How does Genital Tuberculosis affect Fertility?

Tuberculosis (TB) is one of the most common and important communicable diseases in the world. It can affect any organ in the body, even the reproductive system.

TB may spread to the uterus and the Fallopian tubes, thus lowering the rate of conception. Genital tuberculosis is one of the most common reasons behind tubal infertility and continues to remain largely undiagnosed.

The following are some of the facts associated with genital TB that people must know.

Fact #1: Genital TB is a major reason for infertility in men and women
Doctors estimate that between 10 and 15 percent of infertility cases among women are a result of a TB infection that has spread to the reproductive organs (uterus, ovaries and the Fallopian tubes) through bloodstream. Genital TB not only affects women, but men as well.

Genital TB for Male & Female Infertility

Fact #2: Genital TB may affect anyone and cause infertility at any point of time
Anyone may get affected by genital TB – those who have had an exposure to the TB bacteria, people with low immunity and those who are in contact with a TB infection are at an increased risk of genital TB. It may even spread due to a sexual contact with an infected person. People with pulmonary TB, if left untreated, may develop genital TB, over a period of time. As a result, infertility may manifest itself within a few months of contracting TB infection.

Fact #3: Infertility linked to Genital TB is hard to diagnose
Pelvic pain, irregular menstrual cycles, bleeding after sexual intercourse and infertility are some of the symptoms associated with genital TB. However, most often these symptoms are linked to other condition and lack of any uncommon symptoms make it difficult to diagnose genital TB.

Doctor may prescribe a series of tests, including PCR, blood test and tissue sampling to confirm diagnosis. However, there are huge chances that these tests may throw up a false positive results or false negative results. Therefore, it becomes hard to make definite diagnosis.

Fact #4: It’s important to make a clear diagnosis of Tuberculosis before starting medical treatment, not just empirically or on basis of tests with high false positivity
Typically, doctors start treatment with anti-tubercular treatment (ATT) as soon as they get a positive diagnosis, even though there are huge chances that it may be false. Overtreatment and overdiagnosis may put unnecessary burden on the patient, both in terms of time and money.

In addition, indiscriminate use of ATT without clear evidence of tubercular treatment is the reason behind rampant multi drug resistance of TB. The TB bacteria stops responding to the anti tubercular drugs over a period of time, leading to no benefit to the patient.

Thus as important as it is for a clinician to keep genital tuberculosis as a reason for tubal or unexplained infertility, especially in India, it is equally important to be have clear clinical or laboratory evidence of presence of TB in the genital tract before starting anti tubercular treatment.

Fact #5: Surrogacy and IVF are the advanced options for couple rendered infertile due to genital TB with good clinical results
In women, genital TB may lead to tubal obstruction, which is an irreversible condition. In severely affected cases, genital TB may permanently damage the uterus and the Fallopian tubes, thus leaving no chance for the affected woman to conceive. As a result, the treatment of last resort for such women is either surrogacy or in vitro fertilization (IVF), as the women is unable to conceive naturally.

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