A Pune couple, who had been trying to conceive for seven years, were advised to consider adoption due to severe damage caused in the fallopian tubes and endometrium by the woman`s past Tuberculosis infection.
Laparoscopy had revealed fluid-filled fallopian tubes, a scarred uterus (Asherman’s syndrome), and an endometrium too thin to support a pregnancy, leaving specialists unable to operate further.
The fertility specialists at Nova IVF Fertility, Lullanagar in Pune, suggested Platelet-Rich Plasma (PRP) therapy to help regenerate and rejuvenate her endometrium. After carefully monitoring the growth of her endometrium for a year, IVF was initiated at the right time, and the couple successfully conceived and recently welcomed a healthy baby boy.
A year-long therapy to grow the endometrium
The patient had been diagnosed with tuberculosis in 2019 and completed the treatment. However, the infection had caused irreversible damage to her reproductive area. Her periods had become scanty, an indication that her endometrium was not growing properly, yet this wasn’t considered anything serious.
When the couple arrived at the facility in 2023, they faced multiple challenges. The wife’s endometrial thickness measured only 5.5 mm (well below the recommended 7 mm), and the husband had slightly compromised semen parametres. However, the wife had a good number of eggs, and the couple had considered this as their last option to have a biological child. During the IVF cycle, her eggs were successfully retrieved and fertilized with the husband’s sperm, resulting in healthy embryos. However, the critical challenge remained: preparing the uterine lining to support pregnancy. The medical team at Nova IVF Fertility, Pune, led by Dr Rupali Tambe, spent nearly a year improving her endometrial thickness.
Dr Tambe added, “Not just Tuberculosis, even sexually transmitted diseases like chlamydia, and gonorrhoea can cause long-term reproductive damage even after treatment, most often without any symptoms too. Many patients heal from the active infection, but present years later with infertility as the only symptom. The key is early detection and personalised treatment.”
She underwent hysteroscopy with metroplasty (a procedure to correct the uterus, so that it is fit enough to carry on a pregnancy) along with Platelet-Rich Plasma (PRP) therapy, which is clinically proven to improve the lining of the endometrium. PRP treatment is used in IVF when a patient has a thin endometrium, repeated IVF failures, and in a few cases where women have a low reserve of eggs.
Dr Tambe explained, “Most often in IVF treatments, the focus is more on the quality of the gametes; however, in cases like these, we understand that the role of the uterus and endometrium in achieving a pregnancy is equally important. The endometrium is like a soil for the seed. Just as a farmer waits for the right conditions before sowing, we had to ensure the uterus environment is appropriate. Even if the seed is good, and the soil is not nourishing enough, the seed cannot survive. After extensive treatment, the endometrial thickness reached 6.7mm, the maximum achievable in this case. With the right treatment and guidance at the right time, most patients can achieve biological parenthood. It is extremely important to convey the expectations in the beginning, post the diagnosis”.
A single embryo transfer was performed, resulting in a successful pregnancy on the first attempt, a healthy one, which resulted in a baby boy who is about 2 months old.
Genital tuberculosis and achieving pregnancy
Genital tuberculosis remains an under-diagnosed presentation of TB with profound effects on reproduction. According to recent medical research, it is estimated that 5 per cent of women presenting to infertility clinics worldwide have genital TB, with the majority aged between 20-40 years.
In India, where tuberculosis remains prevalent, the condition often goes undetected as it can remain dormant for years after the initial infection heals.