Is Genital Tuberculosis a major factor for infertility?

In this article, Dr Prathiba Govindaiah, Senior & Chief Infertility Consultant, Laparoscopic Surgeon and Gynecologist, Motherhood Hospitals, tells you all about Genital tuberculosis and infertility.

Most people know that Tuberculosis or TB is the dreaded lung disease that affects more than 40% of the country without any symptoms. However, very few are aware that it can also affect other parts of the body like the brain, kidneys and even the genital tract and pelvic area.

This is caused by the TB bacteria moving through the blood from the lungs to other parts of the body. Genital tuberculosis occurs when the bacterium reaches the genital tract through blood or the lymph and infects the pelvic area.

Is Genital Tuberculosis a major factor for infertility?

Genital tuberculosis affects the genital tract, fallopian tubes, uterus, and ovaries. In some cases, it also affects the cervix, vagina and vulva. 

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A survey reveals that about 8.7 percent of married couples suffer from infertility

It can occur in both men and women but in women, it is the major cause of infertility. Nearly 25-30 percent of women are infertile due to tuberculosis in India. It can occur in any age group, but women in the reproductive age group of 15 – 45 years are the most affected.

In these cases, the fallopian tubes are the first and most commonly affected genital organs, in almost 90-100 % cases followed by the endometrium and the ovary in about 20-30 % cases.

A study among women with infertility registered for IVF in north India reported the prevalence of genital TB in patients with tubal factor infertility as 48.5 %.

However, it is a near silent disease with few apparent symptoms and the bacteria can be latent in the body for over twenty years.

Symptoms of Genital Tuberculosis

Some of the symptoms that can appear are pelvic pain, irregular menstrual cycle, amenorrhea (no periods), scanty periods, chronic back pain, abdominal pain and vaginal discharge which is stained with blood and infertility.

Tuberculosis can damage the fallopian tubes if not treated at the initial stage, however in most cases; the disease comes to light only when the woman finds it difficult to conceive.

Diagnosis is rather difficult and there is a combination of tests available to detect this. Being a paucibacillary (few bacteria) disease, demonstration of Mycobacterium tuberculosis is not possible in all the cases. A high index of suspicion is required.

The diagnostic dilemma arises due to a varied clinical presentation, diverse results on imaging and endoscopy and availability of battery of bacteriological, serological and histopathological tests which are often required to get a collective evidence of the diagnosis of genital TB.

Endometrial biopsy, ultra-sonography and laparoscopy can also be used to check whether the fallopian tube is affected or not. Culture and microscopy still remain the best form of diagnosis. There is also a possibility of misdiagnosis and therefore it is always better to take a second opinion from a TB specialist.

Treatment for genital tuberculosis

Treatment for genital TB is the same as for any other form of TB. Antibiotics are given for a period of six months. Most patients tend to discontinue the drugs as the symptoms disappear in a month or two and they feel they can stop the medicine. But chances of drug resistance, recurring TB and treatment failure are a possibility if the full course of medicine is not taken.

Doctors also recommend the snipping of fallopian tubes as a way of dealing with infertility if the tubes are swollen, diseased or damaged.

In vitro fertilization (IVF) is one of the best options for women suffering from infertility due to pelvic tuberculosis provided that the uterine lining remains undamaged. If the uterus and ovary are affected, then, unfortunately, the woman may not be able to conceive despite being treated successfully and cured of the disease.

Prevention in a country like India is unfortunately difficult as the exposure to TB is very high. Hence it makes it critical to create awareness and educate those with the disease, especially the lung form of TB to follow good hygiene in order to prevent its spread.

Read: The grace of waiting: Pregnant after 10 years of waiting

Article authored by Dr. Prathiba Govindaiah, Senior & Chief Infertility Consultant, Laparoscopic Surgeon and Gynecologist, Motherhood Hospitals