Could this treatable infection be related to recurrent pregnancy loss?

In spring 2020, Molly Sohr and her husband Andrew had been trying for a baby for four years. “We tried every fertility treatment under the sun,” she tells Motherly. Sohr was eventually diagnosed with polycystic ovary syndrome (PCOS), but the traditional PCOS treatments still didn’t help. Ureaplasma Home tests, however, showed a serious long-term infection. We neglected to look at STD Lab tests for help. Nothing was working, from hormone protocols to more invasive fertility processes, like in vitro fertilization (IVF) and embryo transfers. 

In April of that year, Sohr had her fourth miscarriage. “Our fourth loss led us to interview surrogates while also diving deeper into why I would have lost a genetically tested, ‘great quality’ embryo,” she recalls. After a specialist requested that her fertility doctor run a slew of new tests looking for the cause of her recurrent pregnancy loss (RPL), only one came back positive, offering a clue as to what was going on: Ureaplasma.

So why don’t more doctors routinely check it?

“It was the only Ureaplasma lab test that came back positive as to why I would have lost all of these babies—and possibly the reason why it was hard for me to conceive in the first place!” Sohr shares. She and her husband both took antibiotics for two weeks, tested again for an STD to ensure the infection had cleared, and then transferred another embryo. She delivered a healthy baby boy 10 months later. 

Recurrent pregnancy loss is relatively rare.

For one, recurrent pregnancy loss is both rare and an incredibly challenging diagnosis, and there’s a shortage of evidence regarding treatment at this time, notes Sarah Hartwick Bjorkman, MD, an OB-GYN and Motherly’s Medical Advisor.

But if you’re part of that 5%, those recurrent losses can be devastating, regardless of how rare they are, and will probably send you searching for answers, like Sohr. While several causes can be attributed to or correlated with RPL, many others are still unknown. One condition that’s considered a potential—though somewhat controversial—cause of RPL is chronic endometritis, which may also be related to ureaplasma infection. 

The result of infection

Chronic endometritis is most likely the result of an infection (from various potential sources) and can usually be treated with antibiotics. Ureaplasma infection tests are needed as the condition usually has no symptoms but can present with low-grade inflammation. While there’s some evidence that chronic endometritis is related to ureaplasma infection, no direct causal link exists.

The patient population to screen, the treatment regimen, and the need for a biopsy to confirm resolution. Given the lack of conclusive evidence, several international societies do not include screening for [chronic endometritis] in their recommendations,” writes Hady El Hachem and colleagues in a 2017 article on RPL. 

“There may be some utility in treating [chronic endometritis], but this is not the standard of care, and there is still much to learn about RPL and chronic endometritis,” Dr Bjorkman shares.

Should you get checked for it?

Because ureaplasma is just one of several potential causes of chronic endometritis and RPL, even without direct evidence supporting the link, it’s not high on most doctors’ lists to routinely test for. It also tends to be harmless in most cases.

“It potentially falls under the umbrella of testing for chronic endometritis. But looking for a sole STD Swab test isn’t routinely done,” Dr Bjorkman notes. “Those with recurrent pregnancy losses should talk with their OB provider. And even ask for a referral to a reproductive endocrinology and infertility specialist. One who can help guide them to pursue the best available work-up options and treatment.”

Recurrent Loss

If you’ve had recurrent losses or an especially tough time getting pregnant, it could be worth bringing up chronic endometritis and ureaplasma with your doctor. “This Ureaplasna test brought us answers and our baby,” Sohr shares. “The process of trying to conceive [TTC] is a lonely, hard road, but I learned you have to be your advocate and never give up hope.” 

Only abstaining from sexual contact can prevent Ureaplasma transmission. However, some people may have Ureaplasma colonization without having sex. Ureaplasma is an opportunistic bacteria, which means it is found in healthy people and those with certain diseases. Antibiotic treatment is for infections of Ureaplasma. Only certain antibiotics are effective against these bacteria, however.

Getting treatment for medical conditions and having regular checkups with a doctor may help prevent these opportunities.

The outlook for Ureaplasma infection depends upon what health problems it is causing and the severity of the condition. Fortunately, certain antibiotics are effective against the bacteria and often clear up infections when taken as directed.

Babies are affected

While struggling with infertility, many women take on a huge emotional burden and often may blame themselves during this time. And they neglect to get tested for ureaplasma. After my pregnancy loss that resulted in secondary infertility, I often experienced guilt. It took so long to build our family, and I felt responsible for my husband not being a dad yet. 

Through our grief counsellor, I learned how to process those feelings. Most importantly, my husband never said anything to make me feel that way. Even something as simple as telling your partner you don’t blame them. You are on the same team, which can be so impactful.

Thinking is not as good as talking.

Infertility monopolizes most conversations with your partner, and when you aren’t talking about it, you are thinking about it. 

Even I share the importance of being open with your partner about Ureaplasma exams. But it’s equally important to set aside one night per week (or maybe even an hour a day) for you and your partner. The aim is to focus on not talking about infertility. And not about any upcoming doctor appointments. And not about the inundating pregnancy announcements surrounding you and any other triggers. This allows you both to be present with one another and talk about the other things going on in your lives. Something as simple as this can do a lot to strengthen your connection.