A 30-year-old woman with primary infertility and irregular menses undergoes hysterosalpingography showing bilateral cornual block and an irregular 'golf-club' appearance of the fallopian tubes. Endometrial biopsy shows granulomas with Langhans' giant cells. The most appropriate management is:
- A Anti-tubercular therapy followed by reassessment of tubal patency ✓
- B Laparoscopic salpingostomy
- C Immediate IVF without anti-TB treatment
- D Hysteroscopic tubal cannulation
Correct answer: A. Anti-tubercular therapy followed by reassessment of tubal patency
Explanation
The clinical picture is diagnostic of genital tuberculosis — cornual block, pipe-stem tubes on HSG, and Langhans' giant cell granulomas on biopsy. The primary treatment is anti-tubercular therapy (standard 6-month rifampicin-isoniazid-based regimen) to eradicate active disease. Tubal patency is reassessed after completing treatment; most cases still require IVF due to irreversible tubal damage. Immediate IVF without ATT risks dissemination and is inappropriate.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.