First steps in preserving fertility or reversing infertility
Any kind of symptomatic genital tract infection, either in the male or in the female warrants serious attention, skillful evaluation and prompt antibiotic therapy. Our clinical experience has shown that fertility has long been compromised by the time a bacterial contamination in the genital-canal reaches a symptomatic level. Infections in the male, such as: orchitis, epididymitis, prostatitis or urethritis; or infections in the female, such as Bartholin duct infection, symptomatic vaginitis, urethritis syndrome, interstitial cystitis (IC), profuse cervical infection, endometriosis, or symptomatic pelvic inflammatory disease are first treated with antibiotics prior to commencing a fertility workup or fertility drug stimulation. An effective way of treating genital track infections, is giving antibiotics intravenously. For both men and women we use an ambulatory pump system. The intravenous therapy can be much enhanced by complementing it with intrauterine lavages for women and direct injections into the prostate for men using broad-spectrum antibiotics without systemic side affects and virtually no local discomfort. See the following illustration.
In women, the most effective antibiotic therapy to treat pelvic infections uses intravenous antibiotics in combination with a series of uterine washes infusing cocktails of broad spectrum antibiotics into the uterus. In men the IV therapy is complemented with direct injection of antibiotics into the prostate. See description under Treatment of Chronic Prostatitis.
Symptomatic patients who have laboratory evidence of genital tract infection, such as white blood cells in the seminal fluid, excess white blood cells with numerous bacteria in the vaginal secretion (bacterial vaginosis ), colposcopically documented chronic cervicitis and endometrial biopsy showing acute or chronic endometritis, hysterosalpingography or sonography evidence of inflammatory tubal disease.
History of Genital or Urinary Tract Infections, Interstitial Cystitis, Chronic Urethritis Syndrome
History of old, especially recurring genital tract infections, 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 that can cause long term health problems in the individual.
Chlamydia Infections of the Female or Male Genital Tract. Special Considerations
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. See chapter: "Treatment for Chronic Prostatitis"
Documented Abnormal Reproductuve Events From the Past
History of primary or multiple miscarriages either in the current or previous relationships, history of ectopic pregnancies. Sexually transmitted diseases are the number one cause of miscarriages, 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).
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).
Unknown Causes of Infertility
Given normal 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 Chlamydia trachomatis and the notorious difficulty in isolating some of the sensitive strains, we prefer a course of broad-spectrum antibiotic therapy with Chlamydia and anaerobic bacterial coverage before suggesting other fertility procedures such as fertility drugs, inseminations or an IVF procedure.