Breaking the Silence on Female Genital Tuberculosis: A Modifiable Burden in Fertility Care.

AIM: This review aims to explore Female Genital Tuberculosis (FGTB) as a significant, yet underdiagnosed cause of subfertility, with a focus on its clinical presentation, diagnostic complexities, and implications for reproductive outcomes. It highlights the importance of early recognition and the role of endoscopic findings in guiding timely treatment.

METHODS: A comprehensive literature review was conducted using PubMed-indexed journals published since 1980, emphasizing studies on FGTB in the context of infertility. Key areas included epidemiology, pathogenesis, clinical features, diagnostic approaches, and treatment strategies. Particular attention was given to the role of hysteroscopy and laparoscopy in identifying characteristic tuberculous lesions and aiding early diagnosis.

RESULTS: Traditional diagnostics like AFB staining and culture often yield false negatives, necessitating a composite reference standard incorporating imaging, biopsy, and endoscopy. Molecular tools such as GeneXpert and PCR have improved detection rates. Hystero-laparoscopy offers direct visualization of intrauterine adhesions, caseous nodules, and tubal beading-findings critical for early initiation of anti-tubercular therapy (ATT). Early ATT can restore fertility in many patients, but advanced cases may still require assisted reproductive techniques, often with limited success.

CONCLUSIONS: FGTB is a preventable cause of infertility that demands high clinical suspicion and multidisciplinary management. Early diagnosis and treatment significantly reduce reproductive morbidity. Enhanced clinician awareness, integration of endoscopic techniques, and access to advanced diagnostics are essential for improving outcomes in high-risk populations.