A 29-year-old with infertility undergoes hysteroscopy showing multiple irregular intrauterine adhesions. Endometrial biopsy shows caseating granulomas with Langerhans giant cells and acid-fast bacilli on ZN staining. What is the significance of finding active (histologically confirmed) genital TB at this stage regarding fertility prognosis?
- A Active endometrial TB with established intrauterine adhesions has an extremely poor reproductive prognosis; ATT prevents progression but rarely restores functional endometrium for implantation ✓
- B ATT treatment restores tubal patency and endometrial function in 70% of cases, making IVF unnecessary
- C Surgical hysteroscopic adhesiolysis combined with ATT restores fertility in 50% of cases
- D Surrogacy is the only option; there is no role for ATT in established endometrial TB
Explanation
Genital tuberculosis causing endometrial adhesions (Asherman-like synechiae from TB) is associated with extremely poor fertility prognosis. While ATT is mandatory to treat the active infection and prevent systemic progression, the fibrotic damage to the endometrium (loss of functional endometrial layer) is largely irreversible. Live birth rates after treatment of endometrial TB-related infertility are <10% even with assisted reproduction. Hysteroscopic adhesiolysis in TB-related Asherman syndrome has very high recurrence due to ongoing scarring. For women wishing to conceive, gestational surrogacy represents the most realistic option after failed attempted treatment.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.