Expressing concern at the rising cases of genital tuberculosis, a leading cause of infertility in both men and women, doctors warn that as much as “10 per cent of the couples seeking fertility assistance have the disease and are unaware of it”.
“Genital tuberculosis is treatable in an early stage but can damage 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 coming with genital TB have increased by over 10 per cent in the past 5 years. Medicines for tuberculosis can eradicate the bacterial infection but cannot revert the damage it has done, which is why such couples seek fertility services, depending on the seriousness of the impairment,” said Dr Gauri Agarwal, founder-director, Seeds of Innocence.
According to Dr Agarwal, embryo transfer has been the most successful IVF treatment for women who have genital TB while men can undergo minor procedures such as testicular sperm aspiration (TESA), in which sperm cells and tissue are extracted from the testicle using a small needle and the sperm is separated from the tissue to fertilise eggs.
Notably, tuberculosis in the reproductive organs is just one of the forms of TB and is caused when the person contracts the mycobacterium tuberculosis bacteria which is then transported by the blood to other organs. In women, genital TB can affect fallopian tubes and uterus, its endometrium lining and cause adhesion of the uterine wall, known as Asherman’s syndrome. In men, it can cause inability to ejaculate, low sperm motility and inability of the pituitary gland to produce sufficient hormones.
According to Dr Amita Shah, medical director and head of obstetrics and gynaecology, Miracles Mediclinic; Apollo Cradle Hospital, Gurugram, genital TB is “mostly found in women when they face issues of infertility and go for treatment”.
“Although in most of the cases, it may not cause any symptoms or signs at all but some of the prevalent symptoms are weight loss, fatigue and mild fever, no menstrual bleeding or abnormally heavy bleeding and infrequent menstrual periods. The infection is always hard to diagnose because of the unawareness about the same and it is a silent invader of the genital tract. In some cases, bacteria might damage the reproductive organs. The chances of pregnancy in women suffering from genital tuberculosis are very poor even after completing the full treatment, though IVF can help in conceiving. Genital tuberculosis can be asymptomatic or may present atypical symptoms or even mimic other clinical conditions that make the situation even more challenging. Therefore it is necessary that we consider the possibility of TB in patients who have symptoms of infertility, chronic pelvic pain and menstrual dysfunction. This is very important for those women who fall unto the high risk category for TB infection,” said Dr Shah.
According to the Indian Council of Medical Research (ICMR), half of the women in India seeking IVF procedure have been reported to have genital TB and the prevalence has increased by more than 10 per cent between 2011 and 2015.
“This is a very alarming statistics 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 missing symptoms are key hindrances to control this health condition,” she mentioned.
So, what can women do?
“Women must watch out for symptoms such as irregular menstrual cycle, swelling in the genital area, vaginal discharge with blood, bleeding or pain after intercourse that may indicate an infection. Adopting safe sexual practices and getting a Bacille Calmette-Guerin (BCG) vaccine can help prevent acquiring an infection in both men and women. Besides, one must ensure well-ventilated rooms, natural light, and good hygiene practices to prevent infection,” added Dr Agarwal.