Changing Trends of Tubercular Assault on Reproduction

Abstract

Background and Objectives. Genital tuberculosis (GTB) is a rare disease in developed countries but is an important cause of subclinical chronic pelvic inflammatory state and infertility in 1–18% of women, being as high as 18 % in India. What we are observing nowadays GTB is changing its way of assault to reproductive process less by infection but more by infestation of the genital tract and thereby leading to harmful molecular changes or may be immunomodulation locally. Reduction of infection may be due to increased surveillance, treatment or use of antibiotics for other reasons indiscriminately, which may make the bacteria dormant. It is being observed as a silent invader of the genital tract of both the female and male partners. It is to be kept in mind that mycobacteria, non- pathogenic to humans, may also cause molecular assault on reproduction. At present, our cohort of patients can be categorized in three groups a) Frank tuberculosis b) LGTB infection c) LGTB infestation There has been extensive research about the involvement of genital tuberculosis in female infertility. Various studies have been undertaken to screen and detect latent genital tuberculosis in apparently normal infertile couples intervening fertility at molecular level. The adverse effects of latent genital tuberculosis, as found in current researches, on the female and male reproductive process has been addressed in the current review. Methods Endometrial aspirates at mid-luteal phase and samples of menstrual blood were collected aseptically from each of those women enrolled in this study and stored at - 80°C for DNA-PCR (Polymerase chain reaction test) and cytokine study. Multiplex polymerase chain reaction (PCR) were performed. DNA-PCR test and sperm DNA fragmentation tests were carried out in semen samples, collected according to WHO guidelines, from male partners in question. Observation. It is being observed that pro-inflammatory cytokines showed significantly different values in TB-PCR- positive and TB-PCR-negative groups. Sperm DNA fragmentation index also appears to be quite high in TB- PCR positive males.Conclusion. LGTB infestation has been found to be responsible for unfavourable molecular changes in reproductive tract and thereby causing a negative impact on fertility. Keywords: latent genital tuberculosis, infertility, cytokine, tubercular infestation, tuberculosis- polymerase chain reaction,