Congenital tuberculosis after in vitro fertilization: suggestion for tuberculosis tests in infertile women in developing countries

Abstract

Congenital tuberculosis (CTB) after in vitro fertilization (IVF) is a major new problem in developing countries. Only 16 cases of CTB after IVF have been reported, and no tuberculosis (TB) tests were performed before IVF in these cases. However, on the basis of data in the literature and from the World Health Organization, the incidence of CTB has been substantially underestimated. We describe two cases of CTB after IVF in detail in our center and provide new insight into the important issue of controlling TB vertical transmission in developing countries. Performing an early diagnosis of CTB, mostly based on evidence of maternal infection and a high index of clinical suspicion, is a challenge. However, most mothers have no symptoms of TB infection during prepartum, and infertility may be the only symptom. Infertility caused by genital TB is common in countries with a high TB burden, and IVF is considered to be an effective treatment to improve their fertility. Therefore, this may lead to more CTB cases without thorough TB tests before IVF. We suggest that thorough TB tests should be conducted in infertile women before IVF to prevent CTB.

Analysis of Clinical Features and Risk Factors in Pregnant Women With Miliary Pulmonary Tuberculosis After In Vitro Fertilization Embryo Transfer

“…Postnatal, one baby was reported with congenital TB. Similar cases with congenital TB after IVF-ET have been reported before ( Zhang et al., 2018 ). The TB screening before IVF-ET is essential to decreasing the prevalence of congenital TB in neonates.…”

Female genital tuberculosis presented with primary infertility and persistent CA-125 elevation: A case report

“…A Chinese study by Zhang et al reported two women with TB successfully conceived via in vitro fertilization (IVF); however, both of their babies died 56 days after the birth due to respiratory disorders with one infant confirmed with the diagnosis of TB. Not surprisingly, TB screenings were not prescribed in both of the mothers before the initiation of IVF [ 17 ]. Therefore, considering the potential deleterious maternal and neonatal outcomes of women with TB if passed undiagnosed, the high prevalence of TB in China, and the enormous number of Chinese women receiving infertility care every year, we strongly propose that TB screening should be mandated for all women seeking infertility evaluation and treatment in China.…”

Perinatal tuberculosis—An approach to an under-recognized diagnosis

“…Possible risk factors for congenital TB are as follows: (1) Infants born to mothers who have primary TB, which often has a haematogenous (bacillaemic) phase (see Clinical presentation) (6), (2) mothers co-infected with TB and HIV, and (3) mothers who had undergone in vitro fertilization (IVF) with TB as the cause of infertility (13).…”

“…TB of the genitourinary tract is a common cause of infertility; several cases of congenital TB were reported in infants of mothers who had undergone IVF; therefore, TB should be excluded and treated before IVF is performed to prevent congenital TB in their infants (13).…”

“…The choice of TPT depends on the confirmed or presumed susceptibility pattern of the source patient and the possibility of other drug interactions. In case of exposure to drug-susceptible TB, 6 months of isoniazid (including in HIV-exposed infants on antiretroviral drugs) or 3 months of isoniazid-rifampicin combination should be provided; in isoniazid mono-resistant TB exposure, a 4-month rifampicin regimen should be used, while in rifampicin-resistant (RR) or multidrug-resistant TB (MDR-TB; resistance to isoniazid plus rifampicin) exposure, levofloxacin alone or in combination with another drug with known or presumed susceptibility should be used (13,23,24). With exposure to MDR strains with fluoroquinolone resistance (pre-extensive drugresistant [pre-XDR] TB), or XDR-TB (pre-XDR-TB plus resistance to bedaquiline or linezolid), TPT may not be possible and expert opinion should be sought.…”