Role of Genital Tuberculosis and Chlamydia Trachomatis as a Tubal Factor in Primary Infertility

Background: Infertility has become nowadays not only a medical, but a social problem as well. Infertility in female is caused by various factors. Tubal disease is responsible for 25-35% of female infertility. Pelvic inflammatory disease (PID) is the most common cause of tubal disease. Aim of the Study: To assess the rate of M. tuberculosis and C. trachomatis infections in patients with tubal factor infertility and to determine the most reliable method for laboratory diagnosis of genital tuberculosis and C. trachomatis using ELISA with respect to laparoscopic finding. Methods: Ninety women with primary infertility and abnormal Hysterosalpingography were enrolled as a studied group and 30 infertile women with polycystic ovary as the only cause of infertility and normal Hysterosalpingography as a control group. Laparoscopy was performed and peritoneal biopsy was taken for histopathological study. ELISA detection for Mycobacterium tuberculosis and C. trachomatis IgG antibodies was done. PCR for detection mpt64 gene of M. tuberculosis and C. trachomatis plasmid DNA also were done in peritoneal fluid. Results: IgGAB for M.tuberculosis were +ve in 72 cases (80%) of the studied group and laparoscopy was +ve in 23 cases (76.7%) of the control group with no statistical significant difference. PCR for mpt64 gene of M. tuberculosis in peritoneal fluid was done for all patients; only 17 cases (18.9%) of the study group showed +ve results. IgG for C. trachomatis were +ve in 43 cases (47.8%) of the study group and it was +ve in 5 cases (13.3%) of the control group with height statistical significant difference. The +ve titers range from >5IU to 40IU. PCR was done for Chlamydia in peritoneal fluid only 5 cases (5.6%) of the studied group was +ve for chlamydia PCR and it was –ve in all control groups. Conclusions: Genital tuberculosis continued to be an important cause of infertility in Egypt. PCR for mpt64 gene of M. tuberculosis plays an important role in diagnosis of genital tuberculosis with results comparable with laparoscopy and histopathology. Detection of C. trachomatis IgG antibodies by ELISA can play a significant role in detection of C. trachomatis in Correspondence to: Dr. Hebat-Allah G. Rashed, The Department of Clinical Pathology, Assiut University Hospital. infertile women. Screening of women with primary infertility for C. trachomatis is recommended in the first year of infertility, so that early therapeutic intervention can be instituted to allow women to conceive naturally.