The role of Chlamydia trachomatis and Mycoplasma genitalium in infertile couples.

Chlamydia trachomatis is one of the most prevalent sexually transmitted diseases. Previous work has shown that C. trachomatis IgG antibody is correlated with tubal factor infertility and reduced pregnancy rates. There has been little research on Mycoplasma genitalium and the incidence in infertile couples remains unknown. This study has investigated 250 infertile couples as well as 250 fertile women. The presence of these organisms was detected by polymerase chain reaction and an analysis of serum IgA, IgM and IgG antibodies to C. trachomatis. Low prevalence of C. trachomatis, low level of concordance within couples and no evidence of M. genitalium was found. Elevation of IL6 and 8 were observed in C. trachomatis positive men and this varied with diagnostic method. Seminal IL-8 was correlated negatively with semen volume and positively with age. Sperm DNA fragmentation (TUNEL) and chromatin structure (AB, AO & CMA3) were not correlated with C. trachomatis infection. TUNEL results correlated negatively with semen volume and the percentage of protamination was related to age. Urethritis was more common in men diagnosed with C. trachomatis by urine DNA. Men who work as drivers were more likely to be positive for IgG. PCOS was more common in women with positive serology for IgM and IgG. C. trachomatis infection in men or women did not affect pregnancy rate and pregnancy outcome in either assisted or spontaneous conception. In conclusion, this thesis does not support the hypothesis that there is a strong relationship between C. trachomatis infection and infertility. Nor does it support the idea that C. trachomatis is linked to poor semen quality. Study limitations include the lack of fertile men as control group and difficulties with some methodology. A number of future studies are suggested along with some recommendations of C. trachomatis screening programmes both in Iran and the world.