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Genital Tuberculosis

Tuberculosis has been eradicated in the developed countries. However it is still endemic in India and in a large proportion of patients with blocked fallopian tubes, the cause is tuberculosis of the genital organs.

Tuberculosis (TB) first affects the lungs in young girls and if not detected may eventually spread through the blood to the genital organs. Over a period of time the body overcomes the infection or it lies dormant waiting to flare up at some time in the future when the woman is more vulnerable. Tuberculosis heals with a lot of scarring and in the genital organs, they usually affect the fallopian tubes (95% of cases) causing irreversible damage, which cannot be corrected by surgery. In 50% of cases, the lining of the uterus (endometrium) is affected which prevents implantation of the pregnancy. Tuberculosis of the genital organs may manifest with reduced menstrual flow but in the majority of cases is only diagnosed in the work up of the infertile couple.

Tuberculosis of the genital organs may be suspected from non specific laboratory investigations. However confirmation of the diagnosis is usually by laparoscopy and histological examination of tissue sent for examination. The HSG picture also helps to clinch the diagnosis in cases where other tests have been inconclusive. Today PCR of tissue suspected to be affected with TB is the gold standard to pick up even in very early cases of TB. 

Very often by the time the disease is diagnosed it is inactive or healed and in these cases lengthy therapy with medication is not necessary. If active, treatment involves taking 3-4 drugs for a period of 6months to a year and definitive treatment of infertility has to be deferred accordingly.

One cannot stress strongly enough that surgery to reopen the tubes blocked due to TB is futile and a medical contraindication. The only treatment possible is IVF and that too, only in those cases in which the endometrium has been spared. If the lining of the uterus is destroyed the only recourse is surrogacy. In cases where the endometrium is uninvolved one can expect results with IVF/ICSI procedures nearly on par as in patients without the disease as the eggs produced by the ovary, in genital TB, are healthy and free from the disease.

© 2007