Chlamydia, Ureaplasma, and E. coli impact fertility—treat infections before IUI.

Male partners providing a semen specimen for IUI must be tested for infectious diseases. Instead of protecting sperm, the presence of leukocytes may actually decrease semen quality. In the evaluation of male infertility by Chlamydia, two prospective studies found significant difference in sperm quality among Chlamydia positive and negative men that were fertile. Ureaplasma is found frequently within the genital tract and semen of males and is thought to cause infertility through the production of reactive oxygen species (ROS and antisperm antibodies. Despite being a unique genus of bacteria, Mycoplasma has not demonstrated any unifying effect on semen quality or relationship with male infertility. Enterobacteriaceae is a family of gram negative bacteria that includes organisms such as E. coli, Klebsiella, Salmonella, Proteus, and Pseudomonas. These bacteria are associated with epididymitis, orchitis, and prostatitis, suggesting that they may have a role in infertility. Although few mechanisms have been proposed for Enterobacteriaceae, E. coli have been found to have a special effect on sperm motility and acrosomal function. The use of antibiotics has been shown to eliminate all non-specific bacteria without having any effect on sperm quality or pregnancy rates. Classic centrifuge techniques (density gradient and swim-up) have been shown to effectively separate bacteria from sperm and select higher quality sperm. New technologies, like microfluidics, electrophoresis, motile sperm organelle morphology examination (MSOME), and birefringence can have similar results and without the ROS production derived from centrifugation. All male partners routinely have a blood workup for infectious disease screen as well as a comprehensive genital culture with appropriate anti bacterial therapy before IUI at MMC IVF.

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