Dr Kshitiz Murdia
Mycobacterium Tuberculosis that causes TB nearly affects more than 20lakh people every year. India accounts for more than 3lakh of death cases caused due to TB and ranks at fifth position on global scale in TB incidents. Majorly disease affects the lungs of human body, but if it’s not treated it can spread to different parts of body through blood and can lead to secondary infections affecting kidney, pelvic, fallopian tubes, uterus, and brain. Well it’s a matter of great concern because, when bacterium reaches genital tract it causes genital TB or pelvic TB, which leads to the phenomenon of infertility in both the sexes.
In women the TB leads to thinning of endometrium due to the infection in uterus, thus resulting as a barrier to proper development of foetus. Whereas in males it causes epididymo-orchitis, blocking the passage, as a result of which the man becomes azoospermic, where sperm is not able to enter the semen. The symptoms don’t appear easily and by the time it’s realized it already leaves an impact on the fertility of humans.
Two in every ten women suffering from TB cannot bear a child and genital tuberculosis accounts for approximately 40% to 80% incidents in women. Mostly if the immune system is low and one is contact with an infected person, then TB is likely to hit your life. When an infected person sneezes or coughs then bacteria of TB travel through air and enters into our lungs while breathing. Even sexual intercourse with an infected person is one of the means of getting genital tuberculosis.
As being a silent intruder it’s very difficult to notice the traits of TB hampering the fertility in females there some symptoms like irregular menstrual cycle, vaginal discharge that is stained with blood, pain after intercourse could be noticed, but in many cases as bacteria remains latent these symptoms are showcased at a later stage. For males symptoms like unable to ejaculate into vagina, low sperm motility and pituitary gland not able to produce sufficient hormones can be seen. This silent invader leading to infertility results from the inflammation and scarring that follow the infection, resulting in distortion of the normal anatomy and causing obstruction.
Even though it’s difficult to diagnose the presence of TB in genital tract, there are certain ways to detect them like a sample of tissue taken from a women suffering from TB of fallopian tubes, endometrial tissue is collected from uterus and sent to lab, where the bacteria are grown and later used for testing. The most trustworthy method of diagnosis is making a histological diagnosis of tubercles, which helps doctors on laparoscopy to confirm whether these suspicious lesions are due to tuberculosis or not. Polymerase chain reaction is also one of the methods to diagnose. Unfortunately it’s expensive and not reliable
Generally females worry; that after getting TB will they be able to conceive or not but a proper TB medication can help them to go on and have a successful pregnancy. Once a baby is born mothers are concerned about the baby getting contracted to the bacterium from breast milk, well it can only affect from the bacteria in the breath. So the mother should breast-feed after putting a mask on the face
After the histologic diagnosis of TB endometritis has been made, then treatment with antiTB medicines should be started to avoid more complications. The course of antibiotics for six to eight months should be completed properly, but it doesn’t guarantee the repair of fallopian tubes. Many doctors perform surgery to repair the tubes, but it’s a futile job. Lastly the intervention has to be either in-vitro fertilization or Intracytoplasmic sperm injection (ICSI).
Adults who are malnourished are easily affected by the wave of TB, because of the low immunity. Hence during the treatment diet plays an important role to get an effective treatment, one should avoid all aerated products, alcohol, processed meat and sugary items like pies, cup cakes etc. Their diet should have leafy vegetables, rich vitamin D, rich iron supplements, whole grain and unsaturated fats. Diet plays a crucial role in the treatment of TB, improper diet could lead to unsuccessful treatment, thus causing secondary infections.
If your family member or a colleague is an active tuberculosis patients, then other people around them need to be cautioned and should go for usual test like chest X-ray, tuberculin test to know whether they are hit by TB or not. For small babies the case is different even though there are easily affected by TB, but it’s very difficult to diagnose. In such special cases some treatment like ionized is given to prevent complications and to check the traits of TB during the test.
One can prevent themselves against TB by staying away from crowded areas, where you could come into regular contact with people who are infected, have access to a proper healthcare system and undergo physical exams on a regular basis, get vaccinated against the condition, if possible.
(The author is working at Indira Infertility Clinic & Test Tube Baby Centre, Udaipur)
Dr Kshitiz Murdia