Patients with cervical Ureaplasma Urealyticum and Chlamydia Trachomatis infection undergoing IVF/ICSI-ET: The need for new paradigm

Abstract

Genital tract infections with ureaplasma urealyticum (UU) and chlamydia trachomatis (CT) are the most frequent sexually-transmitted disease worldwide. UU and CT infections are considered to be the leading cause for infertility and adverse pregnancy outcomes. However, little is known about the specific effect of cervical UU and CT infections on the etiology of female infertility, as well as the pregnancy outcomes of the patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). In order to find the association between cervical UU and/or CT infection and pregnancy outcomes, we conducted a retrospective case-control study on the patients undergoing IVF/ICSI-ET with cervical UU and/or CT infection. A total of 2208 patients who received IVF/ICSI-ET were enrolled in this study. Data on the general conditions, pregnancy history and clinical pregnant outcomes were analyzed in terms of the cervical UU and CT detection. Our results revealed that cervical UU and CT infections were the risk factors for ectopic pregnancy and tubal factor-induced infertility. Moreover, the pregnancy rate, abortion rate, ectopic pregnancy rate and premature birth rate in patients with UU and/or CT infections showed no significant difference when compared with the control group. We recommend that cervical UU and CT detection should be an optional item for infertility patients and clinical UU detection should differentiate the subtypes of cervical UU. Positive cervical UU and CT infections should not be taken as strict contraindications for IVF/ICSI-ET.

Keywords

ureaplasma urealyticum / chlamydia trachomatis / infertility / pregnancy outcomes

References

[1] Aguilera-ArreolaMG, Gonzalez-CardelAM, TenorioAM, et al. . Highly specific and efficient primers for in-house multiplex PCR detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis and Ureaplasma urealyticum. BMC Res Notes, 2014, 6(7): 433-439

[2] MichouIV, ConstantoulakisP, MakarounisK, et al. . Molecular investigation of menstrual tissue for the presence of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis collected by women with a history of infertility. J Obstet Gynaecol Res, 2014, 40(1): 237-242 PMID: 24118383

[3] DieterleS. Urogenital infections in reproductive medicine. Andrologia, 2008, 40(2): 117-119 PMID: 18336462

[4] CasariE, FerrarioA, MorenghiE, et al. . Gardnerella, Trichomonas vaginalis, Candida, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in the genital discharge of symptomatic fertile and asymptomatic infertile women. New Microbiol, 2010, 33(1): 69-76 PMID: 20402416

[5] AkhvledianiL. Prevalence of Mycoplasma hominis and Ureaplasma urealiticum in pregnant and women with reproductive problems. Georgian Med News, 2012, 208-209: 59-63 PMID: 22899414

[6] CicinelliE, De ZieglerD, NicolettiR, et al. . Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. Gynecol Obstet Invest, 2009, 68(2): 108-115 PMID: 19521097

[7] SilvaR, LeonD, ViscarraT, et al. . Frequency of Chlamydia trachomatis infection in a group of women from region of Araucania, Chile. Rev Chilena Infectol, 2013, 30(6): 611-615 PMID: 24522303

[8] KokkayilP, RawreJ, MalhotraN, et al. . Co-infection of Mycoplasma genitalium and Chlamydia trachomatis in an infertile female patient with genital tuberculosis. Indian J Pathol Microbiol, 2013, 56(4): 457-459 PMID: 24441248

[9] NaderiT, KazeraniF, BahraminpoorA. Comparison of chlamydia infection prevalence between patients with and without ectopic pregnancy using the PCR method. Ginekol Pol, 2012, 83(11): 819-821 PMID: 23379188

[10] WitkinSS, KligmanI, GrifoJA, et al. . Ureaplasma urealyticum and Mycoplasma hominis detected by the polymerase chain reaction in the cervices of women undergoing in vitro fertilization: prevalence and consequences. J Assist Reprod Genet, 1995, 12(9): 610-614 PMID: 8580659

[11] KnoxCL, AllanJA, AllanJM, et al. . Ureaplasma parvum and Ureaplasma urealyticum are detected in semen after washing before assisted reproductive technology procedures. Fertil Steril, 2003, 80(4): 921-929 PMID: 14556813

[12] PeerayehSN, YazdiRS, ZeighamiH. Association of Ureaplasma urealyticum infection with varicocele-related infertility. J Infect Dev Ctries, 2008, 2(2): 116-119 PMID: 19738335

[13] MironND, SocolovD, MaresM, et al. . Bacteriological agents which play a role in the development of infertility. Acta Microbiol Immunol Hung, 2013, 60(1): 41-53 PMID: 23529298

[14] CazanaveC, ManhartLE, BebearC. Mycoplasma genitalium, an emerging sexually transmitted pathogen. Med Mal Infect, 2012, 42(9): 381-392 PMID: 22975074

[15] Mania-Pramanik J, Kerkar SC, Salvi VS. Bacterial vaginosis: a cause of infertility? Int J STD AIDS, 2009,20(11):778–781

[16] SharmaM, SethiS, DaftariS, et al. . Evidence of chlamydial infection in infertile women with fallopian tube obstruction. Indian J Pathol Microbiol, 2003, 46(4): 680-683 PMID: 15025381

[17] TakacsL, SeidlerovaJ. Psychosocial climate in maternity hospitals from the perspective of parturients I. Results from a national survey on perinatal care satisfactionusing a representative sample of 1195 Czech parturients. Ceska Gynekol, 2013, 78(2): 157-168 PMID: 23710980

[18] Mackern-ObertiJP, MotrichRD, BreserML, et al. . Chlamydia trachomatis infection of the male genital tract: an update. J Reprod Immunol, 2013, 100(1): 37-53 PMID: 23870458

[19] BromfieldJJ, SheldonIM. Lipopolysaccharide reduces the primordial follicle pool in the bovine ovarian cortex ex vivo and in the murine ovary in vivo. Biol Reprod, 2013, 88(4): 98 PMID: 23515670

[20] ShimadaY, ItoS, MizutaniK, et al. . Bacterial loads of Ureaplasma urealyticum contribute to development of urethritis in men. Int J STD AIDS, 2014, 25(4): 294-298 PMID: 24047884

[21] RaneVS, FairleyCK, WeerakoonA, et al. . Characteristics of acute nongonococcal urethritis in men differ by sexual preference. J Clin Microbiol, 2014, 52(8): 2971-2976 PMID: 24899041 PMCID: 4136159

[22] LiuJ, WangQ, JiX, et al. . Prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis infections, and semen quality in infertile and fertile men in China. Urology, 2014, 83(4): 795-799 PMID: 24411218

[23] PajovicB, RadojevicN, VukovicM, et al. . Semen analysis before and after antibiotic treatment of asymptomatic Chlamydia-and Ureaplasma-related pyospermia. Andrologia, 2013, 45(4): 266-271 PMID: 22897222

[24] KanakasN, MantzavinosT, BoufidouF, et al. . Ureaplasma urealyticum in semen: is there any effect on in vitro fertilization outcome?. Fertil Steril, 1999, 71(3): 523-527 PMID: 10065792

[25] WittemerC, Bettahar-LebugleK, OhlJ, et al. . Abnormal bacterial colonisation of the vagina and implantation during assisted reproduction. Gynecol Obstet Fertil, 2004, 32(2): 135-139 PMID: 15123136

[26] MarovtM, KeseD, KotarT, et al. . Ureaplasma parvum and Ureaplasma urealyticum detected with the same frequency among women with and without symptoms of urogenital tract infection. Eur J Clin Microbiol Infect Dis, 2015, 34(6): 1237-1245 PMID: 25717022

[27] FrolundM, BjorneliusE, LidbrinkP, et al. . Comparison between culture and a multiplex quantitative real-time polymerase chain reaction assay detecting Ureaplasma urealyticum and U. parvum. PLoS One. parvum, 2014, 9(7): 102743

[28] PottsJM, SharmaR, PasqualottoF, et al. . Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. J Urol, 2000, 163(6): 1775-1778 PMID: 10799180

[29] ZhangQ, XiaoY, ZhuangW, et al. . Effects of biovar I and biovar II of Ureaplasma urealyticum on sperm parameters, lipid peroxidation, and deoxyribonucleic acid damage in male infertility. Urology, 2014, 84(1): 87-92 PMID: 24976225

[30] SellamiH, ZnazenA, SellamiA, et al. . Molecular detection of Chlamydia trachomatis and other sexually transmitted bacteria in semen of male partners of infertile couples in Tunisia: the effect on semen parameters and spermatozoa apoptosis markers. PLoS One, 2014, 9(7): 98903

[31] HaggertyCL. Evidence for a role of Mycoplasma genitalium in pelvic inflammatory disease. Curr Opin Infect Dis, 2008, 21(1): 65-66 PMID: 18192788

[32] WeinsteinSA, StilesBG. Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium. Expert Rev Anti Infect Ther, 2012, 10(4): 487-499 PMID: 22512757

[33] CapocciaR, GreubG, BaudD. Ureaplasma urealyticum, Mycoplasma hominis and adverse pregnancy outcomes. Curr Opin Infect Dis, 2013, 26(3): 231-240 PMID: 23587772

[34] KacerovskyM, BoudysL. Preterm premature rupture of membranes and Ureaplasma urealyticum. Ceska Gynekol, 2008, 73(3): 154-159 PMID: 18646667

[35] KaraerA, MertI, CavkaytarS, et al. . Serological investigation of the role of selected sexually transmitted infections in the aetiology of ectopic pregnancy. Eur J Contracept Reprod Health Care, 2013, 18(1): 68-74 PMID: 23256948

[36] RenY, ZhuX. Investigation on biovars and genotypes of Ureaplasma urealyticum in the cervix in a Chinese gynecologic check-up population and sex workers. Acta Derm Venereol, 2003, 83(3): 175-178 PMID: 12816150