Female Genital Koch's : A diagnostic dilemma:

We have to doubly cautions before we embark upon diagnosing FGT(female genital Koch’s):-What spl attention in subfertility cases?? Before we level a female partner as genital Koch’s :-we need to concentrate on other factors causing infertility, not forgetting the most exhausting group of couples with unexplained infertility which exists all over the world. We, try to give a name to the cause of infertility to every couple even if that means labeling them with such devastating diagnosis such as genital TB. The social implications of being labeled a tubercular patient in a patriarchal country like ours are immense.

The question is “Which test, then will show the right path?? “-Well, it is still unanswered question even to consultant!! The main dilemma in the minds of every gynecologist, put  in  such a situation ,one has an above mentioned suspicion and intends to investigate, which test would he/she prefer & recommend? The point is
is there any role for endometrial PCR in diagnosis of TB?

Is there any condition when clinician would start ATT if HPR/culture comes negative? The dilemma is that “Is one justified to give ATT to women with unexplained subfertility but with strong contact with family members having suffered from TB?”-, I have no answer to this dilemma which we are facing OPD almost every week. Any member can highlight Pl.

Amidst such a confusion and dilemma we the clinicians what we can do A) resort to laparoscopy and hysteroscopy with visual, histopathalogical and culture confirmation of tissue or fluid. It's a small price to pay before having ATT printed on ones medical history for ever) What about a) strongly positive Monteux or 2) most popular chest X-ray to establish the diag by indirect method that genitalia may be affected. Showing a calcified hilar node or primary complex should be good indirect evidences in case one is not able to go for laparoscopy and hysteroscopy
In our country with a with high incidence of latent Koch’s and with questionable Lab personnel & consumable we are always skeptical about reports available in India, I am sorry to say at least 60% irregular lab conditions
 Strong clinical suspicion with history of exposure to a active pulmonary TB patient with distorted or partly or fully blocked tubes.  Not in India even if she has latent tuberculosis and tubes are fine and her general health is good.  What test would you recommend to clinch the diagnosis if the tubes are blocked?

 In a young 20 year old girl with no sexual exposure, you find a plastered abdomen but AFB culture is negative?

 There are many new developments in reproductive medicine and we do hope someone from within this country will solve this riddle!

 Perhaps we will get some answers from the ICMR study comparing PCR, immunohistochemistry, gene expression with conventional tests (AFB smear, culture and H/P) and laparoscopy in diagnosis of FGT,(Female Genital Koch's) .