Effect of antitubercular treatment on ovarian function in female genital tuberculosis with infertility

Abstract

AIM:To evaluate the effect of antitubercular therapy (ATT) on an ovarian function such as ovarian reserve, ovarian dimensions, and ovarian stromal blood flow.SETTINGS AND DESIGN:Prospective study design.MATERIALS AND METHODS:Fifty infertile women with female genital tuberculosis (FGTB) without tubo-ovarian masses diagnosed by positive acid-fast bacilli culture or epithelioid granuloma on endometrial aspirate or positive polymerase chain reaction with positive findings on laparoscopy or hysteroscopy were recruited. The ovarian function tests were performed on day 2/3 as follicle-stimulating hormone (FSH) levels and anti-Mullerian hormone (AMH) levels. Ovarian dimensions (length, width, and depth) were measured using a transvaginal ultrasound. Mean antral follicle count (AFC) and ovarian stromal blood flow (peak systolic velocity [PSV], pulsatility index (PI), and resistive index [RI]) were measured using a transvaginal ultrasound. All women were started on ATT for 6 months by directly observed treatment strategy. After completion of ATT, all the parameters were repeated.RESULTS:There was a significant increase in AMH (2.68 ± 0.97 ng/ml to 2.8 ± 1.03 ng/ml) pre- to post-ATT, nonsignificant increase in FSH (7.16 ± 2.34 mIU/ml to 7.26 ± 2.33 mIU/ml) post-ATT, significant increase in mean AFC (7.40 ± 2.12–8.14 ± 2.17), PSV in the right ovary (6.015–6.11 cm/s) and left ovary (6.05–6.08 cm/s), PI in the right ovary (0.935–0.951 cm/s) and left ovary (0.936–0.957 cm/s), and RI in the right ovary (0.62 ± 0.01–0.79 ± 0.02) and left ovary (0.65 ± 0.02–0.84 ± 0.01) with ATT. There was no significant change in mean ovarian dimensions (ovarian length, breadth, and width) and summed ovarian volume with ATT. On laparoscopy, tubercles were seen in 27 (54%) women. Caseous nodules and encysted ascites were seen in 8% cases each.CONCLUSION:ATT improves the ovarian function (AMH and AFC) and ovarian blood flow in women with FGTB.

Effect of Female Genital Tubercular Involvement on Anti-Mullerian Hormone Secretion in Latent Genital Tuberculosis Affected Women

“…We got the AMH level which was 15% higher than previous value but that rise was not exceed 25%. It is very interesting that this rise was not age specific [15]. We have estimated the AMH level after 3 months and 6 months of treatment.…”

Effect of Genital Tuberculosis on Ovarian Reserve

“…Ovarian involvement is found in up to 30% of women with FGTB; 11,13,28 however, its impact on female reproductive health is only beginning to be explored. [29][30][31] A comprehensive understanding of the impact of FGTB on reproductive health is necessary due to an increasing incidence of TB, even in low-burden countries, due to transnational and transcontinental migration of people from high-burden countries, and an accelerated conversion of latent TB infection to active TB in immunocompromised individuals. 12,20,22,32 This narrative review critically looks at the role of FGTB on ovarian reserve and its implications to reproductive health of women.…”

“…29 Importantly, evidence from a single large study shows that AMH and AFC are lower in women who are infertile with latent GTB without any laparoscopic evidence of TB compared to those with unexplained infertility. 30 The above evidence, albeit limited, does indicate an adverse impact of FGTB on ovarian reserve, and is summarized in Table1 [29][30][31]34,61.…”

Female genital tuberculosis

“…Ovaries are affected in 20-30 per cent patients with adhesions, caseation, adnexal cyst or mass formation with defective ovarian function and reserve and sometimes complete destruction of ovary 27 28 . Sometimes tubo-ovarian cyst can manifest as acute abdomen simulating acute appendicitis and may be diagnosed on laparoscopy or laparotomy 29 .…”

“…Endocrine dysfunction, chronic anovulation, antigonadotropic effect of M. tuberculosis even on an in vitro fertilization (IVF) cycle, poor quality of embryo due to intrinsic oocyte factor defect and decreased production of progesterone (luteal phase defect), implantation failure, lower pregnancy rates and higher abortion rates are observed in FGTB 27 28 .…”