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

Abstract

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.

A cross-sectional questionnaire-based landscaping of female infertility reveals genital Infections as a major contributor to reproductive tract anomalies, menstrual disorders, and infertility

“…Moreover, identifying upper reproductive tract pathogens (endometrial/tubal/ovarian) through microbial culture could be challenging requiring invasive sampling and there is also the risk of vaginal and/or cervical pathogens contaminating these samples [13,[20][21][22]. Therefore, a modest clinical suspicion of genital infection is critical to identify women at risk to prompt them for further detailed clinical investigations [33].…”

“…adhesions, cysts and endometrial disorders), pregnancy failures and infertility. The treatment of FGTB involves a combination of anti-TB drugs and surgical intervention(s), however, the success rates of these treatments in terms of the improvement in fertility vary depending on the severity of the reproductive tract damage [20][21][22]. Previous research also links bacterial vaginosis (BV) to PID and endometritis with consequential infertility [11].…”

Molecular Genetic Analysis of Mycobacteria, Causing Female Genital Tuberculosis: Possibilities of Sexual Transmission–An Overview

“…Hence, ELISA was banned by the World Health Organization and Government of India for diagnosis of GTB. 21 A summary of methods associated with detection of FGTB is illustrated in ►Fig. 1.…”

“…All the couples were screened for mycobacterial DNA using the multiplex PCR. The couples were then segregated into group A (40), B (20), and C (21). In groups A and B, both the partners tested positive for GTB but were asymptomatic.…”