Occurrence of female genital tuberculosis among infertile women: a study from a tertiary maternal health care research centre in South India

Abstract

The purpose of this investigation was to estimate the proportion of female genital tuberculosis (FGTB) among infertile women, along with the mean cost of diagnosis by different methods. The study was carried out on 211,335 women, of which 31,755 (15.02 %) were infertile. 202 women were highly suspected of FGTB on laparoscopy, which was later ascertained by multi-gene polymerase chain reaction (PCR), and the cost was estimated. The majority of the patients were infertile (77.23 %), with menstrual disturbances (61.88 %). Many of them were having beaded tubes (68.81 %), tubal block with hydrosalpinx (58.91 %) and tubercular salpingitis (48.01 %). Out of 302 case-controls, 105 infertile women were positive by haematoxylin and eosin staining, 14.57 % were acid-fast bacilli-positive and 86 infertile women were positive on culture. 178 (58.94 %) endo-ovarian tissue biopsies and pelvic aspirated fluid specimens were positive for a 32-kDa protein gene as amplified using multi-gene PCR. The proportion of proven FGTB cases was very high (58.94 %) among infertile women highly suspected of FGTB. The estimated cost in rupees (Rs) of FGTB diagnosis by the conventional method ranges from Rs 3.36 to 38.11, while multi-gene PCR was established as being very expensive (Rs 254.21). The expected time of FGTB diagnosis by the conventional method ranges from 0.5 to 1.83 h, whereas culture took 4-8 weeks. The logical time of FGTB diagnosis by multi-gene PCR was 6.48 h. Compared to Ziehl-Neelsen's staining and culturing, multi-gene PCR improved the detection rate of suspected FGTB. Therefore, FGTB can be diagnosed if multi-gene PCR is considered in the evaluation of infertile patients in areas where tuberculosis is endemic.

Acute Miliary Tuberculosis in Pregnancy After in Vitro Fertilization and Embryo Transfer: Report of Seven Cases and Systemic Review

“…Liu et al reported a similar case in which untreated prior pulmonary TB developed into miliary TB during pregnancy [11]. Genital TB (GTB) is a form of extrapulmonary TB and a major cause of primary infertility among women in TB-endemic countries [24], with a prevalence rate of 28.4% in our hospital, as observed in previous studies [25,26]. GTB may cause fallopian tube obstruction, reduced endometrial receptivity, and ovarian dysfunction, leading to infertility.…”

Acute miliary tuberculosis in pregnancy after in vitro fertilization and embryo transfer: A report of seven cases and systematic review

“…Liu et al reported a similar case in which untreated prior pulmonary TB developed into miliary TB during pregnancy [18]. Genital TB (GTB) is a form of extrapulmonary TB and a major cause of primary infertility among women in TB-endemic countries [32], with a prevalence rate of 28.4% in our hospital, as observed in previous studies [33,34]. GTB may cause fallopian tube obstruction, reduced endometrial receptivity, and ovarian dysfunction, leading to infertility.…”

Caractéristiques épidémio-cliniques de la tuberculose génitale chez la femme tunisienne: une série de 47 cas

“…Dans une étude indienne récemment publiée colligeant plus de 30000 femmes stériles, l'étiologie tuberculeuse a été retrouvée dans 15% des cas [ 12 ], ce qui justifie la recherche systématique d'une TG chez toute femme stérile. Les troubles du cycle à type d'aménorrhée primaire ou secondaire sont un autre motif de consultation, retrouvés dans 5 à 20% des cas [ 13 ].…”

“…Les techniques d'amplification nucléique ont considérablement facilité le diagnostic de certaines formes de tuberculose extrapulmonaire. La détermination rapide de la présence du génome bactérien par polymerase chain reaction (PCR) constitue actuellement un progrès récent dans le diagnostic de la TG [ 12 , 20 ], avec une spécificité et une sensibilité dépassant les 60% dans certaines études [ 21 ]. L'examen histologique d'une biopsie de l'endomètre, de lésion péritonéale ou de masse tubo-ovarienne reste l'examen clé pour confirmer le diagnostic, tout en sachant que la nécrose caséeuse peut manquer dans d'authentiques tuberculoses.…”