Genital tuberculosis in Indian infertility patients

ObjectivesTo analyze the clinical and laparoscopic features of 40 infertile women with genital tuberculosis.Materials and methodsThis prospective clinical study was carried out at a tertiary care hospital from October 1, 2004, to August 30, 2006, with 150 infertile women in whom there was clinical suspicion of genital tuberculosis. All underwent diagnostic laparoscopy and biopsy for confirmation and other causes of infertility were excluded.ResultsAmong the 40 infertile women affected with genital tuberculosis there were cases of primary (n = 30) and secondary (n = 10) infertility; pelvic pain (n = 8); menorrhagia (n = 9); oligomenorrhea (n = 7); hypomenorrhea (n = 8); and primary (n = 2) and secondary (n = 2) amenorrhea. There were histories of pulmonary (n = 9) and abdominal tuberculosis (n = 6), ectopic pregnancy (n = 4), and antitubercular treatment (n = 10) in 10. There were cases of positive Mantoux test results (n = 2); endometrial aspiration showing tubercular endometritis (n = 10); positive acid-fast bacillus culture results (n = 1); and positive polymerase chain reaction results (n = 9). Laparoscopic examination revealed abnormally dilated, tortuous, and blocked fallopian tubes (n = 13); peritubal and periovarian adhesions (n = 18); Fitz Hugh Curtis syndrome (n = 15); omental adhesions (n = 18); and bowel adhesions (n = 15). Hysteroscopy revealed flimsy intrauterine adhesions (n = 7). All patients were treated for tuberculosis and 13 were counseled for in-vitro fertilization and embryo transfer or adoption.ConclusionGenital tuberculosis is common in India and a combination of clinical and laparoscopic diagnoses, along with endometrial histopathologic studies, acid-fast bacillus culture, and polymerase chain reaction assays provides the best available method for the diagnosis of genital tuberculosis in infertile women.