HYSTEROSCOPY FOR DIAGNOSIS OF FEMALE GENITAL TUBERCULOSIS IN INFERTILE WOMEN: AN ESSENTIAL TOOL IN MINIMALLY INVASIVE ERA.

Abstract

INTRODUCTION: Female genital tuberculosis (FGTB) is difcult to diagnose due to asymptomatic presentation and paucity of denitive investigations. Hysteroscopy can be utilized for the diagnosis of genital tuberculosis in infertile women. This study was done to study the role of hysteroscopy in the diagnosis of genital tuberculosis. METHODS: Prospective observational study was performed on 50 infertile women after basic evaluation of infertility. The women with tubal factors for infertility or unexplained infertility were selected for the study. Premenstrual endometrial biopsy (EB) was done for mycobacteria (AFB) detection. Hysteroscopy was performed in the next cycle if no AFB was detected on EB. ATT was given if genital TB was diagnosed on EB, and hysteroscopy was performed after completion of ATT. Hysteroscopic observations were compared with endometrial biopsy results. RESULTS: A total of 4 (8%) cases were diagnosed as bacteriologically positive for genital tuberculosis in endometrial samples. They were given anti-tubercular treatment. On hysteroscopy, pale endometrium (16%), Intrauterine adhesions (46%), and osteal obliteration (18%) were the common abnormal observations. 12 patients had mild adhesions, 6 had moderate and 5 patients had severe adhesions. Overall, 26 (52%) patients had features of intrauterine brosis, like intra-uterine adhesions or ostial obliteration, which could be suggestive of chronic infection like tuberculosis. Hysteroscopic adhesiolysis was performed in 46% and the cavity was restored. CONCLUSION: Endometrial Biopsy and Hysteroscopy are complementary procedures that together can help in the diagnosis of FGTB. Hysteroscopy is not only the gold standard for diagnosing uterine adhesions, distortion of the uterine cavity and tubal ostia, but it can also be a prognostic and therapeutic tool.