Genital tuberculosis as a cause of infertility involves endometrial TB in what proportion of cases, and which diagnostic test has the highest sensitivity for endometrial TB?

• A Endometrium involved in <10% of cases; transvaginal ultrasound with thin endometrium is pathognomonic
• B Endometrium is rarely involved; diagnosis relies primarily on hysteroscopy with direct visualization of tubercles
• C PCR of endometrial aspirate (Gene-Xpert) is the gold standard with 98% sensitivity
• D Endometrium involved in ~50-80% of genital TB cases; endometrial biopsy with culture (Lowenstein-Jensen medium) and histopathology has the highest sensitivity ✓

Explanation

The endometrium is involved in 50-80% of genital TB cases, as TB spreads haematogenously from pulmonary focus. Menstrual blood or endometrial biopsy tissue culture on Lowenstein-Jensen medium remains the gold standard with ~45-60% sensitivity; combined histopathology (caseating granulomas) + culture increases diagnostic yield to ~70-75%. PCR/Gene-Xpert of endometrial aspirate has high sensitivity (~80-90%) and specificity, and is increasingly used as a first-line test due to rapid turnaround (2 hours). Hysteroscopy shows characteristic findings (adhesions, calcifications, pale avascular endometrium) and allows biopsy but is not a diagnostic test per se.

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

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