Guinea-pig inoculation and culture for Mycobacterium tuberculosis in infertile women. A study of cost-effectiveness.

Endometrial biopsy (EB) specimens obtained from infertile women at Natalspruit Hospital are routinely subjected to histological examination, culture for tubercle bacilli and guinea-pig inoculation (GPI). A retrospective analysis of 103 EB specimens from Natalspruit Hospital and 255 specimens from private patients (in the Greater Johannesburg area) examined during January 1981 - August 1983 revealed a 1,96% overall incidence of endometrial tuberculosis (TB). The incidence of endometrial TB in infertile Black women attending Natalspruit Hospital during this period was 4,85%. Confirmed cases of endometrial TB yielded positive cultures in 57% of cases; GPIs were positive in 71% of cases and histological findings were positive in 42% of cases. Statistical comparison of culture and GPI was difficult because of the small number of cases involved. Cost analysis of culture and GPI suggested that culture of EB specimens as a routine screening procedure for infertile patients is more cost-effective and that GPI tests should be reserved for cases in which TB is highly probable. The literature on symptoms, pathology and diagnostic investigation of pelvic TB is briefly reviewed.