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Cervical Ureaplasma Urealyticum Infection: How can it Affect IUI/IVF Outcome?

by Dr. Geoffrey Sher on January 18, 2017

Ureaplasma urealyticum is a bacterium that belongs to the mycoplasma family. It can be detected in the reproductive tract of as many as 40% of individuals (male and female). Ureaplasma probably does not prevent normal conception in the majority of cases, because by and large, the uterine cavity remains  free of such pathogenic bacteria even in women whose cervical mucous cultures positive for the organism. However, when present in the woman’s cervical secretions, the organism can be unintentionally dragged into the uterine cavity through introduction of a catheter into the uterus at the time of embryo transfer (ET) or intrauterine insemination (IUI). Molecular biologists have shown that contamination of rapidly growing cell cultures, by this organism and its close “relative”, mycoplasma hominis rapidly destroys such cells. The implanting embryo is indeed an example of an organism that comprises rapidly growing cells in a biological culture medium (the uterine lining), and as such, the cells of the trophoblast that form the “root system” of the embryo are vulnerable to intrauterine infection with Ureaplasma. However, even if the uterine cavity were to become infected, the infection willl be purged with the shedding of the infected lining at the time of the next menstruation.

While , aside from a non-specific vaginal discharge,  infection with Ureaplasma rarely produces symptoms in the woman, it sometimes causes symptomatic prostatitis or epydidimitis in men. Although ureaplasma can be transmitted from one partner to the other by sexual intercourse, it may also be acquired by other means, since a large percentage of couples in monogamous relationships will culture positive for the organism. It is very difficult for the organism to grow in the laboratory. Accordingly, the reproductive secretions of both partners should be evaluated (sperm and cervical mucus) individually. Successful culturing of ureaplasma requires a specialized media in which the specimens can be transported safely from the physician’s office to the microbiology laboratory.

If both partners culture negative, we can assume that there is no infection present. However, if one partner cultures positive and the other negative, we would err on the side of caution, by assuming that the negative result was caused by the difficulty in culturing the organism. When ureaplasma is detected in the reproductive secretions of either partner, both should be treated concurrently with the appropriate antibiotic (doxycycline, zithromax, erythromycin, ciprofloxin, or metronidazole; cleomycin).

Unfortunately, in approximately 30-40% of couples infected ureaplasma urealyticum, the bacteria will have built resistance to mainstay traditional antibiotics such as tetracyclines (e.g. doxycycline) and erythromycin (e.g. Zythromax) derivatives. In such cases, ciprofloxin or metronidazole (Flagyl) therapy might be needed. This is the reason that we prefer to document cure by reculturing each partner prior to beginning ovarian stimulation for an IVF cycle.

Several authors have shown a difference in pregnancy rates among patients with ureaplasma infection who were treated with antibiotics and those who were not. Other reports have not been able to identify an effect on outcome from ureaplasma infection. Thus, until the final verdict is in regarding the roll of ureaplasma with regard to its effect on IVF implantation, we prefer to err on the side of caution and ensure that this organism is absent in cervical secretions and semen before transferring embryos. To this end, my patients all receive prophylactic antibiotic therapy around the time of embryo transfer. This is administered as oral ciprofloxin. A day or two prior to embryo transfer, vaginal cleomycin suppositories are added.

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  • Laura - October 18, 2018 reply

    Hi doctors, I have been diagnosed with Ureplasma Urealicum, I have the typical symptoms of frequent urination and discomfort. I have take docyciclin twice, one for a week and another for two weeks but I still test positive. I don’t know what to do anymore. The antibiotics have destroyed my flora creating intestinal bloating and oral trush.
    I need to have a hiteroscopy to see if I have scarring of the uterus but my doctor will not do it unless the bacteria is gone.
    Please help me. Many thanks

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 18, 2018 reply

    I understand, but frankly, I do not personally believe that the existence of ureaplasma infection is a contraindication for doing or delaying hysteroscopy.

    Ureaplasma urealyticum is a bacterium that belongs to the mycoplasma family. It can be detected in the reproductive tract of as many as 40% of individuals (male and female). Ureaplasma probably does not prevent normal conception in the majority of cases, because by and large, the uterine cavity remains free of such pathogenic bacteria even in women whose cervical mucous cultures positive for the organism. However, when present in the woman’s cervical secretions, the organism can be unintentionally dragged into the uterine cavity through introduction of a catheter into the uterus at the time of embryo transfer (ET) or intrauterine insemination (IUI). Molecular biologists have shown that contamination of rapidly growing cell cultures, by this organism and its close “relative”, mycoplasma hominis rapidly destroys such cells. The implanting embryo is indeed an example of an organism that comprises rapidly growing cells in a biological culture medium (the uterine lining), and as such, the cells of the trophoblast that form the “root system” of the embryo are vulnerable to intrauterine infection with Ureaplasma. However, even if the uterine cavity were to become infected, the infection willl be purged with the shedding of the infected lining at the time of the next menstruation.
    While , aside from a non-specific vaginal discharge, infection with Ureaplasma rarely produces symptoms in the woman, it sometimes causes symptomatic prostatitis or epydidimitis in men. Although ureaplasma can be transmitted from one partner to the other by sexual intercourse, it may also be acquired by other means, since a large percentage of couples in monogamous relationships will culture positive for the organism. It is very difficult for the organism to grow in the laboratory. Accordingly, the reproductive secretions of both partners should be evaluated (sperm and cervical mucus) individually. Successful culturing of ureaplasma requires a specialized media in which the specimens can be transported safely from the physician’s office to the microbiology laboratory.
    If both partners culture negative, we can assume that there is no infection present. However, if one partner cultures positive and the other negative, we would err on the side of caution, by assuming that the negative result was caused by the difficulty in culturing the organism. When ureaplasma is detected in the reproductive secretions of either partner, both should be treated concurrently with the appropriate antibiotic (doxycycline, zithromax, erythromycin, ciprofloxin, or metronidazole; cleomycin).
    Unfortunately, in approximately 30-40% of couples infected ureaplasma urealyticum, the bacteria will have built resistance to mainstay traditional antibiotics such as tetracyclines (e.g. doxycycline) and erythromycin (e.g. Zythromax) derivatives. In such cases, ciprofloxin or metronidazole (Flagyl) therapy might be needed. This is the reason that we prefer to document cure by reculturing each partner prior to beginning ovarian stimulation for an IVF cycle.
    Several authors have shown a difference in pregnancy rates among patients with ureaplasma infection who were treated with antibiotics and those who were not. Other reports have not been able to identify an effect on outcome from ureaplasma infection. Thus, until the final verdict is in regarding the roll of ureaplasma with regard to its effect on IVF implantation, we prefer to err on the side of caution and ensure that this organism is absent in cervical secretions and semen before transferring embryos. To this end, my patients all receive prophylactic antibiotic therapy around the time of embryo transfer. This is administered as oral ciprofloxin. A day or two prior to embryo transfer, vaginal cleomycin suppositories are added.

    Geoff Sher

  • Myla - May 28, 2018 reply

    Hello Dr. Geoffrey Sher,

    I tested positive for positive for Ureaplasma urealyticum and I have been treated for it with 2 different medication; doxycycline and ciprofloxin twice for 15 days But I am still testing positive. I think I have this bacterias for more than 10 years. What are the complications of having it for so long? What type of medicine should I take this time? How can I know if it affected my fertility?
    Thank you so much!

    Myla

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - May 29, 2018 reply

    Ureaplasma urealyticum is an bacteria that belongs to the mycoplasma family. It can be detected in the reproductive tract of as many as 40% of individuals (male and female). Ureaplasma probably does not prevent normal conception in the majority of cases, because the uterine cavity remains sterile even in women whose cervical mucous cultures positive for the organism, however, when present in the woman’s cervical secretions, the organism can be unintentionally dragged into the uterine cavity through introduction of a catheter into the uterus at the time of embryo transfer (ET) or intrauterine insemination (IUI). Molecular biologists have shown that contamination of rapidly growing cell cultures, by this organism and its close “relative”, mycoplasma hominis rapidly destroys such cells. The implanting embryo is indeed an example of an organism that comprises rapidly growing cells in a biological culture medium, (the uterine lining), and as such, the cells of the trophoblast (that form the “root system of the embryo”) are vulnerable to intrauterine infection with Ureaplasma. However, even if the uterine cavity were to become infected with uterine cavity, the infection willl be purged with the shedding of the infected lining at the time of the next menstruation.

    While infection with Ureaplasma rarely produces symptoms in the woman, it sometimes causes symptomatic prostatitis or epydidimitis in men. Although ureaplasma can be transmitted from one partner to the other by sexual intercourse, it may also be acquired by other means, since a large percentage of couples in monogamous relationships will culture positive for the organism. It is very difficult for the organism to grow in the laboratory. Accordingly, the reproductive secretions of both partners should be evaluated (sperm and cervical mucus) individually. Successful culturing of ureaplasma, requires that a specialized media in which the specimens can be transported safely from the physician’s office to the microbiology laboratory. If both partners culture negative, we can assume that there is no infection present. However, if one partner cultures positive and the other negative, we would err on the side of caution, by assuming that the negative result was caused by the difficulty in culturing the organism. When ureaplasma is detected in the reproductive secretions of either partner, both should be treated concurrently, with the appropriate antibiotic, e.g; doxycycline, zithromax, erythromycin, ciprofloxin, or metranidazole).

    Unfortunately, approximately 30-40% of couples infected ureaplasma urealyticum the bacteria will have built resistance to mainstay traditional antibiotics such as tetracyclines (e.g. doxycycline) and erythromycin (e.g. Zythromax) derivatives. In such cases, ciprofloxin or metronidazole (Flagyl) therapy might be needed. This is the reason that we prefer to document cure by reculturing each partner prior to beginning ovarian stimulation for an IVF cycle.

    Several authors have shown a difference in pregnancy rates among patients with ureaplasma infection who were treated with antibiotics and those who were not. Other reports have not been able to identify an effect on outcome from ureaplasma infection. Thus, until the final verdict is in regarding the roll of ureaplasma with regard to its effect on IVF implantation we prefer to be cautious and err on the side of ensuring that this organism is absent in cervical secretions and semen before transferring embryos. To this end my patients all receive prophylactic antibiotic therapy around the time of embryo transfer. This is administered as oral ciprofloxin and a day or two prior to embryo transfer vaginal cleomycin suppositories are added.

    Geoff Sher

  • Cinthia - February 20, 2017 reply

    Perfect, so 4 days before retrieval and continue 6 more days overlapping with embryo transfer isn’t it?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 20, 2017 reply

    That would be my approach, but you would need to clear this with your own treating RE.

    Geoff Sher

    Cinthia - February 21, 2017 reply

    Good morning , if you should medicate your patient with azitromicina only 1 g (twice a day 500 mg for only a day) which day of the ivf process you would suggest take in it if there is a cervicitis? I am afraid cipro will no succeed with clamidia and cervicitis, that’s my fear

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 21, 2017 reply

    You would start as early as possible.

    Geoff Sher

    Cinthia - February 21, 2017

    So if I do it on day 10 of stims will be fine? Very kind of you for answering our questions,

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 22, 2017

    Probably so…But, discuss with your doctor.

    Geoff Sher

  • Cinthia - February 18, 2017 reply

    Dr sher, ciprofloxin or meteonidazole flagyl will be the same? Then is Safe to have it while waiting for the transfer? Not have it During stims? Could harm the eggs? As ii told before i am in the míddle of an AACP and in january i made a vaginal study which says negative for trichomonas vaginalis, negative for mycoplasma hominis ur urealiticum, abundant positiva gram bacilos Lactovacilus but positiva for clamidia trichomonas, i have never an infección of this Type and my OBGYN believes is an error of the lab, so i must repeat but the thing is that i am in the middle of an IVF, what you suggest doing due to your experience: having the anthibiotic after the retrieval day just in case that the exam is right?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 19, 2017 reply

    If you need an antibiotic in-cycle, I would rather use Cipro.

    Geoff Sher

    Cinthia - February 19, 2017 reply

    Thanks doctor, I take it after retrieval or during stims?

    Cinthia - February 19, 2017 reply

    Azitromicina is not allowed in cycle post retrieval ?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 19, 2017

    If it is an erythromycin derivative it should be fine.

    Geoff Sher

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 19, 2017 reply

    3-4days prior to retrieval.

    Geoff Sher

    Cinthia - February 19, 2017

    Thank you very much, so it won’t harm eggs if I took it during stims before retrieval and it ok azitromicina as derivates from eritromizin. The most important and thing that worry me is that could harm the eggs or interfere with fertility drugs

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 19, 2017

    In my opinion..they will not!

    Geoff Sher

    Cinthia - February 20, 2017

    The dosage of Cipro will be 1 g only dose? Or is a different dose?
    Is effective for cervivitis caused from clamidia? If you usually use that med in your patients i would rather use it instead of azittromizina even though I read it is the antibiotic more effective for clamidia. I took your advises very seriously and think your blog is amazing

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 20, 2017

    I prescribe 500mg Cipro twice daily for 10 days.

    Geoff Sher

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