Commonly, tuberculosis is perceived as a disease that infects the lungs. However, the infection sometimes reaches the genitals and causes infertility in women. Most of the genital TB cases in India are detected at a later stage because of a lack of awareness. One of the reasons behind the lack of awareness is that the majority population still believes that tuberculosis is only a lung disease. However, tuberculosis is caused by a bacterium that can affect any part of the body. 

Thus, it is very important to clear this misconception that when Mycobacterium Tuberculosis (TB Bacteria) travels through the bloodstream and infects the genitals, it causes genital tuberculosis (read more). In women, the bacterial infection severely thins out the innermost layer of the uterus, the endometrium. This condition in turn makes it extremely hard for a woman to conceive as the foetus fails to adhere to the uterine wall. 

Among women suffering from Genital Tuberculosis, 70℅ of them are diagnosed with uterine abnormalities, the fallopian tubes of 90℅ of them are affected, and 25% of the patients suffer from abnormalities in ovaries (read more). This damage to the female reproductive organs results in miscarriages in women with genital tuberculosis.

How does tuberculosis cause infertility?

In the majority of cases, Genital Tuberculosis is diagnosed in women between the age groups of 15-40. Due to the lack of awareness of the disease, many women find out about it only after their miscarriage. Once women go to IVF clinics to try artificial methods of pregnancy, they find out that their uterus is incapable of carrying the foetus. 

Sometimes, the bacteria causing tuberculosis remain dormant in the body and cause infection in the genitals after many days of catching the bacteria. In women, the bacteria majorly target the fallopian tube or the uterus (endometrium), responsible for carrying the foetus and providing it with nutrition to grow. The rate of infertility in women suffering from genital tuberculosis is 60-80%, which is a high percentage. To avoid infertility, the patient must seek medical care at the onset of the infection, i.e., when the symptoms start showing.

Infertility in women can be caused due to infection in the following female reproductive organs:

1. Tubal infection: Mycobacterium Tuberculosis can damage ciliary movements in fallopian tubes, unilateral or bilateral tubal blockage or mass formation in tubes, severely affecting fertilization of the ovum or implantation of the embryo. 90% of the women suffering from genital tuberculosis face infected tubal regions, thereby causing infertility. 

2. Uterine Infection: 70% of women suffering from genital tuberculosis develop an infection in the uterus. Destruction, thinning out, and scar formation in the uterine wall (Asherman’s syndrome)   are some of the reasons for infertility in women. 

• Ovarian Infection: Adhesion, mass formation, and cyst formations are some of the many ways in which tuberculosis can affect the ovaries. These symptoms can cause semi or destruction of ovaries, affecting ovarian function and causing infertility in women. 

Symptoms of Genital Tuberculosis 

The symptoms of genital tuberculosis in women are very similar to any other uterine infection. Because most people are not aware of the disease, they never seek medical help in the beginning. Most patients consult a doctor only once things get worse, or when the couple is unable to conceive. In some cases, seeking medical attention at a later stage can’t overturn the damage already caused to the uterus and thereby, causing permanent infertility. Below are some common symptoms. 

• Discharge from your excretory system may be clear or bloody and may smell bad.
• During urination or sexual intercourse, you might also feel pain. 
• Genital tuberculosis can cause swelling and redness of the skin around your genitals.
• There might be fever and chills, night sweats, weight loss, fatigue and muscle aches.
• The patient might get a genital ulcer, a firm, indurated lesion with irregular borders.
• The patient might have a low-grade fever, lasting more than 24 hours.

Treatment for Genital Tuberculosis

In case of the emergence of the above symptoms, the patient must consult a doctor at the very beginning of the infection. Once the infection progresses, the abdominal pain can get worse, the period will be irregular and the patient may suffer pain in the chest. Any woman facing any of these symptoms must see a doctor at the earliest to be on the safer side. 

If diagnosed and treated on time, infertility in women can be cured. Many women fear that once diagnosed with genital tuberculosis, they can never conceive. That is, however, not the case. If the treatment is followed as per the directions of the doctor, the disease can be cured and there are chances that the patient can be fertile again. It is, however, of utmost importance that the patient completes the full course of antibiotics as prescribed by the doctor to prevent the disease from turning into a chronic infection. 

Remedial Measures 

• Antitubercular Chemotherapy: This is a shorter course of chemotherapy given to patients for six to nine months.
• Directly observed treatment short course: This methodology of treatment is highly recommended because of its efficient, and cost-effective treatment features. In this regimen, a two-month course of the drugs rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) and a daily four-month therapy of the drugs rifampicin (R) and isoniazid (H) are followed strictly.
• Surgery: In some cases, with abnormal symptoms and exceptional medical conditions, surgery is also opted as a remedial measure.

Word of Caution 

Usually, this disease is hard to diagnose because symptoms are often misinterpreted. Therefore, it takes a long list of testing before starting the treatment. However, no need to worry even if you are diagnosed with this medical condition as maintaining good physical health and taking immediate medical aid can be cured. On some occasions, we need to be careful as this disease spreads not only through exterior factors but also through a person’s bloodstream.