Effect of antitubercular treatment on ovarian function in female genital tuberculosis with infertility.
OBJECTIVE
To evaluate the effect of antitubercular therapy (ATT) on an ovarian function such as ovarian reserve, ovarian dimensions, and ovarian stromal blood flow.


METHODS
Prospective study design.


METHODS
Fifty infertile women with female genital tuberculosis (FGTB) without tubo-ovarian masses diagnosed by positive acid-fast bacilli culture or epithelioid granuloma on endometrial aspirate or positive polymerase chain reaction with positive findings on laparoscopy or hysteroscopy were recruited. The ovarian function tests were performed on day 2/3 as follicle-stimulating hormone (FSH) levels and anti-Mullerian hormone (AMH) levels. Ovarian dimensions (length, width, and depth) were measured using a transvaginal ultrasound. Mean antral follicle count (AFC) and ovarian stromal blood flow (peak systolic velocity [PSV], pulsatility index (PI), and resistive index [RI]) were measured using a transvaginal ultrasound. All women were started on ATT for 6 months by directly observed treatment strategy. After completion of ATT, all the parameters were repeated.


RESULTS
There was a significant increase in AMH (2.68 ± 0.97 ng/ml to 2.8 ± 1.03 ng/ml) pre- to post-ATT, nonsignificant increase in FSH (7.16 ± 2.34 mIU/ml to 7.26 ± 2.33 mIU/ml) post-ATT, significant increase in mean AFC (7.40 ± 2.12-8.14 ± 2.17), PSV in the right ovary (6.015-6.11 cm/s) and left ovary (6.05-6.08 cm/s), PI in the right ovary (0.935-0.951 cm/s) and left ovary (0.936-0.957 cm/s), and RI in the right ovary (0.62 ± 0.01-0.79 ± 0.02) and left ovary (0.65 ± 0.02-0.84 ± 0.01) with ATT. There was no significant change in mean ovarian dimensions (ovarian length, breadth, and width) and summed ovarian volume with ATT. On laparoscopy, tubercles were seen in 27 (54%) women. Caseous nodules and encysted ascites were seen in 8% cases each.


CONCLUSIONS
ATT improves the ovarian function (AMH and AFC) and ovarian blood flow in women with FGTB.
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Jai Bhagwan
JB
Sharma
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
J
J
Sneha
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
U B
UB
Singh
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Sunesh
S
Kumar
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
K K
KK
Roy
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Neeta
N
Singh
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Sona
S
Dharmendra
Anti-Mullerian hormone; antral follicle count; female genital tuberculosis; laparoscopy; ovarian blood flow; ovarian function; ovarian reserve; tubo-ovarian mass