A 28-year-old woman with primary infertility undergoes diagnostic laparoscopy showing 'pipe-stem' fallopian tubes, caseous nodules on peritoneum, and 'tobacco-pouch' appearance of the tubes. Hysteroscopy shows synechiae and obliteration of the endometrial cavity. Endometrial biopsy confirms Langerhans giant cells with caseation necrosis. This is a confirmed case of genital tuberculosis. What is the role of anti-TB treatment in restoring her fertility?

• A Anti-TB treatment with extended 9-month regimen reverses 70% of tubal damage and restores fertility in most cases
• B Laparoscopic tubal cannulation after completing anti-TB treatment successfully restores tubal patency in >50% of genital TB cases
• C Anti-TB treatment (standard Cat I, 2HRZE/4HR) sterilises active disease but does NOT reverse established tubal fibrosis or endometrial synechiae; IVF/ET is the only option for pregnancy ✓
• D Genital TB-related infertility is reversible with anti-TB drugs combined with corticosteroids in the first 3 months

Explanation

Anti-TB treatment (Category I: 2HRZE/4HR) eradicates active Mycobacterium tuberculosis infection and prevents disease progression, but cannot reverse structural damage already caused — including tubal fibrosis (pipe-stem tubes), peritubal adhesions, or Asherman-like endometrial synechiae. Once fibrosis has occurred, the Fallopian tube luminal architecture cannot be restored pharmacologically or surgically. The prognosis for natural fertility after genital TB is extremely poor (<5%), and even IVF/ET success rates are reduced due to compromised endometrial receptivity. Surrogate uterus may be required when the endometrium is irreparably destroyed.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.