Martin Hrivňák1, Ján Šalagovič2, Ladislav Bobák3, Zuzana Váczy3, Igor Milichovský1, Ladislav Valanský4
Objective: Infertility is a global health problem, affecting approximately 15-20 % of couples worldwide. Approximately 50 % of infertility is caused by a male factor. Among sexually transmitted diseases, Chlamydia trachomatis infection is considered to play a prominent role in female infertility. The impact of chlamydial infection on male infertility is still unknown and obtained results are controversial. Studies of Chlamydia trachomatis infection in men have provided conflicting evidence as to whether it is associated with reduced fertility. Aim of our study was to determine: 1. the proportion of men with chlamydial infection among infertile men examined in the period of 1996-2005 in the Clinic of Urology of Medical Faculty and Faculty Hospital in Košice, 2. association between chlamydial infection and morphological sperm changes, 3. influence of different strategies of treatment of chlamydial infection on sperm quality. Materials and methods: We have examined 1324 men from infertile couples to determine Chlamydia trachomatis presence in urogenital tract using direct immuno-fluorescence, direct ELISA or PCR methods. Parameters of semen were examined according to WHO manual in all men. Attention was paid especially to morphological changes of sperms. All Chlamydia trachomatis positive patients were divided into 3 therapeutic protocols and success of treatment was compared. Results: Normal sperm parameters were determined in 219 (16.5 %) men. Pathological sperm parameters were found in 1105 patients, out of them 74 (5.6 %) had no ejaculate, or no sperm in ejaculate. Chlamydia trachomatis infection was confirmed in 246 (23.9%) of 1 031 men with pathological sperm parameters and presence of sperms in ejaculate. In 215 (19.5 %) of them chlamydial infection was identified as a single cause of infertility. A significant relationship was found between chlamydial infection and sperm tail pathology (p = 0.035). Moreover, in a high proportion of patients simultaneous presence of both evaluated sperm pathologies in head and tail was observed (p = 0.051). The best treatment strategy was combination of Azithromycin and Ciprofloxacine for 20 days with no relapse of infection. As related to evaluation of therapy influence on sperm pathologies the only significant improvement in sperm tail pathology (p = 0.044) was found after treatment. Conclusions: The results of this study demonstrate a significantly higher rate of incidence of chlamydial infection in infertile men than in normal population and indicated the higher frequency of sperm pathology associated with chlamydial infection in infertile men, predominantly sperm tail pathology. Therefore, detection of Chlamydia trachomatis infection should be included as a routine procedure in male infertility work-up.