Pretreatment with hydrotubation in infertility management improves pregnancy rates

Abstract

Introduction: Tubal disease is the major cause of infertility. Hysterosalphingography (HSG) is a first-line diagnostic tool for assessing the status of a tube. It is a relatively easy procedure which provides a measure of tubal diameter, locates tubal occlusion and identifies pathologies such as hydrosalpings, salpingitis isthmica nodosa. We hypothesize that hydrotubation, which is a simple effective noninvasive procedure for tubal factor, increases the pregnancy rate. Methods: Two hundred fifty patients with normal and abnormal HSG findings were included in the study. The ages of the patients were 24 to 35 years and duration of infertility 5 to 9 years. All patients were routinely investigated with hormonal profile, HSG and semen analysis by known procedures. Tuberculosis was also excluded in all patients. The whole study was divided into three groups according to HSG findings. Group A consists of patients who presented with bilateral tubal blockage, namely, cornual blockage, bilateral hydrosalphinx and fimbrial blockage. Group B consists of patients presenting with unilateral tubal blockage and group C consists of patients with normal HSG findings. Hydrotubation was performed using antibiotic, hyaluronidase and steroidin. It was done in all patients in early proliferative phase for three consecutive days for three to five cycles before proceeding for further management. Result: From the whole study the patients in group A who showed tubal blockage in 27.6%, 68% patients conceived within 3 months of treatment. In group B, 36% of patients conceived within 6 months of treatment. In group C with normal HSG findings 62.5% of patients conceived after hydrotubation. The rest of the patients were subjected to laproscopy and further management. Conclusion: From the above study it was observed that hydrotubation is a simple, effective, safe, noninvasive, cost-effective out-patient department (OPD) procedure which should be routinely recommended in all patients undergoing infertility management to improve the pregnancy rate before going to intrauterine insemination (IUI) and in vitro fertilization and embryo transfer (IVFET).