Spontaneous conception following anti-tubercular treatment for sub-fertile women with multiple imaging markers suggesting genital tuberculosis

Abstract

Background: Female genital tuberculosis (FGTB) primarily an asymptomatic disease is one of the most important causes of female infertility in developing countries. Damage to the pelvic organs after genital tuberculosis (GTB) is a well recognized entity .It is thus prudent to diagnose and treat GTB as early as possible to prevent or at least to minimize the damage to the genital organs. Although diagnosis of GTB has been a challenge, its detection and treatment cannot be based on single test and multiple markers must be utilised with the clinical background and early treatment instituted. Objective: The present study was aimed to diagnose or predict GTB based primarily on imaging modalities in the form of hysterosalpingography, pelvic ultrasound and supported by the basic laboratory investigations like Mantoux test, Erythrocyte Sedimentation rate (ESR) . Once the diagnosis or prediction of GTB was made, an early institution of anti tubercular therapy was done and patients were followed up to observe the spontaneous pregnancy rate. Material And Methods: This was a prospective study wherein the patients underwent complete evaluation for infertility including a hysterosalpingograhy and pelvic ultrasonography. The patients were considered to be positive for genital tuberculosis if three or more of the following were found on evaluation: raised ESR ( ≥ 20mm/first hour), Mantoux test positive ( induration ≥ 10 mm), HSG picture or Ultrasonological picture suggestive of GTB. Observation: It was seen that out of the 400 women who were included; 265 women (Group A) were adjudged to have genital tuberculosis as per our study protocol and thus were started on ATT whereas 135 (group B) were not put on antitubercular therapy. Within this duration (during or after completion of ATT), 157(59.2%) conceived spontaneously in group A, on the other hand only 27(20%) women conceived spontaneously in group B. This difference was found to be statistically significant (P Value<0.0001). Conclusion: Although Genital tuberculosis poses a great diagnostic challenge because of its varied presentations, diverse imaging pictures, and myriads of tests with its own limitations, it is advisable not to resort to all of them. Tests which are simple, feasible, specific and sensitive, and facilitates early diagnosis should be carried out. Institution of anti-tubercular treatment should be done in early disease, thus enhancing the chance of pregnancy and preventing irreversible damage to the genital organs.