For the past four years, 27-year-old Kavita Seth (name changed) from Mumbai’s Andheri had been trying to conceive without success. There were no obvious warning signs — her health appeared normal, her menstrual cycles were largely regular, and her initial tests as well as those of her husband did not raise concerns. But a routine test to check whether her fallopian tubes were open revealed something unusual.

During the procedure, doctors inject a special contrast liquid into the uterus to see if it flows freely through the tubes. In Kavita’s case, the liquid failed to pass through, indicating that both her fallopian tubes were blocked. The finding prompted further investigation. When doctors performed a laparoscopy, the extent of the damage became clear. Both fallopian tubes were severely damaged, and small nodular lesions, or tubercles, were visible on their surface. A biopsy confirmed the diagnosis: genital tuberculosis (TB). She had never been diagnosed with TB before.

She underwent six months of anti-tubercular treatment and was eventually declared cured. However, the infection had already caused irreversible damage to her fallopian tubes, leaving in-vitro fertilisation (IVF) as the only option. The couple went ahead with the procedure and had a child.

Doctors say such cases are not rare and are often detected only when couples seek help for infertility. However, the TB bacteria, which spreads through the air when an infected person coughs or sneezes, can infect those around. Although commonly associated with the lungs, they can also affect other parts of the body, including the brain, intestines, bones and reproductive organs.

When TB bacteria from a previous lung infection impacts reproductive organs, they cause infertility in both women (fallopian tubes, uterus) and men (testicles, prostate). This is a significant yet often overlooked cause of infertility, particularly in women. Although TB is typically associated with symptoms like persistent cough, fever, night sweats, fatigue and weight loss, genital TB may present with mild or no symptoms at all, often remaining undiagnosed until couples face difficulty in conceiving.

Dr Rita Modi, fertility specialist at Motherhood Fertility & IVF, genital TB can damage the fallopian tubes, cause blockage, and affect the lining of the uterus, stalling pregnancy. In men, the infection may affect the testes, leading to reduced sperm count or blockage in the sperm pathway. “These complications can deeply affect a couple emotionally, especially when they are unaware of the underlying cause. The good news is that with early diagnosis and proper treatment, many of these problems can be managed and IVF re-attempted,” she said.

In another case, a woman from Sion, Mumbai, found that she had multiple lesions inside the uterus when her IVF cycles failed repeatedly. She had a prior history of TB treatment but the infection had either persisted or reactivated. Doctors paused fertility treatment and put her on nine months of anti-tubercular therapy.

Doctors advise that individuals with a history of TB, persistent pelvic pain, unexplained infertility or reproductive health concerns should seek medical advice promptly.

Dr Kekin Gala, consultant in Obstetrics and Gynaecology, Apollo Spectra Hospital, Mumbai, says most women ignore early symptoms like irregular periods, lower abdominal pain, weakness, or sudden weight loss. These signs may seem minor but can become serious if not treated in time.

Dr Avantika Vaze, fertility specialist at Nova IVF Fertility, Vashi, Mumbai, warns how genital TB can significantly affect fertility if not diagnosed early. “In women, it can damage the fallopian tubes, uterus and endometrium, leading to blocked tubes, irregular cycles and difficulty in embryo implantation. Because symptoms are often silent, many patients only discover the problem when they seek help for infertility,” she says.

In men, TB can block sperm-carrying tubes, reduce sperm count or quality, and cause swelling or pain in the testes. “Symptoms may include scrotal pain, swelling, or difficulty in conceiving,” says Dr Parikshit Tank, consultant gynaecologist, Zynova Shalby Hospital, Mumbai.

This condition is treated with a six-month course of anti-tubercular therapy (ATT), similar to pulmonary TB. The standard treatment involves a two-month intensive phase of four drugs — isoniazid, rifampicin, pyrazinamide, and ethambutol —followed by a four-month continuation phase of isoniazid and rifampicin.

For drug-resistant genital TB, specialised, longer oral regimens (18–20 months) or shorter, intensified regimens (9-12 months) are required. While treatment cures the infection, it may not reverse structural damage. IVF is often effective after completing treatment if the fallopian tubes are blocked but the endometrium is healthy.