Endometritis in Recurrent Pregnancy Loss Patients: Pregnancy Outcomes After Treatment and Test-of-Cure for Culture-Positive Mycoplasma and Ureaplasma [ID 1194]

INTRODUCTION: Recurrent pregnancy loss (RPL) affects 2–4% of reproductive-aged couples. Less than half will have an identified cause after genetic, endocrinologic, anatomic, and immunologic testing. Infections such as Mycoplasma or Ureaplasma are associated with adverse pregnancy outcomes in humans and bovine species. We determined the prevalence of these bacteria in RPL patients and investigated the successful delivery outcome after treatment. METHODS: This was a single-center, retrospective cohort study of 1,583 RPL patients compared with 263 infertile controls. This study was approved by the IRB. High endocervical cultures for M hominis and U urealyticum were completed. When positive couples were treated with a 14-day course of antibiotics followed by test of cure (TOC). Fisher’s exact test was utilized for analyses. The study was powered to detect a 5% difference in positive culture results and pregnancy outcomes at the 95% level of confidence. RESULTS: Patients with RPL were more likely to be colonized with Mycoplasma [RR 10.9; CI, 1.53–78.7] or Ureaplasma [RR 1.59; CI, 1.09–2.33] compared to infertile controls (19.9% versus 9.90% positive, respectively). Over 95% of patients had negative TOC cultures after treatment. Patients testing positive for Mycoplasma and successfully treated had a subsequent 78% live birth rate (32/41) and those treated successfully for Ureaplasma had a 76% live birth rate (124/163) versus a 64% live birth rate in culture-negative RPL patients with a negative prior evaluation ( P =.002). CONCLUSIONS/IMPLICATIONS: These findings suggest Mycoplasma and Ureaplasma play a role in early RPL, and testing may be considered during workup for these patients.