Genital tuberculosis in the infertile women - an update.

Tuberculosis is endemic in many developing countries of the world including Bangladesh. Genital tuberculosis is a significant cause of infertility in the women of these countries. The diagnosis of genital tuberculosis in infertile women is difficult as most of the cases are usually asymptomatic. A high index of clinical suspicion is required. Genital tuberculosis always affects the fallopian tubes. It affects the endometrium in half of the cases. In addition to tuberculin skin tests and interferon gamma release assays, procedures like hysterosalpingography, laparoscopy-dye test, endometrial curettage and laparoscopy with multiple sampling for smear microscopy and culture for mycobacterium tuberculosis can detect the cases. In recent years diagnosis has been improved by polymerase chain reaction targeted against mycobacterium tuberculosis DNA. Following early diagnosis, treatment with anti-tubercular drugs is favourable for fertility only when tubal and endometrial damage is minimal. In cases where the organs are more severely involved the outcome is poor even with in- vitro fertilization.