An algorithmic approach to female genital tuberculosis causing infertility

Area of Science:

• Reproductive Medicine
• Infectious Diseases
• Gynecologic Oncology

Background:

• Female genital tuberculosis (GTB) is a significant cause of infertility, particularly in endemic regions.
• Diagnosis can be challenging due to the paucibacillary nature of the disease and non-specific symptoms.
• Effective management strategies are crucial for improving reproductive outcomes.

Purpose of the Study:

• To determine the prevalence and clinical presentation of female genital tuberculosis in infertile women.
• To evaluate the effectiveness of a simplified tuberculosis (TB) diagnostic algorithm.
• To assess the management strategies and outcomes, including pregnancy rates, in women with GTB.

Main Methods:

• A retrospective analysis of 150 infertile women (Group I) and 47 women with general gynecological issues (Group II) was conducted.
• Diagnosis of GTB was aided by a simplified TB algorithm, incorporating clinical suspicion, morphological, and laboratory criteria.
• Treatment involved anti-tuberculosis therapy, with outcomes assessed for symptom resolution and pregnancy.

Main Results:

• Genital tuberculosis was diagnosed in 7.2% of infertile women and 2.8% of the control group.
• Anti-tuberculosis treatment led to symptom resolution (excluding infertility) in over 90% of cases.
• Out of 20 total pregnancies, 10 were achieved through in vitro fertilisation (IVF) in 32 treated patients.

Conclusions:

• A definitive bacteriological diagnosis of GTB is often difficult prior to treatment.
• A high index of suspicion combined with a step-wise diagnostic algorithm is essential for managing GTB.
• The study suggests that this approach can aid in the effective management of infertility due to genital tuberculosis.