Tuberculosis Following In Vitro Fertilization: A Systematic Review of Maternal and Newborn Outcomes

Area of Science:

• Reproductive Medicine
• Infectious Diseases
• Maternal-Fetal Medicine

Background:

• Tuberculosis (TB) in pregnancies conceived via in vitro fertilization (IVF) presents unique challenges, particularly in TB-endemic regions.
• Limited data exists on maternal and neonatal TB outcomes following IVF conception.

Purpose of the Study:

• To systematically review and synthesize evidence on maternal and neonatal TB outcomes in pregnancies conceived via IVF.
• To identify diagnostic and management challenges associated with TB in this specific population.

Main Methods:

• Systematic review of case reports, case series, and cohort studies adhering to PRISMA 2020 guidelines.
• Searched major databases (PubMed, Scopus, Embase, Google Scholar) for relevant literature.
• Quality assessment using Murad's framework and Newcastle-Ottawa Scale.

Main Results:

• Analyzed 73 IVF pregnancies with maternal TB; median maternal age 32 years, 63% with no prior TB history.
• Miliary TB (38.4%) and genital TB (27.4%) were most common; CNS TB in 13.7%. Microbiological confirmation in 38.4%.
• Neonatal TB included congenital TB (39.7%), miliary TB (34.2%), CNS TB (15.1%). Live birth survival rate was 50.9% (28/55), with 18 pregnancy losses.

Conclusions:

• Tuberculosis after IVF is often undiagnosed pre-conception and carries high fetal risks, with earlier onset and poorer outcomes compared to natural conception.
• Miliary and CNS TB are prevalent, highlighting the need for heightened awareness and diagnostic vigilance.
• Routine TB screening before IVF is essential in endemic areas, alongside early diagnosis and integrated maternal-neonatal management to improve outcomes.