Tuberculosis (TB) in Infertility is surging and it is no longer a malady
of the poor ladies. Urban lifestyle is one of the reasons why the
epidemic is now spreading among affluent and young Indians women & men both
The Game changer in infertility today is TB which alters the dream of women in getting pregnant. Mind boggling figure of tuberculosis are reported by Gynaecologists andIVF experts in Delhi .TB patients from higher income families have doubled in the
last decade. Kolkata IVF experts reports a new type of IVF patients are seen who are professionals, business owners, & affluent housewives. Infertility Experts from Mumbai
speak the same about the influx of educated, TB infected infertility patients coming to IVF centres.
It is a fact that one third of world population is affected by TB. Globally, if one in 10 with Latent TB actually becomes sick due to active disease, in India this ratio is one in three due to adverse health status of Indians.
Infertility experts in India find Genital TB a silent disease. Only manifestation is infertility and relatively scanty periods in few. But patients from upper class yell at doctor's and crib that diagnosis must be wrong……Denial is routine among our patients, majority of whom are from higher socioeconomic strata. Over 50 percent are working women or professionals. Most feel disgraced by the TB stigma.
In last 6-8 years, TB number in Infertility cases has tripled in our practice. Other IVF expert's statistics stand as a grim reminder of the ever-present danger posed by genital TB. What strikes we gynaecologist about genital TB in India, is not just infertility (25-40%) and scanty periods cases (30%), we find surprisingly genital Koch’s in 20% of chronic pain in abdomen cases and women with post menopausal bleeding too.
Conventional test (Mx test, x-ray chest, raised ESR, AFB C/S) are not giving the diagnosis in 80% cases. It is very important to note that the Tubercle bacilli positivity in endometrial cultures is not as easy as in cases of chest TB with sputum cultures. TB bacilli and granulomas are frequently missed in endometrial biopsies.
Most of test used in Indian doctors are PCR or antibody-based tests on endometrial Biopsy that are not approved by WHO,. Yet Indian doctor's use them liberally to make the diagnosis, so the doctor can start the treatment.
Once diagnosed the Antitubercle therapy has a great role, in my practice I have seen nearly 50% of them have had TB treatment.
Secondly many patients (↑ 35%) are getting pregnant within first few months of starting ATT.
How & why – we have no answer. Total duration of treatment may last from 6 to 9 months.
Curing infertility depends on the extent of damage to tubes and uterus lining.
Tubal block is the most common cause of patient seeking IVF (In Vitro Fertilization) treatment. In Lifecare IVF centre 30 % of Patients undergoing IVF have tubal block. IVF is a good option,if the damage remains up to tubes but if the lady’s uterus lining also gets damaged then her chances of conceiving becomes very poor & surrogacy is only answer for her to have her own baby.
How much is the male partner is affected by tuberculosis or tuberculosis affecting male genitalia. Not much work has been done in this area. There are the patients who don’t do very well even after ICSI. We have come across many males with semen TB PCR test positive in cases of low sperm count & persistent pus cells in semen.
Good news is around. After a long wait, four new vaccines are in late-stage of trials. A dozen different anti TB drugs are in the pipeline. And a brand new molecular diagnostic, XPERT, is shaping up as the game-changer in the fight against TB by providing early diagnosis. By amplifying the DNA of the TB bacteria, it can diagnose 98 per cent of active cases in just 90 minutes. This test is now available in India & in Delhi.
Conclusion:- Latent Genital TB is Big Diagnostic Dilemma it is one of the Biggest Cause of - Infertility & Rec. Miscarriage .However it remainsgrossly under reported due to lack of good tests in virtually symptomless patients.
Ref :- slideshare.net TB in Infertility TB in Recurrent pregnancy Loss
Dr. Sharda Jain
M.D. (PGIMER), MNAMS, FiCOG FIMSA,DHM,QM & AHO
Consultant : Reproductive Medicine Programme : Director : Lifecare IVF
