Role of Latent Genital Tuberculosis in Repeated IVF Failure in the Indian Clinical Setting

Abstract

Genital tuberculosis is reported to be a major pelvic factor causing infertility in Indian women and often exists without any apparent signs and symptoms. The role of latent tuberculosis in repeated IVF failure in unexplained infertility is examined. 81 women with unexplained infertility having repeated IVF failure tested for Mycobacterium tuberculosis using PCR, ZN staining and BACTEC-460 culture were selected. Fresh IVF-ET or frozen embryo transfer (FET) was attempted on patients successfully treated with anti-tubercular drugs (ATD). ATD-treated fresh cycles (group A1) and frozen cycles (group B1) were compared to previously failed fresh cycles (group A2) and FET attempts (group B2), respectively. Main outcome measures were gonadotropin required, terminal E2, number of oocytes retrieved, fertilization rate, embryo quality, endometrial thickness and sub-endometrial blood flow (V_max). Gonadotropin required in group A1 was significantly less as compared to group A2. Number of oocytes retrieved and grade I embryos, endometrial thickness and V_max were significantly higher in group A1. Endometrial thickness and V_max were significantly increased in group B1 as compared to B2. The study indicates that latent tuberculosis should be considered in young Indian patients presenting with unexplained infertility with apparently normal pelvic and non-endometrial tubal factors and repeated IVF failure.

Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy

“…These women may have endometrial and tubal ciliary damage, which prevents a normal conception and implantation. Yet another reason for poor fertility is a diminished ovarian reserve because of GTB [19]. There is even a role for latent GTB in infertility because dormant mycobacteria present in the basal endometrium may impair the endometrial and subendometrial blood flow [19].…”

Current Diagnosis and Management of Female Genital Tuberculosis

“…Jindal [11] observed IVF-ET to be most successful out of all ART modalities in genital TB patients with 17.3 % conception rate in contrast to only 4.3 % with fertility enhancing surgery. Dam et al [45] found latent genital TB responsible for repeated IVF failure in young Indian patients in Kolkata presenting with unexplained infertility with apparently normal pelvis and non-endometrial tubal factors. If after ATT their tubes are still damaged but their endometrium is receptive (no adhesions or mild adhesions which can be hysteroscopically resected), IVF-ET is recommended [8,46].…”

Identification of serum metabolic markers for diagnosis of women with dormant genital tuberculosis

“…Genital tuberculosis (GTB) in women is an important clinical problem often associated with infertility (Bose 2011;Dam et al 2006). According to an estimate, 5 % of women seeking infertility treatment have GTB worldwide (Malik 2003).…”