Hysteroscopic aqua-dissection of fallopian tubes in long standing infertility with pelvic tuberculosis--a retrospective study

Abstract

To assess the effectiveness of hysteroscopic aqua-dissection of fallopian tubes as a fertility enhancing tool in cases of infertility of long duration with pelvic tuberculosis. A retrospective study of 100 cases of long standing infertility with pelvic tuberculosis and to evaluate the results of controlled hysteroscopic aquadissection. 100 cases of pelvic tuberculosis diagnosed on the basis of abnormal hysteroscopy findings Supported by PCR for mycobacerium / AFB culture / histopathology / quantiferon gold / high ESR / chest x-rays / previous history or family history of tuberculosis. All the cases were of 25 to 35 years of age suffering from infertility of more than 7 years duration and had undergone more than 4 cycles of ovulation induction, had at least one HSG more than a year back. All cases were subjected to controlled hysteroscopic aquadissection of fallopian tubes in two stages and were given course of anti-tubercular medication with minimal four drugs for two months and three drugs for four months and the pregnancy outcome was evaluated in relation to the hysteroscopic aqua-dissection. Out of 100 cases studied between 2007 - 2013, a total of 52 cases became pregnant after the hysteroscopic aquadissection and antitubercular medication in cases of pelvic tuberculosis diagnosed on the basis of grossly abnormal hysteroscopy findings with or without other supportive markers. 43 had term delivery, 5 cases had preterm delivery between 34-35 weeks of gestation and 2 cases had missed abortion and 2 cases had anembryonic pregnancy. Hysteroscopy is an important diagnostic and fertlity enhancing tool and controlled hysterscopic aquadissection of fallopian tube must be considered in cases who can not bear expensive IVF treatment.