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Taking AKT4 tablets and streptomycin injections for tuberculosis lymphadenitis. Have male infertility. Can i impregnate my wife?

I am 30 yrs old, got married at the age of 29 and my wife is 21. We wanted to have a baby, so we tried for it for almost 8 months after 1 year of our marriage. After 6 months, my wife stopped her period and after going to doc, it turned out to be just amenorhea but not pregnancy, doctor started her on folic acid and started follicular scanning for 2 months and still did not conceive and for the third month, doc asked me to undergo male fertility test and the result was azoospermia , I was shocked to see the result and then I approached fertility specialist, who suggested another male infertility test and the result was again the same and he asked me to do to 2 more tests, karyotyping and male Y deletion tests, which were both negative without any problem. After a week of these results, I was diagonsed as tuberculosis lymphadenitis. For the first 2 months, I was on AKT4 tablets and streptomycin injections 3 injections weekly for 2 months. Now, I am on AKT3 for the third month and doc has prescribed to take it for another 6 months. After I saw the answer give by one of doc in this forum, I see that TB is the cause of my azoospermia. Should I wait for this AKT3 tablets to be finished and then try for baby or just go for IUI . PLs reply me.............
Asked On : Wed, 30 Jan 2013
Answers:  2 Views:  286
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OBGYN 's  Response
Thanks for the query,
Tuberculous epididymo-orchitis is one of the cause of infertility in males. It cause blockage of the passage ( no sperm enters the semen because the tract is blocked).

Management of tuberculous infertility consists of two parts.
1. Treatment with anti tubercular drugs to treat primary infection.
2. Reconstructive surgery followed by assisted reproductive techniques like ICSI,MESA, TESA.

In the majority of cases, the presentation is late and antitubercular therapy does not improve the fertility status. Infertility here usually results from anatomic obstruction .

What i recommend is to repeat your semen analysis since you have already taken AKT for 2 months.
If semen analysis shows azoospermia, Go on for assisted reproductive techniques like ICSI,TESA, MESA.
Continue AKT for 6 months to treat primary tubercular infection.

Hope this helps,
Dr Nilofer
Answered: Thu, 31 Jan 2013
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General & Family Physician Dr. Shoaib Khan's  Response
Hello and welcome to HCM,

Thank you for your query.

I understand your anxiety, and shall try to explain things in a simple and more detailed way.

Tuberculosis in males is caused as tuberculosis spread to the genitals and causes tuberculosis epidydimo-orchitis (which results in obstruction of the passage through which sperms empty into the semen). This results in azoospermia.

Most male patients are diagnosed in the late stage as diagnosis is not easy. If an early diagnosis is there is a chance we could detect the disease before it causes complete obstruction of those passages. This can be treated with the immediate initiation of anti-tubercular therapy (to prevent progression) of the disease and then correction (removal of obstruction through surgery).

If detected in the late stages, it solely depends on location of the obstruction and feasibility of reconstruction (surgical).

Please continue the AKT4 medications for now, and complete the course. The next step in our course would be to find the location and the amount of obstruction.

Depending on this information we can decide what could be done next, and only then will I be able to honestly answer your question on whether to wait for the completion of treatment or go ahead with IUI.

I hope I have succeeded in answering your questions, you could write back to me anytime for further clarifications.

Best wishes.
Answered: Wed, 30 Jan 2013
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