Mrs. Sharma (name changed) has to undergo immense physical and psychological ordeal for 9 long years when she was undergoing incessant treatment for infertility. While her husband was absolutely fine, she was constantly having problem of blocked fallopian tube. Meanwhile, she also underwent four unsuccessful IVF (in vitro Fertilization, an infertility treatment). And to add on to her agonies, Doctors had no medical clarifications for all these.
It was after all this; she finally reached to Dr. Manika Khanna’s infertility clinic, where all her records were examined, which revealed that she had gone through almost all type of tests, except a biopsy to see whether she had some problem with her uterus. When this was carried out, she was found to have tuberculosis in her uterus. She was treated for 9 months followed by IVF. This time she had twins!
This particular case came up as flash of light for Dr. Manika Khanna and persuaded her to haul out the connecting link between infertility and Genital Tuberculosis (GTB). After this she made it a point to prescribesensitive screening tests like PCR(Polymerase Chain Reaction) which can pick up the diseaseat whichever stage it is, to each and every patient coming to her with unexplained infertility.
She has been continuously observing since then, that as soon as these patients get the treatment of GTB, they have successful IVF. This approach of handling cases of unexplained infertility opened a new door of opportunity for every Mrs. Sharma of the country, who is struggling with problem of childlessness.
With 40% of the population having latent Tuberculosis (when TB bacteria is inactive in body), Genital Tuberculosis, by no means could be considered 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 TB1. 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.Although these data are strong enough for the doctorsto establish connect between infertility and genital tuberculosis but probably lack of concrete scientific backup often holds them back in doing so.
“Many a time tests also pave the way to escape the problem. Because the diagnosis of extra-pulmonary tuberculosis like genital TB is difficult since the bacteria are present in very small numbers. Usually, it is diagnosed by histo-pathological (biopsy) samples of the uterine and tubal tissues and culture of the bacillus from the tissues. The pickup rate of these tests is very low – to the tune of 2 -5%.Moreover, the results of the culture are obtained in 6 weeks. So, especially in cases of unexplained infertility sensitive testes like PCR should be preferred to evade every slip-up in the treatment for infertility and GTB both”says Dr. Manika Khanna, IVF Expert, Gaudium IVF centre, janakPuri, New Delhi.
It is important here to note that delay in diagnosis, or lack of innovative approach in treatment might leave patients of unexplained infertility out of hope, as apart from other reasons, age itself is an important factor for fertility.
According to the study published in pub med, IVF represents a useful treatment and improves the chances of fertility in couples having genital tuberculosis3.
So, taking into account all these factors, considering patients of unexplained infertility for GTB test is always anexcellent idea. Apart from bringing a ray of hope for infertility patients it also helps in treatment of a serious disease if present in body.
- 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 major pelvic factor causing infertility in Indian women; FertilSteril; 1997, 67, 497
- Pubmed Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.