With 40% of the population having latent Tuberculosis(when TB bacteria is inactive in body), Genital Tuberculosis, by no means could be considered Infertility uncommon in the country. And so are its effect on fertility and reproduction. It has been estimated that approximately 5% of females presenting to sub fertility clinics worldwide have genital TB.1 And the estimates of incidence vary enormously depending on the country of origin, being rarest in America and highest in India.
Otherwise also, Tuberculosis in general contributes nearly one-third of the female infertility in the country2.
Probably these data lead doctors to establish connect between infertility and genital tuberculosis. In case of unexplained infertility, 56% of the doctors favor screening their patients for genital tuberculosis3.
In the recently held conference on Genital Tuberculosis and Infertility, 24% of the doctors were explicit on the stand that Genital Tuberculosis (GTB) causes Repeated Pregnancy Loss (RPL/ repeated miscarriage), while 64% of them doubted GTB for this. In spite of the fact that there is no single medical literature which ascertains connect between the two.
Tuberculosis is an infectious disease caused by bacteria called Mycobacterium Tuberculosis and only when the bacteria infects anywhere in reproductive system leads to Genital Tuberculosis.
“Presently there is no evidence to say that RPL can be caused by tuberculosis but since workers in different regions of the country are working on this aspect and finding it to be the cause with good results, large studies need to be undertaken to settle the issue,” said Dr. Manika Khanna, IVF Expert, Gaudium IVF, JanakPuri, New Delhi. owing to dearth of clear evidence and data which can overtly support the theory that Genital TB leads to RPL.
However, the strong links between Genital Tuberculosis and infertility or inability to have child, also tempt those couples for Tuberculosis treatment, who are even found to have Latent TB. The imperative question for such couples and the doctors concerned is not to confirm the association between the two, more important for them is to eliminate any probable reason responsible for infertility.
On the contrary, some evidence also reveals that there is no major difference between the conception rates post Genital Tuberculosis treatment and other cases of unexplained infertility. This basically leads to almost equal requirement of technological intervention for pregnancy in both the cases.
For all those couples deprived from child, due to reasons unknown or due to some specific reasons like low sperm count and obstruction in fallopian tube etc, In Vitro Fertilization (IVF) could be an excellent solution. In IVF, an egg is surgically removed from women’s ovaries and fertilized with male sperm in laboratory. The fertilized egg (now called an embryo) is again returned to women’s womb to nurture and develop.
It must be noted here that success rate of IVF falls sharply from 33.1 % in women aged under 35 to 2.3% in women aged over 45. This simply means, for the couples facing problem of unidentified infertility for years and are diagnosed with latent or active genital tuberculosis, IVF offers good opportunity. According to the study published in pub med, IVF represents a useful treatment and improves the chances of fertility in couples having genital tuberculosis4.
Whether Genital Tuberculosis has any direct relation with infertility? Can it cause RPL? Should all the infertile patients screened with latent tuberculosis treated? All these questions will remain a topic of debate until we get accurate data which will help in making clear guidelines and aid doctors across the country to make judgment accordingly.
In the meantime, doctors should focus on proper treatment of genital tuberculosis as apart from infertility GTB can also lead to various other health complications and providing couples struggling with infertility options like IVF. This will certainly bring a ray of hope in people suffering from infertility and Genital tuberculosis, both in terms of achieving complete health and parenthood.
References
- Schaefer G: Female genital tuberculosis. Clin Obstet Gynecol 19:223, 1976
- Indian Journal of Tuberculosis; Parikh, F.R., Naik N., Nadkarni S.G., Soonawala S.B.Kamat S.A., Parikh R.M.; Genital tuberculosis is a majorpelvic factor causing infertility in Indian women; FertilSteril; 1997, 67, 497
- Poll results in the Conference on Genital Tuberculosis, 13 May, 2012
- Pubmed Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
