Tuberculosis (TB) remains a serious public health issue globally, despite a lowering trend in deaths due to improved diagnosis and treatment. While men account for around 60% of TB infections and deaths, women also bear a significant disease burden. One of the lesser-known but critical concerns related to TB is its impact on female fertility.

The Link Between TB and Infertility

Genital tuberculosis (uterine tuberculosis) in females is widely acknowledged as a key aetiological cause of infertility in regions with high TB incidence. This condition is often a secondary complication resulting from TB in other parts of the body. The disease primarily spreads via haematogenous or lymphatic pathways, affecting the reproductive organs and leading to infertility, among other complications.

Unfortunately, the conception rate in infertile individuals following anti-TB treatment (ATT) is not particularly encouraging. Dr Sunita Kapoor, Director and Laboratory Head at City X-Ray and Scan Clinic Pvt. Ltd., says that diagnosing genital tuberculosis is comparatively difficult, as it requires multiple diagnostic approaches.

Effect of Tuberculosis on Pregnancy

TB can affect every stage of female reproduction, from fertility to birth outcomes. "Infection of the reproductive organs can cause infertility and lead to complications such as abdominal or tubal pregnancy. According to several research studies, vaginal TB accounts for 1 to 17% of all infertility cases," she says.

"Tubal blockage, endometrial involvement impairing implantation, ovarian involvement causing ovulatory failure, and uterine cavity synechiae are all possible complications of genital TB, as per Dr Kapoor. She also points out that TB culture or NAAT are confirmatory tests, provided a good representative sample is obtained from the affected site," Dr. Kapoor adds.

Successful pregnancy following TB treatment is uncommon and often necessitates in vitro fertilisation (IVF) and embryo transfer. Prematurity rates in tuberculous women varied from 23 to 44% before treatment, with the highest rates among those most severely affected. Research further shows that children born to tuberculosis-infected mothers have a 2- to 3-fold higher risk of preterm birth and low birth weight, as well as a 6-fold higher risk of perinatal mortality. Factors such as late diagnosis, insufficient therapy, and severe illness contribute to adverse neonatal outcomes. However, early detection and adequate treatment have shown no negative impact on pregnancy outcomes.

Dr Kapoor explains, “A complete blood count, erythrocyte sedimentation rate, and chest X-ray for active or healed pulmonary tuberculosis can give indirect evidence of acute or chronic infection. TB culture or NAAT are confirmatory tests, subjected to a good representative sample from the affected site. Other options include the microscopic examination of cellular changes in endometrial biopsy specimens for indirect evidence of TB.”

According to Dr Pallavi Panse, Consultant Gynaecology at Jupiter Hospital, “Genital tuberculosis is treated in the same way as pulmonary tuberculosis is treated: with a six-month antibiotic regimen based on WHO recommendations. Some women who were infertile owing to genital tuberculosis can now conceive on their own after receiving therapy. One research study found a 60% overall pregnancy rate, with more than 90% of patients falling pregnant within or within six months of completing TB treatment.”

Dr Panse also emphasises, “Genital tuberculosis is a leading cause of infertility in women, although its unique appearance and diagnostic problems may go unrecognised. Clinicians should examine genital tuberculosis as a possible cause of infertility in their patients. Early detection and appropriate treatment are critical to protecting or restoring these patients' fertility.”

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