Recurrent pregnancy loss and the role of Mycoplasma and Ureaplasma: a prospective cohort study with outcome after treatment.

OBJECTIVE

To study the prevalence of infectious etiologies such as Mycoplasma and Ureaplasma in a population experiencing recurrent pregnancy loss (RPL), assess live birth outcomes after treatment of these infections, and review the current literature on infectious workup for RPL.

DESIGN

This single-center prospective cohort study matched RPL patients 6:1 with infertile controls. Fisher's exact test was used for statistical analysis, and the study was powered to detect a 5% difference in culture positivity and pregnancy outcomes at a 95% confidence level.

SUBJECTS: The study included 1,583 patients with RPL with no identifiable cause after evaluation and 263 infertile controls. Patients with uncorrectable findings or loss of follow-up were excluded.

EXPOSURE: All patients underwent testing for Mycoplasma and Ureaplasma using high-endocervical cultures. Positive cases and partners were treated with a 14-day course of doxycycline, followed by a test-of-cure. Alternative antibiotics were administered if initial therapy failed.

MAIN OUTCOME MEASURES: Primary outcomes included infection rates of Mycoplasma and Ureaplasma. Secondary outcomes assessed treatment success and subsequent live birth rates in the RPL population.

RESULTS

Recurrent pregnancy loss patients had higher infection rates of Mycoplasma (4.2%; relative risk [RR] 10.9, confidence interval [CI] 1.53-78.7) and Ureaplasma (15.7%; RR 1.59, CI 1.09-2.33) compared with controls (0.1% and 9.89%, respectively). Over 95% achieved negative test-of-cure cultures after treatment. Live birth rates were significantly higher in successfully treated patients: 78% for Mycoplasma and 76% for Ureaplasma, compared with 64% in culture-negative RPL cases.

CONCLUSION

Mycoplasma and Ureaplasma may contribute to RPL, as successful eradication improved live birth rates compared with control patients. These findings support consideration of testing for these pathogens during RPL evaluations as a specific and minimally invasive diagnostic method.