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Does TB of the reproductive system cause infertility?

Q: I am a 34 years old woman who had got all the tests done required for infertility treatment. All tests are normal except the PCR test in endometrial biopsy, which gave positive test for Mycobacterium bacillus. My HSG test of tube was normal 3 years back. Uterus and cavity are normal. I had a miscarriage 3 years back after 10 weeks of pregnancy. I also had 3 biochemical pregnancies. My endometrial response was fine but the thickness is slightly less than the normal that time. It was around 9 mm on the 12 or 13th day of pregnancy. Two years back, the Anti TB IGM test had the value 1.12 but no treatment was taken. Does positive PCR test mean active TB in uterus?

A:Tuberculosis of reproductive system is the major cause of infertility in our country. Before the advent of molecular diagnosis (PCR and Real-time PCR) the diagnosis was based on clinical acumen. Molecular diagnostic tests have revolutionized the diagnosis of extra-pulmonary tuberculosis including that of reproductive system. However, a word of caution - since PCR assay is highly sensitive and is capable of detecting even one bacterium, it is very prone to give false positive results due to contamination of the sample. Many laboratories employing this do not take enough precautions to avoid cross contamination of sample during test runs. I do not know from where you got the sample tested. Therefore I suggest:

  • Get a second sample tested from a reputed laboratory.
  • Some times fluid from pouch of Douglas along with endometrial biopsy has more chances of giving a positive result in case of latent tuberculosis.
  • Get your ESR done as well.
  • Did you or any body in your family suffer from tuberculosis in the past?

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