Effect Of Latent Tuberculous Infection And Preventive Chemotherapy On Outcome Of In Vitro Fertilization-Embryo Transfer

Objective:To ananlyze the value of purified protein derivative (PPD) test before in vitro fertilization-embryo transfer(IVF-ET) or intracytoplasmic sperm injection-embryo transfer(ICSI-ET)on infertile patients of latent tuberculous infection(LTBI). To study the impact of preventive chemotherapy and the outcomes of the first IVF-ET or ICSI-ET treatment cycles in LTBI infertile patients.Method:A total of 2585 infertile patients attending to the clinic of Shandong Provincial Hospital Human Preproductive Center in this retrospective study were performed IVF/ICSI-ET procedure between January 2008 and December 2009.The patients were divided into three groups:strong positive reactors of PPD test (group A, 286 cycles);not strong positive reactors of PPD test (group B,2299 cycles). Group A was divided into two groups:patients who took preventive chemotherapy (group A1,253 cycles);patients who did not take preventive chemotherapy (group A2,33 cycles). In addition,we ananlyze four typical cases.Result:(1)Among the 2585 women undergoing their first IVF/ICSI-ET cycles, incidence of LTBI is 11.1%.(2)Cpmpared with group B,group A had longer infertility years and higher fertilization rate of IVF and ICSI (P< 0.05).Days of using gonadotrophin(Gn),total dose of Gn,oocyte number,good embryo number, implantation rate,pregnancy rate,abortion rate,ectopic pregnancy rate,ongoing pregnancy and delivery rate were similar between two groups(P>0.05).(3)Cpmpared with group A2,group A1 showed higher fertilization rate of IVF(P<0.05).Days of using Gn, total dose of Gn, oocyte number,fertilization rate of ICSI,good embryo number,implantation rate,pregnancy rate,abortion rate,ectopic pregnancy rate,ongoing pregnancy and delivery rate were similar between two groups (P>0.05).(4)Caseâ… The patient was in a state of LTBI Before IVF-ET but she rejected any treatment.Then the patient was followed with IVF-ET spontaneous abortion.The second IVF-ET cycle after preventive chemotherapy this patient had triplet pregnancy eventually. Caseâ…¡:An IVF pregnancy exacerbation LTBI then result in miliary pulmonary tuberculosis and spontaneous abortion. Caseâ…¢:The patient had pregnancy failure in the first IVF-ET cycle, she was found LTBI by PPD test and treated, then this patient had singleton pregnancy and preterm dilivery by the second ICSI-ET cycle in the end.Caseâ…£:Five cycles IVF/ICSI-ET treatment failure with strong positive result of PPD test, the patient was futher found pulmonary tuberculosis.Conclusion:(1)Our study firstly reports the prevalence of LTBI in infertile women.Among the 2585 women undergoing their first IVF/ICSI-ET cycles,incidence of LTBI is 11.1%,which was significantly higher than ordinary population.And these LTBI patients had significantly longer infertile years than not LTBI infertile patients.(2)We didn't detect harmful impact on the first IVF/ICSI-ET cycles in patients with LTBI. What's more we didn't find significant value of preventive chemotherapy(3)However, IVF/ICSI-ET and pregnancy can activate LTBI and lead to tuberculosis or spontaneous abortion; preventive chemotherapy may improve the outcomes of new cycle after failure therapy cycles.Then,we advocate routine PPD test before IVF/ICSI-ET in every patients to rule out LTBI. LTBI patients had better undertake preventive chemotherapy before IVF/ICSI-ET.