Deparment of Reproductive Medicine, Sushrut Assisted Conception Clinic, Shreyas Hospital, 6th Lane, Rajarampuri, Kolhapur, India.
Deparment of Critical Care, & Pulmonology, Aster Aadhar Hospital, 628, B Ward, Shastri Nagar, Kolhapur, India.
Hum Reprod. 2018 Jul 1;33(7):1262-1269. doi: 10.1093/humrep/dey117.
What is the effect of latent genital tuberculosis (GTB) on ovarian reserve in infertile women?
Women with latent GTB have lower ovarian reserves and yield lower numbers of oocytes in IVF.
Limited evidence suggests that women with GTB may have a low ovarian reserve. Infertile women have a high incidence of latent GTB and treatment improves fertility outcomes.
STUDY DESIGN, SIZE, DURATION: This prospective study from February 2013 to January 2016 compared 431 infertile women diagnosed with latent GTB (Group I) to 453 infertile women without latent GTB (Group II).
PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was conducted at Shreyas Hospital, Kolhapur, India, a tertiary referral centre for infertility. Women of both groups were 21-38 years of age. Group I consisted of infertile women with proven tubal patency but with latent GTB diagnosed by DNA PCR testing of an endometrial biopsy. Day 2-4 anti-Mullerian hormone (AMH) and antral follicle count (AFC) were assessed in both groups. All women with latent GTB took antituberculosis therapy (ATT). Gonadotropin dosages and oocyte and embryo details were noted in both groups for those who underwent IVF.
Women with latent GTB were younger (29.8 ± 4.4 years vs. 30.8 ± 4.5 years; P = 0.003) and, following adjustment for age, had significantly lower AMH [Median (IQR): 2 (0.9, 4.1) ng/ml vs 2.8 (1.3, 5) ng/ml; P = 0.01] and AFC [Median (IQR): 7 (5, 11) vs 8 (5, 14); P < 0.001]. Post ATT, women with latent GTB yielded fewer oocytes (9.3 ± 7.6 vs. 10.9 ± 8.1; P = 0.01), but had more grade I embryos transferred (1.1 ± 0.5 vs. 0.89 ± 1.0; P = 0.001) and a better implantation rate (26.8% vs. 17.5%; P = 0.004) in IVF compared to women in Group II. Group I had a higher pregnancy rate compared to Group II (51.6% vs. 40.5%; P = 0.001), through various treatment modalities. Considering the adequacy of the sample size and use of robust ovarian reserve markers, the role of chance is minimal.
The study is limited to an infertile population visiting a tertiary referral centre. The mechanisms by which latent GTB infection would lead to ovarian damage are unclear.
It is believed that latent GTB is without any clinical significance. However, a low ovarian reserve in young women with latent GTB necessitates considering it as a cause of infertility, in women with prolonged infertility. These women may experience an accelerated decline in ovarian reserve with reduced success in achieving biological parenthood. Clinicians must be aware of this condition and its consequences while managing infertility.
STUDY FUNDING/COMPETING INTEREST(S): This study was funded by Sushrut Assisted Conception Clinic, Shreyas Hospital, Kolhapur, India. The authors have no conflicts of interest to declare.
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潜伏性生殖器结核（GTB）对不孕女性的卵巢储备有何影响？
患有潜伏性 GTB 的女性卵巢储备较低，在体外受精（IVF）中获得的卵子数量较少。
有限的证据表明，患有 GTB 的女性可能卵巢储备较低。不孕女性潜伏 GTB 的发病率较高，治疗可改善生育结局。
研究设计、大小和持续时间：这项 2013 年 2 月至 2016 年 1 月进行的前瞻性研究比较了 431 名被诊断为潜伏性 GTB 的不孕女性（I 组）和 453 名无潜伏性 GTB 的不孕女性（II 组）。
参与者/材料、设置、方法：该研究在印度 Kolhapur 的 Shreyas 医院进行，这是一家不孕症的三级转诊中心。两组患者年龄均为 21-38 岁。I 组由经 DNA PCR 检测子宫内膜活检证实输卵管通畅但患有潜伏性 GTB 的不孕女性组成。两组均在第 2-4 天检测抗苗勒管激素（AMH）和窦卵泡计数（AFC）。所有患有潜伏性 GTB 的女性均接受抗结核治疗（ATT）。记录两组中接受 IVF 的女性的促性腺激素剂量和卵子及胚胎详情。
患有潜伏性 GTB 的女性更年轻（29.8 ± 4.4 岁 vs. 30.8 ± 4.5 岁；P = 0.003），并且在调整年龄后，AMH [中位数（IQR）：2（0.9，4.1）ng/ml vs 2.8（1.3，5）ng/ml；P = 0.01]和 AFC [中位数（IQR）：7（5，11）vs 8（5，14）；P < 0.001]明显较低。ATT 后，患有潜伏性 GTB 的女性获得的卵子较少（9.3 ± 7.6 个 vs. 10.9 ± 8.1 个；P = 0.01），但在 IVF 中转移的 I 级胚胎更多（1.1 ± 0.5 个 vs. 0.89 ± 1.0 个；P = 0.001），并且着床率（26.8% vs. 17.5%；P = 0.004）更高。与 II 组相比，I 组在各种治疗方式下的妊娠率更高（51.6% vs. 40.5%；P = 0.001）。
考虑到样本量的充足性和使用稳健的卵巢储备标志物，机会的作用最小。
该研究仅限于访问三级转诊中心的不孕人群。潜伏性 GTB 感染如何导致卵巢损伤的机制尚不清楚。
人们认为潜伏性 GTB 没有任何临床意义。然而，年轻患有潜伏性 GTB 的女性卵巢储备较低，这需要将其视为不孕的原因之一，特别是对于不孕时间较长的女性。这些女性可能会经历卵巢储备加速下降，从而降低实现生物学生育的成功率。临床医生在治疗不孕症时必须了解这种情况及其后果。
研究资金/利益冲突：本研究由印度 Kolhapur 的 Sushrut 辅助受孕诊所、Shreyas 医院资助。作者没有利益冲突需要声明。
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