eye to microscope11 Infection Screening

We have seen many cases where treatment with antibiotics has resulted in pregnancy very quickly, despite many years of infertility, miscarriages or IVF failures.

Most doctors regard infections of the male or female genital tract as a problem only if they cause overt symptoms (like blockage of the fallopian tubes, fever, pain, discharge etc.).  But there is growing evidence that infection-induced inflammation can cause damage to sperm, as well as a uterine lining that is not hospitable for an embryo, leading to failed implantation or early miscarriage.

Antibiotic treatment can improve the uterine environment for implantation; as well as significantly improve sperm quality in men with poor sperm parameters (even where we have not been able to identify a specific infection), leading to higher pregnancy rates.

Treating troublesome bacterial infections can reduce the risk and heartache of another failure; and in the case of donor treatment, helps to ensure that their efforts do not go to waste.

Locus Medicus test – €100

We began testing for Chlamydia using a novel test on menstrual fluid (the blood, mucus and tissue that is shed during a period) at Locus Medicus lab in Athens.

Gene Diagnosis “II-in-I” test – €200:

We now run a panel of tests run by Gene Diagnosis lab in Athens, which comprises:

  • an ‘ordinary’ test for Chlamydia Trachomatis;
  •  a test of total bacterial load, which measures the level of ‘good bugs’ (lactobacillae) – a reduced population tends to indicate an abnormal vaginal environment caused by another, more hostile, bacteria, such as E-coli, Proteus etc.;
  • Ureaplasmas;
  • 2 species of Mycoplasmas – Mycoplasma Genitalium and Mycoplasma Hominis;
    • 2 other Bacterial Vaginosis species – Gardnerella Vaginalis and Atopobium Vaginae);
    • Herpes group viruses: HSV1, HSV2 and CMV;
    • HHV 6 (virus recently linked to unexplained female infertility).

    We also offer the Gene Diagnosis test for HHV 6 separately – €100, or a ’10-in-1’ test which includes the above Gene Diagnosis tests apart from HHV-6 for €170.

    We still run the LM test and we would generally recommend having the LM test plus the Gene Diagnosis tests as we often find cases where the Gene Diagnosis test result is negative for Chlamydia Trachomatis but the LM test detects a positive result indicating that another species of the Chlamydia family of bacteria is present in the body.

 

The “II in I” tests do not include the ‘hidden chlamydia test”.  That is the Locus Medicus Chlamydia test and is done separately as above

 

Can I have these tests at home?

It is possible to test for these bacteria in your home country using a standard vaginal swab test.  However, we believe a vaginal swab may miss infections lingering higher up the genital tract (e.g. in the uterine lining), because for most of your menstrual cycle the cervix acts as an effective barrier, which blocks the transit of infected material between the uterus and the vagina.  So you can test negative by vaginal swab, and yet still get a positive result from our tests.

We are aware that these tests are innovative and not well-recognised by many doctors outside Greece, but we have found them to be very useful diagnostic tools, and believe they will gain more widespread acceptance with time.

 

Do I have to come to Athens for the tests?

No, you do not have to come to Greece for the tests.  You can collect a menstrual fluid sample at home, and send it to us in Athens for testing.  We will email you the results within a few days of receipt of your sample.

Note that if you are going to be in Athens for a hysteroscopy, a blood sample can be obtained for you here, as you are likely to have some bleeding after the hysteroscopy.  Generally, though, we prefer you to do the tests before your initial consultation with us, as the results will provide information that will help our discussion and decision on whether you may benefit from a hysteroscopy.

 

How to collect a menstrual sample

In order to perform the test we need a few drops of your menstrual fluid in a clean container, the kind used to collect urine for culture, which you can generally buy very cheaply from your local pharmacy.

IMPORTANT: Please use a clean container with a SCREW top-the safest option is Sterilin Polystyrene 7ml containers-, to prevent the sample from being spilled and contaminated during transfer.

  1. Collect a few drops of your menstrual blood in a small, clean container.  You will probably find this easiest during times of heavy flow i.e. on day 2 or 3 of your period, but only a small amount of blood is needed.

There are several ways you can do it:

  1. Use a Mooncup (available from Boots);
  2. Use a boiled teaspoon;
  3. Squeeze a few drops of blood from a tampon;
  4. Or simply hold the container up to your vagina after lying down for a while.
    1. Add a little normal saline solution e.g. contact lens saline, or COLD boiled water (5-10 ml).  Do not fill the container – the extra liquid is only needed to prevent the sample from drying out before it reaches the lab.

You know you have sufficient when you can shake all the contents down to the bottom of the bottle, and the blood mixes with the saline turning it pink/red.

  1. Screw the cap on tightly, and ensure the container is labelled with your name and date-of-birth.
  2. Put the container in a sealed plastic bag, then in a strong cardboard box with some soft,absorbent packaging material, bubble wrap or cotton wool to protect the container from breaking.
  3. Add a cover letter, containing:
  4. contact details (name and email);
  5. your date-of-birth, and
  6. specify which tests you require.

If you would like both tests, there is no need to send two samples; we will split the sample for you when it arrives.

You can store the sample, if needed in the fridge (NOT the freezer) for several weeks if necessary.

You may want to keep a back up sample in the fridge at home until your sample has been successfully tested just in case of loss or breakage.

If you do not have natural periods

If you do not have natural periods, you should be able to generate a bleed by taking 21 days of Cyclacur (Cyclo-progynova in the UK).

You should start to bleed 3-5 days after the last pill in the packet.

You may be able to get a prescription for Cyclo-progynova from your GP.  Alternatively, we can post you the pills, or send you a prescription you can use in the UK or anywhere in the EU.

Infection testing in men

Where the male partner has symptoms, or the semen analysis is suggestive of infection, we may recommend that testing be done on a semen sample.  We’ve had a lot of success in improving sperm parameters and pregnancy rates after giving antibiotics where a positive result was detected.

It is also possible to do the Locus Medicus and Gene Diagnosis tests on semen by post in exactly the same way as the tests on menstrual blood, but we would generally tend to suggest only testing the female partner unless the male partner has symptoms of infection.

On a fresh sample of semen, we can do a culture test in addition, whereby we culture a sample of bacteria from the semen to identify the species of infection present, and, by testing with samples of antibiotics, determine which antibiotics are capable of killing the specific species.  This test costs €40.

If either partner tests positive on any of our tests, it is prudent to assume that the other is also at risk of having the infection.  So we would always suggest that both partners take the antibiotic treatment simultaneously, and use condoms until the antibiotic course is completed.

Where sperm parameters improve very markedly after antibiotic treatment, we recommend that men repeat the course every 2 years, as protection from potential urinary and prostate problems caused by recurrent infection.

Posting details

Send the package containing your menstrual blood or semen sample to:

Georgia Chronis
Serum
8 Evinou str
11527, Athens
Greece

The regulations for postal services differ between countries.  From the UK, Parcelforce Worldwide will usually send packages to Athens including non-infectious biological samples for about £70, providing you follow their packaging rules (see their website).  Fedex or DHL may require you to open an account with them first in order to send biological samples and to use their specific forms and packaging.  City Sprint Medical Courier are accustomed to dealing with all kinds of biological samples and their prices tend to be reasonable from London/South East (about £70), but from other areas of the UK, their prices can be very expensive.  The ordinary Royal Mail (tracked) service prohibits the sending of biological samples (and they may require a written declaration describing the contents of the package) so we cannot advise you to use it, but because it is very cheap (£2-8), the majority of our patients have chosen to use it.  We receive the majority of samples from patients in UK, Ireland, Sweden and Australia via the ordinary (tracked) post.

Please note that we cannot accept any responsibility your sample until we receive it safely and we cannot arrange courier or shipping for you.  We do not suggest you make payment to us for the tests until we receive your sample.

Unless the weather is very hot, the sample will normally be stable at room temperature for more than 2 weeks (and will keep in the fridge NOT THE FREEZER for several weeks).   It is not necessary to ship the sample with ice packs for these tests.

 

Payment

Once you have sent the sample, please email to our reception staff at:  serum@otenet.gr.  Once your sample arrives we will contact you with our payment request. To arrange payment, our reception staff will aim to contact you as soon as we receive your sample and covering letter but if you don’t hear from us within 5 days of your sample arriving in Athens, please contact our reception staff at:  serum@otenet.gr

We accept payment by bank transfer for these tests.

Your results

Your results will usually be ready about 5-8 working days after we receive your sample.

Once we receive your test results and we have proof of your payment, we will send you a copy of your results by email.

If your results are positive, we will recommend suitable antibiotics to treat any infection detected, and post or email you a prescription for them if you need it.  (If you are not a patient of our clinic, we reserve the right to make a charge of €100 for arranging your prescription).

Please note that we liaise with these laboratories and advise on the antibiotics purely to help your treatment and we do not make a mark-up offering these tests.

Although some women will have no scarring in the uterus as a result of an infection (only inflammation, which will reduce after antibiotic treatment), a positive result tends to indicate a higher risk of significant uterine scarring and adhesions.  So we are more likely to recommend a hysteroscopy if your test result is positive.

We’ve also noticed that women whose progesterone level is unusually low have tended to test positive for Chlamydia, which has led us to suspect that bacteria may be interfering with progesterone metabolism.  Antibiotic treatment can address this, as can monitoring with blood tests, and, where necessary, increasing the dose of progesterone we use during an IVF or natural cycle.

Please note

Some couples will find it upsetting to discover they have an infection, particularly if they have been together for many years.

It can be helpful to remember that once an infection passes above the cervix or down to the testicles, it can be resident for decades.  Other evidence shows that such infections can be transmitted during birth, from mother to child (sometimes called ‘vertical transmission’).

So there is no shame in finding you have an infection.  These infections are common, and widespread.

We usually find that discovering an infection is a positive step, as detecting and treating it is often easy, and can result in your long-awaited pregnancy.

We believed this information was correct at June 2016 but our views and our prices may change.