Evaluation of women with infertility and genital tuberculosis

Infertility is defined as the inability to conceive by at least one year of unprotected intercourse. Treatment may be started earlier in case of an obvious cause or advanced age of the couple. Genital tuberculosis is an important cause of subfertility, more so in endemic zones such as South India. Still, the true epidemiology of this disease remains unknown due to lack of highly sensitive and specific tests. Genital tuberculosis not only causes tubal obstruction and dysfunction but also impairs implantation due to endometrial involvement and ovulatory failure from ovarian involvement 1. Female genital tuberculosis (FGTB) is still a major cause of infertility in South India in spite of the availability of specific therapy. The prevalence of FGTB in infertility clinics shows marked variations in different countries ranging between 15 and 25% 2. In 80-90%of cases, FGTB affects young women between 18 and 38 years of age and is an important cause of infertility 2,3. It is often a secondary complication as a result of reactivation of a silent bacillemia, primarily from lungs, affecting most commonly the fallopian tubes (92-100%), ovaries (10-30%), cervix (5%), endometrium (50%) 2,4, and vagina and vulva (<1%), but in some instances also from kidney, intestines, etc 5. However a few reports have found endometrium to be the most commonly involved site. Direct inoculation of tubercle bacilli can also take place over vulva or vagina during sexual intercourse with a partner suffering from tuberculous lesions of genitalia. Primary infection of the female genital organs is very rare 6. Establishment of the true incidence and prevalence of FGTB is difficult because asymptomatic latent cases predominate over symptomatic ones 6,7.