Genital tuberculosis: an important cause of Asherman's syndrome in India.
OBJECTIVE
To demonstrate the association between genital endometrial tuberculosis and Asherman's syndrome.


METHODS
A total of 28 women who underwent hysteroscopy with or without laparoscopy for suspected Asherman's syndrome from symptoms (amenorrhoea or oligomenorrhoea, and or primary or secondary infertility) and who were found to have genital tuberculosis on endometrial biopsy (histopathology or culture) or positive polymerase chain reaction (PCR) on endometrial aspirate or positive findings of tuberculosis on laparoscopy or hysteroscopy were enrolled in this retrospective study.


RESULTS
The mean age and parity were 26.5 years and 0.3, respectively. There was past history of TB in 67.8% women. All women had menstrual dysfunction, with oligomenorrhoea and hypomenorrhoea in 16 (57%) women and amenorrhoea in 12 (42.8%). All women had primary (n = 19, 67.8%) or secondary (n = 9, 32%) infertility. On hysteroscopy, there were various grades of adhesions in all women, with grade I in 17.8%, grade II in 28.5%, grade III in 28.5% and grade IV in 17.5% women. Only four women (14.3%) had open ostia, while others had bilateral (28.5%) or unilateral (21.3%) blocked ostia or inability to see ostia (28.5%). On laparoscopy performed on 18 women, there were varying grades of adhesions in 16 (88.8%) women, with beading (33.3%), tubercles (33.3%), caseation (11.1%) and tubo-ovarian masses (11.1%). The diagnosis of genital TB was made by histopathology (tuberculous granuloma) on endometrial biopsy in 28.6%, positive culture in 3.6%, positive polymerase chain reaction (PCR) in 46.4% and observation of tubercles, beading or caseation on laparoscopy in 17.8% or shaggy cavity with caseation on hysteroscopy in 3.6% women.


CONCLUSIONS
Genital tuberculosis appears to be an important and common cause of Asherman's syndrome in India, causing oligomenorrhoea or amenorrhoea with infertility.
Sharma
Jai Bhagwan
JB
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India. jbsharma2000@gmail.com
Roy
Kallol K
KK
Pushparaj
M
M
Gupta
Nupur
N
Jain
Sunesh Kumar
SK
Malhotra
Neena
N
Mittal
Suneeta
S
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D004717:Endometrium / Q000382:microbiology / Q000473:pathology; D005260:Female; D006175:Gynatresia / Q000209:etiology*; D006801:Humans; D015907:Hysteroscopy; D007194:India; D007247:Infertility, Female / Q000209:etiology; D010535:Laparoscopy; D008599:Menstruation Disturbances / Q000209:etiology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery; D014384:Tuberculosis, Female Genital / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
D000995:Antitubercular Agents