U N Jindal1, S Verma, Y Bala. 1. Jindal IVF and Sant Memorial Hospital, 3050, Sector 20 D, Chandigarh 160020, India. drunjindal@gmail.com
Abstract
BACKGROUND: The endometrial tuberculosis (TB) PCR test is now commonly employed for the diagnosis of female genital TB, a common cause of infertility in India. Although treatment in the absence of demonstrable tubal damage may be of doubtful benefit to fertility, the presence of mycobacterial DNA demonstrated by a positive PCR indicates infection by tubercle bacilli causing sub-clinical or latent disease potentially responsible for future clinical manifestations. This study was undertaken to assess the outcome of infertility management following early anti-tubercular treatment (ATT) based only on a positive endometrial TB-PCR test. METHODS: This was an intervention study conducted at an IVF center in northern India in 443 infertile women of whom 169 (38.15%) were found to have positive TB-PCR (Group I), while 274 (61.85%) had negative Mycobacterium tuberculosis (MTB)-PCR (Group II). Infertile women of <40 years of age, without any evidence of tubo-peritoneal or endometrial involvement, who underwent endometrial biopsy for the detection of MTB by PCR, were included. All the TB-PCR positive women were administered standard 6-month anti-tubercular chemotherapy. Additional treatment with assisted reproduction techniques was offered in the case of failure of spontaneous pregnancy after completion of ATT. RESULTS: There were no statistical differences in the two groups in the overall pregnancy rate, 101 (59.8%) versus 167 (60.9%). In Group I, 48 (92.3%) spontaneous conceptions occurred within the first 12 months, i.e. during the period of ATT administration or within 6 months of treatment completion; in Group II, the occurrence of spontaneous conceptions was distributed more evenly in relation to time, i.e. 36 (53.7%) in <12 months as compared with 31 (46.3%) after first year (P< 0.001). CONCLUSION: Infertile women without tubal or endometrial damage given early anti-tuberculosis treatment based on a positive endometrial TB-PCR test had an excellent chance of early spontaneous conception.
BACKGROUND: The endometrial tuberculosis (TB) PCR test is now commonly employed for the diagnosis of female genital TB, a common cause of infertility in India. Although treatment in the absence of demonstrable tubal damage may be of doubtful benefit to fertility, the presence of mycobacterial DNA demonstrated by a positive PCR indicates infection by tubercle bacilli causing sub-clinical or latent disease potentially responsible for future clinical manifestations. This study was undertaken to assess the outcome of infertility management following early anti-tubercular treatment (ATT) based only on a positive endometrial TB-PCR test. METHODS: This was an intervention study conducted at an IVF center in northern India in 443 infertile women of whom 169 (38.15%) were found to have positive TB-PCR (Group I), while 274 (61.85%) had negative Mycobacterium tuberculosis (MTB)-PCR (Group II). Infertile women of <40 years of age, without any evidence of tubo-peritoneal or endometrial involvement, who underwent endometrial biopsy for the detection of MTB by PCR, were included. All the TB-PCR positive women were administered standard 6-month anti-tubercular chemotherapy. Additional treatment with assisted reproduction techniques was offered in the case of failure of spontaneous pregnancy after completion of ATT. RESULTS: There were no statistical differences in the two groups in the overall pregnancy rate, 101 (59.8%) versus 167 (60.9%). In Group I, 48 (92.3%) spontaneous conceptions occurred within the first 12 months, i.e. during the period of ATT administration or within 6 months of treatment completion; in Group II, the occurrence of spontaneous conceptions was distributed more evenly in relation to time, i.e. 36 (53.7%) in <12 months as compared with 31 (46.3%) after first year (P< 0.001). CONCLUSION: Infertile women without tubal or endometrial damage given early anti-tuberculosis treatment based on a positive endometrial TB-PCR test had an excellent chance of early spontaneous conception.