrome (PMDS) is a rare 46,XY disorder characterized by the presence of Müllerian structures in phenotypically normal males and is commonly associated with infertility. We report the case of a 28-year-old man with a seven-year history of primary infertility who underwent inguinal hernia repair. Intraoperatively, a uterus-like structure was identified, consistent with PMDS. A fertility-preserving approach was adopted, avoiding extensive dissection to prevent vas deferens injury. Bilateral orchiopexy and testicular biopsy were performed. Histopathology demonstrated active spermatogenesis without malignancy. At the seven-month follow-up, spontaneous conception was achieved without assisted reproductive techniques. This case highlights the importance of intraoperative diagnosis and individualized surgical management in optimizing fertility outcomes.