So, you have tried everything, from ovulation trackers to clean eating to yoga to even the "feet-up" myth. But the pregnancy test still reads a single line. What if the reason you have not conceived is not in your lifestyle, age, or stars but genital tuberculosis (TB)—the problem no one told you about?
It could be the reason behind your unexplained infertility, often overlooked and vastly underdiagnosed. While tuberculosis is typically associated with chronic coughing and lung damage, it is not always a chest issue. Genital TB is a form of extrapulmonary TB that quietly targets the reproductive organs. It can affect the uterus, fallopian tubes, ovaries, or the endometrial lining, all of which are crucial for conception.
According to Dr. Harish Bhatia, founder director of Rebreathe Clinic and senior chest specialist at MGS Hospital, “The biggest challenge that sufferers of genital TB face is that it is usually asymptomatic until you realise that you are unable to conceive even after years of trying. Some women may experience irregular periods, pelvic pain, or unusual vaginal discharge, but many remain asymptomatic.”
He adds, “In India and other TB-endemic regions, genital TB is a leading but underdiagnosed cause of infertility. It can lead to blocked fallopian tubes, thin endometrial lining, or adhesions in the uterus, all of which prevent a fertilised egg from implanting successfully.”
Diagnosis isn’t straightforward either. Dr. Bhatia explains, “Diagnosis is tricky and usually requires a combination of pelvic ultrasound, hysteroscopy, endometrial biopsy, or PCR testing to detect the Mycobacterium tuberculosis bacteria. Early detection is crucial, as timely anti-tubercular treatment (ATT) can help control the infection and improve fertility outcomes.”
“If you’ve had no success with IVF, experienced recurrent implantation failures, or have unexplained infertility despite normal reports,” he advises, “it’s worth discussing the possibility of genital TB with your fertility specialist.”
Dr. Bhatia leaves us with a firm reminder: “Don’t let a silent infection stand in the way of your parenthood journey. Genital TB may not be widely talked about, but addressing it could be the turning point in your fertility path. Pro tip: Women with a history of TB, frequent respiratory infections, or family TB exposure should be screened early, especially before starting IVF.”
Dr. Manini Patel, Senior Consultant – Obstetrics and Gynaecology at Apollo Spectra Hospital, Jaipur, echoes this concern and shares, “We do consider genital TB as a possible cause of infertility and have clinical evidence that women, especially those from high-burden regions or those with a history of TB exposure, are more vulnerable.”
“It is a fact,” she says, “that many women struggle to conceive, and they are not aware that a hidden or undiagnosed infection such as genital TB could be affecting their reproductive tract. Hence, treatment needs a proactive diagnostic approach to give a proper fertility treatment option at the earliest.”
Though silent, Dr. Patel says that genital TB can be a devastating contributor to women’s infertility. It is a form of extrapulmonary tuberculosis that primarily affects the fallopian tubes, endometrium (lining of the uterus), and ovaries and sometimes the cervix and vagina.
“We take this as secondary to a primary infection elsewhere in the body. The lungs are most common in this context.”
“The Mycobacterium tuberculosis organism is the main cause,” she explains, and it spreads through the bloodstream or lymphatics to the genital organs.
Dr. Patel also points out, “In early stages, genital TB is asymptomatic. Gradually, symptoms such as chronic pelvic pain, menstrual irregularities, and abnormal vaginal discharge may appear. Unexplained infertility can also be considered a symptom.”
And it doesn’t stop there. With advancement, it can cause complete tubal blockage and damage ovary functions. It is not only conception problems; even if women conceive, with genital TB, they are at the risk of miscarriage, ectopic pregnancy, and poor foetal outcomes.
Her advice? “We strongly advise early detection through endometrial biopsy, PCR testing, hysteroscopy, or laparoscopy. For prolonged and unexplained infertility, these tests are crucial. We do stress that anti-tubercular therapy (ATT) can treat the infection; however, if diagnosis is delayed, the reproductive damage is often irreversible.”
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