TB and Infertility

Tuberculosis is one of the commonest causes of infertility in underdeveloped countries. In the developed countries it is one of the rarest causes of infertility.

How does TB cause infertility?

It does so only when it infects the genital tract. This is called genital TB. In the woman, it causes tuberculosis endometriosis (infection of the uterus) and salpingitis (infection of the tubes). This infection can often be silent, and may not cause any symptoms or signs at all. Genital TB is always hard to diagnose, because of the fact that it is a silent invader of the genital tract. One of the treatments for this condition is LIT (Lymphocyte Immune Therapy).

The immunology of normal and abnormal pregnancy

Normally after ovulation, the egg travels into the fallopian tube. Fertilization occurs here. This embryo multiplies and moves towards the uterus and finally settles down in the uterine lining to develop into a fetus .The fetus has two components.

In this one part is taken from the mother, the other from the father. If the Mother’s component is not protected; it can lead to spontaneous abortion as in auto immune diseases (blood tests recommended are lupus anticoagulant and anti-cardilipin antibody).These auto-immune defects can be treated by giving aspirin and now molecular weight heparin and if needed even steroids.

The father’s component is not protected as in allo-immune defects. Natural killer cell activity of the white blood cells (WBC) can be now tested in Lab. If this is raised, patient is treated by lymphocyte immune therapy (LIT), using blood leucocytes of husband or an unrelated person. Lymphocyte immune therapy (LIT) is repeated many times until the killer cell activities of WBC have come to normal levels.

Explanation of LIT

The HLA antigens on the placenta cells made by the father are called HLA-G. When the couple shares DQ alpha antigens in common, the G molecule put on the placental cells by the father is too similar to the G molecule that the woman’s father put on her placenta to sustain her in her mother’s uterus.

As a result, she does not make the blocking antibody, the baby dies, and her immune system recognizes the placenta as “altered self”