Richa Sharma, Anjali Kanhere, Sonal Jain, Akrati Jain
Department of Obstetrics and Gynaecology, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
J Hum Reprod Sci. 2023 Apr-Jun;16(2):125-131. doi: 10.4103/jhrs.jhrs_36_23. Epub 2023 Jun 30.
Female genital tuberculosis (FGTB) is a known cause of female infertility. Worldwide incidence is 5%-10% and annual burden in India is around 4%-7%. It is known to cause tubal and endometrial damage. However, the effect on ovarian damage is poorly known. The availability of ovarian markers has contributed to an improved understanding of ovarian reserve in FGTB.
The aim of this study was to assess ovarian reserve by measuring anti-Mullerian hormone (AMH) and antral follicle count (AFC) amongst infertile women and analyse the effect of GTB on ovarian reserve parameters.
This was a prospective study at a tertiary referral centre for infertility for 18 months.
A total of 133 infertile women who underwent diagnostic hysterolaparoscopy and cartridge-based nucleic acid amplification test testing of an endometrial biopsy were included in the study. AMH and AFC of all the infertile women were assessed and compared between cases with and without FGTB.
Independent -test was used to find the outcome differences in the distribution of values. < 0.05 was considered statistically significant.
Fifty-eight (43.6%) cases were diagnosed with FGTB (Group I), and 75 (56.3%) cases were without FGTB (Group II). The mean AMH level 1.88 ng/ml (±1.52) and mean AFC 9.0 (±5.50) were significantly lower ( < 0.001) in Group I than in Group II with AMH 3.57 ng/ml (±2.93) and AFC 12.50 (±6.0).
In women with prolonged infertility and low ovarian reserve, FGTB should be ruled out. Early diagnosis and treatment of GTB may prevent further decline of ovarian reserve and improve the reproductive outcome.
女性生殖器结核（FGTB）是女性不孕的已知原因。全球发病率为5%-10%，印度的年负担约为4%-7%。已知其会导致输卵管和子宫内膜损伤。然而，其对卵巢损伤的影响却鲜为人知。卵巢标志物的可用性有助于更好地了解FGTB患者的卵巢储备情况。
本研究的目的是通过测量不孕女性的抗苗勒管激素（AMH）和窦卵泡计数（AFC）来评估卵巢储备，并分析生殖器结核（GTB）对卵巢储备参数的影响。
这是一项在三级不孕转诊中心进行的为期18个月的前瞻性研究。
本研究纳入了133例行诊断性宫腔镜腹腔镜检查及子宫内膜活检的基于 cartridge 的核酸扩增检测的不孕女性。评估了所有不孕女性的 AMH 和 AFC，并在有和没有 FGTB 的病例之间进行比较。
采用独立t检验来发现数值分布的结果差异。P<0.05被认为具有统计学意义。
58例（43.6%）被诊断为FGTB（第一组），75例（56.3%）没有FGTB（第二组）。第一组的平均AMH水平为1.88 ng/ml（±1.52），平均AFC为9.0（±5.50），显著低于第二组，第二组的AMH为3.57 ng/ml（±2.93），AFC为12.50（±6.0）（P<0.001）。
对于长期不孕且卵巢储备低的女性，应排除FGTB。GTB的早期诊断和治疗可能会防止卵巢储备进一步下降，并改善生殖结局。
