Oocyte quality and ICSI outcome in patients with tuberculosis

Objective: To evaluate the effects of tuberculosis on oocyte characteristics and ICSI outcome. Study design: Prospective comparative observational study. Setting: Tertiary level infertility care centre. Materials and methods: Study group: Women undergoing ICSI with h/o tuberculosis (1 clinical + I laboratory criteria). Control group: Women undergoing ICSI without h/o tuberculosis or tubal factor infertility. Sample size: 28 patients in study and 30 patients in control group. Exclusion criteria: Age >35 yrs. Intervention: ICSI(intracytoplasmic sperm insemination). Statistical analysis method: Statistical analysis was performed by the SPSS program for Windows, version 17.0. Continuous variables are presented as mean ± SD, and categorical variables are presented as absolute numbers and percentage. Data were checked for normality before statistical analysis. Normally distributed continuous variables were compared using the unpaired t test, whereas the Mann-Whitney U test was used for those variables that were not normally distributed. Categorical variables were analysed using either the chi square test or Fisher’s exact test. For all statistical tests, a p value less than 0.05 was taken to indicate a significant difference. Primary outcome measures: no. of mature oocytes (oocyte retrieval rate); no. of other variants of oocytes (M1, dysmorphic, GV, small, large, or polar body). Secondary outcome measures: FSH, LH, AMH, and AFC values; no. of days of stimulation; fertilization rates; embryo morphology; implantation rates; ongoing pregnancy rates. Results: There was no statistically significant difference with regards to age, FSH and LH levels, AFC between the two groups. The mean AMH values in cases and controls were 1.51 ± 0.96and 2.6 ± 1.46 respectively ,the difference being statistically significant. (p value -0.021) mean days of stimulation in cases were 10 while in controls were 10.4, the difference being statisticallt insignificant. Retrieval rates of M2 oocytes in cases and controls were 33.3% and 93.3% respectively , the difference being statistically significant(p value- <0.001) Comparison of other variants of oocytes and the fertilization rates (cases-72.0 ± 29.0,controls-83.7 ± 17.0) didn’t reveal any statistically significant difference between the two groups. There was statistically significant difference (p value -0.0001) between the cases and controls when compared for number of grade A embryos (cases:85.7%, controls: 93.1%). The clinical pregnancy rates in the cases and controls were 14.3 % and 36.7% respectively, the difference being statistically insignificant. However when cases and controls were compared for ongoing pregnancy rates (cases: 3.6% ,controls : 30.0%) the difference was statistically significant (p value-0.013). There was only 1 case of ectopic gestation which was in controls and incidence was statistically insignificant. Conclusion: ICSI cycles in patient with positive history of genital tuberculosis were associated with low AMH values, lesser M2 retrieval rates, lesser grade A embryo formation rates and lesser ongoing pregnancy rates. However the study results are limited because of the small sample size. More studies with greater sample size are needed to evaluate the oocyte quality in these patients undergoing ICSI cycles.