Infertility due to complications of tuberculosis

Ms. Thuong was married for two years without children, took many ineffective Eastern and Western medicines, and went to the Reproductive Support Center, Tam Anh General Hospital, Hanoi (IVF Tam Anh) for examination. Master, Doctor Nguyen Le Thuy, Tam Anh IVF Center, said the husband’s health is normal, while the wife has menstrual disorders, X-rays show uneven uterine absorption, uterine margins messy. The doctor concluded that Ms. Thuong had uterine adhesions and ovulation disorders following tuberculosis, leading to infertility.

Tuberculosis is primarily known for its respiratory manifestations. According to Dr. Thuy, in fact, Mycobacterium tuberculosis can spread through the bloodstream, lymph nodes, from the lungs to many other parts of the body including the reproductive system, causing genital tuberculosis (FGTB). . Tuberculosis bacteria can cause inflammation and scarring in the fallopian tubes, endometrium, ovaries, and less commonly in the cervix, vagina, and vulva. Initially, the damage is not obvious, progresses slowly, then ulcers, necrosis or hemorrhage form, and then scars cause deformation of the reproductive organs, affecting the ability to conceive.

In Ms. Thuong’s case, the uterine walls on the front and back sides stuck together, hindering the implantation process of the fertilized egg, causing infertility. If pregnant, the uterine cavity becomes attached and loses its natural elasticity, the volume of the uterine cavity decreases, and there is not enough space for the fetus to develop. According to Dr. Le Thuy, intrauterine adhesions account for about 5% of female infertility cases.

In addition, some anti-tuberculosis drugs cause hypothyroidism, reducing the ability to produce thyroid hormones. At this time, the ovulation process is hindered, causing menstrual disorders. Decreased reproductive hormone levels, accompanied by existing damage, cause the uterine lining to not reach the appropriate thickness to hold the embryo, increasing the risk of miscarriage. “Fertility in people with genital tuberculosis is low, only about 19%,” Dr. Thuy said, adding that the disease also causes the risk of in vitro fertilization (IVF) failure.

Depending on the condition, the patient can use medication or surgery if the damage causes scarring and affects fertility. Ms. Thuong successfully underwent laparoscopic surgery to separate uterine adhesions, then took medication as prescribed by an endocrinologist to balance the hormone levels in her body. However, the chance of getting pregnant naturally after adhesiolysis surgery is not high. She and her husband failed 3 times of artificial insemination (IUI) so they switched to in vitro fertilization.

Ms. Thuong used ovulation stimulation medication according to an individualized regimen, obtained the optimal number of mature oocytes, and created 7 embryos on day 3. These embryos continued to be nurtured in a time-lapse incubator integrated with artificial intelligence. Obtained 4 good quality embryos on day 5.

After the process of preparing the mucosa, Ms. Thuong had an embryo transferred into the uterus by the doctor but was unsuccessful. In February 2024, she had a second embryo transfer and luckily conceived immediately. Last month, she gave birth to a healthy son at 38 weeks gestation.

According to the World Health Organization (WHO), by 2023, Vietnam will rank 11th among the 30 countries with the highest burden of tuberculosis and drug-resistant tuberculosis in the world. Research around the world shows that female genital tuberculosis is a rare case, accounting for 5% of pelvic infection cases in women and 10% of pulmonary tuberculosis cases.

Female genital tuberculosis has symptoms similar to chronic pelvic inflammatory disease (PID) such as menstrual disorders, lower abdominal pain, vaginal discharge… The disease is easily confused with endocrine problems and gynecological infections. , sexually transmitted diseases, even cancer. Some cases have no symptoms, making diagnosis difficult. Genital tuberculosis can also occur in men, causing reduced sperm quantity and quality, blockage of the vas deferens, and infertility.

Dr. Thuy noted that tuberculosis patients should complete their treatment and rest properly to recover their health, so they should have a plan to have children. Women infected with tuberculosis during pregnancy can transmit it to the fetus, causing congenital tuberculosis in the child, increasing the risk of perinatal death. After tuberculosis treatment, if there are signs of abnormalities in the genital tract or cannot become pregnant naturally after one year of regular intercourse, the couple should have a reproductive health examination soon. Modern techniques such as blastocyst culture, preimplantation genetic screening (PGT), microsurgery to find sperm (micro-TESE), implantation window test (ERA Test), urine-rich plasma injection Autologous bridge (PRP)… can help infertile couples after tuberculosis increase their chances of conceiving and giving birth to healthy children.

To prevent genital tuberculosis, people need to avoid contact with sources of infection. When someone in the house is sick, they need to live and quarantine properly. Building a scientific diet and exercise regimen, avoiding alcohol and stimulants, and getting vaccinated fully and on schedule is also an effective way to improve overall health and prevent disease.