Detection of genital tuberculosis in women undergoing diagnostic hystero-laparoscopy for infertility: Experience from a tertiary care center in North India.

BACKGROUND: Female genital TB(FGTB) remains underdiagnosed since most patients are asymptomatic and are typically identified during infertility evaluation. Aim of this study was to evaluate detection rates of genital tuberculosis in women undergoing hystero-laparoscopy for infertility.

METHODS: This cross-sectional study was conducted in Department of Obstetrics and Gynaecology at a tertiary care centre in North India, from November 2021 to August 2023. Female partners of infertile couples, 20-40 years, who were undergoing hystero-laparoscopy were included. Women with a history of tuberculosis (pulmonary/extrapulmonary), who had received antitubercular treatment or had tuberculosis detected on routine endometrial biopsy, were excluded. A composite reference standard was used to diagnose FGTB. Findings that were suggestive genital TB on laparoscopy and hysteroscopy were noted. Fluid in pouch of Douglas was aspirated, biopsies were taken from suspicious areas and EA was done in all patients. Samples obtained were analysed for AFB, CBNAAT & HPE.

RESULTS: Total 58 women were included. Mean age of women was 29.6 ± 5.7 years. Mean duration of infertility was 6.7 ± 5.1 years. Nineteen (32.7 %) women had findings suggestive of genital tuberculosis on laparoscopy (n = 3; 5.1 %), hysteroscopy (n = 2; 3.4 %), and on both hystero-laparoscopy (n = 14; 24.1 %). Definitive evidence of tuberculosis were seen in 12 cases (12/19 = 63.1 %), while probable findings of genital TB were seen in 7 (36.8 %) cases. histopathology (EA) was positive only in 2 (3.4 %) of these patients and CBNAAT(EA) was positive in only 1 (1.7 %) patient whereas direct visualization of the pelvis and uterine cavity picked up 19/58 (32.7 %) cases. We observed that hystero-laparoscopy diagnosed 16 more cases of genital TB which would have been missed had we only used histopathology and CBNAAT of endometrial biopsy samples as the diagnostic modality.

CONCLUSION: Laparoscopy and hysteroscopy serve as a valuable tool for diagnosing female genital tuberculosis (FGTB), demonstrating a higher detection rate of cases as compared to conventional tests.