Role of latent female genital tuberculosis in recurrent early pregnancy loss: A retrospective analysis

Bishista Bagchi, Siddhartha Chatterjee, Rajib Gon Chowdhury, Bishista Bagchi, Siddhartha Chatterjee, Rajib Gon Chowdhury

Abstract

Background: Latent Female Genital tuberculosis (FGTB) or tubercular infestation is prevalent in Southeast Asia and even the presence of tubercular bacilli in the genital tract is becoming an important factor for reproductive failure. An immature endometrium becomes non-receptive, preventing implantation or rejection of implanted embryo in early months, resulting in recurrent pregnancy loss (RPL) in association with other factors.

Objective: To detect the underlying causes of RPL in addition to the proven causes like uterine cavity defects, thrombophilia, chromosomal abnormalities, etc.

Materials and methods: 317 women with RPL, enrolled over a period of 60 months (January 2014 to December 2018) conducted at Calcutta Fertility Mission in the present study. They were grouped in A, B, and C and undergone routine tests for the same along with the PCR test with an endometrial aspirate.

Results: Patients with only latent FGTB (Group A), patients with FGTB and associated factors (Group B), and patients with other causes of RPL (other than latent FGTB) (Group C) were34.4%, 42.3%, and 23.3% respectively. About 29.36%, 47.01%, and 21.62%of the patients had achieved pregnancy in Group A, B, and C, respectively. The rate of miscarriage was high in both Groups A and B, affected with latent FGTB, and live-birth was higher (75%) in Group C that did not have tubercular involvement of the genital tract.

Conclusion: The tubercular infestation or latent FGTB as per our study appears to be a very important cause of RPL in patients with recurrent "unexplained" miscarriage. It should be treated adequately at an early stage to prevent permanent damage to pelvic organs and restore reproductive health in women.

Keywords: Endometrium; Implantation.; Female genital tuberculosis; Recurrent pregnancy loss.

Copyright © 2019 Bagchi et al.

References

    1. Sharma JB., Sharma E., Sharma S., Dharmendra S. Female genital tuberculosis. Revisited. Indian J Med Res. 2018 Suppl.): S71-S83.
    1. Mahajan N., Naidu P., Kaur S. Insight into the diagnosis and management of subclinical genital tuberculosis in women with infertility. Journal of Human Reproductive Sciences. 2016;9(3):135. doi: 10.4103/0974-1208.192043.
    1. Datta A., Chaudhuri A., Chatterjee S., Chowdhury R., Bhattacharya B. Role of endometrial cytokines of the female genital tract tuberculosis in the context of infertility. BLDE University Journal of Health Sciences. 2018;3(1):24. doi: 10.4103/bjhs.bjhs_1_18.
    1. Ravi B., Gupta D. O., Pooja S., Bokariya P. Alveolar rhabdomyosarcoma of oral cavity##hssm###8212;a rare case. Al Ameen Journal of Medical Sciences. 2010;3(3):255–258.
    1. Shahzad S. Investigation of the prevalence of female genital tract tuberculosis and its relation to female infertility: An observational analytical study. Iranian Journal of Reproductive Medicine. 2012;10(6):581–588.
    1. Singh S., Gupta V., Modi S., Rana P., Duhan A., Sen R. Tuberculosis of uterine cervix: a report of two cases with variable clinical presentation. Tropical Doctor. 2010;40(2):125–126. doi: 10.1258/td.2009.090423.
    1. Ishrat S., Fatima P. Genital tuberculosis in the infertile women - an update. Mymensingh medical journal : MMJ. 2015;24(1):215–220.
    1. Yue J., Zhang B., Wang M., Yao J., Zhou Y., Ma D., Jin L. Effect of antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis. Frontiers of Medicine. 2019;13(1):121–125. doi: 10.1007/s11684-018-0615-2.
    1. Mondal S. K., Dutta T. K. A ten year clinicopathological study of female genital tuberculosis and impact on fertility. Journal of Nepal Medical Association. 2009;48(173):52–57.
    1. Paine S. K., Basu A., Choudhury R. G., Bhattacharya B., Chatterjee S., Bhattacharya C. Multiplex PCR from Menstrual Blood: A Non-Invasive Cost-Effective Approach to Reduce Diagnostic Dilemma for Genital Tuberculosis. Molecular Diagnosis & Therapy. 2018;22(3):391–396. doi: 10.1007/s40291-018-0322-3.
    1. Al eryani A. A., Abdelrub A. S., Al Harazi A. H. Genital tuberculosis is common among females with tubal factor infertility: Observational study. Alexandria Journal of Medicine. 2019;51(4):321–324. doi: 10.1016/j.ajme.2014.11.004.
    1. Jindal U. N., Verma S., Bala Y. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Human Reproduction. 2012;27(5):1368–1374. doi: 10.1093/humrep/des076.
    1. Naredi N., Talwar P., Narayan N., Rai S., Vardhan Sh., Panda S. Fertility Science and Research. Vol. 1. 1: 44-49; 2014. Spontaneous conception following anti-tubercular treatment for sub-fertile women with multiple imaging markers suggesting genital tuberculosis; pp. 44–49.
    1. Vado-Solís I. A., Suárez-Solís V., Jiménez-Delgadillo B., Zavala-Velázquez J. E., Segura-Correa J. C. Toxoplasma gondii presence in women with spontaneous abortion in Yucatan, Mexico. The Journal of Parasitology . 2013;99(2):383–385. doi: 10.1645/ge-3189.1.
    1. Nasirpour H., Azari Key Y., Kazemipur N., Majidpour M., Mahdavi S., Hajazimian S., Issazadeh A., Taefehshokr S. Association of Rubella, Cytomegalovirus, and Toxoplasma Infections with Recurrent Miscarriages in Bonab-Iran: A Case-Control Study. Gene, Cell and Tissue. 2017;In Press(In Press) doi: 10.5812/gct.60891.
    1. El Hachem H., Crepaux V., May-Panloup P., Descamps P., Legendre G., Bouet P. Recurrent pregnancy loss: current perspectives. International Journal of Women's Health. 2017;Volume 9:331–345. doi: 10.2147/IJWH.S100817.
    1. Angeline Grace G., Bella Devaleenal D., Natrajan M. Genital tuberculosis in females. Indian Journal of Medical Research. 2017;145(April):425–436.
    1. Van Niekerk E. C., Siebert I., Kruger T. F. An evidence-based approach to recurrent pregnancy loss. South African Journal of Obstetrics and Gynaecology. 2013;19(3):61. doi: 10.7196/sajog.670.
    1. Cakmak H., Taylor H. S. Implantation failure: molecular mechanisms and clinical treatment. Human Reproduction Update. 2011;17(2):242–253. doi: 10.1093/humupd/dmq037.

Source: PubMed

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