The Prevalence and Reproductive Outcome of Infertile Women With Genital Tuberculosis

• Conditions: Genital Tuberculoses, Female; Infertility, Female
• Interventions: Diagnostic Test: QuantiFERON-TB test & endometrial pathology & endometrial tissue GeneXpert Ultra

• Registration Number: NCT05311423
• Lead Sponsor: Huashan Hospital

Brief Summary

Female genital tuberculosis infection (FGTB) is an important cause of female infertility in TB-endemic areas. The pregnancy rate of assisted reproductive treatment (ART) in the infertile women with FGTB is still unsatisfied even after receiving standard anti-tuberculosis treatment. Moreover, recent years have witnessed an alarming increase in reports of FGTB-related maternal and neonatal complications after fertility treatments. These underscore that timely detection and treatment of FGTB before ART hold benefit for the mother and child.

Detailed Description

This project aims to recruit infertile female with high risk of tuberculosis infecton who need assisted reproductive treatment in multiple reproductive centers. The infertility-related medical history and laboratory examination results were recorded according to clinical routine, and other essential information such as tuberculosis symptoms, tuberculosis-related history and other health conditions were also recorded, and the pregnancy outcomes of these patients were followed up.

According to the results of clinical screening, they were divided into four cohorts: non-tuberculosis (non-TB) group, latent tuberculosis infection (LTBI) group, subclinical genital tuberculosis infection (SGTB) group and female genital tuberculosis infection (FGTB) group.

Non-TB group: QuantiFERON-TB test (QFT) negative, continue assisted reproductive treatment; LTBI group: QFT positive. Excluded active pulmonary tuberculosis, patients have negative endometrial histopathology, acid-fast bacilli (AFB) microscopy, Mycobacterium tuberculosis (Mtb) culture, or GeneXpert MTB/RIF Ultra test results. Then assisted reproductive treatment can be continued, but follow-up for tuberculosis-related symptoms is required; SGTB group: QFT positive. Excluded active pulmonary tuberculosis, patients have negative endometrial histopathology, AFB microscopy, Mtb culture, but GeneXpert MTB/RIF Ultra positive test results. They are recommended to receive 6-month first-line standard anti-tuberculosis treatment (ATT) regimen; FGTB group: QFT positive. Excluded active pulmonary tuberculosis, regardless of GeneXpert MTB/RIF Ultra results, at least one of these test results, including endometrial histopathologiy, AFB microscopy, Mtb culture is positive, they will receive 6-month ATT.

Patients diagnosed with SGTB and FGTB will receive 6-month first-line standard ATT before ART, and follow up their anti-tuberculosis drug-related adverse reactions (TB-ARs) according to clinical routine to prevent the occurrence of grade 3-4 adverse drug reactions.

All cohorts will be followed up for pregnancy outcomes after entering the assisted reproduction cycle, and the pregnancy outcomes of all subjects after the first assisted reproduction after enrollment were recorded. Follow-up nodes included the 2nd, 4th, 10th weeks and 37th weeks of gestation. Follow-up content includes pregnancy status. Follow-up subjects will be terminated when adverse pregnancy outcomes such as ectopic pregnancy and miscarriage occurred; follow-up of pregnant participants will be extended to 2 weeks postpartum. Participants from the SGTB or FGTB group achieve pregnant naturally after drug withdrawal, the follow-up of the natural pregnancy outcome will be started as well.

Study Timeline

• Study Start: 2021-12-01
• Study First Submitted: 2022-01-21
• Status Verified: 2022-03
• Study First Submitted QC: 2022-03-27
• Last Update Submitted: 2022-03-27
• Study First Posted: 2022-04-05
• Last Update Posted: 2022-04-05
• Primary Completion: 2023-06-01
• Study Completion: 2023-08-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Female
• Target Recruitment: 3000

Inclusion Criteria

• 1. Female, aged ≥20 years and <43 years old;
• 2. In line with conventional assisted reproduction indications;
• 3. Meet any of the following:
  1. with tuberculosis infection history;
  2. with a history of close contact to tuberculosis patients;
  3. exact positive IGRA results in the past or chest imaging indicated a past history of pulmonary tuberculosis;
  4. suspected symptoms of tuberculosis, including fever, night sweats, fatigue, cough and sputum;
  5. suspected symptoms of genital tuberculosis, including lower abdominal pain, abnormal menstruation, fallopian tube stenosis, obstruction, thickening, beading changes, uterine cavity adhesions, deformation, pelvic adhesions, etc.;
• 4. Voluntarily join the study and sign the informed consent

Exclusion Criteria

• 1. Co-infection with HIV;
• 2. Chromosomal abnormalities;
• 3. suspected genital tuberculosis infection symptoms (participants meet inclusion criteria 3)e in Inclusion Criteria) known to be caused only by factors part from tuberculosis, such as endocrine factors, history of ectopic pregnancy, history of uterine curettage, chronic pelvic inflammatory disease, endometriosis, malignant tumors, etc.;
• 4. There are other serious physical or mental illnesses that are not suitable for selection;
• 5. Participate in other clinical studies that would affect this study at the same time.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Non-TB Group	QuantiFERON-TB test & endometrial pathology & endometrial tissue GeneXpert Ultra	QuantiFERON-TB test (QFT) negative, continue assisted reproductive treatment
Subclinical genital tuberculosis Group	QuantiFERON-TB test & endometrial pathology & endometrial tissue GeneXpert Ultra	QFT positive. Excluded active pulmonary tuberculosis, patients have negative endometrial histopathology, AFB microscopy, Mtb culture, but GeneXpert MTB/RIF Ultra positive test results. They are recommended to receive 6-month first-line standard anti-tuberculosis treatment (ATT) regimen
Latent tuberculosis infection Group	QuantiFERON-TB test & endometrial pathology & endometrial tissue GeneXpert Ultra	QFT positive. Excluded active pulmonary tuberculosis, patients have negative endometrial histopathology, acid-fast bacilli (AFB) microscopy, Mycobacterium tuberculosis (Mtb) culture, or GeneXpert MTB/RIF Ultra test results. Then assisted reproductive treatment can be continued, but follow-up for tuberculosis-related symptoms is required
Female genital tuberculosis Group	QuantiFERON-TB test & endometrial pathology & endometrial tissue GeneXpert Ultra	QFT positive. Excluded active pulmonary tuberculosis, regardless of GeneXpert MTB/RIF Ultra results, at least one of these test results, including endometrial histopathologiy, AFB microscopy, Mtb culture is positive, they will receive 6-month ATT

Primary Outcome Measures

Name	Time	Method
Clinical pregnancy rate of ART	2 years	the number of participants with gestational sacs seen by ultrasound examination 4-6 weeks after transplantation/the number of embryo transfer cycles in this group
Prevalence of SGTB among infertile women	6 months	the number of SGTB participants/the total number of this project
Continued pregnancy rate of ART	2 years	the number of patients whose pregnancy was confirmed by repeat ultrasonography at 10th week of gestation/the number of embryo transfer cycles in this group

Secondary Outcome Measures

Name	Time	Method
Prevalence of FGTB/LTBI among infertile women	2 years	the number of each group/the total number of this project
Preterm birth rate	2 years	the number of premature births/the number of clinical pregnancy in non-TB or LTBI or SGTB or FGTB group
Neonatal mortality rate	2 years	the number of neonatal mortality/the number of clinical pregnancy in non-TB or LTBI or SGTB or FGTB group
Spontaneous pregnancy rate	2 years	number of Spontaneous pregnancy/number of subjects completed ATT in FGTB/SGTB group
The rate of drug discontinuation due to adverse drug reactions	2 years	the number of patients who discontinued in anti-tuberculosis treatment due to adverse drug reactions / the total number of patients with adverse reactions in FGTB/SGTB group
Abortion rate	2 years	number of abortions/number of clinical pregnancy in non-TB or LTBI or SGTB or FGTB group
Ectopic pregnancy rate	2 years	number of ectopic pregnancy/number of clinical pregnancy in non-TB or LTBI or SGTB or FGTB group
Live birth rate	2 years	the number of live births/the number of clinical pregnancy in non-TB or LTBI or SGTB or FGTB group
Maternal mortality rate	2 years	the number of maternal mortality/the number of clinical pregnancy in non-TB or LTBI or SGTB or FGTB group
The incidence of grade 3-4 adverse events	2 years	the number of patients with grade 3-4 adverse events during anti-tuberculosis treatment / the total number of in FGTB/SGTB group
Treatment completion rate	2 years	number of patients who completed anti-tuberculosis treatment / total number of patients in this group × 100%
Incidence of active tuberculosis of LTBI group during 1 year after enrollment	1 year	the number of subjects who develop to active tuberculosis during 1 year after enrollment/the number of subjects of LTBI group

Trial Locations

Locations (1)

Shanghai First Maternity and Infant Hospital; 🇨🇳 Shanghai, Shanghai, China