Beat the odds

Though infertility due to female genital TB is considered almost absolute, timely diagnosis and treatment may bring positive results, assures  Dr Devika Gunasheela

In developing countries, including India, Tuberculosis (TB) is a major health problem. It is caused by bacteria called Mycobacterium tuberculosis. Lungs are the most common organs involved, but TB is a systemic illness and any organ of the body can be affected. Among women, besides lungs, the genital organ is the common site that gets affected by TB. This leads to infertility in many cases.

The average  incidence of female genital TB in infertile population is reported as 10 percent in India.
Fallopian tubes are the primary focus of genital TB and are almost always affected on both sides of the fallopian tubes. This causes the tubes to thicken and show a rough external surface with adhesions.

When the TB heals, the tubes become encased in heavy connective scar tissue and the lumen develops a beaded, rigid pipe stem appearance. The obstruction of the tube most frequently occurs in the region of transition, between the isthmus and the ampulla, where fertilisation is supposed to occur.

Diagnosis of genital TB is quite difficult. The most important tests include endometrial biopsy. This test is positive in only 50-60 percent of cases. Other tests like chest X-ray, blood test, Mantoux test can be done, but they do not definitely prove or exclude the disease.

Ultrasound is another test which can give clues to the clinician. Endoscopic procedures, such as laparoscopy and hysteroscopy, also, can pick up signs of the disease and provide an opportunity to take samples from the suspected areas for testing.

Once diagnosed, genital TB treatment has to continue for a minimum of six months. In advanced cases, a prolonged treatment may be required.

However, successful cure of TB, using anti-TB drugs, cannot repair the damage done by the disease to the genital organs. Fallopian tubes, which get damaged by the disease, remain blocked and their function cannot be easily restored, even by surgery.

Thus, infertility due to female genital tract TB is considered an almost absolute one. Medical therapy, surgical tuboplastic intervention, and combined treatments are all associated with a relatively poor fertility outcome. But the recent availability of hysteroscopy, and in-vitro fertilisation and embryo transfer (IVF-ET) has given promising results amongst patients.

Timely diagnosis and appropriate treatment may bring about successful conception through IVF.

(The writer is an infertility specialist, Gunasheela Fertility Centre, Bangalore)