Results of in vitro fertilization and embryo transfer in women with infertility due to genital tuberculosis

Abstract

Objective: To determine the results of IVF-ET in women with infertility due to genital tuberculosis.

Design: Retrospective case-control study.

Setting: In vitro fertilization and ET unit of a university hospital.

Patients: Forty-four cycles of IVF-ET were undertaken in 24 women with genital tuberculosis and the results were compared with 366 cycles in 274 nontuberculous tubal factor couples.

Interventions: All women with genital tuberculosis were evaluated with hysteroscopy, endometrial biopsy, and acid fast bacilli stain before treatment with IVF-ET.

Results: Subjects with genital tuberculosis had higher basal FSH levels, required more exogenous gonadotropins for controlled ovarian hyperstimulation, reached lower peak E2 levels, and yielded fewer oocytes and embryos when compared with tubal factor patients. Furthermore, in women with genital tuberculosis, clinical pregnancy rate per cycle was lower and spontaneous abortion rate was higher.

Conclusions: Women with genital tuberculosis appear to represent a less favorable subset within other tubal factor patients when treated with IVF-ET.

PIP: At Hacettepe University Hospital in Ankara, Turkey, 24 women with genital tuberculosis had undergone 44 cycles of in vitro fertilization-embryo transfer (IVF-ET) and 274 women with tubal infertility not related to genital tuberculosis (controls) had undergone IVF-ET. Physicians compared the results of IVF-ET in these two sets of women. Women with genital tuberculosis had significantly higher day-3 follicle stimulating hormone (FSH) levels than the controls (11.6 vs. 7.7 mIU/ml; p 0.001). Thus, they had a higher number of ampules of hMG than the controls (27.3 vs. 18.4; p 0.05) to achieve peak estradiol levels on the day of human chorionic gonadotropin (hCG) and the number of days of follicle stimulation. Peak estradiol levels were lower among cases than controls (852 vs. 1141 pg/ml; p 0.05), while the number of days of follicle stimulation was higher among cases than controls (10.3 vs. 7.5; p 0.01). Women with genital tuberculosis also had a significantly lower number of aspirated oocytes and of transferred embryos than controls (5.8 vs. 7.7 and 2 vs. 2.9, respectively; p 0.01 for both). They also had a much lower clinical pregnancy rate than controls (9.1% vs. 21.3%; p 0.001). Women with genital tuberculosis also had a significantly higher spontaneous abortion rate than controls (75% vs. 19.2%; p 0.05). The only woman with genital tuberculosis who delivered a live infant had undergone hysteroscopic lysis of dense intrauterine synechia. The lower pregnancy rate was largely due to the fewer embryos available for transfer among the women with genital tuberculosis. The implantation rates per transferred embryo were not significantly different between the two groups (5.85% for cases vs. 8.6% for controls). These findings suggest that women with genital tuberculosis are a less favorable subset among tubal factor patients when treated with IVF-ET. Physicians should anticipate these women to have a reduced ovarian reserve, lower intrauterine pregnancy, and higher miscarriage rates.