Pregnancy outcomes after all mode of conception in patients with genital tuberculosis: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to summarize the pregnancy outcomes of women di-agnosed with genital tuberculosis (GTB) who spontaneously conceived or underwent intrauterine in-semination (IUI) or in vitro fertilization (IVF) after being treated with antitubercular therapy (ATT). Pub-lications from the PubMed, Medline, Embase, Ovid, Scopus, Web of Science, and Google Scholar data-bases were searched from December 20, 2021, to March 5, 2022. The outcomes are presented as pooled averages with 95% confidence intervals. The inconsistency index (I2) test was used to measure the heterogeneity between studies. The certainty of the evidence was assessed using GRADEPro (https://www.gradepro.org/). Of the numerous articles identified, 33 met the inclusion criteria and were included in this systematic review. Generally, there was a significant increase in pregnancy rates among patients who underwent IVF compared with those who underwent ATT (37.9% vs. 23.8%; P=0.02). Con-versely, there was no significant difference in pregnancy rates between patients who underwent IUI and those who conceived spontaneously (18.1% vs. 23.8%; P=0.65). In cases in which no abnormalities were found on hysterosalpingography or hysterolaparoscopy, pregnancy rates were comparable be-tween spontaneous and IVF conceptions (48.4% vs. 49.2%). There were no significant differences in pregnancy or live birth rates between patients with GTB and those with other infertility factors under-going IVF treatment (P>0.05). ATT, which is administered during the early stages of GTB is effective in achieving pregnancy outcomes comparable to IVF. However, in patients with advanced-stage disease, IVF is a superior treatment modality, resulting in increased pregnancy rates.