Genital tuberculosis in infertile women: Assessment of endometrial TB PCR results with laparoscopic and hysteroscopic features

Abstract

Mycobacterial infections of the genital tract have been implicated in the etiology of female infertility. The correlation of endometrial TB PCR with laparoscopic and hysteroscopic features in patients with infertility was evaluated. Women suffering from infertility and undergoing diagnostic laparoscopic and hysteroscopic examination were included. Endometrial specimens were assayed by Nested PCR for mycobacterium complex and the results were then retrospectively correlated with laparoscopic and hysteroscopic features. Positive TB PCR was observed in 32.18% (n=56) women. Out of these 56 patients, 48 had endoscopic abnormalities suggestive of tuberculosis (TB) and rest 8did not reveal any endoscopic abnormalities. However, of 174 patients 139 had endoscopic abnormalities with positive TB PCR in only 48. Sensitivity and specificity of endoscopic evaluation was 85.71 and 22.8%, respectively. The presence of periovarian adhesions, cornual block, tubal beading, tubercles, intrauterine adhesions, and ostial fibrosis had very strong association with positive TB PCR. Total predictive value of endoscopic evaluation in diagnosis of genital TB was 42.52%. This study highlights that endoscopic evaluation is an important diagnostic tool, but can neither confirm nor exclude genital TB. Endometrial TB PCR may have to be routinely resorted to make a definite diagnosis of mycobacterial infection in endemic areas.