Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis

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. 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. 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). 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.