Case report of pelvic tuberculosis resulting in Asherman’s syndrome and infertility

Abstract

Approximately one-third of the world’s population is infected with Mycobacterium tuberculosis , and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman’s syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis . The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.

Perinatal Outcome and Long-Term Infectious Morbidity of Offspring Born to Women with Known Tuberculosis

“…Despite previous studies showing strong association between genital tract tuberculosis and infertility [ 7 ], our study did not demonstrate such an association, although in vitro fertilization procedures in Israel are not performed in women with active tuberculosis.…”

“…It arises from hematogenous spread from a pulmonary or other non-genital source and most often involves the fallopian tubes, the endometrial cavity and the ovaries. Genital tract tuberculosis is associated with 21% of infertility cases in developing countries, due to tubal obstruction or adhesions in the uterine cavity [ 7 ].…”

Hysteroscopic and Laparoscopic finding in Infertile Women with proven Endometrial Tuberculosis

“…(24) Intrauterine adhesions (Figure 2) are a dreadful finding of tuberculosis as they often have poor fertility outcomes. (25,26) Infection of the endometrium occurs on many levels, including the basalis layer, which is destroyed by endometrial ulceration. As a result, the endometrium loses its regeneration capacity, and intrauterine adhesions form over time as the lesion heals with fibrosis.…”

A case of disseminated tuberculosis during a twin pregnancy following in vitro fertilization

“…It is still a very important cause of tubal infertility, mostly in the developing world, although occurrence in high income countries is not to be underestimated. The fallopian tubes are affected in approximately 90%-100% of the genital tuberculosis cases, whereas the endometrium is involved in 50%-70% of cases, the ovaria in 20%-25% of cases, and the cervix in only 5% of cases ( Gurgan et al, 2004 ;Fowler ML et al, 2019 ;Sharma JB et al, 2018). In hindsight, the hyperhomocysteinemia in this patient was likely insufficient to explain her tubal infertility, and the presence of chronic pelvic inflammation should have warranted further workup for tuberculosis.…”