Female Genital Tuberculosis leads to infertility among women

Women of all ages are affected by this silent disease, albeit those in their reproductive years are more likely to be affected

Tuberculosis (TB), usually considered restricted to a person’s pulmonary system, can also be a major factor in infertility among women, according to experts. A study conducted by the Indian Council of Medical Research (ICMR) has indicated that more than 50 percent of female patients in India who undergo in-vitro fertilization (IVF) procedures have been diagnosed with genital tuberculosis (FGTB).

Women across various age groups often lack awareness about FGTB, as there are no symptoms. The silent disease affects women of all ages, albeit those in their reproductive years are more likely to be affected. 

According to Dr JB Sharma, Obstetrician and Gynecologist at All India Institute of Medical Sciences (AIIMS) in New Delhi, FGTB causes significant morbidity, also a major reason for infertility. Medical experts stress that FGTB remains underestimated, highlighting the necessity for increased awareness and prompt medical attention. A thorough assessment by healthcare professionals is crucial for accurate diagnosis and effective treatment.

“Female genital tuberculosis is a condition resulting from infection by Mycobacterium tuberculosis in the female reproductive system. This health issue contributes notably to infertility among women, particularly in developing nations,” Dr. Sharma said.

A 2020 study published in the Indian Journal of Tuberculosis highlighted that the Prevalence of FGTB in infertility cases varies from 1 percent in the USA to about 19 percent in India with a higher incidence in tertiary hospitals due to the concentration of referred cases. The genital organs affected by FGTB are fallopian tubes (95-100% cases), uterus (50-60%), ovaries (20-30%), cervix (5-15%), uterine myometrium (2-5%), vulva and vagina (1%).

FGTB damages the cilia in the fallopian tubes. This affects the quality of eggs, making it harder for them to implant, along with cervicitis that influences cervical mucus, hampering the movement of sperm. Experts view this disease as significantly impairing, but early treatment can lead to improved fertility results.

While emphasizing that the uterus acts as the infant’s bed for nine months of pregnancy, Dr Sharma explains FGTB disrupts the uterus’s ability to be ready for pregnancy. 

“The disease results in problems with markers and blood supply in the uterus, and it can cause the endometrium to shrink and form adhesions. Additionally, there are various tube-related issues, such as blocked tubes, damage to cilia affecting their function, and inflammation that leads to mass formation, all of which impact fertilization and the attachment of an embryo,” he says adding that numerous faulty ovarian functions can lead to decreased conception rates and a higher chance of miscarriage.

Hidden problem 

Many FGTB patients don’t show any signs, especially at the beginning. Often, the only sign is infertility. If not treated early, tuberculosis can cause serious harm to the fallopian tubes. It can also cause uterine lining damage and the formation of knots within the uterine cavity, which can sometimes be severe (Asherman’s syndrome). Patients are also more prone to have ovulation issues, low ovarian reserve, poor oocyte (egg) quality, implantation failure, a lower pregnancy rate, and an increased miscarriage rate.

Research from the ICMR found that over 50 percent of women in India who come for IVF treatments have genital TB. The main challenge in dealing with TB in women’s reproductive organs is its complexity and its fewer signs in the early stages. At AIIMS, around 18 percent of women who seek help for infertility are found to have TB in their reproductive areas.

Infertility Treatment

In almost all women with genital TB, the tubes connecting the ovaries to the uterus (fallopian tubes) are affected. About half of these women also have problems with the lining of the uterus. When the tubes are blocked or damaged, a common way to help conceive is called In Vitro Fertilization and Embryo Transfer (IVF-ET). But women with a thin lining of the uterus or something called Asherman’s syndrome might need another procedure before starting IVF.

For patients with fluid-filled damaged tubes (called hydrosalpinges), the success of IVF drops a lot if the IVF is done while the tubes are still like that. For these women, it’s suggested to have a procedure called Hysterolaparoscopy before IVF. In this procedure, the affected tubes are removed or clamped, which helps the chances of IVF working. The success of IVF is based on things like how severe the disease is, how much the lining of the uterus is damaged, the woman’s age and the health of her eggs.

Also Read : Female Genital Tuberculosis: All you need to know about this less known form of TB