Female genital tuberculosis is a disease caused by Mycobacterium tuberculosis infection in the female reproductive tract. The disease burden among women leads to infertility is significant, especially in developing countries. The bacteria can spread from the lung into the reproductive organ through lymphatic or hematogenous. Many patients present with atypical symptoms, which mimic other gynecological conditions. Several investigations are needed to establish the diagnosis. Almost all cases of genital TB affect the fallopian tube and cause infertility in patients and endometrial involvement. Current treatment still relies on antituberculosis therapy with a combination of tubal surgery. The present review describes the epidemiological data, clinical presentation, diagnosis, and currently available treatment to cure the disease and for in vitro fertilization.

This systematic review and meta-analysis aimed to summarize the pregnancy outcomes of women diagnosed with genital tuberculosis (GTB) who spontaneously conceived or underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) after being treated with antitubercular therapy (ATT). Publications from the PubMed, Medline, Embase, Ovid, Scopus, Web of Science, and Google Scholar databases 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). Conversely, 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 between 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 undergoing 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.

Background: This study aims to determine whether there is an effect of oocyte denudation time and ICSI time on embryo quality at assisted reproductive Technology clinic. Methods: An observational analytic retrospective study was conduct using cross-sectional study. The subject were oocytes from in-vitro fertilization procedures using the ICSI method at the assisted reproductive technology clinic in a private hospital in Bandung for the period 2017 - 2019. Three variables were oocyte denudation time, ICSI time and embryo quality collected from samples that met the research criteria. Data will be grouped based on denudation time (T-1) and Intracytoplasmic Sperm Injection time (T-2). Result: From the 5 groups of denudation time; 3-4 hours, 4-5 hours, 5-6 hours, 6-7 hours and more than 7 hours group, the denudation time of 3-4 hours group showed the highest number (66.7%) for excellent embryo quality results, while denudation time of more than 7 hours showed the lowest number (29.2%) for excellent embryo quality results with p < 0.001. From these figures, it shows that the ICSI time of 3-4 hours is superior to the ICSI time of 2-3 hours because the outcome of excellent embryo quality is higher while the outcome of poor embryo quality is lower, although the difference is not significant (p = 0.140). Conclusion: This study shows there was a significant difference in the effect of oocyte denudation time on embryo quality at assisted reproductive technology clinic. There was no significant difference in the effect of intracytoplasmic sperm injection (ICSI) time on embryo quality at assisted reproductive technology clinic.

Introduction and importance: Genital tuberculosis (TB) exerts significant damage in the reproductive organs, particularly the Fallopian tubes and endometrium. Infertility is one of the most common presenting causes, often subsequently requiring assisted reproductive technology (ART). However, we have not had many experiences with genital TB despite being a country endemic for TB. This case series highlights the challenges we face and the solutions we wish we had. Case presentation: In this case series, we recruited 7 patients undergoing in vitro fertilisation (IVF) treatment previously diagnosed with TB between January 01, 2014 and June 30, 2021. Patients were recruited at the beginning of their IVF treatments. Of 7 patients, 2 patients (28.6%) achieved live birth. 5 patients (71.4%) failed to conceive. All patients had good and/or excellent quality embryos upon transfer but only 2/7 managed to conceive and delivered. Clinical discussion: Genital TB is often silent and only encountered during workup for infertility. Genital TB often produces extensive damage on the linings of the endometrium and Fallopian tubes, accounting for the recurrent implantation failures associated with the disease. Whilst antitubercular treatment may improve the prognosis, many women still fail to conceive. Conclusion: Genital tuberculosis remains a significant issue in infertility. Cases are often silent and management is often delayed. IVF is often required due to the longstanding damage caused beforehand yet prognosis may remain poor. HIGHLIGHTS Genital tuberculosis is a significant yet underdiagnosed etiology of infertility. Its profound severity often requires in vitro fertilisation for conception. Poor prognosis may still be found despite IVF due to recurrent implantation failures.

Purpose: Adenomyosis is a complex uterine condition, with emerging evidence indicating epigenetic alterations play a role in its pathogenesis. The methylenetetrahydrofolate reductase (MTHFR) gene polymorphism C677T may reduce enzyme activity, affecting DNA methylation and increasing adenomyosis risk. This study compares the MTHFR C677T polymorphism, 5-methyltetrahydrofolate (5-MTHF) levels, and homocysteine levels in patients with adenomyosis. Patients and Methods: This cross-sectional study involved 61 subjects: 31 patients with adenomyosis and 30 patients as controls. The MTHFR C677T polymorphism was analyzed using PCR-RFLP, serum 5-MTHF and homocysteine levels were measured using ELISA. Statistical analyses were performed to compare genotype distributions and metabolite levels between groups and within the adenomyosis group based on genotype. Results: The study found a significant difference in the distribution of the MTHFR C677T genotype between adenomyosis and control groups (p=0.018), with a higher prevalence of the CT genotype in the adenomyosis group (35.5% vs 10.0%). The frequency of the T allele was also elevated in the adenomyosis group (17.7% vs 5.0%; p=0.027). Serum 5-MTHF levels were notably lower in the adenomyosis group (23.92 ± 4.599 nmol/l) compared to controls (32.45 ± 3.019 nmol/l; p< 0.0001), while homocysteine levels were significantly higher in the adenomyosis group (12.87 ± 8.916 µmol/L vs 8.61 ± 1.352 µmol/L; p=0.019). Further analysis of MTHFR genotypes indicated lower 5-MTHF levels in both CC and CT genotypes among the adenomyosis group compared to controls (p< 0.0001). Homocysteine levels showed no significant difference across genotypes (p=0.074), though there was a trend towards higher levels in the adenomyosis group. Conclusion: This study demonstrates a significant difference in the distribution of the MTHFR C677T polymorphism, lower 5-MTHF levels, and higher homocysteine levels in patients with adenomyosis compared to controls. Lower 5-MTHF levels were also shown to be strongly linked with the heterozygous C677T polymorphism in the adenomyosis group.

The coronavirus disease 2019 (COVID-19) affected the delivery of care in the fertility center. The higher transmissibility feature of omricon variant increase the transmission possibility between patients, healthcare professionals, and staff. Herein, we report the impact of the COVID-19 pandemic to the fertility center in Indonesia during the third wave period of the pandemic. Seven in vitro fertilization (IVF) cases were cancelled because the patients were tested positive for COVID-19 during their IVF program. Six of the total seventeen medical staff in our center were also tested positive for COVID-19 and stayed at home for self isolation. The cancellation of the IVF program was due to the lack of data regarding safety of IVF procedure in COVID-19 patients, shortage of medical staff, and the lack of negative pressure room in our fertility center. Our priority is to protect the remaining healthy patients in our center as well as the medical staff. The COVID-19 disadvantage both patients, care provider in reproductive healthcare. Regular screening of COVID-19 in fertility setting is highly recommended.