Interaction of Microbiology and Pathology in Women Undergoing Investigations for Infertility

Abstract

Background: Cases of endometriosis with no tubal damage are associated with infertility, suggesting an immunological rather than mechanical barrier to reproduction. Laparoscopy and falloposcopy results of clinically asymptomatic women undergoing investigation of infertility were correlated with the outcomes of microbiological screening for Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, ureaplasma species, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia pneumoniae. Methods: A total of 44 women presenting to a hospital IVF service for laparoscopic or laparoscopic/ falloposcopic investigation of infertility provided endocervical swabs, fallopian tube washings, and peripheral whole blood for analysis. Results: Of these 44 women, 15.9% (7) showed evidence of C. trachomatis infection as detected by either PCR or EIA serology. Of these 7 women, 5 (71%) had no or mild endometriosis and 2 (29%) had moderate or severe endometriosis. Of the remaining 37 women who showed no evidence of chlamydial infection, 15 (40.5%) had no or mild endometriosis. Conclusion: Women with infertility, but without severe endometriosis at laparoscopy, showed a trend towards tubal damage and a higher rate of previous C. trachomatis infection. Although not statistically significant, this trend would suggest that, where moderate to severe tubal damage is found to be the primary cause of infertility, C. trachomatis infection could be a likely cause for such tubal damage.

Assessment of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycobacterium tuberculosis infections in women undergoing laparoscopy: the role of peritoneal fluid sampling

“…Despite the paucity of studies which were the object of our qualitative synthesis, the 20-year temporal interval between the first study (published in 1996) and our study (published presently) denotes either a renewed or always alive interest to this topic. It is relevant that, in almost all of these studies (6,8,12,23), the clinical samples used were peritoneal or tubal fluids/tissues, which were tested alone (12; this study) and in combination with cervical (6) and serum (6,8) samples or with tissue samples from ovarian and endometrium lesions (23). Consistent with these studies, we found that endometriosis was not associated with peritoneal CT infection in women undergoing either a fertility or non-fertility diagnostic workup.…”

“…The APTIMA CT assay, used in the present study, is a second generation NAAT; it utilizes target capture, transcription-mediated amplification, and hybridization protection assay technologies to amplify chlamydial specific rRNA, which is then indicative of the presence of viable organisms. For this reason, the percentage of CT positive samples in our study was higher than that reported by other investigators (6,7,23). In a prospective study by Dietrich et al (7), CT was detected in the cervical, vaginal, and urethral specimens of 2 (0.9%) of 202 women; one patient with tubal occlusion of both tubes had a history of PID, and the other patient with tubal occlusion of one tube had no history of PID.…”

Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women

“…In a separate study, PBMC from healthy donors were incubated with C. trachomatis serovar K, leading to the finding that proinflammatory gene expression (measured by microarray and validated by quantitative reverse transcription-PCR) was sustained for up to 7 days, especially for IFN-␥, and IL-2 receptor ␥ (61). However, in one report, cHSP60-stimulated PBMC production of IFN-␥ was lower in women with PID or repeat infections than in women with current infections (62,63). Dendritic cells prepared from human PBMC were infected with C. trachomatis serovar E or L2, which induced the production of IL-1␤, IL-6, IL-8, IL-12p70, IL-18, and TNF-␣ (64).…”

Multiplex PCR Testing Detection of Higher-than-Expected Rates of Cervical Mycoplasma , Ureaplasma , and Trichomonas and Viral Agent Infections in Sexually Active Australian Women

“…Neisseria gonorrhoeae and Chlamydia trachomatis are the most commonly reported pathogens, possibly because they are most frequently screened for. However, the etiology of most cases is undetermined and could be multifactorial in nature (11,34,35,40). Studies undertaken in other epidemiologic settings indicate significant differences in the prevalences of other cervical infectious agents (1,41,44,45,58).…”

“…An underappreciation of the prevalences of and roles played by these nongonococcal and nonchlamydial agents potentially jeopardizes the effectiveness of empirical treatments for cervicitis. Unresolved cervicitis can result in ascending infection, endometritis, pelvic inflammatory disease, and salpingitis (11,23,46). Furthermore, cervicitis may enhance human immunodeficiency virus susceptibility by the disruption of mucosa, allowing increased viral replication within recruited inflammatory cells (30).…”