A 28-year-old woman presents with infertility of 3 years. Hysterosalpingogram shows bilateral tubal block with calcifications. Endometrial biopsy shows granulomas with Langerhans giant cells and caseation. PCR for Mycobacterium tuberculosis is positive. What is the MOST likely prognosis regarding fertility after anti-tubercular therapy (ATT)?

• A Fertility improves significantly after 6 months of ATT and IVF is not required
• B Surgical tuboplasty after ATT restores normal tubal function in >50% of cases
• C ATT eradicates the infection but does not reverse established tubal damage; IVF is usually required ✓
• D ATT is not necessary if PCR is positive but there is no active systemic disease

Explanation

Genital tuberculosis causes irreversible fibrosis and destruction of the fallopian tubes. While ATT (Category I: 6 months for drug-sensitive TB) eradicates the active infection and prevents further tissue destruction, it cannot restore normal tubal anatomy once established fibrosis has occurred. Fertility outcomes after ATT alone are very poor (<5% spontaneous conception). IVF is the preferred fertility treatment for women with genital TB, though endometrial TB (causing Asherman-like syndrome) may also impair implantation and uterine receptivity.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.