IVF-ET Outcome in Female Genital Tuberculosis

Abstract

As there are conflicting results concerning the outcome of IVF-ET in female infertility due to tuberculosis tubal factor (TB);this study is the first one aiming to evaluate its results vs. IVF-ET results in non tuberculous tubal factor infertility (NTB). Retrospective study 15 patients with tuberculous tubal factor infertility and a normal uterine cavity underwent 24 cycles of in vitro fertilization between 1995 and 2004. 13 women have had primary infertility and 2 secondary infertility. In all 15 patients the diagnosis of tuberculosis was confirmed histologically during previous laparotomies and/or endometrial biopsy examinations. The primary location of tuberculosis was as following: pleural (1) pulmonary (1) peritoneal, endometrial and/or tubal (12) nodal tuberculosis (1). All patients were treated with antituberculous chemotherapy for 6 to 12 months. The endometrial cavity was assessed by hysterosalpingography and/or hysteroscopy to evaluate its regular shape. An endometrial biopsy was done before the IVF cycle to rule out a current endometrial tuberculosis. The control group is composed of the two cycles of NTB undergoing IVF-ET just before and following each TB IVF-ET cycle. 24 IVF-ET cycles were done in 15 couples with TB, all women had a normal uterine cavity. The control group includes 87 IVF-ET cycles (NTB) in 82 couples. The results show no differences between TB and NTB infertile women for all results except for endometrial thickness (8.7 ± 2 vs. 10.1mm ± 2.5; P=0.01). The other results are respectively for TB (N: 24) vs. NTB cycles (87) as follow: Women’s mean age: 34.1 ± 5.7 vs. 34.8y ± 3.8 (NS) mean ± SD controlled ovarian hyperstimulation (COH): Down regulation = 22 vs. 80; Flare protocol: 1 vs. 6, antagonist protocol (1 vs1); Mean No of HMG ampoules used/cycle = 44.1 ± 13.5 vs. 43.3 ± 15.3 (NS); Mean dose of reFSH used/cycle = 3100 UI ± 1182.9 vs. 2463UI ± 886.2. Mean No of MII oocytes retrieved/cycle = 9.5 ± 4.9 vs. 9 ± 6.5; Mean No of embryos obtained/cycle: 6.2 ± 4.1vs 5.5 ± 4.4 (NS) Fertilization rate = 64.9 vs. 63.1% (NS) No of fresh embryos replaced/cycle = 2.9 ± 0.8 vs. 2.8± 1.2 (NS) No of cycles with cryopreserved embryos: 07 vs. 17 with 5.1± 2.8 vs. 4.5 ± 2.6 cryopreserved embryos / cycle(NS). Pregnancy rate /cycle = 33.3% vs. 27.6% (NS) Pregnancy rate/transferred cycle = 34.8% vs. 28.2% (NS) Implantation rate = 13.4 vs. 17.5% (NS) Missed abortions = 37.5 vs. 41.7% (NS) Deliveries 05 vs. 13 vs. Live births 06 vs. 16 Multiple pregnancies: 01 vs. 03 One ovarian hyperstimulation syndrome occurred during COH and one severe tuberculous meningo-encephalitis followed a miscarriage in TB group; no complications in NTB group. The success rate of IVF-ET in tuberculous tubal factor infertility with a normal cavity is equal in terms of pregnancies to non tuberculous tubal factor infertility. Nevertheless the occurrence of tuberculous meningo-encephalitis is rare but a matter of concern as well.