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  • Title: Laparoscopic and hysteroscopic findings in women with sub-fertility and tuberculosis: A case series.
    Author: Mondal R, Jaiswal N, Bhave P, Mandal P.
    Journal: BJOG; 2024 Jun; 131(7):929-940. PubMed ID: 37973605.
    Abstract:
    OBJECTIVE: Evaluation of hysteroscopic and laparoscopic findings in subfertile women predictive of tuberculosis. DESIGN: Retrospective case series analysis. SETTING: Tertiary hospital in India. POPULATION: A retrospective analysis of 16 784 subfertile women who had undergone diagnostic hysterolaparoscopy (DHL) was conducted between February 2014 and June 2021. METHODS: Histopathological evidence, acid-fast bacilli (AFB), culture and GeneXpert MTB/RIF assay were used to diagnose female genital tuberculosis (FGTB). Various hysteroscopic and laparoscopic findings were analysed, and a binary logistic regression assessed associations between these findings and positive diagnostic outcomes. MAIN OUTCOME MEASURES: Various hysteroscopic and laparoscopic findings correspond to tubercular manifestation. RESULTS: Of the 16,784 patients, 1083 had hysteroscopy and laparoscopy findings suggestive of tuberculosis, and 309 were diagnosed with FGTB based on diagnostic tests. Logistic regression identified variables strongly predictive of positive status outcomes; tuberculous abdomino-pelvic adhesions of various grades, isthmo-ampullary block, tubercle, tubo-ovarian mass, tuberculous hydrosalpinx, complete tubal destruction, tubal diverticula and rigid tube emerged as strong predictors. CONCLUSIONS: Logistic regression-derived predictors, alongside specific laparoscopic and hysteroscopic findings, can enhance diagnostic accuracy and clinical decision-making to start antitubercular therapy in subfertile women.
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