Endometrial kochs

Tuberculosis is an important cause of female infertility, especially in developing countries.

Tuberculosis is an infectious disease which is caused by the tubercle bacillus. It does so only when it infects the genital tract . This is called genital TB.  In males, it causes tuberculous epididymo-orchitis, blocking the passage, as a result of which there is azoospermia. In the women, it cause tuberculous endomteritis ( infection of the uterus) and salpingitis ( infection of the tubes).

This infection is often be silent, without any signs and symptoms and is hence difficult to diagnose. Endometrial tissue is obtained by currettage and sent to the laboratory for a culture. TB bacillus grows very slowly in the lab. Histological evidence of tubercles inderectly indicate the presence of TB infection.

Tb affectes the fallopian tubes as well as the endometrium. If diagnosed and treated early, the endometrium heals. In severe cases, however, the damage to the endometrium may lead to fibrosis and scarring. Damage to the fallopian tubes is irreversible. Surgical tubal recanalisation is often futile and for women with tubal damage following TB, IVF is the only option. Tubes which have been severely damaged may form a hydrosalpinx, and may need to be removed surgically, prior to IVF, if they are very large.

TB-PCR ( polymerase chain reaction ) can pick up even minute quantities of DNA, and it was hoped that if the lab could pick up the presence of DNA sequences unique to the tubercle bacillus.  Unfortunately, this test has too many false positives and is expensive.

Many doctors advise  blood tests to check for the presence of the antiTB antibodies IgG and IgM. Most Indians are exposed to the TB bacillus, and test positive for the antibodies. Mantoux skin test also tests for the presence of immunity against TB – and can be similarly misinterpreted.