TB Manifests as Infertility: A Systematic Review and Meta-Analysis

Genital TB found in ~26% of infertile women, with most showing no respiratory symptoms — only infertility

Journal: The International Journal of Tuberculosis and Lung Disease | Published: 2026-04-27 | Type: Systematic Review, Meta-Analysis | PMID: 42046227 Authors: Simanjuntak AM et al. — Indonesian university consortium (Universitas Riau, Universitas Bangka Belitung, Universitas Pelita Harapan) Funding/COI: Not listed for either

Summary

Genital tuberculosis (GTB) is a known but underdiagnosed cause of infertility because it produces no cough, no fever, no classic TB presentation — just a failure to conceive. This meta-analysis pooled 2,197 infertility patients across 11 studies to quantify how often GTB is the hidden culprit. The short answer: roughly one in four infertile women had GTB, and two-thirds of those presented with primary infertility — meaning they had never conceived at all.

Claims

• GTB found in approximately 26% of women presenting with infertility
• Of GTB cases, 10% involved the endometrium and 25% the fallopian tubes
• 67% of GTB-related infertility cases were primary infertility
• 15% of women with GTB had infertility as their presenting condition in this dataset
• ~12% of infertile patients with GTB achieved pregnancy
• Male GTB data were insufficient for meta-analysis — no pooled estimates possible
• Most patients had no clinical manifestations beyond infertility (no pulmonary symptoms)

Study Quality

The authors followed a structured methodology using the PECOS framework for literature search and Joanna Briggs Institute (JBI) critical appraisal tools for risk-of-bias assessment — both are credible, established approaches for prevalence meta-analyses. Forest plots and comparative tables were used for synthesis. The inclusion of 2,197 patients across 11 studies provides a modest but meaningful evidence base for a condition that is notoriously difficult to study.

The 11-from-1,546 inclusion rate (0.7%) reflects tight eligibility criteria, which cuts both ways: it reduces noise but concentrates the estimate on a narrow slice of existing literature. Heterogeneity across settings, TB prevalence rates, and diagnostic criteria is a serious concern and the abstract offers no I² or between-study variance statistics — a notable gap.

Red Flags

• Funding and COI entirely absent — no disclosure from any of the ten authors
• Male GTB analysis was impossible due to insufficient disaggregated data in included studies — a major gap for a urology digest
• No heterogeneity statistics reported in the abstract (no I², no confidence intervals) — essential for interpreting pooled prevalence estimates
• All authors are from Indonesian institutions — the included studies and their regional TB burden may not generalize to low-prevalence settings
• Only 11 studies included from a pool of 1,546 — the funnel of exclusion is steep; publication bias is plausible
• The claim that "15% of women with GTB had infertility" and the claim that "GTB found in 26% of infertile women" reflect different denominators — the abstract conflates them without clearly distinguishing the analysis direction

Strengths

• Addresses a genuinely under-researched clinical question with real diagnostic consequences
• Used validated appraisal tools (JBI) rather than ad hoc quality scoring
• Large enough pooled sample (2,197) to estimate prevalence with reasonable precision
• Highlights a diagnostic gap: GTB is silent, which means it can be missed entirely without targeted screening in infertile patients from endemic regions

Verdict

This paper draws attention to a real and underappreciated diagnostic blind spot — tuberculosis presenting as infertility with no pulmonary symptoms is exactly the kind of thing that gets missed for years while patients cycle through IVF clinics. The 26% figure is striking and worth noting. But the missing heterogeneity statistics, the absent funding disclosure, the inability to analyze male cases, and the geographic concentration of included studies mean the headline number should be treated as a rough signal, not a precise estimate. Clinically useful as a wake-up call; methodologically incomplete as a standalone evidence source.