Pelvic tuberculosis and Infertility

Pelvic tuberculosis is a silent disease, may be present for 10-20 years without any symptoms. 8-10% of infertility patients may have active TB .30-40% of ladies suffering from infertility may have had pelvic TB at some stage of their life.

The poor socioeconomic conditions and over crowdedness and frequent village migration of people to urbane locales is responsible for the persistant rise in Tuberculosis in larger cities of India also. So common it in persons like teachers and health care workers or persons affiliated with hospitals. So just as chest TB has never really gone away, Genital TB or TB of other body parts are on rise.

More over poor nutrition, fasting habits, anemia in females make them vulnerable.

These females are usually asymptomatic otherwise, or may have vague symptoms like fatigue , lethargy or slight evening rise of temperature which is frequently ignored., or taken lightly but the one thing they have in common is the INFERTILITY or delay in having child.

Many times general blood test for diagnosing TB are either inconclusive or not being given much importance on the theory that they are bound to be positive as we all are exposed to tuberculosis bacilli which is so prevalent in general population and test positivity of ELISA IgG & IgM or blood PCR are rendered insufficient to start therapy, But the Tubercle bacilli positivity in endometrial cultures is not as easy as in cases of chest TB with sputum cultures. TB bacilli and granulomas are frequently missed in endometrial biopsies.

Dissemination to genitalia is by blood. TB bacteria crosses barrier at lungs , enters blood stream and reaches tubes and uterus. And cause irreparable damage. Tubes are the most commonly affected organ.

Tubal blocks, fibrosis of tubes and Hydrosalpinx swollen tubes with fluid in the lumen are the common findings and with this the Important function of tube ie meeting of sperm and ova will not occur or if happens by chance then high risk of Ectopic (tubal pregnancy) is there.

Hysterosalpingogram, commonly spelled as HSG is the most common and easily available test for diagnosis which reveals not only tubal block but an important X ray findings of lead pipe appearance.

Once diagnosed the Antitubercle therapy has a great role, In my practice I have seen many patients getting pregnant within first few months of starting ATT. Total duration of treatment may last from 9 months to one year. Curing infertility depends on the extent of damage to tubes and uterus lining.

Tubal block is the most common cause of patient seeking IVF (In vitro fertilization treatment). In my IVF centre 60 % of Patients undergoing IVF has tubal block and 30-40% of them may have had TB at some span of their life span. So IVF is a good option if the damage remains up to tubes but if the lady’s uterus lining also gets damaged then her chances of conceiving becomes very poor.

How much is the male partner is affected by tuberculosis or tuberculosis affecting male genitalia not much work has been done to diagnose but we have come across males with semen TB PCR test positive in cases of low sperm count.