Epidemiology of genital tuberculosis in infertile population

To assess the frequency of genital tuberculosis in infertile women, its clinical presentation and association with socio-economic status and geographical latitude and to compare various modes of diagnosis and efficacy of therapy.

This cross-sectional study was carried out in the Gynaecology and Obstetric Department (Unit Ill), Federal Government Services Hospital, Islamabad for a period of two years, from January 1, 2001 to December 31, 2003. A protocol for fertility work-up included complete history, examination, monitoring of ovulation and assessment of male factor. During laparoscopy peritoneal fluid was obtained for cytology and Ziehl-Neelsen (ZN) staining in suspicious cases of chronic inflammation was carried out. Endometrial curettings were obtained for histopathology and culture in Lowenstein-Jensen (LJ) medium. After confirmation of diagnosis, anti-tuberculosis therapy (ATT) was started. Surgical management was done in advanced stage disease with tubo-ovarian masses.

Out of 7628 patients who attended the gynae out-patient department, 534 (7%) women were infertile, of which 2.43% had genital tuberculosis. Six patients had early stage disease (46.15%) and were completely cured, but three patients had successful pregnancy outcome (23%). Seven had advanced stage disease (53.85%) and required conservative surgery in addition to ATT. Among these patients, although tuberculosis was cured, yet fertility could not be achieved. All patients belonged to low socio-economic class, and 85% belonged to Northern areas of the country, who were poor and deprived of health facilities.

It is essential for a gynaecologist working in developing countries to anticipate possibility of genital tuberculosis in infertile patients.