A study on prevalence of endometrial tuberculosis in unexplained infertility using cartridge-based nucleic acid amplification test

Ekta Basera; Radha Rastogi; Lalita Solanki

doi:10.18203/2320-1770.ijrcog20260016

Authors

Ekta Basera Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
Radha Rastogi Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
Lalita Solanki Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260016

Keywords:

Unexplained infertility, CBNAAT

Abstract

Background: Infertility is clinically defined as the inability to achieve pregnancy following one year of regular, unprotected intercourse. Its prevalence exhibits considerable variation across different regions, ranging between 5% and 20%. Extensive research has identified multiple etiological factors contributing to female infertility, including ovulatory dysfunction, infections of the genital tract, tubal obstruction, uterine abnormalities, endometriosis, endocrine disorders, and pelvic inflammatory diseases.

Methods: The study was conducted in the Department of Obstetrics and Gynaecology at RNT Medical College and Allied Hospitals, Udaipur from January 2024 to December 2024, in collaboration with the Department of Microbiology.

Result: Study finding shows that cartridge-based nucleic acid amplification test (CBNAAT) performed on endometrial samples. CBNAAT positivity was observed in 2 out of 70 women (2.86%), while 97.14% tested negative. The detected prevalence aligns closely with global estimates of genital tuberculosis in infertility, reinforcing the value of CBNAAT as a sensitive diagnostic tool in detecting paucibacillary forms of endometrial tuberculosis that might otherwise go undiagnosed through conventional methods.

Conclusion: Study concludes a low prevalence, underscoring that genital tuberculosis may not be a frequent cause in cases labelled as unexplained infertility. While CBNAAT demonstrated high specificity (approaching 100%), its sensitivity remains low (around 22–25%), indicating that although a positive result strongly confirms disease, a negative result does not reliably exclude it.

Metrics

Metrics Loading ...

References

Makar RS, Toth TL. The evaluation of infertility. Am J Clin Pathol. 2002;117:S95-103. DOI: https://doi.org/10.1309/W8LJ-K377-DHRA-CP0B

Esmaeilzadeh S, Delavar MA, Zeinalzadeh M, Mir MR. Epidemiology of infertility: a population-based study in Babol, Iran. Women Health. 2012;52(8):744-54. DOI: https://doi.org/10.1080/03630242.2012.728191

Templeton A. Infertility and the establishment of pregnancy overview. Br Med Bull. 2000;56(3):577-87. DOI: https://doi.org/10.1258/0007142001903283

Belaisch-Allart J. Treatment options for age-related infertility. Rev Prat. 2010;60(7):819-23.

Ali AA, Abdallah TM. Clinical presentation and epidemiology of female genital tuberculosis in eastern Sudan. Int J Gynaecol Obstet. 2012;118(3):236-8. DOI: https://doi.org/10.1016/j.ijgo.2012.04.005

Singh N, Sumana G, Mittal S. Genital tuberculosis: a leading cause for infertility in women seeking assisted conception in North India. Arch Gynecol Obstet. 2008;278(4):325-7. DOI: https://doi.org/10.1007/s00404-008-0590-y

Tripathy SN, Tripathy SN. Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynaecol Obstet. 2002;76(2):159-63. DOI: https://doi.org/10.1016/S0020-7292(01)00525-2

Marzieh N. Epidemiology of infertility in the west of Tehran in 2000. J Am Med Womens Assoc. 2002;57(4):219.

Baum SE, Dooley DP, Wright J, Kost ER, Storey DF. Diagnosis of culture-negative female genital tract tuberculosis with peritoneal involvement by polymerase chain reaction. J Reprod Med. 2001;46(9):929-32.

Sharma JB. Current diagnosis and management of female genital tuberculosis. J Obstet Gynaecol India. 2015;65(6):362-71. DOI: https://doi.org/10.1007/s13224-015-0780-z

Bhanothu V, Lakshmi V, Theophilus JP, Rozati R, Badhini P, Vijayalaxmi B. Investigation of toll-like receptor-2 (2258G/A) and interferon gamma (+874T/A) gene polymorphisms among infertile women with female genital tuberculosis. PLoS One. 2015;10(6):e0125298. DOI: https://doi.org/10.1371/journal.pone.0130273

Grace GA, Devaleenal DB, Natrajan M. Genital tuberculosis in females. Indian J Med Res. 2017;145(4):425-36. DOI: https://doi.org/10.4103/ijmr.IJMR_1550_15

Purohit M, Mustafa T. Laboratory diagnosis of extra-pulmonary tuberculosis (EPTB) in resource-constrained setting: state of the art, challenges and the need. J Clin Diagn Res. 2015;9(4):EE01-6. DOI: https://doi.org/10.7860/JCDR/2015/12422.5792

Noussair L, Bert F, Leflon-Guibout V, Gayet N, Nicolas-Chanoine MH. Early diagnosis of extrapulmonary tuberculosis by a new procedure combining broth culture and PCR. J Clin Microbiol. 2009;47(5):1452-7. DOI: https://doi.org/10.1128/JCM.00066-09

Espy MJ, Uhl JR, Sloan LM. Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev. 2006;19(3):595-601. DOI: https://doi.org/10.1128/CMR.00022-06

Thangappah RB, Paramasivan CN, Narayanan S. Evaluating PCR, culture and histopathology in the diagnosis of female genital tuberculosis. Indian J Med Res. 2011;134(1):40-6.

Urdea M, Penny LA, Olmsted SS, Giovanni MY, Kaspar P, Shepherd A, et al. Requirements for high impact diagnostics in the developing world. Nature. 2006;444:73-9. DOI: https://doi.org/10.1038/nature05448

Sri S, Khannum N, Padmaja P, Taraporewalla FN. Prevalence of endometrial tuberculosis in infertility cases. Int J Sci Res. 2015;4(6):278-9.

Tiwari P, Wadhwani R, Singh P, Kausar Z. Role of CBNAAT (cartridge-based nucleic acid amplification test) in detection of genital tuberculosis in endometrial tissue among women with infertility. Int J Pharm Clin Res. 2022;14(7):818-25.

Sharma D, Depan A, Yadav K, Narayan S, Sharma A. Prevalence of female genital tract tuberculosis in suspected cases attending gynecology OPD at tertiary centre by various diagnostic methods and comparative analysis. Int J Reprod Contracept Obstet Gynecol. 2019;8(6):2286-92. DOI: https://doi.org/10.18203/2320-1770.ijrcog20192419

Yadav S, Kumar N. A prospective study of outcome in infertility patients diagnosed with genital tuberculosis. Int J Reprod Contracept Obstet Gynecol. 2020;9(2):545. DOI: https://doi.org/10.18203/2320-1770.ijrcog20200333

Eftekhar M, Pourmasumi S, Sabeti P, Aflatoonian A, Sheikhha MH. Mycobacterium tuberculosis infection in women with unexplained infertility. Int J Reprod Biomed. 2015;13(12):749-54. DOI: https://doi.org/10.29252/ijrm.13.12.749

Kanti V, Seth S, Gupta S, Verma V, Singh A, Maurya G, et al. Comparison of the efficacy of the cartridge-based nucleic amplification (CBNAAT)/Xpert test and histology of genital tissues in diagnosing female genital tuberculosis. Cureus. 2021;13(5):e15000. DOI: https://doi.org/10.7759/cureus.15000

Naaz A, Sarbhai V, Sarbhai V. Role of GeneXpert in endometrial biopsy for diagnosis of genital tuberculosis in women presenting with infertility. Contracept Obstet Gynecol. 2021;10(5):1832-6. DOI: https://doi.org/10.18203/2320-1770.ijrcog20211496

Chaudhary D, Tyagi M, Gupta S, Yadav L, Pandey A. Study of the frequency of female genital tract infection using cartridge-based nucleic acid amplification test. Int J Reprod Contracept Obstet Gynecol. 2022;11(2):357-61. DOI: https://doi.org/10.18203/2320-1770.ijrcog20220063