İnfertilite Nedeni Olarak Enfeksiyonlar
Özet
İnsan infertilitesi, korunmasız düzenli ilişkiye rağmen 12 ay boyunca gebelik oluşmamasıdır ve enfeksiyonlar genital organ işlevlerini bozarak, sperm/oosit kalitesini düşürerek kısırlığa yol açan önemli faktörlerdendir. Erkek infertilite vakalarının yaklaşık %35'i genitoüriner sistem enfeksiyonları ve iltihaplarıyla ilişkilidir; Chlamydia trachomatis, E. coli, Staphylococcus aureus, Pseudomonas aeruginosa gibi bakteriler, HIV, HBV, HPV ve kabakulak gibi virüsler ile çeşitli protozoon ve mantarlar sperm motilitesini, morfolojisini ve sayısını azaltarak, anti-sperm antikoru oluşturarak veya doku hasarı vererek kısırlığa neden olur. Kadınlarda ise vakaların yaklaşık %35'i post-inflamatuvar değişikliklerden etkilenmekte, C. trachomatis ve Neisseria gonorrhoeae başta olmak üzere patojenler üst genital sisteme yayılarak Pelvik İnflamatuar Hastalık (PID), dış gebelik ve tubal faktör infertilitesine (TFI) yol açmaktadır. Ayrıca laktobasillerin azalarak anaeropların artmasıyla oluşan Bakteriyel Vajinozis (BV) ve HHV-6A gibi virüsler de vajinal mikrobiyotayı bozup inflamasyonu tetikleyerek, müsin bariyerini yıkarak ya da embriyonun tutunmasını zorlaştırarak kadın kısırlığıyla ilişkilendirilmektedir. Sonuç olarak enfeksiyonlar, hem erkek hem kadında üreme hücreleri ve sistem yapıları üzerinde doğrudan veya dolaylı hasarlar bırakarak fertiliteyi azaltmaktadır.
Human infertility is defined as the absence of pregnancy within 12 months despite regular unprotected intercourse, and infections are critical factors causing infertility by impairing genital organ functions and reducing sperm/oocyte quality. Approximately 35% of male infertility cases are associated with genitourinary tract infections and inflammation; bacteria such as Chlamydia trachomatis, E. coli, Staphylococcus aureus, and Pseudomonas aeruginosa, viruses like HIV, HBV, HPV, and mumps, as well as various protozoa and fungi, cause infertility by reducing sperm motility, morphology, and count, inducing anti-sperm antibodies, or causing tissue damage. In females, about 35% of cases are affected by post-inflammatory changes, and pathogens, particularly C. trachomatis and Neisseria gonorrhoeae, spread to the upper genital tract, leading to Pelvic Inflammatory Disease (PID), ectopic pregnancy, and tubal factor infertility (TFI). Additionally, Bacterial Vaginosis (BV), characterized by a decrease in lactobacilli and an increase in anaerobes, and viruses like HHV-6A are linked to female infertility by disrupting the vaginal microbiota, triggering inflammation, destroying the mucin barrier, or hindering embryo implantation. Consequently, infections reduce fertility by inflicting direct or indirect damage on reproductive cells and system structures in both men and women.
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