Infection in the male, such as: orchitis, epididymitis, prostatitis or urethritis; or infection in the female, such as: Bartholin duct infection, symptomatic vaginitis, profuse cervical infection, endometriosis, or symptomatic pelvic inflammatory disease; are first treated with antibiotics prior to commencing a fertility workup or fertility drug regimens.
The most effective way of treating genital track infections is giving antibiotics intravenously. We use an ambulatory pump system. The intravenous therapy can be complemented with intrauterine lavages using broad-spectrum antibiotics without systemic side affects and virtually no local discomfort. See following illustration.
In men the IV therapy is complemented with direct injection of antibiotics into the prostate. See description under Treatment of Chronic Prostatitis.
2.) Asymptomatic patients who has laboratory evidence of genital tract infection, such as white blood cells in the seminal fluid, excess white blood cells with bacterial vaginosis (discharge), colposcopically documented chronic cervicitis and endometrial biopsy showing acute or chronic endometritis, hysterosalpingography or sonography evidence of inflammatory tubal disease.
3.) A history of old, especially recurring genital tract infection, such as prostatitis in the male and pelvic inflammatory disease in the female.
Our clinical experience shows that after an acute, infectious episode in the male or female, certain harmful bacteria can remain in the genital-tract. Therefore, even after the most thorough antibiotic treatment follow up cultures are indicated. After an incomplete antibiotic therapy, an asymptomatic bacteria carrier state can arise with adverse effect on the sexual partner or can cause long term health problems in the individual.
When treatment is planned in Chlamydia infections of the female genital tract special considerations are needed.
This bacterium has a unique life cycle, versatile antigenic potential, changing antibiotic sensitivity and an ability to cause a vide range of medical diseases and reproductive complications. See Female Chlamydial Infections.
When treating chronic prostatitis associated with Chlamydia trachomatis infection special protocol should be followed.
4.) A history of primary or multiple miscarriages either in the current or previous relationship.
Since over fifty percent of our patients, following primary or multiple miscarriages, carry to term following antibiotic therapy only, antibiotic therapy is usually our first therapeutic approach.
5.) A history of ectopic pregnancies.
Due to the fact that pelvic inflammatory disease, with the explosion of sexually transmitted diseases, is the number one cause of ectopic pregnancies, the evaluation and treatment of a patient who recently experienced such a pregnancy, should start with bacteria testing and subsequent antibiotic therapy prior to choosing other options. If and when spontaneous pregnancies are planned following an ectopic pregnancy, ample time should be allowed to pass following a comprehensive, broad spectrum antibiotic therapy course to allow tubal regeneration (at least six months).
6.) Cases where secondary infertility is the main problem.
That is, the first pregnancy occurred with relative ease with or without a successful delivery. A significant number of these cases in our experience are caused by secondary uterine or tubal contamination with bacterial flora either coming from the seminal fluid or bacteria previously existing only in the lower part of the genital canal of the female, in the vaginal canal or in the lower third of the cervix (exo-cervix). Prior to the conception of the first pregnancy the number of these bacteria is not high enough to prevent conception or even the carrying of a pregnancy to live birth. During the course of the first pregnancy the immune system is suppressed allowing for these bacteria to multiply. Following the delivery of the first child the recovering immune system will recognize the presence of the - by now - much more numerous bacteria and initiate an infertility condition mediated either through none specific antibody production that indiscriminately will attack the numerous bacteria and the new pregnancy, or through the direct effect of the excess of bacteria and their toxins. Antibiotics will bring about a fruitful outcome in reversing the secondary infertility condition. There are simple laboratory tests, if analyzed together with the patient's changing symptoms, will easily pinpoint the level within the genital tract where the infection obstructed fertility: If the result of the postcoital test are poor it suggest cervical involvement; a changing menstrual flow pattern with increased or decreased menstrual pain pattern suggest uterine involvement; or luteal phase defect with increased PMS symptoms suggest ovarian involvement. If immune system involvement is minor, a complete recovery of the abnormal reproductive function can be expected shortly after completing the antibiotic therapy. If significant immune reaction is present already, due to the slow recovery of the immune system, it may take four to nine months for a pregnancy to ensue
7.) Unknown causes of Infertility.
Given normal numerical parameters, without documented immunological interference with fertility, some couples are classified as suffering from infertility of unknown etiology. Due to the stubborn nature of anaerobic bacteria and the notorious difficulty in isolating some of the sensitive strains, we prefer a course of broad-spectrum antibiotic therapy with anaerobic bacterial coverage before suggesting other fertility procedures such as fertility drugs, inseminations or an IVF procedure.
