A prospective study of outcome in infertility patients diagnosed with genital tuberculosis
Keywords:Anti tubercular treatment, Cartridge based nucleic acid amplification test, Conception rate, Female genital tuberculosis, Infertility, Live birth rate
Background: Tuberculosis is an increasing health problem worldwide with around 9.6 billion new cases reported every year. Female genital tuberculosis (FGTB) has a varying incidence ranging from a very low of 0.69% in developed nations to as high as 19% in developing nations like India. The average incidence of infertility due to tuberculosis is 5-10% worldwide.
Methods: The study was a hospital based prospective clinical study, from September 2014-2017 with sample size of 355 infertility cases. Endometrial sampling and diagnostic hystero-laparoscopy were used for diagnosis. Endometrial sample subjected for both the test CBNAAT and HPR was used for confirmation of positive patients. Inclusion criteria were, infertile patients diagnosed with genital tuberculosis who were then given treatment. Patients diagnosed to have infertility due to causes other than TB were excluded from the study. Highly suspected cases and those who were willing underwent diagnostic laparoscopy.
Results: Out of 355 cases of infertility, 83 were because of genital TB, received treatment out of which 32 conceived. CBNAAT was very sensitive than histopathology or laparoscopy. The live birth rate and conception rate were 20.24% and 38.09 % respectively.
Conclusions: CBNAAT is OPD based economical test (free by GOI), very sensitive and picked up more cases than histopathology or laparoscopy. The live birth rate and conception rate were found to be higher than other studies possible due to intervention at an earlier stage of the disease process. This test should be widely used by gynecologist for early detection of genital tuberculosis.
Global Tuberculosis Report, 2018. Available at: https://apps.who.int/iris/bitstream/handle/10665/.../9789241565646-eng.pdf. Accessed 14th April 2019.
Shende P, Valecha SM, Gandhewar M, Dhingra D. Genital tuberculosis and infertility. Int J Reprod Contracept Obstet Gynecol. 2017;6:3514-7.
Sharma JB, Dharmendra S, Agarwal S, Sharma E. Genital tuberculosis and infertility. Fertil Sci Res. 2016;3:6-18.
Arora R, Rajaram P, Oumachigui A, Arora VK. Prospective analysis of short course chemotherapy in female genital tuberculosis. Int J Gynecol Obstet. 1992;38(4):311-4.
Nadgouda SS, Mukhopadhyaya PN, Acharya A, Nagee A, Kunjadia PD. A study on genital tuberculosis and infertility in Indian population. Clin Pract. 2010;2:1.
Dawn CS. Pelvic infections; In: Dawn C.S.; ed Textbook of Gynaecology and Contraception: 9th ed.; Calcutta: Arati Dawn; 1998; 321Roy H, Roy S. Use of polymerase chain reaction for diagnosis of endometrial tuberculosis in high risk sub fertile women in an endemic zone. J Obstet Gynecol India. 2003;53:260
Seth A, Kudesia M, Gupta K, Pant L, Mathur A. Cytodiagnosis and pitfalls of genital tuberculosis: A report of two cases. J Cytology/Indian Acad Cytol. 2011;28(3):141.
Roy H, Roy S. Use of polymerase chain reaction for diagnosis of endometrial tuberculosis in high risk subfertile women in an endemic zone. J Obstet Gynecol India. 2003;53:260.
Singh UB, Seth P. PCR diagnosis of tuberculosis – Experience in India. Indian J Pediatr. 2002;69 Suppl 1:S20-4.
Eisenach KD, Sifford MD, Cave MD, Bates JH, Crawford JT. Detection of Mycobacterium tuberculosis in sputum samples using a polymerase chain reaction. Am Rev Respir Dis. 1991;144:1160-3.
Jindal UN, Bala Y, Sodhi S, Verma S, Jindal S. Female genital tuberculosis: early diagnosis by laparoscopy and endometrial polymerase chain reaction. The Int J Tuberculosis Lung Dis. 2010;14(12):1629-34.
Arpitha VJ, Savitha C, Nagarathnamma R. Diagnosis of genital tuberculosis: correlation between polymerase chain reaction positivity and laparoscopic findings. Int J Reprod Contracept Obstet Gynecol. 2016;5:3425-32.
Angeline Grace G, Bella Devaleenal D, Natrajan M. Genital Tuberculosis in Females. Indian Journal of Medical Research. 2017;145(4):425.