Extragenital tuberculosis and female infertility - Is there a correlation? A retrospective observational study

Abstract

Context: It is well-known that genital tuberculosis in women has a definite correlation with infertility but if any such correlation exists between extragenital tuberculosis and female infertility, is not well-known. Aim: This study was performed to find out the impact of extragenital tuberculosis on female genital tract and fertility. Settings and Design: A retrospective observational study was carried out at a tertiary hospital in India in infertility clinic over a period of 1 year. Among 290 patients enrolled, six patients had been diagnosed and treated for genital tuberculosis in the past and were excluded from analysis. Forty-three women (14.82%) with positive history of extragenital tuberculosis served as the study group, and consecutive 43 infertile women without any prior history of exposure to tuberculosis at any site served as the control group. Subjects and Methods: Records of all the women included in the study were evaluated as regards the history, examination findings, and results of various investigations and compared. Results: In women included in the study group, 20.93% (9/43) of women reported new onset menstrual problems after exposure to tuberculosis with higher incidence of hypomenorrhea and dysmenorrhea as compared to control group ( P - 0.080 for each). Histopathological examination of endometrial biopsy showed the presence of granuloma in one patient (2.32%) in study group compared to none in control group. Hysterosalpingography demonstrated intravasation in 4.65% (2/43) patients in study group compared to none in control group. Laparoscopic findings were suggestive of chronic infection in 35.29% (12/34) versus 14.28% (4/28) women ( P - 0.060) while positive hysteroscopic findings were found in 11.76% (4/34) versus 3.57% (1/28) women ( P - 0.238) in study and control groups, respectively. Incidence of genital tuberculosis in women with prior history of extragenital tuberculosis in this study was 13.95% higher than that in overall infertile women population. Conclusion: High index of suspicion aided with highly sensitive tests is required to diagnose genital involvement in women with extragenital tuberculosis as there is an association between extragenital tuberculosis and infertility which is invariably irreversible.