A 28 year old female came to my clinic with inability to conceive since the last 4 years. She has a 6 year old healthy child. She has also got tested for other common reasons – TORCH (Toxoplasma, Rubella, Cytomegalovirus, and Herpes) and tested negative for all. She is not a known Hypertensive, diabetic nor sickle cell disease patient and has no family history of the same. She informs that all the members of the household have not been diagnosed with any major sickness, apart from her mother-in-law who received almost a year-long treatment almost 5 years ago. She was unable to mention the nature of sickness except that mother would cough, have difficulty in breathing and eating, and evening fever. An HSG was done and the image is attached. Few questions for discussions: 1. Differential diagnosis for her secondary infertility 2. Interpret HSG 3. Which test would you do to confirm the diagnosis

5 Likes

LikeAnswersShare
Uterus appears normal size and shape . Both side tubes shows beaded appearance with bilateral fimbrial block.findings suggestive of tuberculosis. Can be confirmed by PcR endometrial biopsy for AFB diag laproscopy.
1) Cause for sec.infertility is Bilateral tubal block. 2) bilateral fimbrial tubal block 3 ) TB PCR, Whiff test clue cells for Bacterial Vaginosis , tests for Clamydia Trachomatis like cell culture PCR on first void urine ,Endocervical or Urethral smear for gram negative cells e.g. N gonococci , culture & newer tests like DNA probes and enzyme immunoassay.
sir how do we collect menstrual blood sample for TB?
1

View 2 other replies

This above HSG shows b/ l tubal block at the fimbrial end. Do enough metrial tissue for TBPCR.and HPE. Genital tuberculosis can be diagnosed by Entometrial biopsy. pID infection. Blood for TBPCR. Gene expert is easy and report is given immediately,but still it needs wide propagation. Sputum is collected. Based on which treatment started.
1.BILATERAL TUBAL BLOCK. 2.UT APPEARS ACCURATE. WORK UP FOR CAUSE USUALLY CHRONIC INFECTIONS KOCH ,STARTING FROM HAEMOGRAM TO P CR COUNTS FOR CONFIRMATION. 2.CONFIRMATION OF FUNCTIONAL BLOCK WE CAN SEE THROUGH LAPAROSCOPY. 3.IF KOCHS +VE COMPLETE TRT. 4.BUT FOR FERTILITY WORK UP BEST IVF WITH MECHANICAL OCCLUSION OF BOTH TUBES BEFORE IVF OR ET.
Do the premenstrual endometrial biopsy for AFB culture and histopathological study. If positive, give AKT and do hysterolaparoscopy after 2 months of AKT. If negative for AFB, do the hysterolaparoscopy (preferably on 10th day). Do peritoneal fluid sampling for culture and microscopy. Then do hysteroscopy and hysteroscopic tubal canulation, identify the site of tubal block by use of methylene blue dye test. She might have peritubal adhesions, release them laparoscopically. Laparoscopic fimbrioplasty gives the best results in such cases.
I have treated a very similar case this way a year back. She is 20 weeks pregnant now.
2

View 2 other replies

TB contacted from her mother in law.. Likely to have TB as etiological factor for infertility as well as HSG findings.. Investigation including TBPCR.. As Genital Koch becoming very common now a days..
Hsg shows b/l fimbrial block. You can do lap + hysteroscopy + endometrial BC for hpe, AFB, TB pcr. Also on laparoscopy, if there are any tubercles , send for hpe and ofcourse open the tubes.
Beaded appearance of bl blocked tubes always suggestive of tb Get tb gold test,1day menstruated blood fr tb culture Start antitb drugs History &pv exam ?with inguinal lymphadenopathy
Endometrial scrapping for H/P Or Gene expert test or both. Tt as per the reports. Gene expert test report prompt so prompt Tt.
Even it is proved to be TB ,no repair operations on tube will eliminate damage . only next step is IVF
2

View 1 other reply

HSG shows bilateral fimbrial block... Diagnosis of genital TB can be confirmed by TB PCR of endometrial sample...
Load more answers

Cases that would interest you