Genital tuberculosis, reason for infertility among women

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It all started with mild abdominal pain and irregular vaginal bleeding for 30-year-old Isha Ravi. Failing to heed the symptoms, the problem aggravated and Isha began to suffer from irregular periods, chest pain and pain in the abdomen.

Despite umpteen attempts by Isha and her husband, the couple failed to conceive.

It was a moment of shock for Isha and her husband, when the doctor revealed that she was an acute patient of "Genital Tuberculosis". An endometrial biopsy was recommended to test the lining of her uterus which clearly stated that she was infertile and the problem aggravated due to her not paying heed to the disease at the initial level.

Though doctors clearly told her that she won't be able to conceive ever, they have suggested to Isha to start the medication to prevent any sort of complication.

Doctors say that nearly 90 percent of women with genital tuberculosis are diagnosed in the 15-40 years age group. Infertility on account of genital tuberculosis is 60-80 percent. Doctors say that usually TB of the uterus and fallopian tubes is the cause for infertility but in the case of Isha the "endometrium lining" of her uterus was damaged.

A thick, healthy lining of the uterus, known as the endometrium is necessary for a healthy menstrual cycle and pregnancy.

Recent studies have concluded that till a decade ago only 10 percent of the total tuberculosis patients suffered from genital tuberculosis, but the percentage has now increased to 30 percent due to ignoring the disease in the initial stages and lack of awareness.

"The tuberculosis starts affecting the genitals once the 'mycobacterium tuberculosis' enters the human body. Initially it does not affect and remains silent as most of us can fight off the infection. However, later these latent bacilli can get reactivated, and then spread throughout the body through the blood stream. It is only when it lodges and infects the genital tract, that TB bacteria can cause genital TB and can cause infertility," Rajesh Chawla, senior consultant, respiratory medicine at Delhi-based Indraprastha Apollo Hospital told IANS.

In males, genital tuberculosis causes tuberculous epididymo-orchitis, blocking the ureteral passage, as a result of which the man becomes azoospermic - lack of sperms - and is not able to ejaculate during intercourse because the tract is blocked.

"While in the woman the TB causes infection of the uterus, fallopian tubes; this infection can often be silent, and may not cause any symptoms or signs at all. It later on leads to infertility. The problems may also include bleeding discharge, ulcers, among other symptoms," Chawla told IANS.

A recent study by the Indian Journal of Medical Research through its survey stated that the number of women with genital tuberculosis in India has increased to 30 percent in 2015 from 19 percent in 2011.

The report also stated that Saudi Arabia has the second highest number of genital tuberculosis patients with 21 percent.

Vikas Maurya, senior consultant, respiratory medicine and Interventional pulmonology at Delhi-based BLK Super Speciality Hospital told IANS: "Genital TB is a matter of great concern because the symptoms don't appear easily and by the time it's realized it already leaves an impact on the fertility of humans."

He said that even sexual intercourse with an infected person is one of the means of getting genital tuberculosis.

"As being a silent intruder it's very difficult to notice the problem in the initial stage. Symptoms like irregular menstrual cycle, vaginal discharge that is stained with blood, pain after intercourse could be noticed in females, while in males -- unable to ejaculate, low sperm motility and pituitary gland not able to produce sufficient hormones can be seen," Maurya told IANS.

Emphasing that genital tuberculosis and the problem of infertility can be cured, he said that women worry whether after contracting genital TB will they be able to conceive. Maurya said proper TB medication can help the women go on and have a successful pregnancy.

"The treatment with anti-TB medicines should be started to avoid more complications. The course of antibiotics for six to eight months should be completed properly, but it doesn't guarantee the repair of fallopian tubes. Many doctors perform surgery to repair the tubes, but it's a futile job. Lastly, the intervention has to be either in-vitro fertilization or Intracytoplasmic sperm injection (ICSI)," he added.

According to the World Health Organisation(WHO), India accounts for more than 300,000 TB deaths every year and ranks at fifth position in the global scale in TB incidents.

Anurag Khaitan, senior consultant, Urology at Gurgaon-based Paras Hospital told IANS: "The disease is very old and has been prevalent since ancient times; it has been found even in Egyptian mummies."

Stressing on the need for awareness, Khaitan said If a family member or colleague is an active TB patient, then people around them need to be cautious and should go for tests like chest X-Ray, tuberculin test to know whether they have been hit by TB or not.

"The government agencies and non governmental organisations need to create awareness through various media. Free medicines need to be supplied. DOTS (Directly Observed Treatment, Short Course) and vaccination are very successful programmes," Khaitan told IANS.