Case report of pelvic tuberculosis resulting in Asherman’s syndrome and infertility

Approximately one-third of the world’s population is infected with Mycobacterium tuberculosis, and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman’s syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis. The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.