**12. Keynote points**

trachomatis antibodies (IgA, IgM and IgG). The proportion of C. trachomatis IgG was significantly higher in the infertile group (23.8%) than in the pregnant group (4.4%), p < 0.05. For C. trachomatis antigen (Ag) and N. gonorrhoea Ag no differences were observed between the two groups. The prevalence of mycoplasma genital infections was higher in the pregnant group (U. urealyticum - 53.3% and M. hominis - 20%) than in the infertile group (U. urealyticum - 39.7% and M. hominis - 7.3%). Higher rate of co-infection with C. trachomatis and myco‐ plasma were observed among the infertile women (25.7%) than among the pregnant women (7.7%). This combination could be involved in the appearance of pelvic inflammatory disease (PID) and its sequele, including infertility. C. trachomatis IgG determination still remains the gold standard for the diagnosis of PID and should be used as a screening test for the prediction of tubal damage in infertile women. They concluded that in view of the large number of cases involving the co-existence of genital infections with C. trachomatis, M. hominis and U. urealyticum, it is clearly necessary to perform screening for all three microorganisms among

Another study [26] was constructed to investigate the detection rates of Chlamydia tracho‐ matis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Gardnerella vaginalis, Escherichia coli, Streptococcus agalactiae and Enterococ‐ cus faecalis, in asymptomatic fertile and infertile women. It encompassed 161 women, including 101 women treated for infertility and 60 fertile women who had already given birth to healthy children. The material for the presence of C. trachomatis, N. gonorrhoeae, M. genitalium, M. hominis and U. urealyticum was collected from the cervical canal and analyzed by PCR. Furthermore, BD Probe Tec ET system was used to detect C. trachomatis infection. Vaginal swabs were collected for classification of bacterial vaginosis and aerobic vaginitis and assessed according to the Nugent score, as well as by traditional culture methods. U. urealy‐ ticum was identified in 9% of the infertile women and in 8% of controls. Presence of M. hominis was demonstrated only in the former (4%) and C. trachomatis only in latter (3%). N. gonor‐ rhoeae and M. genitalium were not found in any of the examined women. The frequency of aerobic vaginitis in both groups was estimated at 12%. There were 7% bacterial vaginosis cases in the study group, and none in the control group (p=0.0096). They concluded that despite having no symptoms of an ongoing acute inflammation of the reproductive tract, many women may experience permanent or periodic shifts of equilibrium of the vaginal and/or cervical microflora. BV develops more frequently in infertile patients when compared to the fertile

all women of reproductive age but especially those who are infertile.

**11. Infection induced by infertility work-up maneuvers**

During the course of infertility work-up, women are subjected to many invasive diagnostic procedures like hysterosalpingography, hysteroscopy, sonohystrography, premenstrual biopsy or laparoscopy. Moreover, some therapeutic procedures are done to treat definite problems like selective salpingography, egg retrieval, operative resectoscopy or hysteroscopy and operative laparoscopy in addition to some minor vaginal maneuvers. All these diagnostic and operative interventions carry the risk of introduction of infection to the genital tract and

women.

30 Genital Infections and Infertility

Infertility specialists should not underestimate overt lower or upper genital tract infections. Vaginal including speculum examination is an important basic step during infertility evalua‐ tion. Gynecologists should keep asepsis during all steps of examination or investigation of the infertile female. Use of appropriate antibiotics is recommended whenever prolonged or invasive procedure is performed. Prompt and aggressive treatment of any detected upper or lower genital tract infection is mandatory to prevent short and long-term sequel that would compromise the fertility status of the female. Concomitant treatment of the male partner shouldn't be forgotten to avoid relapse or persistence of female infections. Think hidden infection of the genital tract in all cases of UI before performing sophisticated procedures like ART. Uterine microbiome is a recent entry to our armamentarium, however its relevance and treatment is unknown and requires more research.
