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Occasionally people belittle my having obtained a Doctor of Veterinary Medicine prior to becoming a Sperm Physiologist and doing research on human infertility.  However, I view the chance to have received both of my degrees as a true blessing.  This is in part because of the more wholistic approach veterinarians have to take in medicine, especially in my previous area of food animal medicine.  For the dairy farmer, his cow’s life literally depends on us being able to figure out why she is not conceiving and my treatment was not done until we could get her to calve. 

For many years, veterinarians have known that a form of organism called a mycoplasma causes infertility in many animals, in particular through damaging the Fallopian Tube.  This was one of my areas of research at Cornell (with Dr. Lein of the cattle article). However, human medicine has been very slow to evaluate and treat this very knowable and treatable pathogen.

Look at this interesting article from 1976.  I have highlighted the authors comments 30 YEARS ago about the need for physicians to use medical knowledge from cattle to lead to progress in women’s health and fertility.

Infertility of cattle caused by mycoplasmas.
Tourtellotte ME, Lein DH.

Mycoplasmas have been well established as pathogens of the bovine urogenital tract, and produce pathologic lesions resulting in infertility. Serologic examination of cattle with infertility problems with Mycoplasma bovigenitalium and Mycoplasma agalactiae subsp. bovis show a high incidence of positive reactors suggesting that mycoplasmas play an important role in bovine infertility. The similarities of pathologic lesions in the urogenital tract of cattle and women with infertility problems and the frequency of isolation of mycoplasmas from human females suggest closer examination for mycoplasmas in human infertility. Studies with bulls suggest that mycoplasmas as a cause of human male infertility should not be ignored.

Luckily for all TTCers out there, the role of Mycoplasma in human infertility has begun to be talked about more.  It is likely involved in pelvic inflammatory disease (PID) and endometriosis.  Most interesting to me was a recent report by Grzesko et al (listed below) which showed that 30% of women with idiopathic infertility (or no known reason for the infertility) had mycoplasma in their cervical canal  while only 4% of fertile women had the organism in their cervix.  This is a HUGE difference between these two groups.  Additionally, for women with genital infections in an ObGyn practice, 43% had mycoplasma present.  Mycoplasma often are “opportunistic” meaning they come in after other acute infections subside.  They are also easily spread between partners. Most importantly, typical treatment protocols for PID do not impact mycoplasmas.  Men, mycoplasma does impact you too, and 50% of partners are cross infected….so you both should get checked and treated if applicable.

The take home message: If you are having trouble conceiving or if you have had chronic intermittent genital irritation or infection, ask your doctor for a mycoplasma genitalium test.   It isn’t a routine test and you may have to work to get it run or have to pay for it out of pocket.  But all the Clomid in the world won’t overcome infertility due to a low grade chronic infection, and getting the proper diagnosis and treatment is something you may have to discuss, educate and push for with your physician.

I am disappointed that we direct so much of our infertility treatment and discussion towards assisted reproduction technologies, without first making sure that a couple is as healthy as can be for nature to take its own course!  I have listed several articles below that are good for information on this topic!

Blessings- Dr.E

• Treatment strategies for pelvic inflammatory disease.
  Sweet RL.
  Expert Opin Pharmacother. 2009 Apr;10(5):823-37.
• Correlation of mycoplasma with unexplained infertility.
  Gupta A, Gupta A, Gupta S, Mittal A, Chandra P, Gill AK.
  Arch Gynecol Obstet. 2009 Mar 26.
• Occurrence of Mycoplasma genitalium in fertile and infertile women.
  Grześko J, Elias M, Maczyńska B, Kasprzykowska U, Tłaczała M, Goluda M.
  Fertil Steril. 2009 Jun;91(6):2376-80.