Correspondence to Dr HongBin Chi; [email protected] ; Dr Xiaoyan Gai; [email protected]
STRENGTHS AND LIMITATIONS OF THIS STUDY
This large retrospective cohort study (n=8769) enhances statistical power for detecting differences in assisted reproductive treatment outcomes.
Multivariable regression adjusted for key covariates (eg, age, infertility duration) to clarify associations.
This is a retrospective study where data were collected from patients’ medical record databases.
Introduction
Infertility is a common health issue affecting many childbearing period females worldwide, with a global prevalence of 9%–25%. In China, the prevalence of infertility has increased from 2.5% to 3% in 1993 to approximately 18% in 2020.1–3 Tuberculosis (TB) is one of the leading causes of female infertility.4 Genital TB (GTB) can result in tubal obstruction, ovulatory dysfunction and decreased endometrial receptivity, all of which impair reproductive function.2 5 The incidence of GTB in developing countries is approximately 3%–16% approximately, with 80%–90% of cases occurring in women aged 20–40 years during their reproductive years. In some cases, infertility is the only presenting symptom.6–9
In vitro fertilisation-embryo transfer (IVF-ET) is an effective technique for treating infertility.8 Clinically, chest radiography (CXR) is routinely performed before assisted reproductive treatment (ART) to screen for active pulmonary TB (PTB). Our team’s previous research found that 10.4% of infertile patients who underwent ART had prior TB lesions on CXR, and 83.3% of them had never received anti-TB treatment.1 The clinical pregnancy rate and live birth rate after ART in untreated patients with prior PTB lesions on CXR were significantly lower than those in patients without TB lesions.1 However, it remains unclear whether prior PTB after completion of anti-TB treatment has an effect on ART outcomes.
In previous studies, Mingming Lin et al at our centre analysed pregnancy outcomes in infertile women after ART, comparing those with fully treated endometrial TB to those without TB. They found that the cumulative live birth rate was lower and the rate of spontaneous miscarriage was higher in the TB group than in the non-TB group.10 For patients with prior TB on CXR, there are currently no published data on pregnancy outcomes after anti-TB treatment. This study using a retrospective cohort analysis aimed to compare ART outcomes, including clinical pregnancy rate, live birth rate and miscarriage rate, among infertile patients with TB who have undergone standardised anti-TB treatment, prior PTB without anti-TB treatment and non-PTB groups. These findings may provide a theoretical basis for infertile patients in clinical management.
Methods
Study design
This retrospective cohort study included infertile patients (20–50 years old) who underwent ART at Peking University Third Hospital, between 1 January 2017 and 31 December 2017.1 Infertile patients aged 20–50 years with prior TB lesions on CXR or with normal radiographic findings were included. Patients were categorised into three groups based on CXR findings and prior anti-TB treatment: (1) treated prior-PTB group: infertile patients showing radiographic evidence of prior tuberculous lesions with a history of anti-TB treatment; (2) untreated prior-PTB group: infertile patients showing radiographic evidence of prior tuberculous lesions without any history of anti-TB treatment and (3) non-PTB group: infertile patients without radiographic evidence of prior tuberculous lesions and no history of anti-TB treatment.
Patients with active TB (including active PTB or GTB) were excluded from undergoing ART. The patient enrolment process is summarised in figure 1, with detailed procedures provided in online supplemental data 1 and online supplemental figure 1. The criteria for diagnosing prior PTB on CXR, such as the presence of fibrotic nodules, calcified lesions and fibrous bands, were consistent with those used in previous studies.1 11 12 CXR results were jointly interpreted by a radiologist and a respiratory doctor.
Figure 1. Flow chart of cohort study. CXR, chest radiography; IVF-ET, in vitro fertilisation and embryo transfer; PTB, pulmonary TB; TB, tuberculosis.
Detailed information on infertile patients who underwent ART at our reproductive centre, including age, body mass index (BMI), duration of infertility and baseline endocrine hormone levels, was acquired from a case registration research database. The infertility factors for each patient were documented and categorised into 10 major groups on the basis of the classifications used in our previous studies.1 12 13 Use of the controlled ovarian hyperstimulation (COH) protocol and pregnancy outcomes were also recorded.
Assisted reproduction protocol
COH was performed in accordance with the routine-assisted reproduction protocol at our centre.1 13 On days 2–3 of the menstrual cycle, four sex hormones (follicle-stimulating hormone, luteinising hormone, oestradiol and progesterone) and the antral follicle count were detected. After embryo transfer, routine luteal support was provided with daily vaginal administration of 90 mg progesterone gel. Blood human chorionic gonadotropin (HCG) levels were measured 14 days after the transfer to confirm pregnancy. For patients with confirmed pregnancies, blood HCG levels were measured again 21 days after transfer, and ultrasonography was performed 30 and 37 days after transfer to assess the gestational sac and fetal heartbeat.
Pregnancy outcomes
The primary outcome was the live birth rate. Clinical pregnancy and miscarriage rates were the secondary outcomes. The definitions and calculation formulas for clinical pregnancy rate, miscarriage rate and live birth rate were consistent with those used in previous studies.1 13 Clinical pregnancy rate was defined as clinical pregnancy per embryo transfer; miscarriage rate was defined as miscarriages per clinical pregnancy; live birth rate was defined as live births per embryo transfer.1
Statistical analysis
The primary outcome of this study was live birth rate. Based on our previous research, the anticipated live birth rate was 23.8% in the untreated prior-PTB group, with an expected 12% difference between the treated prior-PTB group and untreated prior-PTB group. Assuming a 1:4 ratio between the two groups (150 cases in the treated group vs 600 in the untreated group), the estimated statistical power would reach 83.3%.1
Continuous variables are expressed as mean±SD or median (IQR), and independent sample t-tests or Mann-Whitney U tests were used as appropriate. Categorical variables, such as causes of infertility and COH protocol use, are presented as number and percentage, and group comparisons were conducted using the χ2 test. To compare the means of continuous variables among multiple groups, analysis of variance was employed; Bonferroni correction was used when variances were equal, whereas the Tamhane T2 test was applied when variances were unequal.
Multifactorial logistic regression was used to assess the impact of exposure factors on the primary and secondary outcomes. Pregnancy outcomes, including clinical pregnancy, miscarriage and live birth rates, were treated as dependent variables, whereas TB group status was included as an independent variable in the multifactorial logistic regression. Previous studies have identified several factors with substantial evidence of association with pregnancy outcomes, including age, BMI, endometrial thickness, number of good-quality embryos per cycle, causes of infertility and COH protocol. We included these variables in the multivariate analysis to control for potential confounding. These specific covariates were chosen because they consistently demonstrate the highest clinical predictive value for IVF-ET outcomes in infertile patients across multiple studies, including our institutional research.1 13 The results are reported as adjusted ORs, 95% CIs and p values. Statistical analyses were performed using SPSS Statistics for Windows (V.25; IBM), and statistical significance was set at p<0.05.
Results
Baseline characteristics and chest imaging findings of infertile patients
In total, 8769 infertile patients aged 20–50 years old underwent ART and embryo transfer at our reproductive centre during the study period. Among them, 171 from the treated prior-PTB group, 791 from the untreated prior-PTB group and 7807 from the non-PTB group (figure 1). The treated prior-PTB group had a moderate age (33.6±4.7 years vs 34.8±5.0 years vs 33.0±5.0 years), longer duration of infertility (5.1±4.4 years vs 4.6±4.0 years vs 4.3±3.7 years) and lower BMI (22.0±2.9 kg/m² vs 22.6±3.5 kg/m² vs 23.1±3.8 kg/m²) compared with the other two groups (all p<0.05; table 1). There were significant differences in infertility factors among the three groups, with fallopian tubal disease being the most common cause of infertility, occurring at the highest rate in the treated prior-PTB group (36.3%), which was significantly higher than those in the untreated prior-PTB group (23.4%) and the non-PTB group (20.3%). Compared with the non-PTB group, the treated prior-PTB group had a lower number of antral follicles (8.5±4.7 vs 10.3±5.7) and thinner endometrial thickness (10.39±1.66 mm vs 10.78±1.71 mm); among these three subgroups, the treated prior-PTB group had the highest number of retrieved oocytes (10.1±5.9 vs 9.3±4.9 vs 10.0±5.2) and the highest number of good-quality embryos (4.0 (2.0, 6.0) vs 3.0 (1.0, 5.0) vs 3.0 (2.0, 6.0)) (all p<0.05).
Table 1Characteristics of infertile patients who underwent IVF-ET
Characteristic | Treated prior-PTB group (n=171) | Untreated prior-PTB group (n=791) | Non-PTB group (n=7807) | P value |
Age (years) (n=8769) | 33.6±4.7 | 34.8±5.0 | 33.0±5.0 | <0.001* |
BMI, kg/m2 (n=8681) | 22.0±2.9 | 22.6±3.5 | 23.1±3.8 | <0.001* |
Duration of infertility (year) (n=8769) | 5.1±4.4 | 4.6±4.0 | 4.3±3.7 | 0.001* |
Causes of infertility, no. (%) (n=8769) | <0.001* | |||
Female factor | ||||
62 (36.3) | 185 (23.4) | 1582 (20.3) | ||
0 (0) | 28 (3.5) | 334 (4.2) | ||
10 (5.8) | 50 (6.3) | 465 (5.9) | ||
1 (0.5) | 10 (1.3) | 108 (1.4) | ||
23 (13.5) | 113 (14.3) | 906 (11.6) | ||
5 (2.9) | 20 (2.5) | 241 (3.1) | ||
Male factor | ||||
12 (7.0) | 92 (11.6) | 1023 (13.1) | ||
6 (3.5) | 39 (4.9) | 512 (6.6) | ||
34 (19.8) | 170 (21.5) | 1682 (21.5) | ||
18 (10.5) | 84 (10.6) | 954 (12.2) | ||
COH protocol (n=8769) | 0.040* | |||
18 (10.5) | 85 (10.7) | 939 (12.0) | ||
2 (1.2) | 31 (3.9) | 251 (3.2) | ||
94 (55.0) | 404 (51.1) | 4119 (52.8) | ||
4 (2.3) | 39 (4.9) | 227 (2.9) | ||
50 (29.2) | 228 (28.8) | 2225 (28.5) | ||
3 (1.8) | 4 (0.5) | 46 (0.6) | ||
Baseline hormone level | ||||
6.4 (4.8–7.8) | 6.3 (4.6–8.2) | 6.3 (4.7–7.9) | 0.536 | |
3.2 (2.2–4.2) | 3.1 (1.9–4.6) | 3.2 (2.0–4.7) | 0.450 | |
159.0 (120.0–200.0) | 156.0 (119.0–202.0) | 158.0 (120.0–203.0) | 0.974 | |
1.1 (0.8–1.6) | 1.0 (0.8–1.4) | 1.1 (0.8–1.5) | 0.142 | |
2.0 (1.2–3.8) | 2.1 (1.1–3.5) | 2.2 (1.1–3.9) | 0.333 | |
No. of antral follicles (n=5833) | 8.5±4.7 | 9.3±5.6 | 10.3±5.7 | 0.001* |
No. of retrieved oocytes (n=8769) | 10.1±5.9 | 9.3±4.9 | 10.0±5.2 | <0.001* |
Endometrial thickness (mm) (n=7312) | 10.39±1.66 | 10.74±1.75 | 10.78±1.71 | 0.029* |
Endometrial pattern (n=8699) | 0.024* | |||
150 (87.7) | 702 (88.7) | 6721 (86.1) | ||
1 (0.6) | 3 (0.4) | 34 (0.4) | ||
18 (10.5) | 77 (9.7) | 991 (12.7) | ||
0 (0.0) | 0 (0.0) | 2 (0.0) | ||
No. of good-quality embryos per cycle† (n=8769) | 4.0 (2.0,6.0) | 3.0 (1.0, 5.0) | 3.0 (2.0, 6.0) | <0.001* |
No. of embryos transferred (n=8769) | 0.002* | |||
30 (16.9) | 159 (19.3) | 1200 (15.0) | ||
141 (81.2) | 632 (80.8) | 6607 (85.0) |
*p<0.05.
†All good-quality embryos were developed from two-pronuclei zygotes and met the following criteria: (1) >5 blastomeres, (2) a size difference of <20% and (3) fragmentation of <50%.
AMH, anti-Müllerian hormone; BMI, body mass index; COH, controlled ovarian hyperstimulation; E2, oestradiol; ET, embryo transfer; FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; IVF, in vitro fertilisation; LH, luteinising hormone; No., Number; P, prolactin; PCOS, polycystic ovary syndrome; PTB, pulmonary tuberculosis.
Pregnancy outcomes after ART in the treated prior-PTB group
Compared with the untreated prior-PTB group, the treated prior-PTB group had a significantly higher clinical pregnancy rate (41.5% vs 31.7%, p<0.05) and live birth rate (35.3% vs 23.8%, p<0.05). The miscarriage rate was lower in the treated group than in the untreated group (11.3% vs 19.1%, p=0.123), although the difference was not statistically significant (table 2).
Table 2ART outcomes in the treated prior-PTB and untreated prior-PTB group
Pregnancy outcomes | Treated prior-PTB | Untreated prior-PTB | P value |
Clinical pregnancy rate† | 41.5% (71/171) | 31.7% (251/791) | 0.014* |
Miscarriage rate‡ | 11.3% (8/71) | 19.1% (48/251) | 0.123 |
Early miscarriage§ | 9.9% (7/71) | 13.9% (35/251) | 0.367 |
Late miscarriage¶ | 1.4% (1/71) | 5.2% (13/251) | 0.169 |
Live birth rate** | 35.3% (60/170) | 23.8% (186/782) | 0.002* |
*p<0.05.
†Clinical pregnancy rate was defined as clinical pregnancy per embryo transfer.
‡Miscarriage rate was defined as miscarriages per clinical pregnancy.
§Early miscarriage was defined as early miscarriages per clinical pregnancy.
¶Late miscarriage was defined as late miscarriages per clinical pregnancy.
**Live birth rate was defined as live births per embryo transfer.
ART, assisted reproductive treatment; PTB, pulmonary tuberculosis.
When compared with the non-PTB group, the treated prior-PTB group exhibited similar pregnancy outcomes (table 3). The graphical abstract of this article is seen in figure 2.
Figure 2. The graphical abstract. Pregnancy outcomes, including clinical pregnancy rate, miscarriage rate and live birth rate. CXR, chest X-ray; PTB, pulmonary TB; TB, tuberculosis; *p<0.05.
ART outcomes in the treated prior-PTB and non-PTB groups
Pregnancy outcome | Treated prior-PTB | Non-PTB | P value |
Clinical pregnancy rate | 41.5% (71/171) | 38.1% (2973/7807) | 0.360 |
Miscarriage rate | 11.3% (8/71) | 15.5% (462/2973) | 0.325 |
Early miscarriage | 9.9% (7/71) | 12.9% (385/2973) | 0.442 |
Late miscarriage | 1.4% (1/71) | 2.6% (77/2973) | 0.534 |
Live birth rate | 35.3% (60/170) | 30.6% (2375/7768) | 0.187 |
The definition of pregnancy outcomes is consistent with the above.
ART, assisted reproductive treatment; PTB, pulmonary tuberculosis.
In the untreated prior-PTB group, one patient experienced fever at 12 weeks’ gestation, and CT imaging revealed diffuse miliary nodules in both lungs, leading to a diagnosis of acute miliary TB. The pregnancy was terminated because of spontaneous abortion. The mother’s condition improved after anti-TB treatment, and she stopped taking the medication after >1 year of treatment.
Multivariate analysis of factors affecting pregnancy outcomes after ART in infertile patients
After adjusting for age, BMI, causes of infertility and other confounders, multivariable regression confirmed significantly higher live birth rate in the treated prior-PTB group compared with the untreated prior-PTB group (aOR: 1.69, 95% CI: 1.01 to 2.83, p=0.045). Moreover, the treated prior-PTB group demonstrated pregnancy outcomes comparable to those of the non-PTB group (table 4 and online supplemental table 1).
Table 4Results of multivariate logistic regression analyses of pregnancy outcomes in different infertile populations
Variable | Treated prior-PTB vs untreated prior-PTB | Treated prior-PTB vs non-PTB | |
Clinical pregnancy rate | aOR (95% CI) | 1.402 (0.866 to 2.268) | 1.280 (0.849 to 1.929) |
P value | 0.169 | 0.238 | |
Miscarriage rate | aOR (95% CI) | 0.642 (0.174 to 2.367) | 0.586 (0.205 to 1.677) |
P value | 0.505 | 0.319 | |
Live birth rate | aOR (95% CI) | 1.692 (1.013 to 2.826) | 1.385 (0.906 to 2.115) |
P value | 0.045* | 0.132 |
Factors were adjusted for age, body mass index, causes of infertility, COH protocol use, endometrial thickness and number of good-quality embryos per cycle. The definition of pregnancy outcomes is consistent with the above.
Data on BMI, endometrial thickness were missing for 88 and 1457 patients, respectively, in the whole research population.
*p<0.05
aOR, adjusted OR; BMI, body mass index; COH, controlled ovarian hyperstimulation; PTB, pulmonary tuberculosis.
Association between infertility causes and pregnancy outcomes in infertile patients with a history of anti-TB treatment
No significant association was observed between infertility causes and pregnancy outcomes in patients undergoing ART (online supplemental table 2).
Discussion
This study was based on our established cohort of 8769 patients undergoing ART. Here, we analysed the pregnancy outcomes of patients with prior PTB lesions who had a history of completing standardised anti-TB treatment. The results indicated that patients with a history of standardised anti-TB treatment had similar clinical pregnancy rate, miscarriage rate and live birth rate after ART as those in the normal CXR group. And when compared with the untreated prior-PTB group, the treated prior-PTB group had a significantly higher live birth rate after adjusting for multivariables. These research findings suggest that patients with TB who have undergone anti-TB treatment have similar pregnancy outcomes after ART to those without TB. This finding indicates that anti-TB treatment can substantially improve pregnancy outcomes in infertile patients with prior PTB undergoing ART.
After TB infects the human body, it may appear as PTB, GTB, bone TB or TB affecting other organs. Certain investigations have focused on the pregnancy outcomes of patients with GTB following anti-TB treatment. Pregnancy outcomes after ART in patients with cured uterine TB showed that the cumulative live birth rate was lower and the spontaneous abortion rate was higher in the treated TB group than in the non-TB group.10 Another study in China analysed pregnancy outcomes after ART in 155 patients with GTB following anti-TB treatment, including 130 patients with tubal TB and 25 patients with uterine TB. The results indicated that the pregnancy outcomes for the tubal TB group were similar to those of the non-TB group, whereas the fertilisation, implantation and pregnancy rates for the uterine TB group were significantly lower than those of the non-TB group.14 A recent systematic review analysing pregnancy outcomes in patients with GTB indicated that for patients with TB with structural damage, for example, tubal obstruction, the clinical pregnancy rate after anti-TB treatment remained lower than that in the non-TB group. However, for patients with TB without structural damage, a 6-month course of anti-TB treatment did not show a significant effect on pregnancy outcomes. The authors noted that the evidence was uncertain because of the limited number of included studies, with only three studies contributing to the data.15
TB screening before ART is of the utmost importance in patients with infertility. The rapid advancements in ART have enabled an increasing number of infertile patients to fulfil their desire to conceive.16 However, there have been a growing number of reports of pregnancies complicated by active TB, primarily presenting as miliary PTB or tuberculous meningitis.15 17 In a summary of >80 000 patients who underwent ART for infertility at our hospital, 7 cases of active TB during pregnancy were identified, characterised by acute haematogenous disseminated PTB (7/7) and tuberculous meningitis (2/7). Ultimately, four cases resulted in spontaneous abortion, while three cases ended in elective abortion.18 It is also crucial to maintain immune balance in the context of latent or active TB.19 There are three factors that influence the success of implantation and pregnancy, including uterine receptivity, endometrial regeneration and cytokine regulation. Immune factors associated with latent genital tuberculosis infection (LGTB) may play a role in the implantation process by altering endometrial receptivity.2 20 21 Women undergoing ART may be at a higher risk of TB infection and associated with poorer perinatal outcomes.22 Therefore, TB screening in patients with infertility before ART is of paramount importance. Additionally, in this study, the multivariate analysis of pregnancy outcomes revealed that age, BMI, COH protocol use and causes of infertility were significantly associated with pregnancy outcomes. Patients aged <30 years had a higher clinical pregnancy rate and live birth rate, along with a lower miscarriage rate than their older counterparts, which is consistent with age-related reproductive trends.23 Moreover, a higher BMI was associated with reduced clinical pregnancy rate, increased miscarriage rate and significantly lower live birth rate, adversely affecting pregnancy outcomes, which is consistent with findings in the existing literature.24–26 Furthermore, the results indicated that infertility has varying effects on pregnancy outcomes. Infertility due to male factors, for example, oligospermia or asthenospermia, leads to poorer pregnancy outcomes than other causes. However, the small number of male factor infertility cases in the treated prior-PTB group (n=12) may have introduced a potential bias.
Building on previous research, this study further demonstrates that anti-TB treatment can significantly improve ART pregnancy outcomes in infertile patients with radiographic evidence of prior PTB, achieving comparable results to those without TB history. However, current clinical practice lacks consensus regarding the necessity of TB screening and preventive anti-TB treatment for infertile patients. Therefore, our findings provide important clinical guidance for implementing systematic preoperative TB screening and determining the need for preventive anti-TB treatment in this patient population.
Limitations
Our study has several limitations. First, this was a single-centre study; however, as the largest reproductive centre in China, our cohort of >10 000 reproduction cycles annually reflects a broad population base. Moreover, the single-centre setting enabled standardised treatment protocols and consistent follow-ups, ensuring high data quality. Second, the diagnosis of prior TB lesions was based on CXR findings, which may not have fully captured the presence of latent TB infection or accurately distinguished between prior and latent TB. Third, the patients with active GTB were excluded, but it remains uncertain whether latent GTB was present in women. Future studies may benefit from incorporating more advanced diagnostic methods, such as CT and molecular testing, to ensure a more comprehensive assessment of TB infection status. Fourth, while our data were collected from 2017, the biological impact of TB on infertility and the fundamental principles of anti-TB treatment remain unchanged, supporting the continued relevance of our pregnancy outcome findings to current practice.
Conclusions
In infertile patients with CXR showing prior TB lesions who have received anti-TB treatment, ART outcomes, including clinical pregnancy rate, live birth rate and miscarriage rate, are comparable to those of patients with normal CXR findings. Additionally, clinical pregnancy and live birth rates were significantly better than those in patients with untreated prior TB lesions on chest CXR. These findings underscore the potential benefits of anti-TB treatment in this TB patient population. However, the risks associated with untreated patients with prior TB lesions warrant clinical attention and further research.
Strengths and limitations
Currently, no published data exist on pregnancy outcomes after anti-TB treatment in patients with prior TB on CXR. This study addressed this gap by evaluating pregnancy outcomes after ART in such patients who have undergone standardised anti-TB treatment.
Our study demonstrated that infertile patients with prior TB lesions on CXR who have completed anti-TB treatment achieved ART outcomes similar to those with normal CXR findings.
ART outcomes in infertile patients with prior TB lesions on CXR who completed anti-TB treatment are markedly better than patients with untreated prior TB lesions. This finding indicates that anti-TB treatment can substantially improve pregnancy outcomes in infertile patients with prior PTB undergoing ART, providing valuable guidance for clinical management.
ART outcomes in infertile patients with prior TB lesions on CXR who completed anti-TB treatment are markedly better than patients with untreated prior TB lesions. This finding indicates that anti-TB treatment can substantially improve pregnancy outcomes in infertile patients with prior PTB undergoing ART, providing valuable guidance for clinical management.
The authors extend their gratitude to all patients and investigators who contributed to this study.
Data availability statement
Data are available on reasonable request.
Ethics statements
Patient consent for publication
Consent obtained directly from patient(s).
Ethics approval
This study involves human participants and was approved by the Ethics Committee of Peking University Third Hospital (approval number: (2019)327-02). Participants gave informed consent to participate in the study before taking part.
Contributors ZS, XG and HC had full access to all data in the study and took responsibility for the integrity of the data and accuracy of the data analysis. XG and HC jointly directed the study and contributed equally as corresponding authors. ZS, LZ, LC, CZ, XG, HC, YS and RL contributed to patient data collection, data analysis and manuscript preparation. All the authors critically reviewed the manuscript, approved the final version and agreed to be accountable. HC is the guarantor.
Funding This study was supported by the Capital’s Funds for Health Improvement and Research (2022-2G-40910), National Key Research and Development Program of China (2023YFC2705504), Cohort Projects of Peking University Third Hospital (BYSYDL2019005) and Key Clinical Projects of Peking University Third Hospital (BYSYZD2024004). The corresponding author had full access to all data and had the final responsibility for the decision to submit for publication.
Disclaimer The funder played no role in the study design, data collection, data analysis, data interpretation or manuscript writing.
Competing interests XG has received research grants from the Capital’s Funds for Health Improvement and Research (2022-2G-40910), HC has received research grants from National Key Research and Development Program of China (2023YFC2705504), Cohort Projects of Peking University Third Hospital (BYSYDL2019005), and Key Clinical Projects of Peking University Third Hospital (BYSYZD2024004). All the authors declare no conflict of interest.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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Abstract
Purpose
Tuberculosis (TB) is a significant factor contributing to infertility. For some infertile patients, chest radiography (CXR) screenings prior to assisted reproductive treatment (ART) reveal old/inactive TB lesions. However, the pregnancy outcomes after ART for such patients who had a history of prior anti-TB treatment remain unclear.
Design
Retrospective cohort study.
Setting
Peking University Third Hospital, a tertiary care centre.
Participants
This study analysed and focused on infertile patients aged 20–50 years with prior TB lesions on CXR (treated/untreated) and normal CXR. Active TB cases were excluded from this study. Patients were categorised into three groups based on CXR findings and prior anti-TB treatment: treated prior-pulmonary TB (PTB) group, untreated prior-PTB group and a non-PTB control group with normal CXR.
Primary and secondary outcome measures
ART outcomes, including clinical pregnancy rate, miscarriage rate and live birth rate, were compared among the groups.
Findings to date
Among 8769 patients analysed, including treated prior-PTB group (n=171), untreated prior-PTB group (n=791) and non-PTB group (n=7807). The treated prior-PTB group showed a similar clinical pregnancy rate (41.5% vs 38.1%, p=0.360) and live birth rate (35.3% vs 30.6%, p=0.187) compared with the non-PTB group. The miscarriage rate was slightly lower in the treated prior-PTB group than in the non-PTB group (11.3% vs 15.5%, p=0.325), although the discrepancy was not statistically significant. Compared with the untreated prior-PTB group, the treated prior-PTB group exhibited significantly higher live birth rate (35.3% vs 23.8%, p<0.05), clinical pregnancy rate (41.5% vs 31.7%, p<0.05) and with a lower miscarriage rate (11.3% vs 19.1%, p=0.123), although the latter was not statistically significant. Multivariable regression confirmed significantly higher live birth rates in the treated prior-PTB group versus untreated prior-PTB group (aOR: 1.69, 95% CI: 1.01 to 2.83, p=0.045).
Conclusions and Future plans
Anti-TB treatment in infertile women with prior PTB lesions was associated with improved ART outcomes, comparable to those in patients without TB lesions. This suggests a potential clinical benefit of anti-TB treatment in improving reproductive outcomes in this population. Further research is warranted to explore ART outcomes in patients with untreated prior TB lesions.
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Details





1 Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
2 Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
3 Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Beijing, China
4 Information Center, Peking University Third Hospital, Beijing, China