Reports from the University of Maryland (25) and Germany (1) show that before you consult an infertility doctor to help you become pregnant, you and your parther should take antibiotics to treat a possible hidden infection. Many other studies show that the most common cause of infertility is a uterine infection (2,3,4,5,6,7,8).
Of women being evaluated for infertility, 40 percent are infected with chlamydia, mycoplasma or ureaplasma, as are 36 percent of those with a previous history of uterine infection and 50 percent of those with tubal blockage. More than 60 percent had evidence of a past infection (9). The more partners you have, the more likely you are to be infected (10), although you can be infected by one contact (11). An infection can prevent pregnancy by blocking the uterine tubes (12,13,14). It can damage sperm (14A), so they can't swim toward the egg (15), and it can cause abortions, premature birth and low birth weight (16,26,27,28,29). Infected people may have burning on urination, discomfort when the bladder is full or an urgency to void. Women may have only spotting between periods (17).
Infection with chlamydia is the most common cause of blocked Fallopian tubes that cause infertility. First, chlamydia paralyzes the cilia so the egg can't reach the uterus, then it blocks the tubes so that nothing can pass into the uterus. The first study from the Netherlands shows that having antibodies against chlamydia is a potent predictor of blocked tubes (34). The second study shows that many women infected with chlamydia don't have high antibody titers to chlamydia (35).
Men and women can be infected with mycoplasma or ureaplasma (17A,17B), even though all available tests can't find them (18) and they may have no symptoms at all. A dipstick urine test may diagnose the infection (19,20). Semen from 91% of infertile men contains types of bacteria that grow without oxygen (21). Before infertile couples spend between $10,000 and $150,000 for infertility evaluations and treatments, they should ask their gynecologists to treat them with newer erythomycins, Zithromax (250 mg once a day for 8 days) or Biaxin (500 mg BID for 10 days), for chlamydia and mycoplasma infections (22,23).
EVALUATION OF INFERTILITY: Blood tests: Female: FSH (menopause), TSH (thyroid disease), Prolactin (brain tumor), Progesterone (7 days after expected ovulation, around 21 days after start of menstruation), HSG (to check if uterine tubes are open). If masculinization: testosterone, DHEAS, 17-oh progesterone, sonogram of ovaries. Male: semen analysis.
1) C Aspock, D Bettelheim, F Fischl, AM Hirschl, A Makristathis, P Pruckl, B Willinger, ML Rotter. Chlamydia trachomatis infections in patients attending an infertility clinic. Wiener Klinische Wochenschrift 107: 14 (1995):423-426.
2)K Yoshida, N Kobayashi, T Negishi. Urologia Internationalis 53: 4 (1994):217-221.
3) GA Greendale, ST Haas, K Holbrook, B Walsh, J Schachter, RS Phillips. The Relationship of Chlamydia-Trachomatis Infection and Male Infertility. American Journal of Public Health 83: 7 (JUL 1993):996-1001.
4) SS Witkin, KM Sultan, GS Neal, J Jeremias, JA Grifo, Z Rosenwaks. Unsuspected Chlamydia trachomatis infection and in vitro fertilization outcome. American Journal of Obstetrics and Gynecology. 1994(Nov);171(5):1208-1214.CONCLUSION: Unsuspected C. trachomatis infection or reactivation of an immune response to the C. trachomatis heat shock protein may induce an inflammatory reaction in the uterus that impairs embryo implantation and/or facilitates immune rejection after uterine transfer of in vitro fertilized embryos.
5) LV Westrom. Sexually Transmitted Diseases and Infertility. Sexually Transmitted Diseases 21: 2 Suppl.(MAR-APR 1994):S32-S37.
6) PE Hay, BJ Thomas, PJ Horner, E Macleod, AM Renton, D Taylor-Robinson. Chlamydia Trachomatis in Women - The More You Look, the More You Find. Genitourinary Medicine APR 1994;70(2):97-100.
7) J Paavonen. Immunopathogenesis of pelvic inflammatory disease and infertility - What do we know and what shall we do? Human Reproduction 11: 2 Suppl. (FEB 1996):42-45.
8) LV Westrom. Chlamydia and its effect on reproduction. Human Reproduction 11: 2 Suppl. (FEB 1996):23-30.
9) S Chutivongse, M Kozuhnovak, J Annus, ME Ward, JN Robertson, W Cates, PJ Rowe, TMM Farley. Tubal infertility: Serologic relationship to past chlamydial and gonococcal infection. Sexually Transmitted Diseases 22: 2 (MAR-APR 1995):71-77. The majority of women with bilateral tubal occlusion reported no history of pelvic inflammatory disease symptoms. Other infertile women had a prevalence of C. trachomatis antibodies (60%), which was similar to that of patients with bilateral tubal occlusion (71%).
10) O Steingrimsson, JH Olafsson, H Thorarinsson, RW Ryan, RB Johnson, RC Tilton. Risk Factors for Recurrent Chlamydia-Trachomatis Infections in Women. American Journal of Obstetrics and Gynecology 170: 3(MAR 1994):801-806.
11) Chlamydia and Mycoplasma Infections in Male Partners of Infertile Couples. Geburtshilfe und Frauenheilkunde 53: 8 (AUG 1993):539-542.
12) Z Samra, Y Soffer, M Pansky. Prevalence of Genital Chlamydia and Mycoplasma. Infection in Couples Attending a Male Infertility Clinic. European Journal of Epidemiology 10: 1 (FEB 1994):69-73.
13) K Czerwenka, F Heuss, J Hosmann, M Manavi, D Jelincic, E Kubista. Salpingitis caused by Chlamydia trachomatis and its significance for infertility. Acta Obstetricia et Gynecologica Scandinavica 1994(Oct);73(9):711-715. 38% of the women in the PID-positive group and 68% in the PID-negative group conceived within a period of one year after having completed a treatment with antibiotics.
14) BP Katz, S Thom, MJ Blythe, JN Arno, VM Caine,RB Jones. Fertility in Adolescent Women Previously Treated for Genitourinary Chlamydial Infection. Adolescent and Pediatric Gynecology 7: 3 (SUM 1994):147-152. 14A) EH Yanushpolsky, JA Politch, JA Hill, DJ Anderson Is leukocytospermia clinically relevant? Fertility and Sterility 66: 5 (NOV 1996):822-825.
15) K Purvis, E Christiansen. The impact of infection on sperm quality. Human Reproduction 11: 2 Suppl. (FEB 1996):31-41.
16) RB Kundsin, A Leviton, EN Allred, SA Pollin. Ureaplasma urealyticum infection of the placenta in pregnancies that ended prematurely. Obstetrics and Gynecology 87: 1 (JAN 1996):122-127. casues miscariages.
17) Chlamydia (a sexually-transmitted disease) is the most common cause (30%) of spotting between periods for women who are on birth control pills. Obstetrics and Gynecology May,1993;81(5):728-731.
17A) CL Knox, DG Cave, DJ Farrell, HT Eastment, P Timms. The role of Ureaplasma urealyticum in adverse pregnancy outcome. Australian & New Zealand Journal of Obstetrics & Gynaecology 37: 1 (FEB 1997):45-51. 17B) P Claman, L Honey, RW Peeling, P Jessamine, B Toye. The presence of serum antibody to the chlamydial heat shock protein (CHSP60) as a diagnostic test for tubal factor infertility. Fertility and Sterility 67: 3 (MAR 1997):501-504.
18) American Journal of Epidemiology March, 1993;137(5):577-584.
19) A paper test Leukocyte Esterase strip dipped in urine detected venereal disease in men (chlamydia and gonorrhea) That's a painless way to find out what you have. Sexually Transmitted Diseases May-June, 1993;20(3):152-157.
20) LO Svensson, I Mares, PA Mardh, SE Olsson. Screening Voided Urine for Chlamydia Trachomatis in Asymptomatic Adolescent Females. Acta Obstetricia et Gynecologica Scandinavica 73: 1:JAN 1994:63-66.
21) W Eggertkruse, G Rohr, W Strock, S Pohl, B Schwalbach, B Runnebaum. Anaerobes in ejaculates of subfertile men. Human Reproduction Update. 1995(Sept);1(5):462-478. Nearly all ejaculates (99%) were colonized with anaerobic micro-organisms, and potentially pathogenic species were found in 71% of men. This rate was more than four times higher than that obtained with routine cultures and standard transportation (16%). In addition, aerobic growth was f
ound in 96% (greater than or equal to 10(6) CPU/ml in 21%), potentially pathogenic species in 61% of semen specimens. 22) Single Dose Azithromycin Treatment of Gonorrhea and Infections Caused by C-Trachomatis and U-Urealyticum in Men. SD Hillis, A Nakashima, PA Marchbanks, DG Addiss, JP Davis.Sexually Transmitted Diseases 1994(Jan-Feb);21(1):43-46.
23) MR Bush, C Rosa. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstetrics and Gynecology 84: 1 (JUL 1994):61-63.
24) JR Papp, PE Shewen. Localization of chronic Chlamydia psittaci infection in the reproductive tract of sheep. Journal of Infectious Diseases 174: 6 (DEC1996):1296-1302. Twelve sheep experimentally infected with Chlamydia psittaci during pregnancy either aborted or gave birth to weak, low-birth-weight lambs as a result of uteroplacental infection.
25). FI Sharara, JT Queenan, RS Springer, EL Marut, B Scoccia, A Scommegna. Elevated serum Chlamydia trachomatis IgG antibodies: What do they mean for IVF pregnancy rates and loss? Journal of Reproductive Medicine 42: 5 (MAY 1997):281-286. We recommend that all couples with elevated titers be treated with doxycycline prior to the first IVF attempt to optimize pregnancy rates and minimize infectious complications.
26) Infectious Agents Disease 1995;4:196-211.
27) Am J Obst Gyn 1992;166:1515-28.
28) L Kovacs, E Nagy, I Berbik, G Meszaros, J Deak, T Nyari. The frequency and the role of Chlamydia trachomatis infection in premature labor. International Journal of Gynecology & Obstetrics 62: 1(JUL 1998):47-54.
29) VK Paul, M Singh, K Buckshee. Erythromycin treatment of pregnant women to reduce the incidence of low birth weight and preterm deliveries. International Journal of Gynecology & Obstetrics 62: 1(JUL 1998):87-88.
30) FI Sharara, JT Queenan.Elevated serum Chlamydia trachomatis IgG antibodies - Association with decreased implantation rates in GIFT.Journal of Reproductive Medicine, 1999, Vol 44, Iss 7, pp 581-586.
31) VK Paul, M Singh, U Gupta, K Buckshee, VL Bhargava, D Takkar, VL Nag, MK Bhan, AK Deorari.Chlamydia trachomatis infection among pregnant women: Prevalence and prenatal importance.National Medical Journal of India, 1999, Vol 12, Iss 1, pp 11-14.
32) Bacterial vaginosis is a vaginal infection that causes a fowl odor, itching and discharge. It does not cause infertility, but it is associated with miscarriages.SG Ralph, AJ Rutherford, JD Wilson.Influence of bacterial vaginosis on conception and miscarriage in the first trimester: cohort study. British Medical Journal, 1999, Vol 319, Iss 7204, pp 220-223.
33) NEJM 2000(Feb24);342:534-40.
34) The value of Chlamydia trachomatis antibody testing in predicting tubal factor infertility. Human Reproduction, 2002, Vol 17, Iss 3, pp 695-698. LMW Veenemans, PJQ vanderLinden. van der Linden PJQ, Deventer Ziekenhuis, Dept Obstet & Gynaecol, POB 5002, NL-7400 GC Deventer, NETHERLANDS. 35) Chlamydia antibody testing in screening for tubal factor subfertility: the significance of IgG antibody decline over time. Human Reproduction, 2002, Vol 17, Iss 3, pp 699-703. AP Gijsen, JA Land, VJ Goossens, MEP Slobbe, CA Bruggeman. Gijsen AP, Acad Ziekenhuis Maastricht, POB 5800, NL-6202 AZ Maastricht, NETHERLANDS
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