Impact of three-month tuberculosis preventive treatment (3HP) on IVF-ET outcomes in infertile women with tuberculosis infection: a retrospective before–after study

TL;DR

This study found that tuberculosis preventive treatment improved pregnancy outcomes in infertile women undergoing IVF, with no added benefit from longer treatment durations.

Contribution

The study is the first to show that standard 3-month TB preventive treatment improves IVF outcomes in women with tuberculosis infection.

Findings

After TPT, biochemical, clinical pregnancy, and live birth rates increased significantly.

Live birth rates did not improve with TPT durations longer than 3 months.

Pregnancy outcomes were similar regardless of whether embryos were frozen before or after TPT.

Abstract

This retrospective before–after study aimed to evaluate whether tuberculosis preventive treatment (TPT) for tuberculosis infection (TBI, previously referred to as “latent TB infection” or LTBI) is associated with improved pregnancy outcomes in infertile women undergoing in vitro fertilization and embryo transfer (IVF-ET), and whether outcomes differ by the TPT duration and embryo origin.

All participants initiated the WHO-recommended 3HP regimen (once-weekly isoniazid plus rifapentine; 12 doses over 3 months) after active TB was excluded. In this retrospective real-world cohort, the total documented duration of combination therapy varied in the medical record (3–18 months). Using a within-patient design, we compared pregnancy outcomes between embryo transfer cycles conducted before and after TPT. Post-TPT cycles were further stratified by TPT duration (3 months, 6 months, 12 months, 18 months) and embryo origin (embryos were cryopreserved from a cycle prior to TPT or derived after TPT ) to compare pregnancy outcomes within each stratum.

After TPT, biochemical pregnancy, clinical pregnancy, and live birth rates increased significantly, while early miscarriage rates decreased. Live birth rates did not differ significantly across the TPT duration subgroups (range: 32.69–39.29%). Among women with recurrent implantation failure, the live birth rate increased to 34.38% after TPT. Pregnancy outcomes did not differ by embryo origin.

In infertile women with TBI undergoing IVF-ET, initiation of TPT with the guideline-recommended 3-month 3HP regimen was associated with improved pregnancy outcomes. In exploratory analyses, longer documented durations beyond 3 months were not associated with higher live-birth rates, supporting consideration of the standard course while acknowledging residual confounding inherent to this retrospective design.

The online version contains supplementary material available at 10.1186/s12884-026-08725-x.