Significance of isolating non-tuberculous mycobacterial organisms in infertile women with tubal disease: an observational study.

Objectives: To explore whether non-tuberculous mycobacteria (NTM) are associated with tubal disease leading to infertility.

Design: Prospective observational study.

Setting: Teaching hospital.

Population: Women with tubal factor infertility.

Methods: In all, 173 infertile women with tubal disease were investigated for genital tuberculosis, Chlamydia trachomatis and Neisseria gonorrhoeae using polymerase chain reaction, culture and histopathological examination. On culture, NTM were grown in 23.7% of endometrial samples. The mycolic characteristics of these organisms were analysed.

Main Outcome Measure: Whether NTM are associated with tubal disease leading to infertility.

Results: The organisms identified in association with tubal disease were Mycobacterium tuberculosis in 30%, gonococci in 1.7%, Chlamydia in 7.5% and NTM in 23.7% of cases. Mycobacterium chelonae was the predominant organism identified by high-performance liquid chromatography. In ten women, for whom there was laparoscopic evidence of tubal disease, the only organism that was grown was NTM, and the tests for other organisms were negative. Tests for possible environment (theatre, instruments) contamination was reported negative.

Conclusion: While evaluating infertile women for tubal disease, culture studies revealed a high prevalence of NTM in the endometrium. In the absence of M. tuberculosis, gonococci and Chlamydia infection, the presence of NTM suggests the possibility that these organisms may be responsible for tubal damage leading to infertility.

Tweetable Abstract: On evaluating the causes of tubal disease, NTM were associated with tubal disease.