Genital TB and IVF- Symptoms and Treatment

Female genital tuberculosis is one of the major causes of essential morbidity whether short or long term sequelae largely in infertility. You have around 5 to 15% of cases in India. The major causing agent is Mycobacterium tuberculosis. And, it majorly includes fallopian tube in around 90 to 100% cases, ovaries in around 30% of the cases, endometrium in around 60 to 80% of the cases and cervix in 15% cases of genital tuberculosis. Vaginal and vulva tuberculosis include around 1-2% cases. Diagnosis is done by the test of acid-fast bacilli under a microscope or endometrial biopsy culture or through a histopathological examination of epithelioid granuloma through biopsy. Opting for polymerase chain reaction may not alone with sufficient to get an accurate diagnosis for this problem.

Laparoscopy and hysteroscopy are the last benchmarks to diagnose the disease. The WHO alarmed because of its high prevalence and mortality has promoted an efficient TB control remedy depending on the 5 essential elements called dots (Directly Observed Treatment Short Course) strategy in India to get 70% case detection and 85% curing rates.

Female genital TB is a significant form of extrapulmonary TB (EPTB) which is basically secondary to TB. It may lead to high morbidity and small and long term sequelae, majorly infertility to the infected women because of scarring and fibrosis. Early FGTB diagnosis is important for on-time treatment and prevention of any kind of complication occurrence majorly because of infertility and fibrosis. Your medication history and past history of the family is also needed for diagnosis. History report of HIV positivity is also needed. The doctors perform a physical examination to see any evidence of TB at any other place in the body such as chest, bone, skin or joint. There is an abdominal examination and genital examination conducted along with bimanual examination (fallopian tube and endometrial TB) to diagnose genital TB.

All tests are not needed for every genital TB case. The test depends on the place of TB and the genital TB symptoms which the patient has. Once the doctors conduct the test depending on the symptoms, the treatment method is prescribed.

The latent genital TB treatment is detected only on PCR (positive polymerase chain reaction) is contradicting because of the high false positivity. Often ART (assisted reproductive technology) professionals treat positive PCR patients with higher pregnancy results in those woman treated with ATT than those without any treatment. The idea of treating TB in the early stage is that it can be treated without causing any permanent damage to the genital organs and endometrium. It adds up the pregnancy rate to 30.5%.

The short term chemotherapy is also prescribed for 6 to 9 months for the effective treatment of FGTB. Surgery is sometimes needed to drain the abscess. Sometimes in vitro fertilization and embryo transfer is needed in those women whose endometrium is healthy but fallopian tubes are damaged. For those women whose endometrium is damaged, adoption or surrogacy is suggested.

A lot of women suffering from genital TB with infertility problems or having a poor prognosis for infertility have a low conception rate of 19% with birth rate being as low as 7%. IVF treatment in genital TB appears to be their only hope for those whose endometrium is not damaged with 16% pregnancy rate per embryo transfer.

IVF ET has seen great success rates out of all ART technologies in genital TB patients offering a conception rate of 17.5% against only 4.3% with fertility-enhancing operations. Latent genital TB stands responsible for constant IVF failure in young women showcasing unexplained infertility. The pregnancy rates and delivery rates are improved when early detection is done as there are the lowest damage and instant management of the problem.

As suggested women with FGTB have low-quality embryo and poor ovarian reserve and thus require higher gonadotropins. Thus, the pregnancy rates vary from 9.1% to 39% and some may end up into ectopic pregnancy or abortion cases. Poor IVF treatment in genital TB may occur because of the following reasons.

1.       Some women are poor responders

2.       They require a higher dosage of gonadotropins.

3.       The endometrium is badly developed

4.       Embryo quality and pregnancy rate are very low.

Gestational surrogacy in genital TB

Some women with a blocked fallopian tube or non-receptive endometrium are suggested to go for gestational surrogacy. In this treatment, another woman’s uterus is consumed for implantation where the ovum belongs to the mother and sperm belongs to the father. She becomes the genetic mother of the foetus. However, for this treatment, you need a normal ovarian reserve.