Adverse clinical outcomes in patients with good ovarian reserve are linked to a history of cured tuberculosis: a retrospective cohort study

BACKGROUND: This study examined the effect of prior tuberculosis infection on clinical outcomes in patients with good ovarian reserve. METHODS: Based on the POSEIDON criteria, we analyzed data from 5,381 women with normal ovarian reserve who underwent fresh in vitro fertilization (IVF) cycles. Through stratified analysis, we compared the clinical characteristics, IVF laboratory parameters, and clinical outcomes between TB-naïve and TB-cured patients within POSEIDON Group 1 and Group 2. RESULTS: TB-cured women had significantly lower pregnancy rates (OR 0.766, 95% CI 0.603-0.972) and clinical pregnancy rates (OR 0.710, 95% CI 0.552-0.912) across all ages. In Poseidon group 1, the TB-cured group exhibited an increased risk of ectopic pregnancy (aOR 2.641, 95% CI 1.058-6.595; P = 0.038) and reduced clinical pregnancy rate (77.89% vs. 86.35%, P = 0.007). In Poseidon group 2, the TB-cured group demonstrated impaired ovarian response: a reduction in the number of mature oocytes retrieved (4.94 vs. 6.05; P = 0.007). Among individuals cured of TB in Poseidon group 2, anti-Müllerian hormone (AMH) levels below 1.785 ng/mL provided optimal prediction of insufficient oocyte retrieval (< 5 oocytes; AUC 0.764), outperforming antral follicle count (AFC; AUC 0.557) in predictive accuracy. CONCLUSIONS: Prior TB is independently associated with compromised ART success in normo-responders through residual reproductive dysfunction, with young patients experiencing heightened ectopic pregnancy risk.