TB (Tuberculosis) is endemic in India.It has been estimated that almost 30 % – 40 % of the population is affected by TB.TB is an infectious disease caused by the tubercle bacillus. Many of those infected with tuberculosis are not even aware of it as mostly the infection does not show any symptoms.
How TB causes infertility:
While TB is generally thought to be a respiratory disease, it can effect any part of the body including reproductive system. TB can infect and damage the fallopian tubes and the lining of the uterus resulting in infertility. This results in blockade of fallopian tubes. It may sometimes cause permanent damage to the endometrium or lining of the uterus thereby causing infertility. It even affects the quality of eggs. It is known that fallopian tubes are affected in almost all the cases of genital TB followed by endometrium (uterine lining) in 50%, ovaries in 20%, cervix in 5% and less than 1% in vagina and vulva.
In men too, the bacteria may reach the testicular area and cause of epididymo-orchitis. If this is left untreated, it may decrease or stop the production of sperms or may cause obstruction of male reproductive tract, thereby causing infertility.
Symptoms and signs of Genital TB
Although in most of the cases the infection is silent, and may not cause any symptoms at all but some of the following symptoms may be found:
Systemic
- Weight loss
- Fatigue
- Low-grade fever
- Loss of appetite
- Signs of pulmonary TB
Specific to genital TB
- Menorrhagia (abnormally heavy bleeding) occours initially followed by hypomenorrhea ( scanty menstrual periods) or amenorrhea (no menstrual bleeding)
- infertility
- Difficult or painful sexual intercourse
- Vaginal discharge
- Pain in lower abdomen
Symptoms in males
- Swelling, irritation and pain in the testicles
- infertility
Diagnosis of Genital TB
Genital TB is mostly incidentally diagnosed,
because it is a silent invader of the genital tract. The suspicion for TB
arises when an infertile woman gives a family or personal history of TB along
with one or more symptoms. Following tests can be performed to diagnose genital
TB:
Investigations for
genital tuberculosis
- Complete blood count
- Chest radiographs
- Tuberculin test (obsolete)
- Menstrual blood for TB culture
- Endometrial curettage for biopsy
- Histologic examination
- Culture for Mycobacterium tuberculosis
- Ultrasonography
- Laparoscopy
- Hysteroscopy
- Other serologic tests
Recommended tests for diagnosis of TB infertility: Most of the above named tests are no longer recommended for the diagnosis of tuberculosis. Guidelines only support one or more of the following tests.
- Gene Xpert
- Polymerase chain reaction (PCR)
- TB culture
- CB-NAAT
Serological or blood tests are of no value in diagnosis. Empirical treatment only on the basis of suspicion is not advisable. It may lead to widespread resistance of TB bacteria to medicines and side effects of the therapy.
Treatment of genital TB
After a confirmed diagnosis, prompt treatment is required to prevent further damage and spread of infections through the tubes. Unfortunately, the chances of spontaneous pregnancy in women suffering from genital tuberculosis are very poor even after completing the full anti tubercular treatment. For such patients, Assisted Reproductive Techniques (ART), specifically In Vitro Fertilisation (IVF) has been very effective in tackling infertility.
Best approach to infertility because of TB:
- Confirm that there is no active tuberculosis
- Use of correct investigations for diagnosis.
- Empirical TB treatment to be discouraged.
- Once started, adhere to the full course of TB treatment.
- Early use of IVF or test-tube baby treatment.
- Consult your infertility specialist at the earliest.
We, at Vasundhara Hospital and Fertility Research Centre, Jaipur have helped numerous couples suffering from genital TB to complete their families with the use of advanced ART techniques and our individualised IVF programs. You can also realise your dream of parenthood by embracing technology and leaving behind the pain of being infertile at the Best IVF Hospital in Jaipur.
