Hysteroscopy findings and its correlation with latent endometrial tuberculosis in infertility

Abstract

In India, 5 to 18 % of females attending infertility clinics are diagnosed to be suffering from genital tuberculosis. The present study was conducted to find out the prevalence of endometrial tuberculosis in infertility and its correlation with hysteroscopic changes. Patients attending infertility clinic with history of more than 2 years of unexplained infertility, failure to conceive in spite of successful ovulation induction in anovulatory infertility, and secondary infertility with a history of unexplained abortion or ectopic pregnancy were included in the study. In all the 105 cases, hysteroscopy was done, and the endometrium was subjected to DNA-PCR (polymerase chain reaction) testing for detection of Mycobacterium tuberculosis infection. Hysteroscopy features were compared in tuberculosis positive (39 %) and negative (61 %) cases for correlation. Tuberculosis was detected in 43.75 % of ostial and periostial fibrosis, 48.48 % of intrauterine fibrosis, and 66.67 % of the irregular cavity surface. A complete 6-month course of antitubercular treatment was given to the tuberculosis positive cases among which 39 % conceived without any additional treatment. The pregnancy rate of 64.7 % in secondary infertility and 20.8 % in primary infertility was very much promising. Tuberculosis is one of the major etiological factors in female infertility in developing countries. Preliminary assessment by hysteroscopy followed by PCR testing for Mycobacterium tuberculosis will detect it early. Subsequent antitubercular treatment may reverse the reproductive capability and prevent permanent damage to the female reproductive organs.