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Reproductive Physiology, Endocrinology, and Infertility

Question
38 out of 56
 

Women with infertility with B/L cornual block on HSG, next investigation for management is (AIIMS Nov. 2011)



A Tuboplasty

B ivf
C hydrotubation

D Chromotubation plus laparoscopy

Ans. D

Chromotubation plus laparoscopy

1. The first thing to do is to confirm the Block…general practice being the diagnostic laparoscopy and chromotubation which generally will clear almost 50-60% of such blocks on HSG.

2. The HSG may provide erroneous results.

3. The cornu of the uterus may go into spasm, as a result of which the dye may not enter the tubes at all. This may be interpreted as a tubal block, when the tubes are actually open.

4. If a hydrosalpinx is very thin and if the dye is injected under pressure, the dye may appear to spill into the abdomen through a tear in the wall of the hydrosalpinx - suggesting tubal patency when really the tubes are closed.

5. It provides little information on structures outside the tube which could nevertheless impair tubal function - such as peritubal adhesions.

6. An HSG can be painful - and when the dye is injected into the uterine cavity, most women will experience a considerable amount of pain.

7. An HSG can be technically difficult for some women (especially if the cervix is too small or too tight

8. If the HSG shows that the tubes are closed, then it may be advisable to repeat the HSG; and also to do a laparoscopy to confirm this diagnosis.

9. Laparoscopy. This has already been described, and is the gold standard for making a diagnosis of tubal disease.

Reproductive Physiology, Endocrinology, and Infertility Flashcard List

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