Tuberculosis is usually discussed as a disease of the lungs. Cough, fever, weight loss and weakness are the symptoms most people recognise.

But doctors say the infection does not always stay limited to the lungs. In some men, tuberculosis quietly reaches the reproductive organs and begins affecting fertility long before the condition is detected.

This form of the disease is known as genitourinary tuberculosis. It can involve the testicles, epididymis, prostate or urinary tract. Because the symptoms may appear mild or confusing, many men do not realise that the infection is slowly harming sperm health.

Fertility specialists warn that delayed diagnosis may lead to long-term complications. Yet the good news remains simple: when tuberculosis is identified early and treated fully, many men recover normal reproductive function.

Tuberculosis is not just a lung disease

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. The infection spreads through airborne droplets when a person with active TB coughs or sneezes.

According to India’s Ministry of Health and Family Welfare, TB can affect several organs beyond the lungs, including the kidneys, bones and reproductive system. Government health data under the National TB Elimination Programme (NTEP) highlights that extrapulmonary tuberculosis forms a significant portion of TB cases in India.

When TB bacteria reach the male reproductive organs, they can cause inflammation, swelling and tissue damage. This may slowly begin interfering with sperm production and movement.

How TB quietly interferes with male fertility

Fertility specialists say tuberculosis can damage the reproductive system in several ways.“In males, genitourinary TB may remain undetected for months, as symptoms are often mild. Common signs include pain or swelling in the testicles or scrotum, difficulty urinating, blood in semen or urine, and sometimes low-grade fever or weight loss. If untreated, TB can cause scarring, blockages, and inflammation in reproductive organs, reducing sperm count, motility, or even causing infertility. TB in men can affect sperm production and transport. Infections in the epididymis or testicles can lead to scarring, obstructing sperm flow. Even after the infection is treated, some men may experience reduced fertility. Couples trying to conceive may require assisted reproductive techniques like IVF to achieve pregnancy. Early intervention can prevent permanent damage and improve outcomes,” said Dr Sandeep Talwar, Fertility Specialist, Nova IVF Fertility, East of Kailash, Delhi NCR.

The epididymis, a narrow tube that stores and carries sperm, is particularly vulnerable to TB infection. If scarring blocks this pathway, sperm may not reach the semen even when production inside the testicles is normal.

Warning signs men should not ignore

One reason genitourinary TB often escapes attention is that its symptoms resemble other common conditions.

Some early signals include:

• Persistent swelling or pain in the testicles
• A lump or heaviness in the scrotum
• Burning sensation during urination
• Blood in semen or urine
• Low-grade fever or unexplained weight loss
• Difficulty conceiving despite regular attempts

Doctors say these symptoms should never be ignored, especially in countries like India where TB remains widespread.

The Central TB Division of the Government of India reports that India accounts for a large share of global TB cases. Early screening and treatment remain key priorities under national health programmes.

Recognising these symptoms early allows doctors to begin treatment before permanent reproductive damage occurs

How doctors diagnose TB in the reproductive system

Diagnosis of genitourinary tuberculosis usually requires a combination of medical tests. Fertility specialists evaluate both infection and sperm health.

“Diagnosis involves urine tests, semen analysis, ultrasound of the reproductive organs, and sometimes biopsy or culture to detect TB bacteria. Standard TB treatment with antibiotics is highly effective if followed completely. Men diagnosed early often regain normal reproductive function. Fertility assessment after treatment will help to identify any lasting issues and decide if IVF or other interventions are needed. Hence, men with TB who wish to embrace fatherhood should seek timely TB treatment and stay in touch with the fertility consultant. The fertility expert will guide you toward fulfilling the dream of fatherhood,” explained Dr Sandeep Talwar.

These tests help identify whether sperm production has been affected or whether scarring has created blockages. Once the infection is controlled, doctors may reassess fertility through semen analysis and imaging tests.

Why male fertility is overlooked in TB discussions

In many fertility conversations, the focus often shifts quickly toward female reproductive health. Experts say this can delay diagnosis in men.

“Many couples tend to focus only on female fertility, but male factors play an equally important role. Tuberculosis in men is often overlooked and can silently affect sperm production or block sperm transport, reducing the chances of natural conception. Screening both partners for infections before planning a pregnancy is essential. If TB is detected and treated early, it can prevent permanent damage to the reproductive system. Once the TB infection is managed, then only start your IVF procedure to conceive without any challenges. But simultaneously keep a watch on females age as well,” said Dr Beena Muktesh, Clinical Director-IVF, Motherhood Fertility & IVF, Gurgaon.

Medical experts say couples planning pregnancy should consider complete health screening. This approach helps detect hidden infections, hormonal problems or structural issues affecting fertility.

Early treatment can protect both health and parenthood 

The most reassuring aspect of tuberculosis is that it remains a treatable disease. Standard TB therapy includes a combination of antibiotics taken over several months under medical supervision. When patients follow the treatment schedule carefully, the infection can be cured.

For men who wish to become fathers, early treatment may prevent long-term reproductive damage. In cases where fertility remains affected, modern reproductive technologies such as IVF can still help couples conceive.

Awareness about tuberculosis must therefore include its lesser-known effects, including reproductive health.

Medical experts consulted

This article includes expert inputs shared with TOI Health by:

Dr Beena Muktesh, Clinical Director-IVF, Motherhood Fertility & IVF, Gurgaon.

Dr Sandeep Talwar, Fertility Specialist, Nova IVF Fertility, East of Kailash, Delhi NCR. Inputs were used to explain how tuberculosis can silently affect the male reproductive system, the symptoms men should watch for, the potential impact on sperm health and fertility, and why early diagnosis and timely treatment are crucial.

Across the world, millions of women spend years searching for answers to pain that quietly disrupts their daily lives. Severe cramps, fatigue, stomach issues, or trouble getting pregnant often appear long before doctors identify the real cause. For many, that cause is endometriosis.

According to the WHO, endometriosis affects around 10 percent (around 190 million) of women of reproductive age globally, yet diagnosis often takes seven to ten years after symptoms begin. This delay is not just a medical issue. It reflects how menstrual pain is discussed, how symptoms are interpreted, and how the condition itself behaves inside the body.

When a disease hides behind common symptoms and social silence, the path to diagnosis becomes long and confusing.

What exactly is endometriosis? 

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. These growths can appear on the ovaries, fallopian tubes, bowel, bladder, or other pelvic organs.

Each month, this tissue reacts to hormonal changes in the same way the uterine lining does. It thickens, breaks down, and bleeds. But because the tissue sits outside the uterus, the blood cannot leave the body easily. Over time, this can lead to inflammation, scarring, and severe pain.

The condition is also strongly linked to fertility challenges. Some estimates suggest that 30 to 50 percent of women with infertility may have endometriosis.

Dr Kavitha Kovi, Head of Department - Obstetrics & Gynaecology, Aster Whitefield Hospital, explains, “Endometriosis develops when uterine lining tissue grows beyond the uterus, which results in inflammation and pain and creates potential fertility issues. The process of obtaining a diagnosis requires patients to endure through a lengthy and challenging path.”

Why cases appear to be rising 

Doctors are noticing more diagnoses today than in the past. That does not always mean the disease itself is suddenly increasing. In many cases, it simply means that doctors are recognising it more often.

But lifestyle and reproductive patterns may also play a role. Women today often start menstruation earlier, delay pregnancy, and experience more menstrual cycles during their lifetime. Each cycle exposes endometrial tissue to hormonal changes that may influence disease progression.

A large study supported by the Indian Council of Medical Research (ICMR) has highlighted the need for better awareness and earlier identification of gynecological disorders including endometriosis in Indian women.

Researchers also note that increased urban stress, environmental exposures, and changes in diet are being studied as possible contributors. These factors are still under investigation, but they highlight how complex the disease may be.

Why the symptoms are often misunderstood 

Endometriosis does not look the same in every woman. That is one reason it escapes attention for years.

Some women experience sharp pelvic pain during periods. Others struggle with bloating, fatigue, digestive problems, or pain during intercourse. A few only discover the condition when they try to conceive.

Dr Ruchi Jain, Fertility Specialist at Nova IVF Fertility in Kolkata, explains the confusion clearly, “People frequently confuse the symptoms which include severe menstrual pain and pelvic discomfort and fatigue and painful periods with ordinary menstrual issues. Women develop the misconception that intense menstrual pain must be endured because they have spent their lives experiencing this discomfort.”

Because the symptoms overlap with conditions like irritable bowel syndrome, pelvic infections, or routine menstrual discomfort, doctors may treat other possibilities first.

This creates a cycle of temporary treatments but no clear diagnosis.

The medical challenge of detecting it 

Another difficulty lies in how the disease appears inside the body. Endometriosis lesions can be tiny and scattered across pelvic organs. Early-stage disease often remains invisible on routine scans.

Dr Ruchi Jain points out the diagnostic difficulty, “The clinical process of diagnosing endometriosis becomes difficult because standard imaging methods fail to provide clear results for early-stage detection. Medical confirmation of certain conditions requires advanced imaging techniques or surgical approaches which only become viable after a person shows ongoing health issues.”

In some cases, the only way to confirm endometriosis is through laparoscopy, a minimally invasive surgery that allows doctors to see the tissue directly.

Because surgery is not the first step doctors take for pelvic pain, diagnosis can be delayed for years.

Social silence also slows diagnosis 

Medical science is only one part of the story. Cultural attitudes toward menstruation play an equally strong role.

In many societies, menstrual pain is considered normal. Girls grow up hearing that cramps are simply part of being a woman. When pain becomes severe, it may still be dismissed as “just a bad period.”

Dr Kavitha Kovi highlights this concern, “The main reason for this delay occurs because many societies have established menstrual pain as an acceptable condition. Patients and healthcare providers sometimes treat severe cramps and heavy bleeding and pelvic pain as standard components of the menstrual cycle.”

When symptoms are normalised, women may delay seeking medical care. Even when they do visit doctors, the conversation about menstrual health may remain limited.

Public figures have also spoken about the long struggle for diagnosis. Actor Lena Dunham, who lives with endometriosis, once described the condition as “an illness that hides in plain sight,” reflecting how often it is overlooked despite severe symptoms.

What doctors and healthcare systems need to watch for 

Experts say early recognition can significantly improve quality of life. Treatment options today include medication, hormone therapy, pain management, and in some cases surgery.

But the first step is listening carefully to symptoms.

Dr Kavitha Kovi notes, “The disease presents multiple obstacles because its complex nature creates challenges. Endometriosis does not present the same way in every individual. Women experience different symptoms because some develop severe pelvic pain while others report ongoing fatigue and digestive problems and lower back pain and pain during intercourse.”

Doctors are increasingly encouraged to look beyond routine explanations when symptoms persist. Severe menstrual pain that disrupts daily life should not be dismissed.

Doctors are increasingly encouraged to look beyond routine explanations when symptoms persist. Severe menstrual pain that disrupts daily life should not be dismissed.

Greater menstrual health education also helps women recognise when something is not normal.

Dr Ruchi Jain emphasises this point, “Women who receive prompt assessment of their symptoms experience improved life quality because medical professionals take their symptoms seriously.”

A condition that needs earlier attention 

Endometriosis is not rare. It is simply under-recognised.

When severe period pain is dismissed, when digestive symptoms are treated separately, and when scans appear normal, the condition can remain hidden for years.

But awareness is slowly improving. Doctors, researchers, and patients are speaking more openly about menstrual health. That conversation may shorten the long wait many women currently face before hearing the correct diagnosis.

For millions living with unexplained pain, that change could mean answers arriving years earlier.

Medical experts consulted

This article includes expert inputs shared with TOI Health by:

Dr Kavitha Kovi, Head of Department - Obstetrics & Gynaecology, Aster Whitefield Hospital.

Dr Ruchi Jain, Fertility Specialist at Nova IVF Fertility in Kolkata.

Inputs were used to explain why endometriosis diagnosis is often delayed and how greater awareness of symptoms can help women seek timely medical care.

For many young couples who want to have a baby, IVF feels like a miracle ticket. However, it is important to realise that it is not a guarantee. Many couples are faced with unexpected roadblocks during their pregnancy and IVF journey. Understanding the biology and realistic limits of this procedure can help families make clearer, less painful decisions as they go down this route.

We speak to Dr Santosh Gupta, Clinical Director & Fertility Specialist, Nova IVF Fertility, Koramangala, Bengaluru, to understand when one knows the right time to stop IVF treatments and look at other options to have a child:

When IVF “fails," in most cases, this implies either failed implantation of the embryo or loss of early pregnancy by miscarriage. Indeed, the process of implantation is rather complex, as only a healthy embryo needs to be introduced at the precise time to the receptive endometrium, and, in fact, both of these need to be healthy as well. Factors such as low quality of the embryo (related to egg age), timing, any pathology in the uterus, immunological or infection problems, and environmental factors might disrupt this complex process.

Egg quality — the single biggest biological limiter

Egg quality declines with age because of chromosomal errors. That’s why younger patients generally have higher success per IVF cycle. The number of eggs retrieved also matters: more good eggs increase the chance of one embryo that will implant and carry to term. Recent prediction models and cohort studies show age-specific thresholds where the probability of live birth drops sharply, making age the dominant predictor that clinicians use when counselling patients.

Some common culprits

Factors affecting uterine difficulties are polyps, fibroids, adhesions, blood flow problems, blood clotting problems, immune system problems, and inconsistent hormonal patterns. Environmental factors include air pollutants affecting eggs, as shown in recently emerging studies on systemic inflammation affecting egg quality and success rates of IVF.

Treatments help, but there are limits

Modern medicine has a number of fixatives: improved embryo selection (like genetic screening), skillful lab work, hysteroscopy to remove any issues in the uterus, or directed medical attention for clotting or hormonal troubles. In cases involving pituitary or ovarian function, directed medical attention is available. Nevertheless, many cycles fail to produce a live-born child at even the most successful fertility centres.

When should you stop? It’s a decision, not a rule

There’s no single “stop here" button that fits everyone. But several practical rules guide specialists:

• Age matters most. Outcomes fall steeply after the late 30s; after about 45, autologous (your own eggs) IVF is widely considered futile or of extremely low probability, and many experts discourage further cycles. Decisions change if donor eggs are an option.
• Ovarian reserve and egg yield. If repeated cycles produce very few eggs or poor-quality embryos, the incremental benefit of more cycles is low. New models can estimate cumulative live-birth chances based on age and egg numbers — use these to guide realistic planning.
• Repeated failure despite “good” embryos. If you’ve transferred multiple good embryos over several cycles with no pregnancy (some definitions use three cycles or four good embryos), clinicians invoke the concept of recurrent implantation failure and start deeper investigations; sometimes a different strategy or a pause is wiser.
• Emotional, financial and health costs. If treatment is causing harm — severe stress, relationship breakdown, depleted finances, or medical risks — stepping back is a valid, often healthy, choice. Ethics guidance urges clinicians to discuss futility and limits openly rather than push endlessly.

How to make this call — a practical checklist

There’s no single “stop here" button that fits everyone. But several practical rules guide specialists:

• You may ask your clinic for your overall live birth probability given your age and egg supply.
• Assessment of cycle logs: Embryo Grades, Genetics Results (if performed), Uterine Evaluation.
• Reflect on whether any modifiable risk factors (such as smoking, weight, or air pollution exposure) have been addressed.
• Seek a second opinion if a possibility was not explored.
• Establish what your end criteria are: what makes you or your partner want to stop trying to get pregnant? Discuss this with your doctor and agree upon it.

IVF can achieve remarkable results, but it has biological limits. The smartest approach mixes science with honest conversations about probability, cost, and well-being. That way, families can choose hope without losing sight of reality.

Before the nausea, the scans, the cravings. Before conception itself, there is an entirely different chapter taking shape for women in India and around the world today. It is called the ‘zero trimester’, a term coined by American sociologist Miranda Waggoner in her 2017 book of the same name, which examined how medicine and public health had begun focusing on women’s bodies as perpetually ‘pre-pregnant’.

Today, the concept has escaped the pages of academic sociology and landed squarely in the wellness mainstream driven by social media, biohacking culture, and a growing anxiety about getting pregnancy ‘right’ from the very start.

As Wired reported, the cultural obsession with wellness and optimisation, “currently driven and designed by male biohackers like Bryan Johnson and Peter Attia,” has now come for this murky preconception period. Women have started training for pregnancy “like it’s a marathon,” as influencer Kaylie Stewart announced to her 1 million TikTok followers.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

The numbers bear this out. Wired states in its report that the hashtag “#preconception appears in 106,000 Instagram posts and #pregnancyprep in 36,000.”

It adds, “Singular TikTok ‘prep’ videos rack up tens of thousands—sometimes millions—of views and likes.” ‘Pregnancy Prep’ influencers post curated lists, aesthetic vlogs, and GRWM (Get Ready With Me) TikToks filled with glowing, happy women. They suggest a litany of lifestyle changes, niche products, books, courses, and ‘quick’ tips to follow in the six to twelve months before getting pregnant.

But what does this global trend look like when it lands in India, with its particular mix of tradition, urban aspiration, and overburdened healthcare systems?

What real women experience

For the women actually living through this, the picture is more textured. Juilee Ghadigaonkar, an account director, did not plan her pregnancy in advance. “Once I found out I was pregnant, I became very conscious about taking care of my health,” she says. Her guidance came primarily from her gynaecologist and not from social media, which she found overwhelming. “Too much overthinking is not good during pregnancy,” she notes.

Her pregnancy was hormonally challenging, requiring medication to stabilise her levels, and she experienced persistent nausea throughout. But what carried her through was professional medical guidance, a supportive work environment, and the empowerment to continue working despite the physical demands.

Prerna Gagerna, 33 and nine months pregnant at the time of speaking with indianexpress.com, had a more ambivalent relationship with the flood of preconception content available today. She was mindful about her health beforehand, taking balanced meals, staying active, and doctor-recommended supplements, but stopped well short of following any structured programme.

“There are videos explaining what you should be doing in every single week of pregnancy, discussions around the ‘best birthing plan’, endless doctor recommendations online,” Gagerna observes. “In some ways, it’s empowering because you feel more informed. But at the same time, it can become overwhelming.” The anxiety that comes from feeling like you may have missed something, or that an unexpected development is somehow your fault, is real. Her conclusion: “Pregnancy is not a one-size-fits-all journey. You have to step back from the noise.”

Brinda Gupta, a new mother at 27, hadn’t consciously prepared for pregnancy at all. Her body was low in iron, calcium, and DHA when she found out she was expecting, making the first trimester particularly gruelling. Her recovery came not from supplements or structured programmes but from instinct and tradition: increasing water intake, prioritising sleep, eating simple home-cooked vegetarian meals, and drawing on the food wisdom of her elders.

She also maintained a daily practice of chanting and meditation. “That practice gave me a lot of calmness and strength during the journey,” she says. “By God’s grace, I had a normal delivery exactly at 36 weeks without much pain or complications. After delivery, there was a little discomfort, which is natural, but today when I see my baby’s little smile, it makes everything completely worth it,” she mentions.

Let’s talk about what actually works, medically

Doctors across India are quick to point out that preconception care, stripped of its wellness-influencer packaging, has genuine medical merit. Dr Deepthi Ashwin, consultant in Obstetrics and Gynaecology at Aster Whitefield Hospital, outlines what evidence-based preparation actually involves: screening for chronic conditions such as thyroid disorders, diabetes, anaemia, and hypertension; ensuring vaccinations like rubella and hepatitis B are up to date; and optimising nutrition, particularly folic acid intake, to reduce the risk of neural tube defects.

“Maintaining a healthy weight, managing stress, quitting smoking, and moderate alcohol consumption represent essential lifestyle changes which help people achieve better fertility results,” she tells indianexpress.com.

Dr Pallavi Vasal, clinical director of Obstetrics and Gynaecology at Marengo Asia Hospitals in Gurugram, is noticing a generational shift. More and more couples are becoming conscious of ‘clean living’ before pregnancy, she says — driven by increased urbanisation, lifestyle pressures, and a more educated population.

“Couples want to be sure of conceiving in a state of good health.” What concerns do they bring to her clinic? Work pressure, frequent travel, and questions around alcohol and smoking.

Dr Aindri Sanyal, clinical director and senior fertility specialist at Nova IVF Kolkata, makes a compelling case for the importance of early planning, especially as delayed parenthood becomes the norm. She says, “Life plans can be adjusted, but the biological clock remains constant,” she says.

Female fertility declines notably after the mid-30s, affecting both the quantity and quality of eggs. Pre-conception consultations, she argues, offer a window to catch conditions that may otherwise go unnoticed for years — from PCOS and thyroid disorders to endometriosis and genetic risks like thalassaemia.

She shares a striking case of a couple who sought preconception counselling simply to understand their readiness, discovered that the woman had a large endometriotic cyst and very low AMH levels despite having no symptoms whatsoever. Without that early evaluation, their fertility challenges might not have surfaced until after months of unsuccessful trying.

And yet, the doctors are unanimous on one thing: below the age of 35, couples should try naturally for at least a year before considering fertility intervention. “Getting pregnant is a natural process and should be left to nature, at least for a couple of months,” says Dr Vasal. “The human body does not behave like maths.”

What you eat and what you don’t need to cut out

Nutrition is the most crowded arena in the preconception wellness space, and the one most vulnerable to misinformation. Dr Shabana Parveen, head of Clinical Nutrition and Dietetics at Artemis Hospitals, recommends that women start thinking about their diet at least three to six months before trying to conceive — not to embark on an extreme regimen, but simply to ensure nutritional reserves are in place.

The essentials? Folic acid, iron, iodine, vitamin D, and vitamin B12. These nutrients support egg health, hormonal balance, and early foetal development. Beyond that, the prescription is refreshingly unglamorous: whole grains, fruits, vegetables, healthy fats, dairy or calcium-rich foods, adequate hydration, and consistent meal timings. “The goal is always to give the body good food, not to follow strict diets that make you stressed or miss out on important nutrients,” she says.

Sandhya Narasimhan, Clinical Nutritionist and Founder at Svastha Wellness: Health and Beyond, addresses some common myths. “One common belief is that certain ‘superfoods’ can improve the chances of conception on their own. Foods like nuts, seeds, and traditional ingredients such as turmeric or ginger are certainly nutritious. However, no single food can guarantee fertility,” she stresses.

Another myth is that taking multiple supplements can replace a healthy diet. Narasimhan says that many people think that supplements alone are enough to boost fertility. “In reality, fertility nutrition works best with a mix of balanced whole foods and supplements when necessary.”

“Not every woman needs every supplement,” reveals Narasimhan, adding that supplementation should always be personalised based on blood reports and medical advice. It’s important to remember that taking too many supplements can sometimes cause more harm than good and may even lead to toxicity.

The mental health dimension: when optimising becomes overwhelming 

Psychologist Abhilasha Chouhan offers perhaps the most nuanced lens on this trend. She acknowledges that in a world of environmental uncertainty and busy lives, approaching pregnancy from a ‘planning and preventive perspective’ is understandable. But she draws an important distinction between informed preparation and relentless optimisation.

“Women may begin to treat pregnancy as a constant task,” she observes, by monitoring diet, exercise, blood pressure, ultrasounds, and appointments in an unending loop. For women navigating fertility challenges in particular, this hyper-vigilance can tip into catastrophic anxiety. Chouhan compares it to an alarm system stuck in the ‘on’ position: “Vigilance can sometimes make a person constantly alert or anticipating future outcomes.”

Social media, she notes, plays a complicated role. It can spread awareness and reduce stigma. But it also pushes women to compare their pregnancies and their bodies against carefully curated versions of others, without any knowledge of those individuals’ actual health circumstances. “It is influencing women’s choices and decision-making, and at times affecting their trust in available resources such as doctors and the advice or wisdom of elders.”

Her advice for a healthier approach is to add mindfulness and breathing practices; spend time with loved ones; don’t let the idea of independence become an excuse to refuse help; reconnect with yourself through hobbies; and engage in genuine self-care. And, most importantly, “trust your available support system, from doctors and hospitals to family, and also trust your own body.”

There is something real and valuable in the idea of the zero trimester, particularly for women with underlying health conditions, nutritional deficiencies, or a family history of genetic disorders. But the wellness industry has taken this kernel of medical truth and wrapped it in a layer of optimisation anxiety that serves commercial interests far more than it serves women.

The most experienced doctors keep returning to the same, unglamorous prescription: see your doctor, eat well, manage stress, and trust your body. That’s not a trending hashtag. But then, the healthiest pregnancies rarely are. 
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

When discussing infertility in India, common causes like hormonal imbalances, lifestyle factors, and delayed pregnancies often take centre stage. The disease genital tuberculosis remains an important but underrecognized factor that contributes to this situation. The high tuberculosis burden in India creates a dual problem because people fail to recognize its effects on female reproductive health which results in delayed diagnosis and missed chances for effective medical care.

What is Genital Tuberculosis?

Genital tuberculosis is a form of extrapulmonary tuberculosis which spreads from lung infections and other body infections to invade the female reproductive system. The disease predominantly targets the fallopian tubes and uterus while it occasionally affects the ovaries. Mycobacterium tuberculosis usually causes the infection which can remain dormant for multiple years without showing any noticeable signs of disease. The absence of typical infection indications makes it hard to identify genital tuberculosis during its initial stage which differs from the common symptoms of pulmonary tuberculosis that include cough and fever and weight loss.

How Does It Lead to Infertility? 

The most severe result which genital tuberculosis brings to human beings affects their ability to reproduce. The infection causes scarring and blockage and damage to the fallopian tubes which prevents the egg and sperm from meeting. The condition may also disrupt the uterine lining which hinders successful embryo implantation.

Women who experience regular menstrual cycles face difficulty achieving pregnancy in most situations. The infection creates extensive damage which becomes apparent only after doctors start evaluating infertility problems. Reproductive assistance methods become ineffective in extreme cases because of insufficient uterine receptivity.

Why It Often Goes Undiagnosed

The condition known as genital tuberculosis gets labeled as a "silent disease" because its symptoms display either low intensity or people mistake them for different medical conditions. Women will show non-specific symptoms that include irregular menstrual cycles and pelvic discomfort and unusual vaginal discharge which people usually link to hormonal disorders or infections. Patients and healthcare providers need better education about the condition because their understanding of it currently remains restricted. Doctors may fail to recognize the infectious origins of infertility because patients consider their infertility to be their main problem. The diagnosis process needs specialized tests which include endometrial biopsy and imaging and molecular testing because these tests do not appear in standard fertility evaluation procedures.

Who Is at Higher Risk?

The natural risk of genital tuberculosis infection increases for women who reside in areas where the disease occurs at high rates. People who have a history of tuberculosis together with those who have weakened immune systems and those who have poor nutritional status and those who have been in close contact with tuberculosis patients face increased risk of developing the disease. The likelihood of genital tuberculosis to cause infertility in India exceeds that of most other countries because tuberculosis remains an endemic disease throughout the country.

Challenges in Diagnosis and Treatment

The diagnosis of genital tuberculosis becomes difficult because its symptoms appear in a discreet manner. The diagnosis needs multiple tests to achieve confirmation even when there is a suspicion of the condition. The medical team starts treatment after they confirm the diagnosis through direct observation of the infection, which they will treat with a complete anti-tubercular treatment regimen. The treatment eliminates the infection but does not restore the damage that has already happened to the reproductive system. The medical field requires early disease detection because it provides two benefits: First, it helps people become disease-free, and second, it protects their ability to have children.

The Importance of Early Screening in Infertility Cases 

Genital tuberculosis should be considered as a potential diagnosis for women who experience unexplained infertility because the disease remains hidden and its effects persist for extended periods. The implementation of targeted screening within infertility assessment procedures enables healthcare providers to detect the condition at an earlier stage, which results in better treatment results. Women who have had multiple IVF attempts fail and who have experienced multiple pregnancy losses and who have unexplained uterine problems should undergo evaluation for genital tuberculosis because it will provide them with valuable medical assessment.

Raising Awareness for Better Outcomes

The treatable nature of genital TB remains unknown to people which leads to delayed diagnosis and results in continuing fertility problems. The hidden cause of infertility requires awareness among patients and healthcare providers to ensure its proper identification. The understanding of infectious origins of infertility leads to different methods for diagnosing and treating this condition. The infection will be permanently eliminated through proper treatment yet some cases will experience improved fertility results.

A Silent but Significant Factor

A country like India, which currently faces tuberculosis as a significant health problem, requires research into its lesser-known forms of the disease. Genital tuberculosis may not always present with obvious symptoms, but its impact on reproductive health can be profound. The process of recognizing a condition requires its identification, which needs proper investigation, and then treatment should begin immediately. The solution provides women who face the difficulties of infertility with an opportunity for improvement through early diagnosis and proper investigation and timely medical treatment.

(By Dr. Apurva Satish Amarnath, Fertility Specialist, Nova IVF Fertility, Kammanahalli, Bengaluru) 
Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

Hormones control all bodily processes in humans because they affect everything from metabolism and mood through reproduction and sleep. However, one of the most important yet often misunderstood aspects of human biology is that women's hormones do not follow the same pattern as men's. Male hormone levels maintain day-to-day stability while female hormones experience continuous changes throughout both the menstrual cycle and various life stages. The observed differences exist as deliberate components of a system that operates to maintain ovulation and fertility and pregnancy.

The Hormonal Pattern in Men: Relatively Stable

The main reproductive hormone for men in their bodies functions as testosterone. The body maintains stable hormone levels throughout the day although testosterone levels experience minor daytime fluctuations which reach their highest point in the morning and decrease until evening.

The body maintains stable hormone levels throughout the day which results in predictable energy patterns which affect all biological functions that depend on hormones including energy levels and muscle building and mood changes and sexual desire. The hormonal changes that come with aging process begin to happen in a slow manner which continues until the end of life.

The Female Hormonal Cycle: A Monthly Rhythm 

The hormonal system of women operates in a distinct manner According to their reproductive cycle women experience hormonal changes which create recurring patterns that last for 28 days During the menstrual cycle two primary hormones estrogen and progesterone exhibit specific times of their respective rise and fall activities

Estrogen levels start to rise during the follicular phase which represents the first half of the menstrual cycle. This hormone enables the ovarian egg to develop while it readies the uterine lining to receive an embryo if conception occurs. The body uses a luteinizing hormone surge to trigger ovulation which leads to the release of the egg around the cycle midpoint.

The luteal phase starts after ovulation has taken place. The period of time shows that progesterone functions as the primary hormone. The substance serves to maintain the uterine lining while protecting the embryo during its initial stage of development through the process of fertilization. When fertilization does not take place progesterone and estrogen levels decrease which triggers menstruation and marks the beginning of a fresh menstrual cycle.

Also Read: Do Colds Impact Men And Women Differently? Science Says Yes, Here's Why

Why These Fluctuations Exist

The reproductive process depends on these hormonal changes. The menstrual cycle controls ovulation while constructing the uterine environment for implantation and managing the bodily changes that occur during pregnancy. The natural conception process needs this rhythmic hormonal pattern to function properly.

Hormones beyond their role in fertility also impact various bodily systems which include metabolic processes and brain activity and sleep cycles and immune functions. The menstrual cycle causes women to experience different mood states along with changes in energy levels and appetite and ability to focus.

Hormonal Changes Across Life Stages 

Women experience major hormonal changes throughout their various life stages. The start of puberty brings increasing estrogen levels which lead to the development of reproductive organs and secondary sexual traits. The reproductive phase of a woman's life continues to show regular hormonal cycles throughout her entire life.

Women in their late 30s and 40s start to experience perimenopause which serves as a transitional period that brings unpredictable hormone changes. The body reaches menopause when menstrual cycles stop and there is a substantial reduction in estrogen and progesterone production. 
Also Read: Women Are Losing Bone Strength Much Earlier Than Expected, Doctor Explains Why

Why Understanding These Differences Matters 

The differences between women's hormone patterns and men's hormone patterns need to be understood because they play a crucial role in improving health education. The natural hormonal patterns of women cause them to experience symptoms which include mood swings and sleep problems and tiredness and appetite variations. Healthcare professionals need to understand women's hormonal patterns because this knowledge helps create better healthcare services and workplace programs and personal health strategies. The biological pattern of men should not be used as standard to study women's health because their hormonal cycles require researchers to adopt different investigational methods.

(By Dr. Deepak Shetty, Fertility Specialist, Nova IVF Fertility, Davanagere) Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

The acquisition signifies a major expansion for Nova IVF Fertility in southern India, enhancing access to state-of-the-art reproductive services while leveraging Craft Fertility’s established expertise in the region

Nova IVF Fertility, backed by Asia Healthcare Holdings (AHH), has announced the strategic acquisition of Craft Fertility, marking its formal entry into Kerala. The partnership will see the launch of 10 new IVF centres across the state over the next three to five years, bringing advanced reproductive medicine to couples across urban, tier 2, and tier 3 cities.

“Craft Fertility is a treasure trove of clinical excellence,” said Vishal Bali, Executive Chairman, Asia Healthcare Holdings. “This is not just an entry for Nova into Kerala, it is access to four decades of transformative clinical practice in reproductive medicine.”

Founded in 2011, Nova IVF Fertility operates a pan-India network of IVF centres. AHH acquired the company in 2019. Today, the company performs more than 19,000-21,000 IVF treatments annually, supported by over 150 fertility specialists and over 200 embryologists.

Kerala-based CRAFT Fertility Centre, founded by Dr C. Mohamed Ashraf, announced a strategic partnership with Bengaluru-based Nova IVF Fertility, owned by Asia Healthcare Holdings.

Among the many factors that inhibit fertility in young couples, some, like metabolic health, are well known and others are more recent, said Dr C. Mohamed Ashraf, founder of CRAFT Fertility Centre. He was speaking at a news conference announcing a strategic partnership with Nova IVF Fertility, owned by Asia Healthcare Holdings.

“Among the newer causes are trends driven by education and career choices, where couples postpone pregnancies. While that is a choice, there are other factors that leave the partners with no choice,” Ashraf said. “Covid-19, for example, has added to fertility challenges and detailed studies are being undertaken abroad. The early results are disturbing.”

In the Romanian Journal of Morphology and Embryology, a paper published by Dr Maria Sidonia Săndulescu and others pointed at lesions caused by Covid-19.

The paper said: “After the virus enters the body, the first lesions are produced in the respiratory tract. Extrapulmonary lesions specific to COVID-19 include acute renal lesions/acute kidney damage, hepatocellular lesions, neurological diseases, myocardial dysfunction and arrhythmia, gastrointestinal diseases, but also genital impairment.”

In the Journal of Obstetrics, Gynaecology and Cancer Research, Drs Sarah Lotfi and Abbas Ahmadi indicated that “active Covid-19 infection significantly reduces the ratio of testosterone to Luteinizing hormone”. Secreted by the pituitary gland, Luteinizing hormone drives “processes important for puberty, sexual function, reproduction, and sex drive”.

Ashraf said that newer technologies allow couples to check their reproductive health before they set out to build a family. The checks can flag both individual issues and genetic issues, and addressing these would help the couple avoid the trauma that stems from failed pregnancies, Ashraf said.

“There is also the cost factor,” he added. “For example, a baby with spinal muscular atrophy comes with a potential bill of Rs 18 crore for the Zolgensma injection, which is one of the world's most expensive drugs. But early screening and medical support could give the same couple a healthy baby at a cost of around Rs 5 lakh. Craft has had the honour of gifting nine babies to eight couples with the (SMN1) gene mutation.”

Speaking about the partnership between the institutions, Shobhit Agarwal, CEO of Nova IVF Fertility, said: “This is not another deal in the health care industry. We were drawn to Craft for its academic rigour and clinical credibility. Nova IVF has delivered one lakh successful pregnancies, and we bring with us the most advanced IVF protocols. The fertility market does not need expansion as much as it needs credibility. We are not here to be the biggest, but the most credible one.”

Dr Noushin Abdul Majiyd, director and senior consultant at CRAFT, said that the centre did not stop at supporting couples. “We are a board-certified centre providing a fellowship in reproductive medicine, and we have empowered over 500 doctors who are serving countrywide,” she said.

 

Omega-3 fatty acids are essential nutrients the body cannot produce, so they must come from food such as fish, walnuts, flaxseeds and soybeans. Regular intake supports hormonal balance, improves sperm quality and ovulation, enhances blood flow to reproductive organs, and may increase chances of conception and outcomes during fertility treatments.