Effect of antitubercular treatment on ovarian function in female genital tuberculosis with infertility

Abstract

AIM:To evaluate the effect of antitubercular therapy (ATT) on an ovarian function such as ovarian reserve, ovarian dimensions, and ovarian stromal blood flow.SETTINGS AND DESIGN:Prospective study design.MATERIALS AND METHODS:Fifty infertile women with female genital tuberculosis (FGTB) without tubo-ovarian masses diagnosed by positive acid-fast bacilli culture or epithelioid granuloma on endometrial aspirate or positive polymerase chain reaction with positive findings on laparoscopy or hysteroscopy were recruited. The ovarian function tests were performed on day 2/3 as follicle-stimulating hormone (FSH) levels and anti-Mullerian hormone (AMH) levels. Ovarian dimensions (length, width, and depth) were measured using a transvaginal ultrasound. Mean antral follicle count (AFC) and ovarian stromal blood flow (peak systolic velocity [PSV], pulsatility index (PI), and resistive index [RI]) were measured using a transvaginal ultrasound. All women were started on ATT for 6 months by directly observed treatment strategy. After completion of ATT, all the parameters were repeated.RESULTS:There was a significant increase in AMH (2.68 ± 0.97 ng/ml to 2.8 ± 1.03 ng/ml) pre- to post-ATT, nonsignificant increase in FSH (7.16 ± 2.34 mIU/ml to 7.26 ± 2.33 mIU/ml) post-ATT, significant increase in mean AFC (7.40 ± 2.12–8.14 ± 2.17), PSV in the right ovary (6.015–6.11 cm/s) and left ovary (6.05–6.08 cm/s), PI in the right ovary (0.935–0.951 cm/s) and left ovary (0.936–0.957 cm/s), and RI in the right ovary (0.62 ± 0.01–0.79 ± 0.02) and left ovary (0.65 ± 0.02–0.84 ± 0.01) with ATT. There was no significant change in mean ovarian dimensions (ovarian length, breadth, and width) and summed ovarian volume with ATT. On laparoscopy, tubercles were seen in 27 (54%) women. Caseous nodules and encysted ascites were seen in 8% cases each.CONCLUSION:ATT improves the ovarian function (AMH and AFC) and ovarian blood flow in women with FGTB.

Effect of Female Genital Tubercular Involvement on Anti-Mullerian Hormone Secretion in Latent Genital Tuberculosis Affected Women

“…We got the AMH level which was 15% higher than previous value but that rise was not exceed 25%. It is very interesting that this rise was not age specific [15]. We have estimated the AMH level after 3 months and 6 months of treatment.…”

Hysteroscopic and Laparoscopic finding in Infertile Women with proven Endometrial Tuberculosis

“…A study was done to know the effect of anti-tubercular therapy (ATT) on ovarian function, such as ovarian reserve, ovarian dimensions, and ovarian stromal blood flow showed that a significant increase in AMH (2.68 ± 0.97 ng/ml to 2.8 ± 1.03 ng/ml) pre-to post-ATT, nonsignificant increase in FSH (7.16 ± 2.34 mIU/ml to 7.26 ± 2.33 mIU/ml) post-ATT, significant increase in mean AFC (7.40 ± 2.12-8.14 ± 2.17), PSV in the right ovary (6.015-6.11 cm/s) and left ovary (6.05-6.08 cm/s). (36) In women with genital TB, ATT enhances ovarian function (AMH and AFC) and ovarian blood flow. (36,37) Endo-ovarian tissue biopsy can also be used to diagnose FGTB.…”

Emerging progress on diagnosis and treatment of female genital tuberculosis

“… 10 Patients with ovarian TB account for 10% of the total FGTB cases and show tubo-ovarian masses. 11 Patients with cervical TB account for 5% to 15% of the total FGTB cases and show granulomatous lesions. 12 Vaginal and vulval TB cases are rare and only account for 1% to 2% of the total FGTB cases, and often have hypertrophic lesions or a non-healing ulcer.…”