Times of India
24 March 2009
By Umesh Isalkar
Pune, India

Reproductive system TB causing infertility
Of the various factors responsible for infertility in women, a little–known disease, genital (reproductive system) tuberculosis (TB), is gradually emerging as one of the biggest causes of the condition. The silent disease is drawing the attention of gynaecologists and infertility experts, as most infertility centres in the city get at least 10 to 15 cases of TB–induced infertility every month.

“Initial exposure to the TB–causing bacteria is through the lungs,” said gynaecologist Sanjay Gupte, “When the bacteria infects a woman’s genitals, it infects the uterus and the tubes, thus leading to infertility. It is also known to cause infertility in men, although the prevalence is much less.”

Calling genital TB one of the leading causes if infertility, gynaecologist and infertility expert Sunita Tandulwadkar said, “The disease, which can affect anyone from a 15 to 60 years of age, accounts for almost 15 per cent of the total patients attending OPD at IVF ( in–vitro fertilisation) and Endoscopy Centre at the Rubyhall Clinic. We found it to be the second most common cause of infertility after polycystic ovarian disease.” Tandulwadkar is also chief of IVF and Endoscopy Centre at Ruby Hall Clinic.

Elaborating on its symptoms, Gupte said genital TB is silent and does not have aggressive symptoms. “The disease may remain totally symptom–less or may lead to pelvic pain, fever, menstrual disturbances or vaginal discharge,” he explained.

Tandulwadkar said, “Fallopian tubes are the most commonly affected parts (50–70 per cent cases) followed by uterine cavity (5–10 per cent) and ovaries (10 per cent).”

What must be remembered here is that once the fallopian tubes are infected, infertility may become permanent, also patients whose pelvic cavity has been damaged cannot be helped with fertility problems. “TB in the fallopian tubes blocks this passage and leads to permanent infertility,” Gupte said. “These patients can be helped for their pregnancy by IVF if only the tubes are damaged. But if the pelvic cavity has been damaged, it needs skillful surgery to reverse this damage,” Tandulwadkar added.

Gupte said the percentage of rural women contracting the disease was slightly more than that of urban women. “Apart from that there were no differentiating factors in terms of socio–economic background or diet of patients,” Gupte said. Gynaecologist Leena Patankar said, “We screen all patients who come with complains of infertility for genital TB so that it is detected early.” Though the diagnosis is difficult, the most important test is endometual biopsy, ie testing the menstrual blood taken from the uterus.