Pregnancy outcomes after all modes of conception in patients with genital tuberculosis: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to summarize the pregnancy outcomes of women diagnosed with genital tuberculosis (GTB) who spontaneously conceived or underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) after being treated with antitubercular therapy (ATT). Publications from the PubMed, Medline, Embase, Ovid, Scopus, Web of Science, and Google Scholar databases were searched from December 20, 2021 to March 5, 2022. The outcomes are presented as pooled averages with 95% confidence intervals. The inconsistency index (I2) test was used to measure the heterogeneity between studies. The certainty of the evidence was assessed using GRADEPro (https://www.gradepro.org/). Of the numerous articles identified, 33 met the inclusion criteria and were included in this systematic review. Generally, there was a significant increase in pregnancy rates among patients who underwent IVF compared with those who underwent ATT (37.9% vs. 23.8%; p=0.02). Conversely, there was no significant difference in pregnancy rates between patients who underwent IUI and those who conceived spontaneously (18.1% vs. 23.8%; p=0.65). In cases in which no abnormalities were found on hysterosalpingography or hysterolaparoscopy, pregnancy rates were comparable between spontaneous and IVF conceptions (48.4% vs. 49.2%). There were no significant differences in pregnancy or live birth rates between patients with GTB and those with other infertility factors undergoing IVF treatment (p>0.05). ATT, which is administered during the early stages of GTB is effective in achieving pregnancy outcomes comparable to IVF. However, in patients with advanced-stage disease, IVF is a superior treatment modality, resulting in increased pregnancy rates.

Keywords: Female genital tuberculosis; Imaging findings; In vitro fertilization; Pregnancy outcome; Spontaneous conception.

Fig. 1

Study flow diagram. TB, tuberculosis.

Fig. 2

Risk of bias of the included studies. (A) Risk of bias graph of the included studies in the qualitative synthesis. a) Clear criteria for the inclusion. b) Method of measurement of the condition. c) Methods used for identification of the condition for all participants included in the case series. d) Drop-out rate. e) Demographic of the participants. f) Clear report of clinical information of the participants. g) Adequacy of follow-up time. (B) Risk of bias summary of the included studies in the qualitative synthesis. (C) Risk of bias graph of the included studies in the meta-analysis. a) Representativeness of the exposed cohort. b) Selection of the non-exposed cohort. c) Ascertainment of exposure. d) Demonstration that outcome of interest was not present at start of the study. e) Comparability of cohort on the basis of the design or analysis. f) Assessment of outcome. g) Length of follow-up time. h) Adequacy of follow-up cohort. (D) Risk of bias summary of the included studies in meta-analysis.

Fig. 3

Forest plot of pregnancy outcomes after spontaneous conception among patients diagnosed with GTB compared with patients who were infertile due to other causes. (A) Pregnancies per patients. (B) Miscarriages per pregnancies. GTB, genital tuberculosis; M-H, mantel-haenszel test; CI, confidence interval.

Fig. 4

Forest plot of pregnancy outcomes after IVF among patients diagnosed with GTB compared with patients who were infertile due to other causes. (A) Pregnancies per patients. (B) Pregnancies per cycles. (C) Miscarriages per pregnancies. (D) Live birth per pregnancies. (E) Average oocytes retrieved per cycles. (F) Average embryos transferred per cycles. (G) Implantation rates per embryos transferred. (H) Endometrial thickness. GTB, genital tuberculosis; M-H, mantel-haenszel test; CI, confidence interval; SD, standard deviation.

Fig. 5

Forest plot of the number of pregnancies observed among patients diagnosed with GTB following various modes of conception. (A) IVF vs. spontaneous conception after ATT. (B) IVF vs. IUI. (C) IUI vs. spontaneous conception after ATT. IVF, in vitro fertilization; M-H, mantel-haenszel test; CI, confidence interval; IUI, intrauterine insemination; GTB, genital tuberculosis; ATT, antitubercular therapy.

Fig. 6

Algorithm delineating the management approach for patients presenting with infertility and diagnosed with genital tuberculosis (GTB). TB, tuberculosis; USG, ultrasound sonography; HSG, hysterosalpingography; M.tb PCR, mycobacterium tuberculosis polymerase chain reaction; ATT, antitubercular therapy; IVF, in vitro fertilization.