Case Report Series and Mini Review on Tuberculosis in IVF-ET Pregnancies: A Call for Vigilant Monitoring and Early Intervention.

Abstract

Background: The risk of tuberculosis during pregnancy is significantly increased, and untimely Mycobacterium tuberculosis (M. tuberculosis) treatment during pregnancy increases the risk of perinatal complications and poor fetal prognosis. Hormonal use in vitro fertilization and embryo transfer (IVF-ET) promotes the growth of M. tuberculosis, leading to more severe disease and adverse pregnancy outcomes. However, its clinical characteristics and possible mechanisms of TB infection in pregnant women who conceive by IVF-ET remain unclear. Therefore, we report three cases of young pregnant women diagnosed with TB after IVF-ET and describe their diagnosis and treatment.

Case presentation: Three young women (age: 26-31 years) diagnosed with primary infertility underwent IVF-ET treatment. They lacked a history of TB or manifestations of activated TB before transplantation. After presenting with fever, cough, and headache at 5-12 weeks of pregnancy, they were diagnosed with miliary TB, disseminated TB, and tuberculous meningitis, respectively. Initially, the patients were on a daily fixed-dose combination of first-line anti-TB treatment (ATT), which comprised rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by medication adjustment during treatment for 6-12 months. Although all fetuses were lost, the patients achieved optimal outcomes after timely ATT.

Conclusions: This report demonstrates the increased risk of TB in pregnant women who conceive by IVF-ET. Therefore, it is important to carefully monitor these women even if they lack a history of or exposure to TB. Accordingly, prompt diagnosis and treatment of TB in these patients is necessary to optimize patient outcomes.