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Can I conceive after endometrial tuberculosis?

Friday, 26 June 2009
Answered by: Dr B Shakuntala Baliga MD (AIIMS), FICOG
Professor and Senior Consultant Gynecologist & Colposcopist Mazumdar-Shaw Center for Cancer Research & Narayana Hrudayalaya Multispecialty Hospital, Bangalore
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Q. I am a 30 years old married woman have been trying to conceive for the last 3 years. Six months back I was diagnosed with blocked tubes. Laparascopy was carried out after 3 months and a sample of the fluid present in the tubes revealed endometrial tuberculosis (TB). I was under extensive therapy for 2 months and since then I am on AKT3. The doctor told me that the entire medication would be over after 3 months. 1. Will I be able to conceive normally after the therapy? Is it safe to go ahead with a pregnancy during the last two months of medication? 2. I have read that the infected tubes never get repaired. How far is it true? After laparascopy, the doctor told me that the tubes are open now. Should I go for another HSG? 3. How do I know that I am cured of TB? How is it decided that I can stop my medicines after 6 months? 4. Before all of this was diagnosed, I had normal periods. The flow had decreased somewhat though. Follicular monitoring showed satisfactory results. No other problems. Does it indicate that TB was detected at an early stage?

A.  I guess the diagnosis was on PCR for Myc TB and NOT on histopathology of the tubes? If this is so, then the TB is early, and you have good chance of spontaneous conception, once treatment is over. I wonder whether or not the doctor has performed endometrial biopsy for TB- histopathology and PCR. This is very important to diagnose whether or not the TB has involved the uterus (endometrium- which is lining of uterus). As per details given by you this has not been done? The TB starts with the tubes first (most of the time) and then spreads down to the uterus- so it is important to have a biopsy from the uterus. In any case, treatment has to be taken even if only tubes are involved. If the biopsy from uterus is positive for TB on histopathology, then your chances of spontaneous conception are extremely less; however, if histopathology is negative for TB but PCR is positive, then chances of spontaneous conception are fair. However, if you miss your menses, and you test positive for pregnancy, you MUST have ectopic pregnancy ruled out (pregnancy in tubes), as this is quite common after TB treatment, as the tubes are functionally destroyed, even though "open", and the fertilized egg does not reach the uterus. Finally, you can conceive by IVF-ET (test tube baby), even if histopatholgy of uterus biopsy is positive for TB, and you do not have a spontaneous conception. However, even this depends upon hysteroscopic findings PRIOR to IVF to judge how the endometrium is, whether or not there are intrauterine adhesions, their severity etc. You need to undergo an endometrial biopsy for PCR Myc TB and histopathology after a minimum of total 4 months (some do after 6 months) of treatment to see whether or not it has become negative- that will show response to treatment. Therefore, it is important to have had this test PRIOR to starting treatment, because one cannot undergo laparoscopy just for this. Also, I usually give treatment for total 9 months, and advise patient not to conceive before treatment is complete. Lastly, if no other focus of TB was detected in your case (usually lung or abdomen), then your husband needs to have his semen tested for PCR Myc TB as sometimes it is passed on from one partner to the other.

A.  I guess the diagnosis was on PCR for Myc TB and NOT on histopathology of the tubes? If this is so, then the TB is early, and you have good chance of spontaneous conception, once treatment is over. I wonder whether or not the doctor has performed endometrial biopsy for TB- histopathology and PCR. This is very important to diagnose whether or not the TB has involved the uterus (endometrium- which is lining of uterus). As per details given by you this has not been done? The TB starts with the tubes first (most of the time) and then spreads down to the uterus- so it is important to have a biopsy from the uterus. In any case, treatment has to be taken even if only tubes are involved. If the biopsy from uterus is positive for TB on histopathology, then your chances of spontaneous conception are extremely less; however, if histopathology is negative for TB but PCR is positive, then chances of spontaneous conception are fair. However, if you miss your menses, and you test positive for pregnancy, you MUST have ectopic pregnancy ruled out (pregnancy in tubes), as this is quite common after TB treatment, as the tubes are functionally destroyed, even though "open", and the fertilized egg does not reach the uterus. Finally, you can conceive by IVF-ET (test tube baby), even if histopatholgy of uterus biopsy is positive for TB, and you do not have a spontaneous conception. However, even this depends upon hysteroscopic findings PRIOR to IVF to judge how the endometrium is, whether or not there are intrauterine adhesions, their severity etc. You need to undergo an endometrial biopsy for PCR Myc TB and histopathology after a minimum of total 4 months (some do after 6 months) of treatment to see whether or not it has become negative- that will show response to treatment. Therefore, it is important to have had this test PRIOR to starting treatment, because one cannot undergo laparoscopy just for this. Also, I usually give treatment for total 9 months, and advise patient not to conceive before treatment is complete. Lastly, if no other focus of TB was detected in your case (usually lung or abdomen), then your husband needs to have his semen tested for PCR Myc TB as sometimes it is passed on from one partner to the other.

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