A MUST-HAVE GUIDE TO INFECTION TESTING FOR FERTILITY
There’s a good chance your clinic isn’t talking about vaginal and uterine infections.
I know, I know. When you're trying to have a baby, the last thing you want to read about is one more thing to deal with. There’s already so much. But stick with me, because this may be at least one of the most important posts you read on your fertility journey precisely because it’s often missed.
Here's the deal.
Over my twenty-plus years working with fertility patients, I've seen so many people struggle unnecessarily because providers never checked two things: 1) anatomical issues like polyps, fibroids, and scar tissue, and 2) infections that were quietly sabotaging the patients’ chances of conceiving and staying pregnant. I’m talking about common, treatable infections that can make it harder to get pregnant, increase miscarriage risk, and tank IVF success rates.
The frustrating part? Many fertility clinics don't routinely test for these. And when they do find something, they don't always treat it properly or treat both partners. Spoiler alert — you often need to treat both!
So consider this your handy-dandy guide to making sure you're not missing anything in the infectious disease department. Because you deserve comprehensive care that gives you the best possible chances.
Let's dive in.
Why infections actually matter for your fertility.
Here's what the research shows: Undiagnosed infections in the reproductive tract can significantly impact your ability to conceive and maintain a healthy pregnancy. Treating these infections before conception can:
Improve conception rates and IVF/IUI success rates
Up implantation and early pregnancy outcomes
Prevent miscarriage and other pregnancy complications
Help overall reproductive health for both partners
The bad news? Many clinics don't test for them comprehensively, or treat them properly when found. But the good news? Most of these infections are totally treatable when properly identified!
So here’s how to pay attention and advocate for yourself like a boss.
Signs and symptoms to watch for.
Here's the tricky thing — many fertility-impacting infections cause no obvious symptoms, especially when they're hanging out in your uterus. This is why testing is so important if you're dealing with fertility challenges or recurrent pregnancy loss.
That said, here are some signs that might up the odds that you need testing:
During Your Period
Unusual tissue in menstrual blood (ie. film-like material, gray flakes, tissue-like specs, strings of slime)
Large clots (bigger than a quarter)
Texture changes (mucus)
Heavy bleeding (soaking through tampons or pads every hour)
Other Times
Discharge changes (color, odor, or consistency)
Fishy or foul odor, especially after intercourse
Pelvic pain or pressure outside typical menstruation cramps
Painful intercourse or bleeding after sex
Burning during urination or urinary frequency
Persistent itching or irritation of the vulva or vagina
Irregular bleeding or spotting between periods
Fever-like symptoms (chills, body aches, fever) around when implantation would occur or at the start of a miscarriage
Red Flags in Your History
Prior reproductive infections including yeast
Recurrent UTIs
Frequent or recent antibiotic use
Procedures where instruments were inserted into the uterus (D&Cs, hysteroscopies, C-sections, IUIs)
History of using douches or fragranced ‘feminine hygiene’ products
Unprotected sex without consistent STI testing for you or your partner(s)
It’s important to note, the absence of symptoms does NOT mean you're in the clear. Many people with chronic endometritis or Ureaplasma/Mycoplasma infections feel totally fine.
What to actually ask your doctor.
Okay, this is where you become your own best advocate. Here's exactly what to say:
For Endometritis (Uterine Lining Inflammation)
Chronic endometritis is sneaky — it's inflammation of your uterine lining that often has zero symptoms but can seriously impact fertility. Research shows it affects somewhere between 10 - 67% of women with recurrent implantation failure or miscarriages, and up to 50% of those with unexplained infertility.
What to say:
"I'd like to be evaluated for chronic endometritis."
"Would an endometrial biopsy be appropriate in my case?"
"Is the ALICE test (Analysis of Infectious Chronic Endometritis) available here?" And if not, “Could I get tested for elevated CD138 (a sign of endometritis)?”
“While we’re doing a uterine biopsy, could we also do the ReceptivaDx test to check for inflammation from endometriosis?”
The ALICE test is a more advanced test that uses PCR technology to detect bacteria that cause chronic endometritis. It's often offered alongside two other tests called ERA and EMMA as part of something called ‘EndomeTRIO.’
Here's the thing — you probably don’t need the ERA or EMMA tests. The ERA has been shown ineffective and unnecessary. The EMMA tests for good bacteria and you can just add vaginal probiotics to be safe and skip the expensive test. But the ALICE test is the one that checks specifically for infectious chronic endometritis. Don't let anyone upsell you on tests you don't need — but DO advocate for testing that makes sense.
For Vaginal and Cervical Infections
What to say — and this is important, ask for all of these:
"I'd like a wet mount and pH test to check for bacterial vaginosis."
"Can we ALSO test for yeast infection even if I don't have itching?" (You can have yeast without symptoms!)
"Please include Ureaplasma and Mycoplasma hominis PCR testing."
"I also need a separate test specifically for Mycoplasma genitalium."
"I'd like complete STI screening per CDC guidelines."
Why the emphasis on Mycoplasma genitalium? This one requires its own separate PCR test. It's not included in standard STI panels, and many doctors won't test for it unless you specifically ask. But it can absolutely impact fertility and it's often asymptomatic.
Infection treatment to expect when TTC.
If testing shows you do have an infection, here's what should happen:
Medication Safety Matters
Tell your doctor you're actively trying to conceive. Some antibiotics, like doxycycline, should be avoided if you might be pregnant. Safer options include:
Azithromycin
Clindamycin
Other pregnancy-safe antibiotics
Your doctor might recommend timing treatment around your cycle for maximum safety.
Partner Treatment is NON-Negotiable
Listen up, because this is where a lot of people miss out.
For Ureaplasma/Mycoplasma infections: BOTH partners MUST be treated simultaneously, even if one person has no symptoms
For bacterial vaginosis: Female partners should definitely be treated, male partner treatment is sometimes recommended for recurrent cases
For yeast infections: Treat partners if symptomatic or if infections keep recurring
Use the same antibiotic regimen in both/all partners to prevent the ping-pong effect of reinfection
Be sure to only have protected sex or abstain during treatment
This one is not optional. I cannot tell you how many times I've seen people treat one partner only to get reinfected immediately.
Good Treatment Protocols
Probiotics
This helps restore the good bacteria that antibiotics wipe out
Start during or right after antibiotic treatment
Continue for 3 - 6 months for optimal vaginal and gut health
See my post about probiotics for more details
Biofilm Disruption
Using boric acid in the US (or other suppositories depending on the country you live in) to break down the protective biofilm that many infections create makes the antibiotic treatment much more effective
Check out the brand VagiBiom for combination boric acid and probiotic suppositories
Recovery Time
Allow 4 - 6 weeks recovery after treatment before resuming conception attempts
This gives your body time to clear the infection and heal
Test of Cure
Retest 3 - 4 weeks after finishing treatment
Both partners should have negative follow-up tests
Some infections may require extended or sequential treatment
Resistance testing may guide treatment for difficult cases
Questions to ask your healthcare provider regarding infections that may impact fertility.
Use these scripts to have productive conversations.
At Initial Consultation
"Given we're trying to conceive, what infections should we test for?"
"Do you include Ureaplasma, Mycoplasma hominis, and Mycoplasma genitalium in your standard testing?"
"Should my partner also be tested?"
"Do my symptoms (or history) suggest possible endometritis?"
When Infection Is Detected
"Which antibiotic is most effective and safest if I might become pregnant?"
"Should we wait to try conceiving during or after treatment?"
"Does my partner need treatment even without symptoms?"
"When should we do a test of cure?"
"Are there any resistance concerns with this particular infection?"
For Recurrent Infections
"Could chronic endometritis be causing my symptoms?"
"Would an endometrial biopsy help identify the problem?"
"Should we consider resistance testing or different antibiotics?"
"What can we do to prevent reinfection?"
“Do you suggest I consult with an infectious disease specialist?”
Before Fertility Procedures
"Given my situation, is it worth ruling out infections before and embryo transfer or IUI?”
"How long should we wait after treatment to proceed?"
"Could we do follow up clearance testing?"
Your key takeaways — the TL;DR version.
Before Starting Fertility Treatments
Get comprehensive testing
Specifically request Mycoplasma genitalium PCR (it's a separate test)
Consider endometrial evaluation if you have recurrent loss or failed IVF
Don't assume no symptoms means no infection
During Treatment
Both partners must be treated simultaneously (especially for Ureaplasma/Mycoplasma)
Use pregnancy-safe antibiotics if actively trying to conceive
Start probiotics early in or after treatment
Allow adequate recovery time before resuming TTC
After Treatment
Get test of cure for BOTH partners
Confirm negative results before resuming trying to conceive
Continue probiotics for 3 - 6 months
Monitor for any returning symptoms
The bottom line.
I know this is a lot, and I know you're probably already exhausted from everything else on your fertility journey. But here's why this matters: these are fixable problems.
Unlike so many things in fertility that feel out of your control, infections are something you can actually test for and treat. And treating them can genuinely improve your chances.
You deserve comprehensive care. You deserve to have all the information. And you deserve providers who take the time to check for these issues BEFORE you spend thousands of dollars and months (or years) trying treatments that might not work because there's an underlying infection no one bothered to rule out or treat first.
So print this out. Email it to yourself. Screenshot the questions. And go have that conversation with your doctor. Lemme know how it goes!
Nicole
Important Medical Disclaimer
This post is for educational purposes only and does not constitute medical advice. Every person's situation is unique, and the information provided here is meant to help you have informed conversations with your healthcare providers — not to replace professional medical evaluation and treatment.
Always consult with qualified healthcare providers for:
Proper diagnosis and testing
Individualized treatment plans
Medication selection based on your specific circumstances
Monitoring and follow-up care
Individual cases may require modified approaches based on medical history, allergies, antibiotic resistance patterns, and other clinical factors. Treatment protocols should be tailored to your specific situation by your healthcare team.
If you experience severe symptoms (high fever, severe abdominal pain, heavy bleeding), seek immediate medical attention.
This guide was compiled by Nicole Lange of Life Healing Life and combines established medical guidelines from the CDC, ACOG, and international research organizations with current clinical practices. Some recommendations reflect evolving research, particularly regarding fertility-specific protocols.
Nicole Lange
LICENSED ACUPUNCTURIST
HOLISTIC FERTILITY EDUCATOR
Often overlooked and make a big difference for your fertility.