Expressing concern about the increase in cases of genital tuberculosis, one of the leading causes of infertility in both men and women, doctors warn that up to “10 percent of couples seeking fertility assistance have the disease and are unaware of it.”
“Genital tuberculosis can be treated at an early stage, but it can damage the fallopian tubes in women and cause azoospermia (complete absence of sperm in semen) in men if diagnosis or treatment is delayed. The number of couples who come with genital tuberculosis has increased by more than 10 percent in the last 5 years. Tuberculosis drugs can eradicate the bacterial infection, but cannot reverse the damage it has caused, so these couples seek fertility services, depending on the severity of the disability, ”said Dr. Gauri Agarwal, founding director of Seeds of Innocence.
According to Dr. Agarwal, embryo transfer has been the most successful IVF treatment for women who have genital TB, while men may undergo minor procedures such as testicular sperm aspiration (TESA), in which sperm cells and tissue are removed from the testicle with a small needle and separates the sperm from the tissue to fertilize the eggs.
In particular, tuberculosis in the reproductive organs is just one of the forms of TB and occurs when a person contracts the bacterium Mycobacterium tuberculosis, which is then carried by the blood to other organs. In women, genital tuberculosis can affect the fallopian tubes and uterus, the lining of the endometrium, and cause adhesion of the uterine wall, known as Asherman’s syndrome. In men, it can cause the inability to ejaculate, low sperm motility, and the inability of the pituitary gland to produce enough hormones.
According to Dr. Amita Shah, Medical Director and Head of Obstetrics and Gynecology at Miracles Mediclinic; Apollo Cradle Hospital, Gurugram, genital tuberculosis “is found mainly in women when they face infertility problems and seek treatment.”
Although in most cases, it may not cause any symptoms or signs, but some of the prevalent symptoms are weight loss, fatigue and mild fever, not menstrual bleeding or abnormally heavy bleeding and infrequent menstrual periods. Infection is always difficult to diagnose due to ignorance of it and is a silent invader of the genital tract. In some cases, bacteria can damage the reproductive organs. The chances of pregnancy in women with genital tuberculosis are very slim even after completing the full treatment, although IVF can help to conceive. Genital tuberculosis can be asymptomatic or have atypical symptoms or even mimic other clinical conditions that make the situation even more challenging. Therefore, we need to consider the possibility of TB in patients with symptoms of infertility, chronic pelvic pain, and menstrual dysfunction. This is very important for those women who are in the high risk category for TB infection, ”said Dr. Shah.
According to the Indian Council for Medical Research (ICMR), women in India seeking IVF procedure They have been reported to have genital tuberculosis and the prevalence has increased by more than 10% between 2011 and 2015.
“This is a very alarming statistic as India has about a quarter of the global TB burden and genital TB can be a silent infection. Lack of awareness about the disease and the absence of symptoms are key obstacles to controlling this health condition, “he mentioned.
So what can women do?
“Women should be on the lookout for symptoms such as irregular menstrual cycle, swelling in the genital area, bloody vaginal discharge, bleeding or pain after intercourse that may indicate infection. Adopt safe sexual practices and obtain a Bacille Calmette-Guerin (BCG) can help prevent the acquisition of an infection in both men and women. In addition, well-ventilated rooms, natural light and good hygiene practices must be ensured to prevent infection, ”added Dr. Agarwal.