Infertility Caused by Pelvic Tuberculosis: A Forgotten and Rare Diagnosis

Active tuberculosis (TB), caused by the Mycobacterium TB bacillus, has the highest mortality rate among all infectious diseases worldwide. TB can be classified into two forms: pulmonary and extrapulmonary. The majority of patients infected with TB clear the mycobacterium after the primary infection. Genital TB is usually secondary to hematogenous spread from a primary site, typically the lungs. Fertility can be impaired by genital TB, primarily due to involvement of the fallopian tubes, which are the most commonly affected site. In addition, infection of the uterus, ovaries, and peritoneum has also been reported.

We describe two cases of pelvic TB identified during infertility workups focused on fallopian tube involvement. Both cases were managed with a combination of surgical and medical therapies.

Female genital TB typically presents with infertility, abdominal pain, or menstrual disturbances. Imaging studies often reveal nonspecific findings. Laparoscopic surgery can provide more definitive diagnostic information. A biopsy is useful for confirming the diagnosis of TB more accurately and rapidly. Treatment of genital TB requires a four-drug regimen due to the high recurrence rate and the prevalence of drug-resistant strains. In cases of large abscesses or fallopian tube obstruction, surgical intervention may be necessary.

Given the increasing trends in immigration from TB-endemic areas and the established relationship between pelvic TB and infertility, it is advisable to consider TB as a potential cause of infertility in women from these regions.