Mycoplasmas and ureaplasmas in infertility and abortion

The prevalence of Mycoplasma canis in the vaginas of breeding bitches

Introduction

How bacterial infections of the reproductive tract cause infertility and the correlation between the health status of female dogs and the presence of Mycoplasma canis (M. canis) in the vagina are still unclear. The aim of this study was to determine the M. canis population in the vagina of breeding bitches and to correlate this microbial population with some fertility outcomes.

Material and Methods

A total of 275 breeding bitches were included in the study. Vaginal samples were collected for microbiological and PCR testing.

Results

Mycoplasma canis was identified in 34.91% of the samples. One-third of bitches from the problem-free group and 41.18% from the group with problems were positive. In general, there were no significant differences in the prevalence of M. canis between the groups (P-value > 0.05). Mycoplasma canis occurs in both mated and unmated bitches and was found in a large number of kennels (67%). There was a correlation between M. canis in the kennel and the incidence of single puppy deaths and low litter sizes. There was also some correlation between the presence of M. canis in the vagina with at least two other bacterial strains and reproductive disorders.

Conclusion

Our results indicate that M. canis is part of the normal vaginal flora of breeding bitches, although a role for this bacterium in causing some reproductive disorders remains to be disproved.

Chlamydia, Mycoplasma and Ureaplasma infections in infertile couples and effects of these infections on fertility

OBJECTIVE

In our study, we aimed to determine the prevalence of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections among infertile couples and effects of these infections on infertility.

MATERIALS AND METHODS

Prevalence of Chlamydia, Mycoplasma, Ureaplasma antibodies and Chlamydia IgM antibodies and its effect on these agents' sperm parameters, namely, morphology, density, and motility were investigated among a total of 212 patients including fertile and infertile couples. Chlamydia, Mycoplasma, Ureaplasma antigens were evaluated using ELISA in the cervical and urethral samples. Chlamydia IgM antibody was measured using micro-ELISA in blood samples.

RESULTS

No difference was detected among the fertile and infertile groups in the serological investigation of urethral and cervical samples with respect to the prevalence of Chlamydia, Mycoplasma, Ureaplasma antigens and Chlamydia IgM antibody and sperm parameters (p > 0.05).

DISCUSSION

There is no significant difference between fertile and infertile couples in terms of the prevalence of the above mentioned infections. Accordingly, during the infertility assessment, infertile couples should not be routinely screened for these infective agents without any clinically sound evidence.

Reproductive performance of beef heifers: effects of vulvo-vaginitis, Ureaplasma diversum and prebreeding antibiotic administration

A group of 450 heifers, 13 to 15 mo of age, were individually identified, vaccinated (IBR, PI(3), Leptospira, Campylobacter fetus), examined (body condition score, reproductive tract evaluation, assessment of vaginal lesions), and cultured for U. diversum . Heifers were randomly allocated to either a treated group given chlortetracycline (approximately 350 mg/hd/d for 30 d in a grain crumble) or a nontreated control group. Prebreeding, most heifers showed signs of vulvovaginitis, 44% cultured positive for U. diversum . Significant associations were found between the severity of vaginal lesions and ovarian activity (P < 0.05), and between BCS and ovarian activity (P < 0.02). The U. diversum vaginal culture (positive or negative) showed no significant association with BCS, severity of vaginal lesions, or ovarian activity (all were P > 0.5). At pregnancy examination (35 d following conclusion of a 61-d breeding season), treated compared with nontreated heifers showed 1) a slight but not significant (P > 0.25) decrease in vaginal colonization by U. diversum (46 to 34% and 41 to 37%, respectively); 2) an association between increased severity of vaginal lesions and increasing pregnancy rate, especially in treated heifers; and 3) an increased pregnancy rate (72 and 57%, respectively; P < 0.01). Prebreeding treatment with chlortetracycline appeared to improve pregnancy rates in beef heifers with endemic U. diversum infections, although the role of U. diversum in heifer fertility is still not clear.

Prevalence of genital chlamydia and mycoplasma infection in couples attending a male infertility clinic

To investigate the prevalence of genital mycoplasma (Ureaplasma urealyticum and Mycoplasma hominis) and Chlamydia trachomatis infections in infertile and fertile couples, 135 infertile couples from a male infertility clinic and 88 fertile couples from a prenatal care clinic were randomly screened. Semen, urethral and cervical smears were cultured for genital mycoplasma and chlamydia. Antichlamydia IgA, IgG and IgM antibodies were tested in blood and semen. Although the overall prevalence of Ureaplasma urealyticum was higher than that of Mycoplasma hominis, the prevalence of Mycoplasma hominis was significantly higher in the infertile men and women. The prevalence of Chlamydia trachomatis, positive culture was higher in infertile couples, but this difference was not significant. The prevalence of serum-specific IgG was significantly higher in infertile than in fertile women (11.9 vs 3.4%, p < 0.05). Specific semen IgA was significantly higher in infertile than in fertile men (8.9 vs 1.1%, p < 0.015). A low rate of concordance between partners was found in Mycoplasma and Chlamydia culture, and in the same patient between seminal IgA and urethral culture. In conclusion it is necessary to check both culture and serology findings in both partners.

Coxiella burnetii penetration into the reproductive system of male mice, promoting sexual transmission of infection

Coxiella burnetii bacteria penetrate different host organs via the bloodstream. In infected mice, bacteremia was observed during the first week of infection: later, bacteria were cultured from the spleens, livers, testes, epididymes, prostate, and semen; bacteriuria developed beginning from the second week of infection. On day 21 of infection, degenerative changes with aggregated macrophages containing bacteria were observed in capillary blood vessels and the surrounding tissues of the adipose envelope of the epididymis. C. burnetii was shed to semen from the urogenital tract, probably from an abscess in the epididymis. There they were bound to the surface of spermatozoal cells, mainly to their heads, suggesting specific adhesion. Bacteria shed to semen were transmitted to female mice by sexual contact; this was demonstrated by the detection of antibodies against C. burnetii antigens in the blood of females and later by the cultivation of bacteria from the spleens, livers, and amniotic fluids of female mice.

The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population

OBJECTIVE

The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population.

DESIGN

Forty consecutive patients were enrolled in the study group and 41 in the control group.

SETTING

The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa.

PATIENTS

Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic.

INTERVENTIONS

Endocervical swabs were taken, and monoclonal direct immunofluorescence for C. Trachomatis were done on each.

MAIN OUTCOME MEASURES

A difference was expected between the prevalence of C. trachomatis infection in the fertile and infertile population.

RESULTS

In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained. In the control group, 3 patients (7.32%) tested positive.

CONCLUSION

Although no correlation was found between C. trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility. This justifies routine screening tests and antibiotic treatment of positive infertile couples. Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populations.

Artificial insemination with donor semen: the necessity of frequent donor screening

Artificial insemination with donor semen has become a well established alternative for couples with untreatable male factor infertility. Because of the widespread use of donor insemination, and the increasing awareness and prevalence of sexually transmitted diseases, the American Fertility Society recently redrafted procedural guidelines for the use of donor screening for insemination. Our series of donor screenings is reported to emphasize the necessity of donor evaluations at frequent intervals. From June 1986 through August 1987, 48 healthy male volunteers presented as potential semen donors for our donor program. Each was evaluated with a careful medical history, physical examination and 2 semen analyses for evidence of sexually transmitted disease. On initial evaluation, no donor presented with a positive human immunodeficiency virus antibody, abnormal karyotype, elevated serum glutamic oxaloacetic transaminase, rapid plasma reagent, or positive cultures for Chlamydia or Mycoplasma. One potential donor was excluded because of a positive hepatitis B-core antibody and 1 because of a positive IgM test for cytomegalovirus. At initial examination 3 potential donors had a positive culture for Ureaplasma; all 3 were treated with 3 weeks of tetracycline, and repeat cultures were all negative. Routine followup screening was performed on all donors at 3-month intervals for all sexually transmitted diseases. During this 14-month period cultures converted to positive for Ureaplasma in 4 donors. Furthermore, 1 donor at 6 months contracted gonorrhea. He was treated but no longer used as a donor. Since initiation of the outlined protocol more than 800 inseminations have been performed using fresh semen with no case of sexually transmitted diseases reported from our recipients. We conclude that careful sexual history, and frequent donor and semen evaluation are necessary for prevention of diseases that might be transmitted sexually. If these precautions are strictly observed use of donor semen is safe and effective.

Male genital mycoplasmas and Chlamydia trachomatis culture: its relationship with accessory gland function, sperm quality, and autoimmunity

To study the effect of mycoplasmas and Chlamydia trachomatis infection on semen quality, these microorganisms were cultured from the semen and anterior urethra respectively, in a group of 175 infertile men suspected of a silent genital infection with a poor postcoital test. Chlamydia infection, but not mycoplasmas, was parodoxically more frequent in the apparently normal than oligotetratoasthenozoospermia patients. Mycoplasmas male infection, but not chlamydia, was more frequent in cases with female, mechanical, and/or organic infertility factors. Infection was unrelated to the accessory gland evaluation or sperm variables. However, seminal antisperm antibody activity was significantly increased in cases with any positive culture. By this local antibody increase, chlamydia and mycoplasmas may significantly reduce sperm egg penetration ability.

Unexplained infertility: evaluation of treatment with clomiphene citrate and human chorionic gonadotropin

A double-blind, randomized, prospective therapeutic trial was conducted in 148 couples with unexplained infertility. Treatment consisted of 4 consecutive months of placebo or clomiphene citrate (CC) (100 mg) by mouth on cycle days 5 to 9, and placebo or human chorionic gonadotropin (hCG) (5,000 IU) intramuscularly on cycle days 19, 22, 25, and 28. There were 14 pregnancies during the trial and 39 pregnancies during observation before and after the trial. Placebo treatment resulted in no pregnancies over 4 months. Clomiphene citrate was significantly better than placebo (P less than 0.04), with a pregnancy rate of 19% over the course of 4 months. The pregnancy rate with hCG either alone (11%) or in combination with CC (7.6%), was not significantly better than placebo. Treatment-independent pregnancies, defined as those before treatment (but after enrollment), or more than 1 month after therapy, occurred in 16% of the couples, with a mean time to conception of 8.8 months. As part of their follow-up, 39 of the study couples subsequently underwent in vitro fertilization (IVF), and 43% were found to have a previously unrecognized male factor or fertilization defect. A pregnancy rate of 16% was achieved after a mean of 1.1 cycles in these 39 couples. The authors conclude that CC is useful in treating unexplained infertility and is a reasonable initial therapy. For couples who fail to conceive, IVF may be diagnostic as well as therapeutic.

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).

Screening to reduce transmission of sexually transmitted diseases in semen used for artificial insemination

The practice of artificial insemination by donor semen is increasing in the United States. Many sexually transmitted organisms are found in semen, but screening procedures for the detection of these agents in donor semen have not been standardized. Sexually transmitted organisms have been transmitted during artificial insemination by donor, and such transmission can cause local, disseminated, or fatal disease in the recipient woman and may harm the fetus or newborn. Therefore, screening of both the donor and the donated semen is necessary to avoid infectious complications. Because semen samples cannot be evaluated completely on the day of donation, the use of fresh semen for artificial insemination should be discouraged. Until accurate, rapid diagnostic tests are available, only frozen semen that has been appropriately screened should be used.

Antibodies to microbial, leukocyte and organ antigens

Hemagglutinating antibodies to Mycoplasma hominis were present in 30 of 83 infertile, 15 of 40 pregnant and 5 of 20 post-partum females and 20 of 82 infertile males in contrast to only 2 of 21 fertile females and 5 of 25 fertile males. Their presence correlated with sperm antibody detection by TAT in Lab. 4, the immunobead-binding assay of Lab. 1 and the SIT of Lab. 11, but not with other sperm antibody assays. Immunofluorescent antibodies to Chlamydia trachomatis, on the other hand, did not correlate with the incidence of sperm antibodies. Among 305 serum samples tested, 12 were positive for testicular antibodies, 8 had antibodies to kidney, 7 to ovary and 15 to endometrium. A majority of serum samples positive for antibodies to testis and ovary, but not endometrium, reacted against sperm in different assays. Eight of 135 samples tested had antibodies to human leukocyte antigenic HLA-Aw19 (Aw19, A28, A29, A30 and A32) and/or B35 (B35, B5 and B15) complexes. Six of these samples were also positive for sperm antibodies by one or more antibody assays. Cross-reactive antigens may be present in sperm, M. hominis, testis, ovary and leukocytes.

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.

A simplified method using enzyme-linked immunosorbent assay for titration of antisperm antibodies

We selected sera from 44 patients (36 males and 8 females) that were positive for antisperm antibodies using ELISA (titer ranged from 1:32 to 1:512) for the evaluation of a simplified method for determination of antisperm antibodies. This method uses a correlation between a single absorbant value and the endpoint titer of the same serum. This simplified procedure increases the number of the sera that can be tested on each plate, resulting in considerable saving of time, reagent costs, and materials. A standard curve allows the direct determination of endpoint titer using the absorbance value found at a single dilution. This modification improves the utility of the assay for the epidemiological screening of antisperm antibodies in patients who may have an immunological cause of infertility.

Microscopical evidence of mycoplasma-like organisms in mycoplasma positive bovine semen

Contamination with mycoplasma-like organisms was observed microscopically in a bull with impaired sperm quality and positive isolation of Mycoplasma bovigenitalium and ureaplasma. The bull's spermiogram was characterized by decreased initial motility and post-freeze survival rate, primary defects in nucleoplasm, changes in tail conformation and regressive changes of the plasmalemma and acrosome. Vesiculo-lamellar bodies in the periacrosomal region were an accompanying feature. The cytologic picture described is compatible with descriptions reported earlier and related to mycoplasma infection.

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.

Unexplained infertility

To recapitulate, four questions must be raised when the couple has been evaluated and found to be normal: (1) Was the infertility evaluation complete in terms of modern standards? (2) Were the results of studies and observations appropriately interpreted? (3) Has a factor which was considered within normal limits and compatible with fertility at the onset of the workup changed during the course of the evaluation? (4) How accessible for evaluation are processes necessary for conception which occur within the reproductive tract? Both members of the couple as well as the managing physician are frustrated and plagued by feelings of inadequacy when no positive findings can be identified during the course of an infertility evaluation. This situation obviously requires of the physician a combination of delicacy, patience, and considerable attention to each detail of the evaluation which has just been completed. The material herein was designed to raise suggestions for approaches to such couples when faced with the designation of "unexplained infertility."

The enzyme-linked immunosorbent assay for detection of the antispermatozoal antibodies

An immune-enzymatic method was developed for the determination of antispermatozoal antibodies. Sera of 94 infertile patients were studied with the enzyme-linked immunosorbent assay (ELISA). Twelve patients were positive for antispermatozoal antibodies. Forty-six of these patients were studied also with the gelatin agglutination test (GAT). Eight sera were positive in the ELISA and nine in the GAT. With ELISA, immunoglobulin classes can be demonstrated; in fact, nine of our patients were positive for IgG and three for IgM. In all patients the IgA titer was less than 1:16. In addition, 61 seminal fluid specimens were studied by ELISA, and 7 were positive. The serum and seminal fluid of 12 patients were simultaneously studied. Seminal fluid was positive in only three patients, serum was positive in four, whereas serum and seminal fluid were both negative in five. This study illustrates that ELISA is apparently less sensitive than GAT; however, it is certainly more practical and an easier method for antibody research in sera and in seminal fluid.