Assisted Reproductive Therapy (ART) Outcomes in Women with a History of
Tuberculosis: Systematic Review and Meta-Analysis
Abstract
Background: Genital tuberculosis (TB) is a significant cause of
infertility in high disease burden countries. Assisted Reproductive
Therapy (ART) success in this population remains unclear.
Objectives: To conduct a systematic review and meta-analysis to
assess ART outcomes in women with a history of TB. Search
Strategy: Studies were identified through PubMed, Embase, Global Health
and Cinhal. Selection Criteria: Studies reporting ART outcomes
in women with a history of TB, compared to women without TB, were
included. Studies without a non-TB comparison group were excluded.
Data Collection and Analysis: Four authors independently
screened articles. Risk of bias was assessed with the Newcastle-Ottawa
Score. Meta-analysis was performed with random-effects models to compute
odds of clinical pregnancy, miscarriage, live birth and mean differences
in oocytes retrieved. Main Results: Of 1184 records identified,
12 studies were included. Ten studies underwent meta-analysis,
comprising 3,532 TB patients and 9,163 non-TB patients. Women with TB
had significantly lower odds of clinical pregnancy (odds ratio [OR]
0.82, 95% CI [0.67, 1.01], p=0.06) and live births (OR 0.74, 95%
CI [0.61, 0.90], p=<0.001). The odds of miscarriage (OR
1.37, 95% CI [0.91, 2.05], p=0.13) was higher in TB patients with a
trend towards significance. Mean number of oocytes retrieved (mean
difference -0.20, 95% confidence interval CI [-1.32, 0.92], p=0.73)
was not different between the groups. Conclusions: ART outcomes
are poorer in women with a history of TB. Variability in study quality
and bias suggests the need for multi-centre studies with standardized
reporting of ART outcomes and TB treatment.