Infection in the couple may lead to failure of fertility treatment ,hence proper screening and management of the condition is mandatory before starting fertility treatment.

1. DR NABANEETA PADHY
FEMELIFE FERTILITY FOUNDATION
www.femelife.com

2. Genital infection is an important cause of infertility
worldwide, affecting not only Fallopian tubes but all
anatomic urogenital sites, both male and female.
Chlamydia trachomatis , gonococus, Candida,
Escherichia coli and Klebsiella
pneumoniae,Ureaplasma urealyticum and
Mycoplasma hominis are commonly found
organisms.

3.  Chlamydia is the predominant pathogen detected in
about 20% of cases of acute salpingitis
 In a study of 286 women undergoing 344 oocyte
retrievals, seropositivity for chlamydia and the
presence of bacterial vaginosis were highly
associated with tubal disease

4. subclinical infection and fertility –
 focused on two potential pathogens: Chlamydia
trachomatis and Mycoplasma species.
 Positive Chlamydia cultures may be higher among
infertile patients than among controls
Mycoplasma - recovered from the cervical mucus
and semen of infertile couples.

5. Pelvic inflammatory disease is still a frequent cause
of infertility.
approximately 5-10% of the time, women with pelvic
inflammatory disease (PID) develop the most severe
form which is a tubo-ovarian abscess (TOA)
 Sexually transmitted diseases or STDs, are the
most common infection associated with male
infertility.

6. Infectious processesmay lead to
 deterioration of spermatogenesis,
 impairment ofsperm function and/or
 obstruction of the seminal tract

7. Ureaplasma urealyticumin human semen varies from 10
to 40%.
 Enterobacteria can evenbe found in up to 90% of semen
samples
Chlamydia trachomatis is the mostfrequent sexually
transmitted bacterial organism in industrializedcountries
It is suggested that its main influence is due tosexual
transmission resulting in tubal disease and subsequent
infertility in the female partner rather than a direct
influenceon male reproductive functions

8. Detectionof bacteria in semen does not necessarily
signify infectionsince bacteriospermia may represent
contamination, colonizationor infection.
The effect of leukocytospermiaon male fertility is
controversial. This is probably due todifferent detection
methods, different populations studied andto the fact that
leukocyte subtypes in semen may have different
functions. In addition to potentially negative effects,
leukocytesmay even have protective effects on
spermatozoa

9. Human immunodeficiency virus type-1 (HIV-1)
affects mostly menand women in their reproductive
years.
 For those who have accessto highly active
antiretroviral therapy (HAART), the courseof HIV-1
infection has shifted from a lethal to a chronic
disease

10. Both sexual and perinataltransmission
the level ofviral replication
(being almost negligible in patients withundetectable
viremia)
Assisted reproductionafter ‘sperm washing' may further
reduce the chances ofinfection

11. The predictors ofsuccess of intrauterine insemination
following sperm washingin HIV+
men, as well as
assessing the effect of HIV on spermparameters -James
D.M. Nicopoullos1(
Human Reproduction 2004
19(10):2289-2297)
When sperm characteristics were correlated with
markers of HIVinfection a significant positive correlation
between CD4 cellcount and ejaculate volume, sperm
concentration, total spermcount, sperm motility,
progressive motility and sperm morphology was found

12. In the USA in 1990, the Centers for Disease Control
recommendedagainst insemination of women with
semen from men infected withHIV, following a single
report of HIV transmission to a womanwho
underwent IUI using sperm from her HIV+
husband
Undetectable viral load andthe use of anti-retrovirals
improve the outcome of IUI/spermwashing in HIV+
men.

13. HPV is the most common viral sexually transmitted
disease affecting reproductive aged women.
 Each year, 30 million people contract the HPV virus
according to the World Health Organization
. In most women, HPV infections do not produce any
illness or symptoms

14.  the medical journal Fertility and Sterility reported a
study performed in New York.
patients with HPV were less likely to become
pregnant after undergoing IVF. The pregnancy rate
in HPV positive patients was 23.5%; in those without
HPV it was 57%.

15. The long-term studies conducted in Sweden found
that women's risk of infertility increased with each
episode of PID:
 The risk of infertility with one PID episode was 8
percent; with two, 19 percent; and with three or
more, 40 percent.
 The risk of infertility increased directly with the
observed severity of tubal inflammation

16.  DO ALL NEED TREATMENT ?
 WHICH INFECTIONS NEED TREATMENT ?
 DOES THE PARTNER NEEDS TREATMENT ?
 TREATMENT VS NO TREATMENT- EFFECT ON INFERTILITY
OUTCOME

17.  bacterial vaginosis is a condition that results when high
concentrations of anaerobic bacteria replace the normal H2 O2
-producing lactobacillus species in the vagina.
 . Blackwell et al. have contrasted treatment of 7 days of
metronidazole with a regimen of 2 g of metronidazole divided over
12 hours. They described a 95% cure rate with 7 days versus a 75%
cure rate with single-day therapy.
 Purdon et al. found similar results, with 67% of women treated with
single-day therapy and 86% of patients cured receiving the 7-day
course.

18. Women who are allergic to metronidazole, or
resistant cases, should be treated with oral
clindamycin 300 mg every 12 hours for 7 days.
Concurrent treatment of the male partner is
controversial.
The male partner should be treated if there is
recurrent vaginitis or any suspicion of associated
upper genital tract infection.

19. Many women who harbor Trichomonas in their
vaginal secretions are free of symptoms
T. vaginalis is a highly contagious sexually
transmitted disease
Metronidazole (Flagyl, Protostat) is the treatment of
choice for T. vaginalis infection.

20. The asymptomatic female who has Trichomonas
identified in the lower genital urinary tract definitely
should be treated
Women who have recurrence have in most cases
either been reinfected or complied poorly with
therapy
 If the conventional regimen is not successful, the
woman should be treated with a single 2 g dose of
metronidazole once a day for 5 days

21.  One of the continuing debates regarding therapy is treatment of the
asymptomatic male partner.
 Gardner and Dukes documented a 2.5-fold greater reinfection rate
when the sexual partner was not treated.
 Some physicians elect to treat the male partner only when the
vaginitis is recurrent.
 Trichomonas infection should be treated in a similar fashion to any
sexually transmitted disease.
 Male sexual partners are treated with 2 g of metronidazole (single-
day therapy).

22.  Greater than 75% of cases are caused by Candida
albicans, with 5% to 20% of vaginal fungal infections
produced by C. glabrata or C. tropicalis
 The greatest enigma of this condition is the
recurrence rate after an apparent cure, varying from
20% to 80%. Approximately 3% to 5% of these
women experience recurrent vulvovaginal
candidiasis.

23.  Treatment of recurrent or persistent vulvovaginal
candidiasis using ketoconazole (400 mg daily), an
oral preparation has shown 50% recurrence rates
after the drug was discontinued
Potential therapy for recurrent disease includes
gentian violet, boric acid, povidone-iodine douching
etc.
Optimal treatment of recurrent vaginal infections
related to C. albicans often involves therapy similar
to treating recurrent urinary tract infections- patient
initiated therapy.

24. The treatment of choice for mucopurulent
cervicitis(non gonococcal) is oral doxycycline 100
mg twice a day for 7 days or azithromycin 1 g orally
in a single dose
The male partner should receive identical therapy

25. Generally leukocytospermia (WBC in the semen)
affects 5-10% of the patient population, but can rise
to 20% in certain patients groups.
Semen has to be cultured for aerobic and anaerobic
infection as well as Chlamydia and Mycoplasma.
Detection of pathogens in significant number (colony
forming units) needs treatment.
Potential pathogens are- E.coli, proteus,
streptococcus, klebsiella etc

26. Treatment of mycoplasma , enterobacter species is
controversial as it has not shown any improvement
in conception rates.

27. CRYOPRESERVED SAMPLE should be used
Should be free from all sexually transmitted
diseases.
HIV screening should be repeated at an interval of 6
months before cryopreservation .

28. Asymptomatic, or occult, infection of the upper
female genital tract and the male genital tract can be
a cause of infertility
Although some studies have shown that treatment of
infertile couples with antibiotics, such as tetracycline or
doxycycline, that eradicate mycoplasma resulted in high
pregnancy rates, controlled studies have reported no
difference in pregnancy rates between couples treated
with antibiotics and those not treated.
Pathogenic organisms in semen need treatment before
proceeding for ART.

29. THANK YOU