Statistics indicate that about 30 percent of women with any type of TB can develop genital tuberculosis (TB), a condition that is one of the major causes of infertility in women.
The fact that Genital tuberculosis may be asymptomatic and could often go unrecognized or masquerade as other gynaecological conditions make it all the more necessary for a high degree of vigilance to be in place for proper diagnosis and treatment.
TB infection is often serious and can damage the complete fallopian tube. In the beginning, small nodules of tubercular material deposit on the surface of the tubes. Later, the infection invades the tubes, affecting the internal surface of the tubes. Pus collects within the tubes, blocking them either completely or partially, resulting in a condition known as hydro salpingitis. About 5 percent to 10 percent of women are prone to this.
Speaking about this, Dr Hrishikesh D Pai, Director IVF & Infertility at Fortis Bloom IVF Center, Delhi/Gurgaon, said, “TB affects the lungs primarily and can be easy to detect. Bacteria that directly attack the genital organs can make diagnosis difficult especially in the later stages, thereby reducing the chances of conception. Genital TB is of two types – primary, where the TB has initiated in the genital tract itself and secondary, where it spreads through the bloodstream to the genital organs following tuberculosis infection anywhere else in the body. It is imperative to understand that women with low immunity need to be extremely particular and undergo regular age-appropriate health checkups. This is one of the best ways to diagnose any such infection at an early stage and avoid further complications.”
Vaginal discharge, severe pain in the lower abdomen, menstrual irregularities, amenorrhea, heavy bleeding and infertility are some common symptoms of genital TB. In extreme cases, where there is severe damage to the uterine lining, menstruation can completely cease.
Dr Nandita Palshetkar, Director IVF & Infertility at Fortis Bloom IVF Center, Delhi/Gurgaon, further said, “An endometrial biopsy and laparoscopy can help detect whether the fallopian tube has been affected. Another best advisable test that can be used to diagnose TB is a combination of AFB smear, culture and PCR for tuberculosis.”
“Treatment should begin as soon as the condition is detected to prevent further complications. However, a lack of awareness and social stigma associated with TB, makes this difficult. There is a need to address this aspect extensively as many cases go undetected even today. Although infertility is a cause of concern in genital TB, women who undergo timely treatment can still hope to conceive thanks to assisted reproductive techniques such as IVF,” she added.
Due to its high prevalence, especially in developing countries like India, it is the duty of the medical fraternity to take care that the work-up of an infertile couple should always include evaluation for tuberculosis irrespective of history or exposure.