Genital Tuberculosis-A Silent Infection in Infertile Indian Population

Abstract

Background: Genital tuberculosis is reported to be a major factor causing infertility in Indian women and often exists without any apparent signs and symptoms. Aim: To study the effect of tuberculosis, a common infectious disease in the Indian subcontinent, its subsequent effect on female fertility. To assess the clinical presentation of genital tuberculosis and to study various modes of diagnosis. Method: Study was done between Jan 2005- Dec 2006 on 250 infertile women at an infertility care and assisted reproductive unit in Central India, in whom there was clinical suspicion of genital tuberculosis. All underwent diagnostic laparoscopy and biopsy for confirmation and other causes of infertility were excluded. Utility of various laboratory parameters AFB smear, AFB culture and PCR to diagnose genital tuberculosis were assessed. Laparoscopic findings were correlated with laboratory results. Result: The prevalence of genital TB was higher than one might imagine. Among the 170 infertile women affected with genital tuberculosis there were cases of primary (n = 149) and secondary (n = 21) infertility The diagnosis of endometrial tuberculosis was confirmed by AFB smear 52, AFB culture 6, PCR112. Treatment with anti-tubercular drug therapy resulted in increased conception rate. Laparoscopy examination is a valuable procedure for the etiological diagnosis of tubal infertility and correspond with positive PCR 88%, AFB smear 72% and AFB culture in 98%. Conclusion: It is essential for a gynaecologist working in developing countries to anticipate possibility of genital tuberculosis in infertile patients. This study highlights the fact that tuberculosis, a chronic infectious disease, is one of the major etiologic factors of female infertility, especially on the Indian subcontinent. Female genital tuberculosis is a symptom-less disease inadvertently uncovered during investigation for infertility. Clinicians need to be aware of the existence of this important cause of infertility in women, in view of the current upsurge in tuberculosis worldwide.