Genital Tuberculosis and its Impact on Male and Female Infertility

et al. 2021

J Obstet Gynecol India

Female genital tuberculosis (FGTB) is an important cause of significant morbidity and infertility. Gold-standard diagnosis by demonstration of acid fast bacilli on microscopy or culture or detection of epithelioid granuloma on histopathology of endometrial or peritoneal biopsy is positive in only small percentage of cases due to its paucibacillary nature. Use of gene Xpert on endometrial or peritoneal biopsy has improved sensitivity of diagnosis. Composite reference standard (CRS) is a significant landmark in its diagnosis in which combination of factors like AFB on microscopy or culture, positive gene Xpert, epithelioid granuloma on endometrial or peritoneal biopsy, demonstration of definite or probable findings of FGTB on laparoscopy or hysteroscopy. There have been many advances and changes in management of FGTB recently. The program is now called National Tuberculosis Elimination Program (NTEP), and categorization of TB has been stopped. Now, patients are divided into drug-sensitive FGTB for which rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) are given orally daily for 2 months followed by three drugs (rifampicin, isoniazid and ethambutol (RHE) orally daily for next 4 months. Multi-drug-resistant FGTB is treated with shorter MDR TB regimen of 9–11 months or longer MDR TB regimen of 18–20 months with reserved drugs. In vitro fertilization and embryo transfer have good results for blocked tubes and receptive endometrium, while surrogacy or adoption is advised for severe grades of Asherman’s syndrome.

Section: Epidemiologymentioning

confidence: 99%

Recent Advances in Diagnosis and Management of Female Genital Tuberculosis

et al. 2021

J Obstet Gynecol India

“…Tuberculosis has a major impact on both female and male fertility, but there are many controversies and pitfalls in its diagnosis 29 , 30 . However, laparoscopy appears to be a useful diagnostic modality in the diagnosis of FGTB along with other tests.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic evaluation of female genital tuberculosis in infertility: An observational study

Indian Journal of Medical Research

Dharmendra

et al. 2023

Background & objectives: Female genital tuberculosis (FGTB) is an important variety of extrapulmonary TB causing significant morbidity, especially infertility, in developing countries like India. The aim of this study was to evaluate the laparoscopic findings of the FGTB. Methods: This was a cross-sectional study on 374 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling/biopsy for acid-fast bacilli, microscopy, culture, PCR, GeneXpert (only last 167 cases) and histopathological evidence of epithelioid granuloma. Diagnostic laparoscopy was performed in all the cases to evaluate the findings of FGTB. Results: Mean age, parity, body mass index and duration of infertility were 27.5 yr, 0.29, 22.6 kg/m 2 and 3.78 years, respectively. Primary infertility was found in 81 per cent and secondary infertility in 18.18 per cent of cases. Endometrial biopsy was positive for AFB microscopy in 4.8 per cent, culture in 6.4 per cent and epithelioid granuloma in 15.5 per cent. Positive peritoneal biopsy granuloma was seen in 5.88 per cent, PCR in 314 (83.95%) and GeneXpert in 31 (18.56%, out of last 167 cases) cases. Definite findings of FGTB were seen in 164 (43.86%) cases with beaded tubes (12.29%), tubercles (32.88%) and caseous nodules (14.96%). Probable findings of FGTB were seen in 210 (56.14%) cases with pelvic adhesions (23.52%), perihepatic adhesions (47.86%), shaggy areas (11.7%), pelvic adhesions (11.71%), encysted ascites (10.42%) and frozen pelvis in 3.7 per cent of cases. Interpretation & conclusions: The finding of this study suggests that laparoscopy is a useful modality to diagnose FGTB with a higher pickup rate of cases. Hence it should be included as a part of composite reference standard.

“…FGTB causes significant morbidity in the form of menstrual irregularities, chronic pelvic pain, tubo‐ovarain masses and infertility (primary infertility being more common) 5,7 . Most significant impact of genital TB is infertility especially in the third world countries which can affect both men and women 46 . Tal et al 47 .…”

Section: Epidemiologymentioning

confidence: 99%

“…5,7 Most significant impact of genital TB is infertility especially in the third world countries which can affect both men and women. 46 Tal et al 47 and Langer et al 48 have recommended all the women at-risk, seeking infertility care in the USA, to be screened for latent genital TB. The prevalence of FGTB in infertility varies in developed and developing countries and is only .72% in Portugal (Europe), 1% in USA, 20% in Pakistan, and ranges from 6% to 25% in various centers of India being more common in tertiary centers and assisted reproduction centers catering to referred patients from high risk areas like Bihar and Uttar Pradesh.…”

Section: Epidemiologymentioning

confidence: 99%

Immune disturbances in female genital tuberculosis and latent genital tuberculosis

Sharma³

et al. 2022

American J Rep Immunol

Background Female genital tuberculosis (FGTB), an important clinical sub‐type of extra‐pulmonary tuberculosis (EPTB) is responsible for about 10% cases of infertility in India. Both FGTB and latent genital tuberculosis (LGTB) can cause infertility through blockage of fallopian tubes and through altered uterine endometrial receptivity. Aims This review tries to elucidates the role of various immune factors in FGTB and LGTB. Content Various immune disturbances are observed in FGTB and LGTB like growth factors and cytokines which inhibit implantation and several inflammatory signaling pathways like mitogen activated protein kinase (MAPK), natural killer (NK) cells, nuclear factor kappa‐B (NF‐KB), tumor necrosis factor (TNF), and toll like receptors (TLR) signaling are dysregulated. These altered immune factors and pathways may be detected in the endometrial biopsies at the early stages of disease before permanent damage. Prompt and adequate treatment with the four anti‐tubercular drugs (rifampicin [R], isoniazid [H], pyrazinamide [Z], and ethambutol [E]) can increase pregnancy rates in some of these women. Assisted reproduction especially in‐vitro fertilization and embryo transfer may be required for some women. Implications Inflammatory pathways identified from the gene profiling have enabled development of potential biomarkers for early diagnosis of FGTB. Immunomodulation and novel biotechniques like stem cell transplantation, nanoparticles and host directed therapies are being tried in selected patients of FGTB and LGTB with promising results.