Ureaplasma: A potential key factor in infertility and miscarriage
Ureaplasma is a type of bacteria commonly found in the human reproductive system. Unlike many bacteria, Ureaplasma lacks a cell wall and produces an enzyme called urease, which breaks down urea into ammonia and carbon dioxide. The two main species affecting human health are Ureaplasma urealyticum and Ureaplasma parvum. These bacteria can significantly impact fertility and pregnancy, making it crucial to understand their role in reproductive health.
Ureaplasma and Infertility
Ureaplasma can live in the urogenital tract without causing symptoms, but in some individuals, it leads to infections that can harm reproductive health. One of the primary ways Ureaplasma affects fertility is through inflammation. The bacteria can cause conditions such as urethritis (inflammation of the urethra), endometritis (inflammation of the uterus lining) and salpingitis (inflammation of the fallopian tubes). This inflammation damages reproductive tissues and impairs their function, leading to infertility.
Additionally, Ureaplasma can adhere to sperm, reducing their motility and viability, which are essential for successful fertilization. This attachment hinders the sperm's ability to reach and fertilize the egg. Furthermore, the infection can trigger the production of antibodies against sperm, further reducing their functionality and leading to immune-mediated infertility.
Several studies highlight the link between Ureaplasma and infertility. A recent study found that women undergoing infertility treatments had a higher prevalence of Ureaplasma infections compared to fertile women, suggesting a potential role of these bacteria in unexplained infertility. Another study discovered that infertile men with Ureaplasma urealyticum had significantly lower sperm quality, indicating a direct negative impact on male fertility. Additionally other researhers investigated the presence of Ureaplasma, Chlamydia and Mycoplasma in infertile couples and found that these infections negatively affected fertility, highlighting the importance of screening for these pathogens in infertility evaluations.
Ureaplasma and Miscarriage
Ureaplasma can contribute to miscarriage through several mechanisms. One significant factor is chorioamnionitis, an infection of the fetal membranes caused by Ureaplasma ascending from the lower genital tract to the upper genital tract. Chorioamnionitis can lead to preterm labor and miscarriage. Additionally, Ureaplasma can cause chronic inflammation of the placenta, impairing its function and leading to fetal demise due to inadequate nutrient and oxygen exchange.
Infections by Ureaplasma also stimulate the production of inflammatory cytokines, disrupting the immune environment necessary for maintaining pregnancy and potentially leading to increased uterine contractions and miscarriage. Research supports the link between Ureaplasma infections and adverse pregnancy outcomes. Studies show that Ureaplasma infections significantly increased the risk of spontaneous miscarriage, especially in the first trimester. Researches stipulated that women with recurrent miscarriages often had Ureaplasma in their genital tracts, suggesting the bacteria's role in repeated pregnancy loss.
Ureaplasma in the Vaginal microbiota
Ureaplasma are commensal bacteria commonly found in the vaginal microbiota of 40-80% of women of reproductive age. There are fourteen known serotypes of Ureaplasma, divided into two biovars: Ureaplasma parvum and Ureaplasma urealyticum. Although typically part of the normal vaginal flora, Ureaplasma has been implicated in various conditions such as non-gonococcal urethritis (NGU), prostatitis, gynecological diseases and infertility. The association between Ureaplasma and bacterial vaginosis (BV) is controversial. Some studies report a higher prevalence of Ureaplasma in women with BV, while others find no significant difference. Despite these mixed results, Ureaplasma can induce the production of pro-inflammatory cytokines in vaginal and cervical epithelial cells, contributing to reproductive complications.
Diagnostic and Treatment Approaches
Accurate diagnosis of Ureaplasma infections is crucial for managing infertility and preventing miscarriage. The main diagnostic methods include Polymerase Chain Reaction (PCR), culture techniques and serological testing. PCR is highly sensitive and specific, detecting Ureaplasma DNA in samples from the endocervix, semen and placental tissues. Although less sensitive than PCR, culturing Ureaplasma remains useful, especially for antimicrobial susceptibility testing to guide treatment. Serological testing detects antibodies against Ureaplasma but is less commonly used due to variable antibody responses among individuals.
Treatment of Ureaplasma infections typically involves antibiotics like doxycycline, azithromycin and erythromycin. However, the emergence of antibiotic-resistant strains requires careful antibiotic selection based on sensitivity testing. A study noted increasing resistance of Ureaplasma to common antibiotics, highlighting the need for ongoing surveillance and the development of new treatment strategies.
Personal Experiences and Additional Insights
We see the real-world impact of Ureaplasma infections in our clinic. Some of our clients after experiencing recurrent urinary tract infections (UTIs) and vaginal infections, came to us and through testing, we discovered Ureaplasma as their underlying cause for their infertility and pregnancy loss. We also saw clients that despite initial antibiotic treatments with medical professionals, their symptoms persisted, leading them to explore alternative therapies, including functional medicine and nutritional therapy. It is now clear to those clients how important hormonal balance, gut health and immune support in managing chronic Ureaplasma infections and based on experience we can just emphasize the necessity for personalized and comprehensive treatment approaches in dealing with these infections, especially when preparing to get pregnant or experiencing infertility.
Conclusion
Ureaplasma infections are a significant but often overlooked cause of infertility and miscarriage. Routine screening for Ureaplasma in individuals facing reproductive challenges is essential. Our clinic is well equipped to recognise the potential underlying causes in your infertility struggles and we are able to easily test via a reputable functional testing company with a vaginal swab. Book a discovery call to understand how we can support you and your partner to achieve your dream of a healthy baby and healthy pregnancy.
References
Männistö, J., Jalkanen, J., Paju, S., et al. (2019). "Prevalence and Risk Factors of Ureaplasma and Mycoplasma among Infertile Couples." Journal of Clinical Microbiology, 57(3): e01440-18.
Gdoura, R., Kchaou, W., Chaari, C., et al. (2008). "Ureaplasma urealyticum and Male Infertility in Tunisia." Asian Journal of Andrology, 10(6): 895-900.
Edwards, R.K., Ferguson, R.J., Reyes, L., et al. (2006). "Assessing the Role of Ureaplasma urealyticum in Spontaneous Preterm Labor." Obstetrics & Gynecology, 107(1): 125-132.
Kataoka, S., Yamada, T., Chou, K., et al. (2006). "Association between Ureaplasma urealyticum Infection and Preterm Birth." American Journal of Perinatology, 23(6): 329-334.
Waites, K.B., Duffy, L.B., Bébéar, C.M., et al. (2009). "Emerging Antimicrobial Resistance in Ureaplasma: Trends Over Time and Relationship to Clinical Outcomes." Journal of Antimicrobial Chemotherapy, 64(6): 1160-1165.
Günyeli, I., Abike, F., Dünder, I., Aslan, C., Tapısız, O. L., Temizkan, O., Payaslı, A., & Erdemoğlu, E. (2011). "Chlamydia, Mycoplasma and Ureaplasma infections in infertile couples and effects of these infections on fertility." Archives of Gynecology and Obstetrics, 283(2): 379–385.
Hunjak B, Sabol I, Vojnović G, et al. Ureaplasma urealyticum and Ureaplasma parvum in women of reproductive age. Arch Gynecol Obstet. 2014;289(2):407-412.
Hillier SL, Krohn MA, Rabe LK, Klebanoff SJ, Eschenbach DA. The Normal Vaginal Flora, H2O2-Producing Lactobacilli, and Bacterial Vaginosis in Pregnant Women. Clin Infect Dis. 1993;16(Supplement_4):S273-S281.
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