After treatment for genital tuberculosis (TB), IVF helps woman give birth

This is not sensational news but in spotlight because CNS recently reported that genital tuberculosis was one of the lead causes of tubal infertility and only 2 per cent women with genital TB delivered live births. It was a very positive news that a woman with genital TB successfully completed anti-TB treatment and then due to in-vitro fertilisation technique, also succeeded in giving births to normal baby (well, two babies in this case!). The Hindustan Times (Lucknow, 25 March 2011) reported that: "Deepti of Rajajipuram, married for eight years, delivered twins (male children) on Wednesday after being treated at the fertility centre of the Queen Mary's Hospital. The in-vitro fertilisation technique helped the woman conceive. Earlier, she was unable to conceive due to genital tuberculosis (TB)."

Genital tuberculosis (TB) is a major cause of tubal infertility, said Mamta Jacob of Global Health Advocates (GHA) at a meeting on importance of addressing TB in context of women's health in New Delhi, India, to mark the International Women's Day (8th March). Only two per cent of women with genital TB have live births. It is usually asymptomatic so needs higher degree of suspicion so that proper diagnosis can be made and standard treatment provided as early as possible, said Dr Nerges Mistry, Director, The Foundation for Medical Research, Mumbai, who was another keynote speaker at the above mentioned meet.

Genital TB is responsible for infertility in 5-10 per cent of women. In Australia, 1 per cent infertility in women is attributed to genital TB but in India, 19 per cent infertility in women is attributed to genital TB, said Dr Nerges Mistry.

Also the impact of genital TB is more severe on lives of women because mostly genital TB impacts women of age group 15-35 years. Only 10% of genital TB in women is post-menopausal, said Dr Nerges Mistry.

Women with genital TB present with bleeding discharge, ulcers, among other symptoms if any. Genital TB is always hard to diagnose, because of the fact that it is a silent invader of the genital tract. For diagnosing genital TB, AFB smears, polymerase Chain Reaction (PCR) tests, CT or MRI scanning or ultrasound might be used as appropriate, said Dr Nerges Mistry. The treatment of genital TB is same in case of drug-susceptible TB - 6 months of WHO recommended directly observed treatment shortcourse (DOTS). However, 2 per cent of genital TB cases are likely to be of multidrug-resistant TB (MDR-TB). Surgery might be required if medicines fail said Dr Nerges Mistry.

The solution lies in early case detection and providing standard treatment for genital TB. Sadly if women with genital TB are diagnosed late, the infertility risk and other harm done to their tissue are likely to be much more severe.

In 2008, 3.6 million women were sick with TB. "Compared to pregnant women without TB disease, pregnant women with TB have more severe impact on pregnancy outcomes. Rates per 1000 pregnancies of low birth weight (< 2.5 kg) for women without TB is 165, and for women with TB is double at 342; for prematurity (< 37 weeks) the rate for women without TB is 111 and for those with TB is 228 (twice); for perinatal death, the rates for women without TB is 16, but for those with TB is nearly five times higher at 101; for foetal death (16-28 weeks), the rates for women without TB is 2, but for those with TB is nearly ten times higher at 20" said Mamta Jacob.

Raising awareness about genital TB is surely a key. Engaging women with TB or who have successfully completed TB treatment as equal partners in addressing the challenge posed by genital TB will go a long way in saving human agony, morbidity and lives.

Bobby Ramakant - CNS 

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Citizen News Service (CNS), India/Thailand