A 28-year-old woman with primary infertility undergoes laparoscopy revealing dense peritubal adhesions, tobacco-pouch appearance of tube ends, and tubercles on the peritoneum. Histology confirms caseating granulomas. What is the MOST appropriate management for her infertility?
- A Anti-tubercular therapy (ATT) for 6 months followed by IVF ✓
- B Tubal reconstructive surgery after ATT completion
- C Intrauterine insemination (IUI) after ATT completion
- D Spontaneous conception is expected after successful ATT
Correct answer: A. Anti-tubercular therapy (ATT) for 6 months followed by IVF
Explanation
Genital tuberculosis causes irreversible tubal damage (fibrosis, occlusion, tobacco-pouch fimbriae) and endometrial destruction (Asherman-type synechiae). Tubal function is not restored by ATT or reconstructive surgery. IVF (after completion of ATT to eliminate active disease) is the only realistic option for fertility. IUI requires patent tubes. Natural conception is essentially impossible with bilateral tubal damage from pelvic TB.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.