Genital tuberculosis as a cause of female infertility: a diagnostic challenge

Background: Infertility is an important health issue which has definite physiological, psychological and social implications. 40 to 50% cases of infertility are attributed to the female factors. Although genital tuberculosis is among the main causes of female infertility, it poses a great diagnostic challenge in women of reproductive age. A high degree of suspicion aided by intensive investigations is important in the diagnosis of the disease, especially in its early stage, so that treatment may improve the prospects of cure before the tubes are damaged beyond recovery.
Objective: To find out the prevalence of genital tuberculosis in females presenting with infertility in a tertiary care hospital over a given period of time, and diagnostic comparison of endometrial tuberculosis by Histopathological examination (HPE) and GeneXpert.
Methods: The prospective observational study was conducted over one year duration. A total of 176 endometrial samples were collected from the women, satisfying the inclusion and exclusion criteria.
Results: GeneXpert test was positive in 1 patient (0.56%) in our study. On histopathological examination of endometrium, 10 cases (5.7%) were found positive for tubercular endometritis. Hysteroscopy of patients with past history of tuberculosis revealed chronic inflammatory changes (intrauterine synechiea, periostial fibrosis, and calcification) in 39.5 % cases.
Conclusions: Endometrial histopathological examination shows not only the tuberculous endometritis, but also gives additional information about local factors of endometrium concerning non-specific and specific infections and anovulatory cycles. GeneXpert if positive on endometrial biopsy is a reliable test for FGTB and treatment can be started on its basis.