Sheng Zikang, Zeng Lin, Chen Lixue, Zhang Chen, Gai Xiaoyan, Chi HongBin, Sun Yongchang, Li Rong
Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.
Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
BMJ Open. 2025 Jul 18;15(7):e098692. doi: 10.1136/bmjopen-2024-098692.
Tuberculosis (TB) is a significant factor contributing to infertility. For some infertile patients, chest radiography (CXR) screenings prior to assisted reproductive treatment (ART) reveal old/inactive TB lesions. However, the pregnancy outcomes after ART for such patients who had a history of prior anti-TB treatment remain unclear.
Retrospective cohort study.
Peking University Third Hospital, a tertiary care centre.
This study analysed and focused on infertile patients aged 20-50 years with prior TB lesions on CXR (treated/untreated) and normal CXR. Active TB cases were excluded from this study. Patients were categorised into three groups based on CXR findings and prior anti-TB treatment: treated prior-pulmonary TB (PTB) group, untreated prior-PTB group and a non-PTB control group with normal CXR.
ART outcomes, including clinical pregnancy rate, miscarriage rate and live birth rate, were compared among the groups.
Among 8769 patients analysed, including treated prior-PTB group (n=171), untreated prior-PTB group (n=791) and non-PTB group (n=7807). The treated prior-PTB group showed a similar clinical pregnancy rate (41.5% vs 38.1%, p=0.360) and live birth rate (35.3% vs 30.6%, p=0.187) compared with the non-PTB group. The miscarriage rate was slightly lower in the treated prior-PTB group than in the non-PTB group (11.3% vs 15.5%, p=0.325), although the discrepancy was not statistically significant. Compared with the untreated prior-PTB group, the treated prior-PTB group exhibited significantly higher live birth rate (35.3% vs 23.8%, p<0.05), clinical pregnancy rate (41.5% vs 31.7%, p<0.05) and with a lower miscarriage rate (11.3% vs 19.1%, p=0.123), although the latter was not statistically significant. Multivariable regression confirmed significantly higher live birth rates in the treated prior-PTB group versus untreated prior-PTB group (aOR: 1.69, 95% CI: 1.01 to 2.83, p=0.045).
Anti-TB treatment in infertile women with prior PTB lesions was associated with improved ART outcomes, comparable to those in patients without TB lesions. This suggests a potential clinical benefit of anti-TB treatment in improving reproductive outcomes in this population. Further research is warranted to explore ART outcomes in patients with untreated prior TB lesions.
结核病（TB）是导致不孕的一个重要因素。对于一些不孕患者，辅助生殖治疗（ART）前的胸部X线摄影（CXR）筛查发现陈旧性/非活动性结核病灶。然而，对于有抗结核治疗史的此类患者，ART后的妊娠结局仍不明确。
回顾性队列研究。
三级医疗中心北京大学第三医院。
本研究分析并聚焦于年龄在20至50岁、CXR显示有既往结核病灶（已治疗/未治疗）以及CXR正常的不孕患者。活动性结核病例被排除在本研究之外。根据CXR结果和既往抗结核治疗情况，患者被分为三组：既往肺结核（PTB）已治疗组、既往PTB未治疗组和CXR正常的非PTB对照组。
比较各组间的ART结局，包括临床妊娠率、流产率和活产率。
在分析的8769例患者中，包括既往PTB已治疗组（n = 171）、既往PTB未治疗组（n = 791）和非PTB组（n = 7807）。与非PTB组相比，既往PTB已治疗组的临床妊娠率（41.5%对38.1%，p = 0.360）和活产率（35.3%对30.6%，p = 0.187）相似。既往PTB已治疗组的流产率略低于非PTB组（11.3%对15.5%，p = 0.325），尽管差异无统计学意义。与既往PTB未治疗组相比，既往PTB已治疗组的活产率（35.3%对23.8%，p<0.05）、临床妊娠率（41.5%对31.7%，p<0.05）显著更高，流产率更低（11.3%对19.1%，p = 0.123），尽管后者无统计学意义。多变量回归证实，既往PTB已治疗组的活产率显著高于既往PTB未治疗组（调整后比值比：1.69，95%置信区间：1.01至2.83，p = 0.045）。
有既往PTB病灶的不孕女性进行抗结核治疗与改善ART结局相关，与无结核病灶的患者相当。这表明抗结核治疗在改善该人群生殖结局方面具有潜在的临床益处。有必要进一步研究探索既往未治疗的结核病灶患者的ART结局。
