Successful pregnancy outcome following latent tuberculosis infection management in in vitro fertilization and embryo transfer (IVF-ET)

In our previously published case report, “Reactivation of latent tuberculosis infection after in vitro fertilization and embryo transfer: two case reports” (1), we detailed two cases of women with latent tuberculosis infection (LTBI) who underwent in vitro fertilization and embryo transfer (IVF-ET). The report underscored the potential risks of LTBI reactivation during pregnancy following IVF-ET treatment. At the time of our initial publication, the patient in Case 2 had completed a 6-month course of anti-tuberculosis (TB) therapy after a positive interferon-gamma release assay (IGRA) test result. However, her pregnancy outcome was still unknown, as the embryo transfer had been postponed until after the completion of TB treatment. We recently conducted a follow-up assessment with this patient and are pleased to report a successful pregnancy outcome following frozen embryo transfer. Specifically, a single blastocyst was thawed and transferred successfully, resulting in conception on the first attempt. Notably, there were no complications throughout the entire gestation period. Given the high significance attached to this pregnancy, a cesarean section was chosen as the mode of delivery at 38 weeks and 3 days gestation to ensure the safest possible outcome for both mother and child. Consequently, a healthy male infant was delivered at term. Both mother and child are currently in excellent health.

TB, an infectious disease caused by Mycobacterium TB, poses a significant global health threat. It is not only a pulmonary disease but can also invade the reproductive system, leading to infertility, thus making TB a potential cause of infertility (2). For patients planning IVF-ET, particularly those from high TB burden areas or those who are human immunodeficiency virus (HIV) positive or immunodeficient, TB screening is critical to prevent TB issues during pregnancy that could lead to adverse pregnancy outcomes (2). The significance of screening results lies in identifying both active TB, which requires early anti-TB therapy before IVF-ET to reduce the risk of TB progression during pregnancy (3), and LTBI, a condition characterized by a sustained immune response to Mycobacterium TB without symptoms of active TB (4). However, there is ongoing debate regarding the necessity of preventive anti-TB therapy for patients with LTBI before IVF-ET (5). Some experts recommend that infertile women with LTBI from high-TB-burden areas or high-risk factors (e.g., HIV) should undergo preventive anti-TB therapy before IVF-ET (5). However, this is controversial due to the potential delay in assisted reproduction progress and the adverse effects of anti-TB drugs.

A series of studies indicate that LTBI may have varying impacts on reproduction and pregnancy outcomes compared to non-tuberculous infertility patients. A retrospective study from China used IGRA positivity as an LTBI marker to assess the impact of LTBI on pregnancy outcomes in infertile women indicated that LTBI patients had lower biochemical pregnancy, clinical pregnancy, and live birth rates than non-LTBI patients, although these differences were not statistically significant (6). A prospective study in the U.S. observed higher rates of recurrent miscarriage and Asherman’s syndrome in LTBI-positive women compared to non-LTBI counterparts (7). Another study in India found significantly lower anti-Müllerian hormone levels and antral follicle counts in LTBI patients compared to non-LTBI patients, with improved pregnancy outcomes post-anti-TB therapy, suggesting that treatment may enhance ovarian reserve in infertile women (8).

To summarize, TB screening and treatment are essential for infertile patients, particularly before undergoing assisted reproductive technologies such as IVF-ET. Although previous findings highlight the complexities and ongoing debate regarding LTBI management in patients undergoing IVF-ET, the potential implications of LTBI on pregnancy outcomes, including the risk of reactivation during gestation and the possible effects on fertility markers, suggest that proactive screening and treatment strategies may be advisable for high-risk patients. However, the lack of conclusive evidence necessitates further research to establish definitive guidelines, particularly regarding preventive treatment timing and its impact on reproductive outcomes. Our follow-up case also underscores that successful pregnancy can be achieved with careful LTBI management. This growing body of research reinforces the importance of individualized care approaches and highlights an opportunity for further exploration into LTBI screening protocols and treatment pathways tailored to IVF-ET patients.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Gynecology and Pelvic Medicine. The article has undergone external peer review.

Peer Review File: Available at https://gpm.amegroups.com/article/view/10.21037/gpm-24-50/prf

Funding: This work was supported by the National Key R&D Program of China (grant No. 2021YFC2009100), the Science & Technology Department of Sichuan (grant No. 2023YFS0158), and the National Natural Science Foundation of China (grant No. 2023NSFSC0738).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gpm.amegroups.com/article/view/10.21037/gpm-24-50/coif). T.C. serves as an unpaid editorial board member of Gynecology and Pelvic Medicine from July 2024 to December 2025. The other authors have no conflicts of interest to declare.

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