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Asked to have genital TB test after IVF failures. Suggestion?

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Practicing since : 1999
Answered : 1677 Questions
I would appreciate if a physician in the USA answers these questions as these are specific to the country.

My wife and I are originally Indians (born in India) living in the US for the past 8 years (my wife) and past 11 years (me). My wife has been asked to undertake a genital TB test by Indian fertility specialists, just to rule out the possibility of our failures with IVF. Everything else has been normal in case of our fertility, and we have been labeled as "unexplained" for these failures. Hence the recommendation to do genital TB test.

We have the following questions regarding Genital Tb test in the USA:

1. If the PPD comes back positive, but negative chest X-ray and negative Genital Tb, will I still have to take Anti-TB medications for the latent infection in the USA?

2. Can I refuse the treatment for Latent TB, if pulmonary and genital TB are absent?

3. What are the tests that they will run to evaluate whether I have genital TB or not in the US, and are these tests reliable and confirmatory regarding the diagnosis?

We will appreciate your response

Posted Fri, 4 Oct 2013 in Women's Health
Answered by Dr. Timothy Raichle 21 days later
Brief Answer:
I will try to help you with your question!

Detailed Answer:
First of all, than you for the question. This is not an easy question, because in the US, TB has a low prevalence and our experience as it relates to infertility is even less. But I will give you the approach that would be taken here based on my research as well a recommendations of the Centers for Disease Control (CDC).

I am sorry about your fertility issues. This is very frustrating, I am certain as we also deal with such patients on a daily basis in our practice. With regard to the theory that she might have problems related to TB affecting fertility, I will suppose that besides being from a country with higher rates of TB, that the concern for active infection in your wife is zero. I will assume that the concern is that of 'latent' infection and possible effects on the genital tract or peritoneal cavity.

Specifically with regard to diagnosis of TB of the genital tract (quoting a reputable source), "the diagnosis is established with open biopsy, dilation and curettage, and/or colposcopy, with histologic examination and culture of biopsy materials." In other words, if there was strong suspicion that this was an issue, I believe that our approach would be:
1. A thorough exam that would include colposcopy (microscopic examination of the cervix)
2. An ultrasound
3. Hysteroscopy to look into the uterine cavity and endometrial biopsy at that time
4. A laparoscopy (putting cameras through tiny incisions in the abdomen)to evaluate for peritonitis and tubal disease caused by prior TB infection and to assess tubal patency.

Getting back to the testing question:
1. If a skin test has been performed and is positive
2. A chest radiograph should be performed, and if negative, then
3. TB blood tests might be indicated (also called interferon-gamma release assays or IGRAs)
4. Positive IGRA: This means that the person has been infected with TB bacteria.
5. Negative IGRA: This means that the person’s blood did not react to the test and that latent TB infection or TB disease is not likely.

But to some extent you have put the "cart before the horse". You do not know if she has been infected, and you imply that the PPD has not even been performed. If it is negative, and the pelvic evaluation is negative, then this conversation is not necessary. If it is positive, I imagine that you can refuse treatment, but this also would make absolutely no sense given that reactivation of latent TB can have implications for your wife and EVERYONE she comes into contact with!

With regard to diagnosis and treatment before or during pregnancy, here are two excellent links from the CDC regarding TB. This includes the current recommended treatment regimens:
I hope that this helps. Please tell me where the answer may have fallen short.
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