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Anti Tubercular Treatment And Infertility – RCOG London 2023
Today we talk about our work on tuberculosis and infertility. This was presented this year in London RCOG Conference. There has been a lot of debate on this topic especially whether and when and for how long we should be giving antitubercular treatment. There are multiple tests for tuberculosis .There can be microscopic examination, culture, PCR along with the initial test of monteaux and quantiferon gold.
A very good paper by many scientists including Dr JB Sharma from all India Institute suggests the composite reference screening ( CRS ) which has also been suggested by the WHO. https://www.sciencedirect.com/science/article/abs/pii/S0019570722000439 . In CRS history, physical examination and tests are put all together to decide whether ATT should be started or not.
History includes repeated failed IVF Cycles or repeated miscarriages without any underlying or a detectable cause. Examination could reveal a fixed uterus or multiple pelvic masses. Ultrasound could reveal a thin endometrium or adnexal mass . Laparoscopic findings of tuberculosis could be in the form of a python shaped tube , beaded tubes or adhesions in the abdomen . When we do a hysteroscopy it could be a scarred uterus. All these history ,examination findings plus laparoscopic and hysteroscopy findings combine to be give the CRS score which allows to start the antitubercular treatment.
This treatment is usually given for six months. It consists of two months of intensive treatment of rifampicin, isoniazid, pyrazinamide and ethambutol followed by four months of three drug treatment. Our paper that we presented saw about more than 50 patients with similar criteria . After receiving antitubercular treatment to them we found a significant increase in IVF pregnancy rates almost touching to 55 percent per embryo transfer.This is an important finding we’ve shared it in the world forum. We would like more and more uh doctors especially from countries where tuberculosis is common to collaborate these findings and see whether this treatment really helps our patients suffering from infertility.