Tuberculosis (TB) is widely recognized as a respiratory illness, but the infection caused by the bacterium Mycobacterium tuberculosis is capable of affecting virtually any organ system in the body. When the disease impacts areas outside of the lungs, it is classified as extrapulmonary tuberculosis. This systemic reach directly answers the question of whether TB can cause infertility, as the bacteria can migrate to and damage the reproductive organs in both men and women. Infertility is often the only presenting symptom of Genital Tuberculosis (GTB), making it a significant concern for reproductive health specialists.
The Pathogenic Link: Spread to the Reproductive System
The initial infection typically starts in the lungs. The bacteria reach the genital tract primarily through hematogenous spread, traveling via the bloodstream from the primary site of infection. This can occur shortly after initial exposure, even if the patient never develops active pulmonary disease.
The resulting infection in the reproductive tract is known as Genital Tuberculosis (GTB), a form of extrapulmonary TB. The bacteria can remain latent in the reproductive organs for years, causing slow, progressive damage without noticeable symptoms. Reproductive issues may surface long after the initial infection has cleared in the lungs.
Specific Impact on Male and Female Fertility
Genital Tuberculosis causes damage by inciting a chronic inflammatory response that leads to scarring and obstruction in the reproductive system. The severity and location of this anatomical destruction determine the resulting fertility impairment. This damage is often irreversible, even after the bacterial infection has been successfully treated.
Impact on Female Fertility
In women, the fallopian tubes are the most frequently affected site, involved in 90% to 100% of female GTB cases. The inflammation, known as salpingitis, leads to scarring, kinking, and eventual blockage of the tubes. This prevents the egg and sperm from meeting for fertilization, resulting in tubal factor infertility. Blockage often results in hydrosalpinx, where the tube becomes distended with fluid.
The next most common site is the endometrium, the lining of the uterus, affected in 50% to 80% of cases. Endometrial damage can lead to intrauterine adhesions, similar to Asherman’s syndrome, which reduces the uterine cavity size. This makes it difficult or impossible for an embryo to implant. Ovarian involvement can also occur, potentially causing abscesses, masses, and a diminished ovarian reserve by damaging egg-producing tissue.
Impact on Male Fertility
In men, the primary sites of infection are the epididymis and the vas deferens, the ducts responsible for transporting sperm. Infection of the epididymis, called epididymitis, causes inflammation and subsequent scarring that leads to blockages. This obstruction prevents sperm from being ejaculated, resulting in obstructive azoospermia.
The disease can also affect the seminal vesicles and the prostate gland, which produce the fluid components of semen. Damage to these structures can impair semen quality, even if blockages are not complete. This may lead to reduced sperm count, decreased motility, and overall poor function, lowering the chances of natural conception.
Identifying the Cause: Diagnostic Procedures
Diagnosing Genital Tuberculosis (GTB) as the cause of infertility is challenging because the infection is often asymptomatic, lacking typical TB symptoms like night sweats or weight loss. Diagnosis usually begins during a routine infertility workup when tubal damage or uterine abnormalities are discovered. Standard diagnostic procedures are employed in combination, as no single test is completely reliable for this paucibacillary (low bacterial load) infection.
Imaging techniques like hysterosalpingogram (HSG) are often the first step, revealing characteristic damage such as bilateral tubal blockage or an irregular uterine cavity. Direct visualization through laparoscopy and hysteroscopy allows specialists to observe signs of inflammation, scarring, and adhesions. Biopsy of the affected tissue, particularly the endometrium, is a direct method for diagnosis.
Confirmation involves detecting the Mycobacterium tuberculosis bacteria through culture or histopathology, looking for characteristic granulomas in the tissue sample. Due to the low number of bacteria in GTB, molecular methods like Polymerase Chain Reaction (PCR) testing on endometrial or menstrual blood samples are increasingly relied upon for their higher sensitivity. A diagnosis of GTB often relies on a composite of clinical suspicion, imaging findings, and positive results from specialized tests.
Treatment and Reproductive Options
The management of infertility caused by Genital Tuberculosis is twofold: eradicating the active infection and addressing the residual anatomical damage. Treating the active infection requires a standardized, multi-drug anti-tubercular regimen (ATT). This typically involves a combination of drugs, such as rifampicin, isoniazid, pyrazinamide, and ethambutol, administered for six to nine months. Completion of the full course is mandatory to prevent drug resistance and ensure the bacteria are eliminated.
Although ATT effectively cures the infection, it cannot reverse the scarring and structural damage that has already occurred in the reproductive organs. For women, the conception rate after successful GTB treatment remains low due to permanent tubal blockages and endometrial damage. Surgical repair of the fallopian tubes is generally not recommended because it rarely restores normal function and carries risks.
Assisted Reproductive Technologies (ART) become the primary pathway to parenthood for many affected couples. In Vitro Fertilization (IVF) is the most viable option, especially when the fallopian tubes are irreparably blocked, as it bypasses the need for the tubes entirely. IVF success depends heavily on the health of the uterine lining; if the endometrium is significantly scarred, a woman may require additional treatments or may need to consider gestational surrogacy or adoption.