One in ten Indian female affected by TB related ailment
Dr Sowjanya Aggarwal
With over 20 lakh cases of Tuberculosis worldwide, India is the second leading country to contribute to the related mortality rate. Usually the TB bacteria affects the lungs and if left unnoticed can also spread throughout the body and cause secondary infection affecting the kidneys, abdomen, brain and pelvis. Genital TB can be a great cause of concern for both the partners if they are trying to conceive.
“Though the symptoms may not be so evident enough but the effects can be seen if timely diagnosis is not done. The infections can spread to the uterus and cause thinning of the endometrium thereby creating a barrier in development of the foetus.
Blockage of fallopian tubes along with the involvement of the endometrium is the major cause of infertility. Women are more often affected than males and present with symptoms such as irregular menses, vaginal discharge with blood stains and chronic pelvic pain. The condition can even mimic other gynecological conditions like ovarian cysts, PID, and even genital cancer.
As per the latest study done by the ICMR, over 50% of female patients coming for IVF procedure have been reported to have genital TB. In over 95% of the cases, the infection was found to affect the fallopian tube, 50% endometrium and 30 % ovaries. In most of the cases the disease was asymptotic or present with very few symptoms. Incidents reported in the Delhi NCR region shows that one in every five women with TB were unable to conceive naturally which accounted for 40%.
The diagnosis is made by detection of acid-fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy can diagnose genital tuberculosis by various findings. In males Clinical presentation may range from a painless scrotal mass, which is the commonest, to irritative lower urinary tract symptoms, hematuria, dysuria, hemospermiaand infertility where there is reduction in sperm quality, concentration and motility.
Timely diagnosis and treatment are imperative to prevent any permanent injury to patient’s reproductive organs. Treating TB with medications can help women to conceive. The spontaneous conception rate may vary from 31 to 59 per cent among patients treated with ATT for FGTB with better rates in patients diagnosed and treated earlier. If the patient fails to conceive spontaneously, assisted reproduction techniques can be considered to increase the conception rate. Treatment with ATT followed by In vitro fertilization showed an overall pregnancy rate of 60 per cent.
One can prevent themselves against TB by staying away from crowded areas, where you could come into regular contact with people who are infected, have access to a proper healthcare system and undergo physical exams on a regular basis, get vaccinated against the condition.
Most of the patients present in advanced stage with scarring, severe fibrosis and adhesions and treatment outcomes, especially with regard to infertility, are poor. Hence, early diagnosis and correct treatment is vital to avoid complications and to restore fertility.
(DrSowjanyaAggarwal is an IVF Expert at the Max Hospital, Vaishali, New Delhi)
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