Unassisted conception with a normal pregnancy outcome in a woman with active Mycobacterium tuberculosis infection of the endometrium. A case report.

BACKGROUND: Tuberculosis of the endometrium is usually associated with infertility. Once a patient is diagnosed with endometrial tuberculosis, she is almost certain to experience infertility; in vitro fertilization and embryo transfer offer the only realistic treatment for tuberculous infertility. We describe one case of unassisted conception with a normal pregnancy outcome in a patient with Mycobacterium tuberculosis infection of the endometrium. CASE: A 34-year-old woman who suffered from 10 years of infertility was investigated in the authors' unit. She gave no significant past medical or surgical history, and initial examinations and investigations were normal. Her husband was 34 years old, and his semen analysis was normal. The patient underwent diagnostic laparoscopy, chromohydrotubation and endometrial biopsy, which showed patency of both fallopian tubes and normal pelvic organs, with no evidence of endometriosis or previous pelvic inflammatory disease. Histologic examination of the biopsied endometrium showed no granulomas; however, culture of the endometrium yielded Mycobacterium tuberculosis. When the patient was called back for antituberculosis chemotherapy, we found that she had become pregnant within one month of the endometrial biopsy. Antituberculosis chemotherapy was commenced at 14 weeks' gestation with rifampicin, isoniazid, pyrazinamide and pyridoxine. The pregnancy remained uneventful, and the patient delivered a normal female infant, 3,380 g at term. Pathologic examination of the placenta was performed, but there were no granulomas or features of chronic inflammation. CONCLUSION: Despite the successful fertility outcome in our patient, we do not think that this case was a challenge to previous concepts of endometrial tuberculosis. In vitro fertilization and embryo transfer are usually the most suitable options for these patients.