Dr. Emmanuel L. Sta. Cruz

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   My experience in treating Infection- related Infertility has shown that this can affect practically everyone, even those with already proven Fertility because the cumulative effect of injury to our reproductive system from an infection is bound to catch up on us. 

   This explains why some couples who had ease in having their first child may have difficulty in their second or later attempts at bearing a child. This also holds true with couples who elect to have a child at a later age.

   It is important for men and women in their reproductive ages to know more about Infection-related Infertility. This knowledge may aid them in how to protect and preserve their Reproductive Capability.

Infertility

   Is defined as a condition where a couple fails to conceive after one year of regular sexual contact without contraception.

Fecundity Patterns of Normal Fertile Couple

   One survey stated that 75% will conceive in six months and 90% will conceive in one year (Taylor, 2003).

   From a proactive point of view, one year of waiting is quite long to suspect that there may be something wrong with a couple who aspires to have a child and yet fails. I believe that three menstrual cycles may be long enough for a woman to conceive if there is no apparent problem or obstacle hounding her or her partner.

Optimum Fertility Age for Women

20 - 29 y/o -----------85%

30 - 35 y/o -----------63%

36 - 39 y/o-----------52%

Causes of Decline of Fertility in Women

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1. The cumulative effect of injury from infection

2. The effect of aging on the quality of the oocyte or egg.

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Men                                                  Women

(Low or absent Sperm count)

1. Genital Infection                                  1. Genital Infection

    -Prostatitis                                                - Cervicitis

    -Epididymitis                                            - Endometritis

                                                                        - Salpingitis

2. Blockage                                              2. Ovulatory Dysfunction

3. Hormonal                                             3. Uterine Diseases

4. Varicocele (?)                                       4. Tubal Diseases

5. Smoking (?)                                          5. Cervical Problem

6. Chronic Alcoholism                            6. Immunologic Factor

                                                                   7. Infectious

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   Through the years of treating Infertility, I came to realize how a Genital Infection such as Prostatitis in men and Cervicitis in women could  play a major role in infertility. 

   Genital Infection is said to be the most common cause of Infertility in men and women (Jewelewicz & Wallach, 1995). Accordingly, Genital Infection may cause infertility, ectopic pregnancy, recurrent spontaneous abortion, stillbirth, neonatal death and blockage of the Fallopian Tubes in women and Epididymis in men.

   Since Infection-related Infertility is said to be the most common cause of Infertility, then a complete work-up for Genitourinary Infection should be the first step in the evaluation of an Infertile Couple. But ironically, it is not being routinely done.

Steps in Diagnosis of Infertility

   1. History and Physical Examination 

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   2. Complete Genitourinary work-up for infection 

       a. Gram Stain 

       b. Chlamydia Immunofluorescence test by Direct Fluorescence Antibody (DFA) 

       c. Comprehensive Culture and Sensitivity Tests to include Ureaplasma and Mycoplasma Cultures

       d. Semen Analysis for men including Cultures 

   3. Assessment of ovulatory function: A more objective parameter is by way of a test called Follicular Monitoring through a series of Transvaginal Ultrasounds. This could also diagnose an ovulatory problem called Polycystic Ovary (PCO).

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   4. Hormonal work-up (Men and Women)

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   5. Assessment of cervical factors 

       Post-coital test (PCT) 

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   6. Assessment of Uterine and tubal function by Hysterosalpingogram or Laparoscopy, when called for, should be done only after a woman has been cleared of Genital Infection (Cervicitis). Otherwise, injecting a fluid (Dye) into the Cervix could push an infection from the Cervix into the Fallopian Tubes that might also cause an infection called Salpingitis which could lead to scarring and result in a partial or total blockage of the tube/s. Due prudence should be exercised in assessing tubal function.

Traditional Treatment of Infertility

    Almost all of the Infertility couples I have seen in my practice were previously treated by one to five different physicians or infertility specialist, but it would seem that Genital Infection was practically never considered a factor that may have contributed to Infertility in the said couples as apparently, no test or treatment for Genitourinary Infection was ever done on them.

    The female patients were previously treated with either, Clomiphene, Bromocriptine, Menotropins, Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) or a combination of two or more of these. The male patients, on the other hand, were either treated with Testosterone, Parlodel or a Varicocelectomy was done where a Varicocele was present. In all the aforementioned cases, the chosen therapies were unsuccessful in producing conception.

   It would seem that it is not general knowledge in clinical practice that Genital infection is a major factor in Infertility, nor is it given much attention.

Relevance of Varicocele

   According to R. Jewelewicz, M.D., and Edward E. Wallach, M.D., “the relevance of a Varicocele to infertility in men is highly controversial”.

   A positive effect of Varicocelectomy was first reported  by Tulloch in 1952, but subsequent studies by Model et al. in 1990 then Peng et al., also in 1990, have shown that Varicocele has no relevance to Infertility.

Treatment of Infection-Related Infertility

   Since Genital Infection is common and affects everyone, it is imperative that a complete test for Genital Infection for a couple be performed before initiating any form of treatment because ignoring a concomitant infection causing Infertility could lead to an irreversible damage to the Reproductive Tract.

   Whenever Genital Infection is documented, it is essential to treat the infection together as a couple, for what is with the man is with the woman. They should be treated with the same culture-based antibiotics to avoid the ping-pong effect.

   In my experience, an Infection-related Infertility in men (Prostatitis) and women (Cervicitis) becomes a much more tedious process to treat as the years go by and the longer it remains untreated, compared to a couple who has been Infertile for a year or two against a couple who has been Infertile for five years or more.

   This is because the organisms naturally become more virulent through time and various strains could accumulate. The course of antibiotic treatment becomes longer as the organisms become a harder nut to crack. While an accumulation of different organisms may require two to three courses of antibiotic medications or even more in some cases. So, it is best to address Infertility early on.

   In men, the antibiotic treatment should be combined with thrice weekly Prostate Massage because antibiotics do not readily penetrate an infected Prostate without the massage, and this would be the root cause of recurring infections or the failure of a treatment course for the couple. (See Chapter 3 of Genitourinary & Prostate Health)

   Male and female Genital Infections definitely play a major role in Infertility. Although its effects may not be absolute, it is bound to take its toll on the Reproductive Health sooner or later. The Infertility that Infection can cause is usually and initially reversible but eventually, this could lead to a more permanent or irreparable damage to the Reproductive System.

   It is the potential of these Genital Infections to do  irreversible damage to the Reproductive System that concerns me the most. Time is of the essence and there is an urgency to diagnose an Infection when present and to treat it adequately before it causes blockage of the Fallopian Tube/s in women and Epididymis in men. The preservation of the Reproductive System has to be an important requisite in the treatment of Infertility and this should not be left to chance. Know more about Infection-Related Infertility before it gets you.

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