Mycoplasma and human reproductive failure

Is there a role for Chlamydia trachomatis and genital mycoplasma in male infertility?

We believe that, without evidence of inflammation (greater than 5 WBC on VB1), there is no indication for routine culture or antibiotic treatment of infertile men. In the presence of active inflammation and positive cultures for chlamydia, treatment with antibiotics is appropriate. However, active inflammation and positive chlamydial cultures were rare findings in our population (2 of 52 and 1 of 52, respectively). Thus, we find no evidence for a role of current asymptomatic mycoplasma or chlamydial infection in male infertility.

Removal of bacterial contaminants from semen for in vitro fertilization or artificial insemination by the use of buoyant density centrifugation

Buoyant density centrifugation of semen produces the accumulation of populations of highly motile, morphologically normal spermatozoa in the lowermost 1 ml of Percoll (Pharmacia Fine Chemicals AB, Uppsala, Sweden) density gradients. In addition, the majority of bacteria present in semen are retained in the seminal plasma at the top of the gradients. Of 40 semen samples examined, 37 contained detectable bacteria, but after buoyant density centrifugation, the spermatozoal populations collected from the lowermost 1 ml of the Percoll columns were found to contain few or no bacteria. When preparations were collected using sterile technique (by boring a hole through the bottom of the centrifuge tube), 14 of the 20 preparations were found to be bacteria-free. When preparations were collected by passing a spinal needle from the surface through the seminal plasma to the bottom of the centrifuge tube, the sterility of the final spermatozoa preparations was not maintained, with only 5 of the 20 samples completely free of bacteria. The residual bacterial contamination of the remaining 15 samples was, however, very low (less than 5 colonies after a 48-hour culture period).

Ureaplasma urealyticum: subcultures invalid for antibiotic susceptibility tests

We tested the antibiotic susceptibilities of 100 Ureaplasma urealyticum strains from 99 patients using a broth-disk method and two types of inocula: urine sediments and overnight broth subcultures of the sediments. Of the 100 ureaplasma-positive urine sediments tested, nine (9%) of the ureaplasmas were found resistant to all four tetracyclines. When overnight broth cultures were used as the inoculum, 54 (54%) were found to be resistant to all four tetracyclines, an increase in resistance of 45 (45%). Thirty-seven susceptible strains remained susceptible upon subculture. The nine resistant strains remained resistant. Loss of susceptibility was not related to the pH or titer of ureaplasmas in the urine sediment inoculum but was related to the pH and titers when subcultures were used as the inoculum. Results of cultures following treatment, available for 53 patients, showed that treatment successes and treatment failures were significantly related to antibiotic susceptibility tests done with urine sediments but not to those done with broth subcultures as the inocula. Because reliable susceptibility testing is essential for appropriate therapy for U. urealyticum infections, all factors influencing this test need to be recognized and defined.

The effect of Mycoplasma hominis and Ureaplasma urealyticum on hamster egg in vitro penetration by human spermatozoa

The effects of some genital mycoplasmas on the in vitro penetration of human spermatozoa into the master egg were studied. Ureaplasma urealyticum serotypes 4, 8, and 6 showed high interfering activity: 6.3% (P less than 0.01), 12.3%, and 14.5%, respectively, against the 55.6% penetration rate of untreated sperm. Neither a cytotoxic effect of mycoplasmas on gametes nor a masking of the binding sites on the egg surface were demonstrated. In experiments carried out with U. urealyticum serotype 4, the production of diffusible relatively heat-labile factor(s) responsible for the inhibition of sperm penetration was postulated.

Microbial flora in semen of asymptomatic infertile men

A microbiological examination has been carried out in 116 patients with unexplained infertility and with asymptomatic bacteriospermia. Organisms more frequently isolated were Staphylococcus epidermidis (81.9%), non hemolytic streptococci (23.3%), diphtheroids (25%) and alpha-hemolytic streptococci (18.1%). None of the 103 patients were positive for C. trachomatis. Mycoplasmas were isolated in 56 (48.3%) of the 116 examined samples, U. urealyticum was present in 49 (42.2%), M. hominis in 3 (2.6%) and both species in 4 (3.5%) samples of examined fluids. Forty-one of the 56 mycoplasmas-positive patients have been treated with doxycycline therapy. The treatment improved motility and caused decrease of coiled tails in 12 cases. Conception occurred in 5 (26.3%) of the 19 treated patients whose cultures were negative for mycoplasmas. These 5 pregnancies occurred in the patients that had high titers (greater than 10(5) c.c.u./ml) of ureaplasmas and in which the antibiotic therapy was successful. No pregnancy was seen in the other 22 patients where treatment failed to eradicate mycoplasmas.

Ureaplasma urealyticum (T-mycoplasma) infection: does it have a role in male infertility?

Ureplasma urealyticum (T-mycoplasma) has been related to male infertility by some observers. To assess further this question 150 couples who presented for fertility had semen and cervical mucus cultures for mycoplasma. Positive cultures were obtained from 69 couples. There were no significant differences in the semen analyses among patients with positive or negative cultures. The presence of mycoplasma in the semen is probably the result of contamination at the time of ejaculation. Routine investigation for the presence of mycoplasma in subfertile men is unjustified. The routine use of broad-spectrum antibiotics in subfertile patients with positive mycoplasma culture is unnecessary.

Mycoplasma infection and infertility

Attempts were made to isolate mycoplasmas from the uterine cervix of infertile women and normal pregnant and nonpregnant women to investigate the relationship of genital mycoplasma infection to infertility. Ureaplasma urealyticum was demonstrated in 63% of patients with infertility, 68% of normal pregnant women, and 62% of normal nonpregnant women. The incidence of Mycoplasma hominis infection was found to be noticeably lower, with corresponding isolation rates of 10%, 11%, and 6%, respectively. The differences in rate of isolation for U. urealyticum and for M. hominis among the three groups did not reach statistical significance. During a follow-up period of more than 12 months without any treatment for mycoplasma infection in the infertile cases, 11 women (27.5%) became pregnant. These included 7 (28%) of 25 women with positive U. urealyticum cultures. The results demonstrate a fairly high incidence of female genital infection with U. urealyticum which, as the data would indicate, cannot be directly associated with infertility.

Genital mycoplasma infections

Three different species of mycoplasmas--M. hominis, M. fermentans, and Ureaplasma urealyticum--have been found to infect human genitalia. In the man, mycoplasmas appear to play a role in the etiology of nonspecific urethritis and prostatis. Mycoplasmas repeatedly have been cultured from the tubes of patients with acute salpingitis and a significant antibody response to the organisms during recovery has been reported. Obstetric infections and puerperal sepsis occasionally seem to be caused by mycoplasmas. These organisms also appear to induce spontaneous abortion as well as cause infertility in a small proportion of couples.

Ureaplasma urealyticum (T-mycoplasma) in vaginal fluid and cervical mucus from fertile and infertile women

Ureaplasma urealyticum (T-mycoplasma) was isolated more frequently and in heavier growth from cervical mucus (49%) than from vaginal fluid (34%). It was isolated in 24% of vaginal fluid samples and in 35% of cervical mucus samples from fertile women, and in 29% of vaginal fluid samples and in 47% of cervical mucus samples from infertile women. The incidence of infection was high following abortion or total hysterectomy and during pregnancy or oral contraceptive use. T-mycoplasma was also isolated from the vaginal fluid and cervical mucus of a woman with tubo-ovarian abscess, but was not present in women with Trichomonas vaginalis infection. U. urealyticum did not alter the physiophysiologic characteristics of vaginal fluid and cervical mucus or the sperm penetration and sperm viability in cervical mucus. Treatment with tetracycline eradicated the organism in 88% of the infected women. Pregnancies were recorded during a 6-month follow-up in 1 of 19 infertile women who were treated with tetracycline.

On the etiologic role of ureaplasma urealyticum (T-mycoplasma) infection in infertility

Two hundred consecutive infertility patients and sixty-seven controls subjects were studied for the incidence of infection with Ureaplasma urealyticum (T-mycoplasma). On the basis of a complete infertility investigation, the infertility patients were subdivided into those with explained infertility and those with unexplained infertility. Of the patients with unexplained infertility, 55% had a positive culture for T-mycoplasma as compared with a 32% incidence of positive cultures in the control population. The differences were statistically significant. The 6-month pregnancy rate following successful antibiotic treatment in patients with unexplained infertility was 42%. The 6-month pregnancy rate in a comparable group of patients with unexplained infertility, seen during a 3-year period prior to mycoplasma culture and treatment, was 32%. The difference in pregnancy rates between the two groups was not statistically significant. No correlation was found between a poor postcoital test and the presence of T-mycoplasma infection nor between T-mycoplasma infection and poor cervical mucus. The role of T-mycoplasma infection in infertility was neither proven nor disproven by this study.