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Q. Should we get D and C as a part of treatment to get baby?

Answered by
Dr. Sonal Prasad
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 16, 2018 and last reviewed on: Oct 09, 2018

Hello doctor, We both are 30 year old couple and we have been planning for a baby for more than a year. My wife has normal period and as per the medical report my semen is fine. We have visited a doctor in our locality and he advised cleaning of the uterus (D and C - dilation and curettage). Could you please advise if our treatment is going in the right direction? Should we go for cleaning of the uterus (D and C)? My wife's current medications are JP Tone, Femitone, D3 Must, Norflox 400, Zentor 500 (Levofloxacin) and Tido (Tinidazole). Her past medication includes Ovares SR and Krimson. Please also check the medical reports and prescription attached. We have also undergone the following tests. Syphilis urine test, E.coli culture and sensitivity test, HIV transvaginal sonography, hormone tests - LH, FT4, TSH, prolactin, FSH, AMH and semen analysis. What should we do?

Dr. Sonal Prasad

Childbirth Educator Lactation Counselor Obstetrics And Gynaecology
#

Hello,

Welcome to icliniq.com.

Please send me the complete reports to get better knowledge about your problem. A few suggestions based on the other information mentioned in the description are as follows.

  • Norflox (Norfloxacin), Tinidazole and Levoflox (Levofloxacin) if being taken by your wife should be stopped as they may cause congenital malformations.
  • Your wife took Ovares SR (Combination of Dehydroepiandrosterone and Folic acid), did your wife ovulate after taking them?
  • D and C is done for infertility, but is done as a last option. Your wife needs to undergo HSG (hysterosalpingography), a test to test tubal patency before doing D and C.
  • Also, plain D and C is an old procedure. It would be better to get a hysteroscopic D and C. It is a procedure where a telescope is used to visualize the whole of the uterine cavity and D and C is not done blindly, but from the specific area where infection or abnormality is detected.
  • Both plain D and C and hysteroscopic D and C takes almost the same time (about half an hour), but hysteroscopic D and C is far more superior.
  • Please note that the D and C must be done only if both tubes are patent on HSG, otherwise it is of no use.

Investigations to be done:

HSG.

Differential diagnosis:

Primary infertility.

Regarding follow up:

Revert back with the reports to an obstetrician and gynaecologist online.---> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist


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Thank you doctor,

Do both fallopian tubes need to be open to go for hysteroscopic D and C? Is tube opening the prerequisite? What test needs to be done to check if the tube is open or not? If the tube is closed, then hysteroscopic D and C does have any use? What procedure is required to open the tube if closed? Is it necessary to go for this procedure? Can we expect some result with medicines?

Dr. Sonal Prasad

Childbirth Educator Lactation Counselor Obstetrics And Gynaecology
#

Hi,

Welcome back to icliniq.com.

I just went through the reports and prescriptions (attachment removed to protect patient identity). For pregnancy to occur the following functions should be normal in structure and function.

  • Husband' semen analysis (normal in your case).
  • Ovulation (egg production), which occurs in the ovary (discussed later in detail).
  • Tubes to be patent, sperm travels through this tube to reach the egg near ovary.
  • The lining of the uterus where the pregnancy gets implanted.

Please note that in the reports sent AMH - antimullerian hormone levels are low and USG shows lack of developing follicles. These two points towards absence of ovulation. However, FSH level (third predictor of ovulation) is within normal range. I hope it was done on day 2 of periods. To reconfirm, you need to get the AMH levels repeated and ultrasound for the follicular count on day 10 of periods. The day of cycle is very important to interpret reports correctly.

The tube patency can be tested by hysterosalpingography (HSG). It is not mandatory for D and C, but D and C test will not help you conceive, if the tubes are not patent. It is a step, which is done prior to hysteroscopic D and C. Moreover, if the tubes are not patent a hystero-laparoscopy can be planned in which, besides evaluating the lining of the uterus, attempts can be made to recanalize the tubes in the same sitting.

Patent tubes are prerequisite for pregnancy and not for D and C. D and C is a test that can be done on anyone. Please note that all these shortcomings (ovulation or non-patent tubes) can be treated, but you need to pinpoint the defect and work to eliminate them. Please review with the requested reports, so that the best approach can be decided in your case.


Investigations to be done:

AMH levels, ultrasound for antral follicle count on day 10 of cycle and hysterosalpingography (HSG on day 7 of cycle).

Differential diagnosis:

1. Premature ovarian failure.
2. Cornual spasm (the link between womb and fallopian tube get blocked mostly due to uterine contraction).
3. Fimbrial block (block in the terminal part of the fallopian tube).

Probable diagnosis:

Primary infertility.

Treatment plan:

1. Tubal recanalization if required.
2. COI with IUI (controlled ovulation induction with intrauterine insemination), if follicle count is borderline.
3. Egg donation plus IVF (in vitro fertilization), if no ovulation.

Regarding follow up:

Revert back with the reports to an obstetrician and gynaecologist online.---> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist


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