A silent cause of Infertility
Tuberculosis (TB) is a very common disease and is caused by a bacterium called Mycobacterium tuberculosis. Lungs are the most common organs involved followed by the genitourinary tract (meaning the kidneys and pelvic organs in both males and females) but TB is a systemic illness and any organ of the body can be affected. Route of entry into the body is through lungs.
Female genital organs are one of the common sites to be involved in women. It is a chronic disease and bacteria remain for long time in the body slowly destroying the organs (uterus, fallopian tubes and the ovaries in females and related organs in men).
The disease may remain totally asymptomatic or may lead to pelvic pain, fever, menstrual disturbances (heavy bleeding or no periods at all) or vaginal discharge (leucorrhoea). Sometimes fluid may accumulate in the abdomen.
Fallopian tubes which transport eggs from the ovaries to the uterus are the most common organs involved and when blocked (due to inflammation or adhesions) leads to permanent infertility.
Genital tuberculosis is diagnosed by:-
Mantoux test (minor skin test)
Endometrial biopsy/TB-PCR i.e. testing the inner lining of the uterus which is best done by a gynec practitioner. It is a very simple procedure and is done in the clinic. This test is positive in only 50-60 % of cases.
Endoscopic procedures i.e. Laparoscopy and Hysteroscopy can help in diagnosing the disease and also in treating adhesions caused due to tuberculosis.
Very effective medicines are now available, commonly called antitubercular therapy or ATT. The medicines are very effective in killing the bacteria. The treatment has to continue for a minimum of 6-9 months. Intensive therapy with 4 drugs is given for 2months followed by a 3drugs for 4 months.
However, the drugs cannot repair the damage done by TB. Fallopian tubes which are commonly damaged by the disease remain blocked and function cannot be easily restored – But with FTC (Fallopian tube catheterization) tubes can be recannulated to a large extent.
Infertility is the commonest presentation for genital tuberculosis; Other symptoms may be profuse white discharge and irregular/scanty periods. Almost 60 - 70 % cases of genital TB present with infertility. In India almost 5 % - 10 % of all infertility is caused by genital TB. Medical treatment may restore fertility in early cases.
Advanced tuberculosis in which the fallopian tubes are completely blocked or damaged patients have to resort to Laparoscopy to open blocked tubes or IVF (In vitro fertilization) and IMSI (Intracytoplasmic injection of a morphologically selected sperm)
Most patients treated at our center fall pregnant within a year of FTC with ATT