Abstract
Method: 110 infertile women, after exclusion of male factor infertility, were evaluated for clinical and laboratory evidence of tuberculosis. Premenstrual endometrial biopsies from these women were subjected to examination of smears for presence of acid fast bacilli (AFB) and to culture for mycobacterium tuberculosis. Polymerase chain reaction and histopathology of endometrium was done in all cases. Women with tubercular endometritis were given anti-tubercular treatment. AFB staining, culture and histopathology was repeated on endometrial samples following completion of treatment. Laparoscopy was performed if spontaneous conception did not occur. Results: 40 women had raised IgG against 38 kDa M. tuberculosis antigen on ELISA. One endometrial sample was positive for AFB, four samples showed tubercular granulomas on histopathology. The PCR assay was positive for mycobacteria in 13 (10.18%) cases. Repeat endometrial samples in 9 PCR positive cases with all other tests negative for endometrial tuberculosis were again negative for tuberculosis on smear examination, culture and histopathology. Since PCR positivity may denote dead bacilli, only 4 women with tubercular endometritis on histopathology were given anti-tubercular treatment. Repeat endometrial biopsy after completion of treatment in these 4 cases showed no evidence of tuberculosis. One woman conceived but had ectopic pregnancy. Three women did not conceive during a further six month follow up period and had adhesions and blocked tubes on laparoscopy. Conclusion: Genital tuberculosis is common in infertile women in India. Investigations to exclude tuberculosis must be included in the workup of infertility. Anti-tubercular treatment is effective but fertility prognosis remains poor because of early tubal damage.
Published Version
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