Hydrotubation in the female infertility management– An important tool in low resource settings

Abstract

Background: Infertility remains a major reason for gynaecological consultation in developing countries. HSG is the first line diagnostic tool for assessing the status of tubes. It was hypothesised that hydrotubation which is a simple, effective and non invasive for tubal factor increase the pregnancy rate. Aim: To determine the outcome of therapeutic hydrotubation (tubal flushing) in patients with tubal infertility and unexplained infertility. Material and Methods: This prospective study was carried out in MRA medical college, Ambedkar Nagar district of Uttar Pradesh, India among Infertile women with tubal and unexplained infertility. The study period was of 4 years from august 2014 to July 2018. During this period 178 hydrotubation were performed, but 150 cases that were followed up for at least 6 months post procedure were analysed in this study. All patients were routinely investigated with hormonal profile, HSG and semen analysis by known procedure. Tuberculosis was also excluded in all patients. For hormonal upset, proper interventions were done. SPSS software version 22.0 was used for data analysis. Results: One hundred and fifty patients that had therapeutic hydrotubation over 4 years were analysed. The age range was 23-38 years with mean of 34 years. Secondary infertility was found in 30 (20%) patients and primary infertility in 120 (80%) patients. Indication for hydrotubation were bilateral cornual blockage (8.66%), bilateral fimbrial blockage (20%), bilateral hydrosalpinges (24.66%), unilateral blockage (33.33%) and unexplained infertility(13.33%). Eighty three conceptions were recorded in this study and the overall conception rate was 55.3% and post-hydrotubation patency rate was 70.8%. Pregnancy outcome of 83 conceptions were 84.4%, preterm pregnancy 9.2%, miscarriage 4.2% and ectopic pregnancy 2.2%. Recorded complications were pelvic pain in 105(70%) patients and vaginal bleeding in 36(24%) patients. Conclusion: Therapeutic hydrotubation may be beneficial in low resource settings, especially in incomplete tubal blockage.