AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2693-4779/082
Department of Obstetrics and Gynecology, Lord Buddha Koshi Medical College and Hospital, Bihar, India.
*Corresponding Author: Kalyani singh, Department of Obstetrics and Gynecology, Lord Buddha Koshi Medical College and Hospital, Bihar, India.
Citation: Kalyani singh. (2022) Pregnancy Following D & C and Hydrotubation after Failed IUI - A Rare Case Report. Clinical Research and Clinical Trials. 5(3); DOI:10.31579/2693-4779/082
Copyright: © 2022 Kalyani singh. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 17 January 2022 | Accepted: 19 February 2022 | Published: 25 February 2022
Keywords: hydrotubation; pregnancy; hysterosalpingography
Infertility is a defined as failure to achieve a pregnancy after 12 months or more of regular, unprotected sex. It affects millions of people of reproductive age worldwide and has an impact on their families and communities. Having babies gives an unparalleled satisfaction to parents and lack of baby may make one’s life miserable at times.
Here we are presenting a case where a lady who got pregnant and gave birth to a child just following Dilatation & Curettage and Hydrotuabtion (tubal flushing) when other measures like diagnostic laparoscopy and IUI failed. Dilatation and curettage and tubal patency test/ hydrotubation (D & C & TPT} was an old diagnostic procedure before the advent of ultrasonography and laparoscopic technique. It is an easy, minor operative procedure to evaluate the condition of uterus and tubes. Examination under anesthesia gives information regarding parametrium also to a considerable extent.
Infertility is defined as failure to conceive after 12 months or more of regular, unprotected sex [1]. Almost 10- 12% of couples seek treatment for infertility. According to WHO, about 48 million couples and 186 million individuals live with infertility globally [2].
Infertility could be primary with no history of pregnancy or secondary with a history of prior conceivement. In about 30% of cases, female reproductive system is at fault, in about 30
A lady, 34 years old, reported in the Gynecology Department at urban unit of Lord Budha Koshi Medical College, on 7th Dec 2019 with 10 years of infertility. She had consulted at Mehrauli, New Delhi, then was referred to AIIMS, New Delhi for tubal blockage. Her FSH, LH was within range. Husband’s semen count was 28 million with 10% motility. Diagnostic laparoscopy and hysteroscopy was done on 9th oct2018. Both tubes and ovaries were found healthy with bilateral spillage. Tissues were sent for HPE. After one year, on 17th Oct 2019, IUI was done on AIIMS,
Delhi. No Pregnancy resulted.
She finally came to have a trial of D& C + Hydrotubation here. Her LMP was 28th Nov2019. HSF was 56 million per ml and other blood reports were within range. Although I was initially apprehensive to perform D&C but finally on their utmost request, D & C and tubal patency test (Hydrotubation) was done under IV Ketamine anesthesia the next day on 8th Dec 2019. Cervix was dilated with difficulty with Hegar’s dilator no. 6. A sterilized rubber catheter no. 8 was passed through cervix and 20ml of fluid was pushed through it slowly. Fluid contained normal saline, hydrocortisone and an antibiotic. Fluid passed under pressure. Then curettage was done. Endometrial cavity was smooth but curettings were thin. Recovery was good and lady was discharged same day with an advice of letrozole, HMG and dydrogesterone for subsequent cycle.
She went back to Delhi.
On 17th Feb, 2020, the lady reported at AIIMS OPD with 5 weeks of amenorrhoea. Her LMP was 12th Jan, 2020. Her pregnancy test was positive. She again consulted on 2nd March with 7 weeks of pregnancy. Folic acid and Eltroxin 75 µgm were prescribed and she was advised for NT scan and dual marker test at 11-13 weeks of pregnancy.
On 8th June 2020, the lady reported back here with 5 months of pregnancy. Ultrasound level II scan confirmed 21 weeks of pregnancy. She had regular visits thereafter and delivered a healthy male boy by C-Section on 20th October 2020.
She gave birth to her second male baby on Dec 2021 by LSCS again. Bilateral tubal sterilization was done on request.
Infertility is defined as the inability to conceive after one year of unprotected sex. It’s a tragedy for many couple, bringing a sense of loss, failure and exclusion. Relationship between couples can be very strained when children are not forthcoming. One partner may seek the other as being defective or unwilling [4]. The desire for children is quite primitive as people search their own reflection in their babies so not having a baby could be source of personal misery.
In general, according to Sharlip et al 50% of infertility cases are due to female factor, pure male factor accounts for 20-30 of the problem and remaining 20-30% is due to both male factor and unknown causes comprising to unexplained infertility [5].
If HSF is within range then a brief marital history may exclude the husband.
In women, tubal factors may account upto 35
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
