A 28-year-old nulliparous woman with infertility undergoes laparoscopy. Findings include bilateral hydrosalpinges, peritubal adhesions, and granulomatous deposits on peritoneum. Biopsy confirms genital tuberculosis. She is started on RNTCP Category I ATT. After completing 6 months of ATT with culture negativity, she requests reproductive outcome counseling. The MOST accurate statement regarding her fertility prognosis is:

• A Natural conception rates after ATT exceed 30% in patients with endometrial tuberculosis as medical treatment reverses intrauterine adhesions
• B Tubal patency is rarely restored after hydrosalpinx caused by genital TB; IVF is the treatment of choice, but implantation rates remain low due to endometrial involvement ✓
• C Laparoscopic salpingolysis after ATT completion restores tubal function in 60–70% of cases of genital TB with hydrosalpinges
• D Intrauterine adhesion lysis by hysteroscopy has excellent success rates (>90%) for restoring fertility in genital TB-related Asherman's syndrome

Explanation

Genital tuberculosis causing bilateral hydrosalpinges confers a very poor fertility prognosis. Even after successful ATT, tubal patency is rarely restored because fibrous scarring and obliteration of the fallopian tube epithelium is permanent — unlike the mucosal changes in acute PID that may partially recover. Additionally, endometrial tuberculosis causes intrauterine adhesions (Asherman's syndrome) and endometrial atrophy that impair implantation. IVF is recommended but has significantly lower implantation and live birth rates (15–30% vs 40–50% in non-TB patients) because endometrial receptivity is compromised. Salpingolysis (C) cannot restore functionally damaged tubal epithelium from TB. Hysteroscopic adhesiolysis (D) has only 20–40% success for TB-related Asherman's compared to >80% for post-curettage cases.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.