Abstract
Tuberculosis (TB) in pregnancies conceived via in vitro fertilization (IVF) presents unique diagnostic and management challenges, especially in TB-endemic regions. This systematic review synthesizes evidence on maternal and neonatal TB outcomes after IVF. We conducted a systematic review of case reports, case series, and cohort studies, following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Embase, and Google Scholar. Quality assessment was performed using Murad's framework and the Newcastle-Ottawa Scale. Seventy-three IVF pregnancies complicated by maternal TB were analyzed. Median maternal age was 32 years; 63.0% had no prior TB history. TB was diagnosed during pregnancy (56.2%) or postpartum (38.4%). Miliary TB (38.4%) and genital TB (27.4%) were most common; central nervous system (CNS) TB occurred in 13.7%. Microbiological confirmation was achieved in 38.4%. Anti-TB therapy was administered to 79.5%; 8.2% had drug-resistant TB. Neonatal TB manifestations included congenital TB (39.7%), miliary TB (34.2%), and CNS TB (15.1%). Of 55 live births, 28 infants survived, 12 died neonatally, and outcomes were missing for 15; there were 18 pregnancy losses. Most mothers recovered, some had residual deficits, and three deaths occurred. Seven cohort studies from China reported earlier TB onset in IVF pregnancies (11-19 weeks' gestation), higher incidence of miliary and CNS TB, and poor fetal outcomes, including >80% pregnancy terminations or losses, in comparison with natural conceptions. TB after IVF is often undiagnosed before conception and carries high fetal risks. Routine TB screening before IVF is essential in endemic areas. Early diagnosis and maternal-neonatal management can improve outcomes.