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Tuberculosis has been eradicated in the developed countries. However it is still
endemic in India and in a large proportion of patients with blocked fallopian
tubes, the cause is tuberculosis of the genital organs.
Tuberculosis (TB) first affects the lungs in young girls and if not detected
may eventually spread through the blood to the genital organs. Over a period of
time the body overcomes the infection or it lies dormant waiting to flare up at
some time in the future when the woman is more vulnerable. Tuberculosis heals
with a lot of scarring and in the genital organs, they usually affect the
fallopian tubes (95% of cases) causing irreversible damage, which cannot be
corrected by surgery. In 50% of cases, the lining of the uterus (endometrium)
is affected which prevents implantation of the pregnancy. Tuberculosis of the
genital organs may manifest with reduced menstrual flow but in the majority of
cases is only diagnosed in the work up of the infertile couple.
Tuberculosis of the genital organs may be suspected from non specific laboratory
investigations. However confirmation of the diagnosis is usually by
laparoscopy and histological examination of tissue sent for
examination. The
HSG picture also helps to clinch the diagnosis in cases where other
tests have been inconclusive. Today PCR of tissue suspected to be affected with
TB is the gold standard to pick up even in very early cases of TB.
Very often by the time the disease is diagnosed it is inactive or healed and in
these cases lengthy therapy with medication is not necessary. If active,
treatment involves taking 3-4 drugs for a period of 6months to a year and
definitive treatment of infertility has to be deferred accordingly.
One cannot stress strongly enough that surgery to reopen the tubes blocked
due to TB is futile and a medical contraindication. The only treatment possible
is IVF and that too, only
in those cases in which the endometrium has been spared. If the lining of the
uterus is destroyed the only recourse is surrogacy. In cases where the
endometrium is uninvolved one can expect results with IVF/ICSI procedures
nearly on par as in patients without the disease as the eggs produced by the
ovary, in genital TB, are healthy and free from the disease.
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