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Maksimovic Celicanin M, Haahr T, Humaidan P, Skafte-Holm A. Vaginal dysbiosis - the association with reproductive outcomes in IVF patients: a systematic review and meta-analysis. Curr Opin Obstet Gynecol 2024; 36:155-164. [PMID: 38597377 PMCID: PMC11062609 DOI: 10.1097/gco.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE OF REVIEW To examine impact of vaginal dysbiosis (VD), including bacterial vaginosis (BV) and aerobic vaginitis (AV) on reproductive outcomes of in vitro fertilization (IVF) patients. RECENT FINDINGS BV-bacteria (e.g. Gardnerella ) and AV-bacteria (e.g. Streptococci and Enterococci ) have been identified in the endometrium. However, there is inconclusive evidence whether IVF patients with VD have lower success rates. SUMMARY The present systematic review and meta-analysis of PubMed/Medline, until December 2023 included 25 studies, involving 6835 IVF patients. Overall VD was defined as an approximation of community state type IV, including BV and AV-type dysbiosis based on either molecular or microscopy methods. Outcomes were live birth rate (LBR), early pregnancy loss (EPL), clinical pregnancy rate (CPR), and biochemical pregnancy rate (BPR).Vaginal dysbiosis prevalence was 19% [1271/6835, 95% confidence interval (CI) 18-20%]. Six studies examined AV-type dysbiosis with a prevalence of 4% (26/628, 95% CI 3-6%). Vaginal dysbiosis correlates with a higher EPL [relative risk (RR) = 1.49, 95% CI 1.15-1.94] and lower CPR (RR = 0.82, 95% CI 0.70-0.95). No statistically significant impact of VD, BV, or AV was found on LBR and BPR.Thus, the association between VD and reproductive outcome remains puzzling as it is difficult to explain how VD impacts CPR and EPL but not LBR and BPR.
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Affiliation(s)
| | - Thor Haahr
- The Fertility Clinic, Skive Regional Hospital Skive, Denmark
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Axel Skafte-Holm
- Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark
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Mongane J, Hendwa E, Sengeyi D, Kajibwami E, Kampara F, Chentwali S, Kalegamire C, Barhishindi I, Kujirakwinja Y, Maningo JB, Kasago B, Mulinganya G. Association between bacterial vaginosis, Chlamydia trachomatis infection and tubal factor infertility in Bukavu, Democratic Republic of Congo. BMC Infect Dis 2024; 24:480. [PMID: 38730346 PMCID: PMC11083818 DOI: 10.1186/s12879-024-09379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Tubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV. OBJECTIVES To determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI. METHODS We included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations. RESULTS The prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI. BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively. CONCLUSION BV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.
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Affiliation(s)
- Jules Mongane
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo.
| | - Erick Hendwa
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Dieudonné Sengeyi
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Etienne Kajibwami
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Freddy Kampara
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Serge Chentwali
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Claude Kalegamire
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Isaac Barhishindi
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Yvette Kujirakwinja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Jeanne Beija Maningo
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Benjamin Kasago
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Guy Mulinganya
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
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Hao X, Li P, Wu S, Tan J. Association of the Cervical Microbiota With Pregnancy Outcome in a Subfertile Population Undergoing In Vitro Fertilization: A Case-Control Study. Front Cell Infect Microbiol 2021; 11:654202. [PMID: 34631595 PMCID: PMC8495128 DOI: 10.3389/fcimb.2021.654202] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 09/10/2021] [Indexed: 01/13/2023] Open
Abstract
The microorganisms of the reproductive tract have been implicated to affect in vitro fertilization (IVF) outcomes. However, studies on the reproductive tract microbiota of infertile women are limited and the correlation between cervical microbiota and IVF outcome remains elusive. This study aimed to characterize the cervical microbiota of IVF patients undergoing embryo transfer (ET) and assess associations between the cervical microbiota and pregnancy outcomes while exploring the underlying contributing factors. We launched a nested case-control study of 100 patients with two fresh or frozen-thawed cleavage embryos transferred per IVF cycle. Cervical swabs were collected on the day of ET and divided into four groups according to clinical pregnancy outcomes. Variable regions 3 and 4 (V3-V4) of the 16S rRNA gene were amplified and sequenced on the Illumina MiSeq platform. In fresh IVF-ET cycles, the clinical pregnancy group (FP, n = 25) demonstrated higher α diversity (P = 0.0078) than the non-pregnancy group (FN, n = 26). Analysis of similarity (ANOSIM) revealed a significant difference in β diversity between the two groups (R = 0.242, P = 0.001). In frozen-thawed ET cycles, though not significant, similar higher α diversity was found in the clinical pregnancy group (TP, n = 27) compared to the non-pregnancy group (TN, n = 22) and ANOSIM analysis showed a significant difference between the two groups (R = 0.062, P = 0.045). For patients in fresh IVF-ET groups, Lactobacillus, Akkermansia, Desulfovibrio, Atopobium, and Gardnerella showed differentially abundance between pregnant and non-pregnant women and they accounted for the largest share of all taxa investigated. Among them, Lactobacillus was negatively correlated with the other genera and positively correlated with serum estradiol levels. Logistic regression analysis suggested that the composition of the cervical microbiota on the day of ET was associated with the clinical pregnancy in fresh IVF-ET cycles (P = 0.030). Our results indicate that cervical microbiota composition has an impact on the outcome of assisted reproductive therapy.
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Affiliation(s)
- Xinyao Hao
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Pingping Li
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Shanshan Wu
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Reproductive Dysfunction Disease and Fertility Remodeling of Liaoning Province, Shenyang, China
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The Association between Vaginal Dysbiosis and Reproductive Outcomes in Sub-Fertile Women Undergoing IVF-Treatment: A Systematic PRISMA Review and Meta-Analysis. Pathogens 2021; 10:pathogens10030295. [PMID: 33806442 PMCID: PMC8001118 DOI: 10.3390/pathogens10030295] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
Recent advances in molecular microbiology have enabled refined studies of the genital tract microbiota. This constitutes the basis of the present updated systematic review and meta-analysis which investigate vaginal dysbiosis (VD) as defined by either microscopy (e.g., Nugent score for bacterial vaginosis) or molecular methods (qPCR and Next Generation Sequencing) to evaluate the impact of VD on the reproductive outcomes in women undergoing IVF-treatment. A total of 17 studies were included, comprising 3543 patients and with a VD prevalence of 18% (95%CI 17–19). Across all methods, VD is a significant risk factor for early pregnancy loss in IVF (Relative risk (RR) = 1.71 95%CI 1.29–2.27). Moreover, a predefined sub-analysis of studies using molecular methods for VD diagnosis showed a significant reduction in the clinical pregnancy rate when compared to normal vaginal microbiota patients (RR = 0.55 95%CI 0.32–0.93). However, regardless of diagnostic methodology, VD did not significantly influence live birth rate (LBR). In conclusion, molecular tools have provided a more detailed insight into the vaginal microbiota, which may be the reason for the increased adverse effect estimates in IVF patients with molecularly defined VD. However, the quality of evidence was very low across all outcomes according to GRADE and thus, more studies are warranted to understand the impact of VD in IVF.
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Mauries C, Ranisavljevic N, Gallet R, Fournier A, Gala A, Ferrières-Hoa A, Brouillet S, Hamamah S. [Assessment of genital microbiota: An emerging approach in assisted reproductive techniques]. ACTA ACUST UNITED AC 2020; 49:185-192. [PMID: 32758671 DOI: 10.1016/j.gofs.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 10/23/2022]
Abstract
The genital microbiota actively participates in women's reproductive health. Indeed, a genital dysbiosis (microbial imbalance associated with adverse effects on host health) can lead to vaginal infections (such as mycoses or bacterial vaginosis). Recent data reported that genital dysbiosis (e.g. vaginal or endometrial) was associated with fewer chances of live births in assisted reproductive technologies (ART), via decreased pregnancy rates and an increased risk of miscarriages. The presence or diversity of certain bacterial strains (in particular Gardenellavaginalis, Proteobacteria, Lactobacillusjensenii, Lactobacilluscrispatus or Atopobiumvaginae) within the genital microbiota seem to be associated with the outcomes of ART cycles, suggesting new approaches to improve ART results. In this review, we aim at presenting the state of art on the association between the female genital microbiota and ART success. The diagnostic and therapeutic approaches (i.e. probiotics, antibiotic therapy and transplantation of vaginal microbiota) in the management of patients with altered microbiota will also be discussed. The confirmation of these data in the coming years could significantly improve the management of infertile patients in ART with a more personalized approach partially based on the female genital microbiotic profile.
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Affiliation(s)
- C Mauries
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France
| | - N Ranisavljevic
- Département de médecine de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France
| | - R Gallet
- Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - A Fournier
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - A Gala
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - A Ferrières-Hoa
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France
| | - S Brouillet
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France; Centre clinique et biologique d'assistance médicale à la procréation, centre d'étude et de conservation des œufs et du sperme humains (CECOS), centre hospitalier universitaire de Grenoble, hôpital Couple-enfant, 38700 La Tronche, France.
| | - S Hamamah
- Département de biologie de la reproduction, CHU de Montpellier, université de Montpellier, 34000 Montpellier, France; Inserm 1203, développement embryonnaire précoce humain et pluripotence, université de Montpellier, 34000 Montpellier, France.
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6
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Koedooder R, Singer M, Schoenmakers S, Savelkoul PHM, Morré SA, de Jonge JD, Poort L, Cuypers WJSS, Beckers NGM, Broekmans FJM, Cohlen BJ, den Hartog JE, Fleischer K, Lambalk CB, Smeenk JMJS, Budding AE, Laven JSE. The vaginal microbiome as a predictor for outcome of in vitro fertilization with or without intracytoplasmic sperm injection: a prospective study. Hum Reprod 2020; 34:1042-1054. [PMID: 31119299 DOI: 10.1093/humrep/dez065] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/21/2019] [Accepted: 03/01/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the presence or absence of certain vaginal bacteria associated with failure or success to become pregnant after an in vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (IVF-ICSI) treatment? SUMMARY ANSWER Microbiome profiling with the use of interspace profiling (IS-pro) technique enables stratification of the chance of becoming pregnant prior to the start of an IVF or IVF-ICSI treatment. WHAT IS KNOWN ALREADY Live-birth rates for an IVF or IVF-ICSI treatment vary between 25 and 35% per cycle and it is difficult to predict who will or will not get pregnant after embryo transfer (ET). Recently, it was suggested that the composition of the vaginal microbiota prior to treatment might predict pregnancy outcome. Analysis of the vaginal microbiome prior to treatment might, therefore, offer an opportunity to improve the success rate of IVF or IVF-ICSI. STUDY DESIGN, SIZE, DURATION In a prospective cohort study, 303 women (age, 20-42 years) undergoing IVF or IVF-ICSI treatment in the Netherlands were included between June 2015 and March 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Study subjects provided a vaginal sample before the start of the IVF or IVF-ICSI procedure. The vaginal microbiota composition was determined using the IS-pro technique. IS-pro is a eubacterial technique based on the detection and categorization of the length of the 16S-23S rRNA gene interspace region. Microbiome profiles were assigned to community state types based on the dominant bacterial species. The predictive accuracy of the microbiome profiles for IVF and IVF-ICSI outcome of fresh ET was evaluated by a combined prediction model based on a small number of bacterial species. From this cohort, a model was built to predict outcome of fertility treatment. This model was externally validated in a cohort of 50 women who were undergoing IVF or IVF-ICSI treatment between March 2018 and May 2018 in the Dutch division of the MVZ VivaNeo Kinderwunschzentrum Düsseldorf, Germany. MAIN RESULTS AND THE ROLE OF CHANCE In total, the vaginal microbiota of 192 women who underwent a fresh ET could be analysed. Women with a low percentage of Lactobacillus in their vaginal sample were less likely to have a successful embryo implantation. The prediction model identified a subgroup of women (17.7%, n = 34) who had a low chance to become pregnant following fresh ET. This failure was correctly predicted in 32 out of 34 women based on the vaginal microbiota composition, resulting in a predictive accuracy of 94% (sensitivity, 26%; specificity, 97%). Additionally, the degree of dominance of Lactobacillus crispatus was an important factor in predicting pregnancy. Women who had a favourable profile as well as <60% L. crispatus had a high chance of pregnancy: more than half of these women (50 out of 95) became pregnant. In the external validation cohort, none of the women who had a negative prediction (low chance of pregnancy) became pregnant. LIMITATIONS, REASONS FOR CAUTION Because our study uses a well-defined study population, the results will be limited to the IVF or IVF-ICSI population. Whether these results can be extrapolated to the general population trying to achieve pregnancy without ART cannot be determined from these data. WIDER IMPLICATIONS OF THE FINDINGS Our results indicate that vaginal microbiome profiling using the IS-pro technique enables stratification of the chance of becoming pregnant prior to the start of an IVF or IVF-ICSI treatment. Knowledge of their vaginal microbiota may enable couples to make a more balanced decision regarding timing and continuation of their IVF or IVF-ICSI treatment cycles. STUDY FUNDING/COMPETING INTEREST(S) This study was financed by NGI Pre-Seed 2014-2016, RedMedTech Discovery Fund 2014-2017, STW Valorisation grant 1 2014-2015, STW Take-off early phase trajectory 2015-2016 and Eurostars VALBIOME grant (reference number: 8884). The employer of W.J.S.S.C. has in collaboration with ARTPred acquired a MIND subsidy to cover part of the costs of this collaboration project. The following grants are received but not used to finance this study: grants from Innovatie Prestatie Contract, MIT Haalbaarheid, other from Dutch R&D tax credit WBSO, RedMedTech Discovery Fund, (J.D.d.J.). Grants from Ferring (J.S.E.L., K.F., C.B.L. and J.M.J.S.S.), Merck Serono (K.F. and C.B.L.), Dutch Heart Foundation (J.S.E.L.), Metagenics Inc. (J.S.E.L.), GoodLife (K.F.), Guerbet (C.B.L.). R.K. is employed by ARTPred B.V. during her PhD at Erasmus Medical Centre (MC). S.A.M. has a 100% University appointment. I.S.P.H.M.S., S.A.M. and A.E.B. are co-owners of IS-Diagnostics Ltd. J.D.d.J. is co-owner of ARTPred B.V., from which he reports personal fees. P.H.M.S. reports non-financial support from ARTPred B.V. P.H.M.S., J.D.d.J. and A.E.B. have obtained patents `Microbial population analysis' (9506109) and `Microbial population analysis' (20170159108), both licenced to ARTPred B.V. J.D.d.J. and A.E.B. report patent applications `Method and kit for predicting the outcome of an assisted reproductive technology procedure' (392EPP0) and patent `Method and kit for altering the outcome of an assisted reproductive technology procedure' by ARTPred. W.J.S.S.C. received personal consultancy and educational fees from Goodlife Fertility B.V. J.S.E.L. reports personal consultancy fees from ARTPred B.V., Titus Health B.V., Danone, Euroscreen and Roche during the conduct of the study. J.S.E.L. and N.G.M.B. are co-applicants on an Erasmus MC patent (New method and kit for prediction success of in vitro fertilization) licenced to ARTPred B.V. F.J.M.B. reports personal fees from Advisory Board Ferring, Advisory Board Merck Serono, Advisory Board Gedeon Richter and personal fees from Educational activities for Ferring, outside the submitted work. K.F. reports personal fees from Ferring (commercial sponsor) and personal fees from GoodLife (commercial sponsor). C.B.L. received speakers' fee from Ferring. J.M.J.S.S. reports personal fees and other from Merck Serono and personal fees from Ferring, unrelated to the submitted paper. The other authors declare that they have no competing interests. TRIAL REGISTRATION NUMBER ISRCTN83157250. Registered 17 August 2018. Retrospectively registered.
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Affiliation(s)
- R Koedooder
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre (UMC), Wytemaweg, CN Rotterdam, The Netherlands
| | - M Singer
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, location VUmc, De Boelelaan, HZ Amsterdam, The Netherlands
| | - S Schoenmakers
- Division Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Wytemaweg, CN Rotterdam
| | - P H M Savelkoul
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, location VUmc, De Boelelaan, HZ Amsterdam, The Netherlands.,Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, P. Debyelaan, HX Maastricht, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, location VUmc, De Boelelaan, HZ Amsterdam, The Netherlands.,Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - J D de Jonge
- ARTPred B.V., Kruisweg, NC Hoofddorp, The Netherlands
| | - L Poort
- IS-Diagnostics Ltd, Department of Medical Microbiology and Infection Control, Amsterdam UMC, VUmc, Science park, XG Amsterdam, The Netherlands
| | - W J S S Cuypers
- Dutch Division, MVZ VivaNeo Kinderwunschzentrum Düsseldorf GmbH, Völklinger Straße 4, Düsseldorf, Germany
| | - N G M Beckers
- VivaNeo Medisch Centrum Kinderwens, Simon Smitweg, GA Leiderdorp, The Netherlands
| | - F J M Broekmans
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Heidelberglaan, CX Utrecht, The Netherlands
| | - B J Cohlen
- Isala Voortplantingscentrum, Isala Kliniek, Dokter Spanjaardweg, BT Zwolle, The Netherlands
| | - J E den Hartog
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Maastricht Universitair Medisch Centrum+, P. Debyelaan, HX Maastricht, The Netherlands
| | - K Fleischer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein, HB Nijmegen, The Netherlands
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam UMC, location VUmc, De Boelelaan, HV Amsterdam, The Netherlands
| | - J M J S Smeenk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Sint Elisabeth Ziekenhuis, Hilvarenbeekseweg, GC Tilburg, The Netherlands
| | - A E Budding
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, location VUmc, De Boelelaan, HZ Amsterdam, The Netherlands.,IS-Diagnostics Ltd, Department of Medical Microbiology and Infection Control, Amsterdam UMC, VUmc, Science park, XG Amsterdam, The Netherlands
| | - J S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Centre (UMC), Wytemaweg, CN Rotterdam, The Netherlands
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7
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Singer M, Borg M, Ouburg S, Morré SA. The relation of the vaginal microbiota to early pregnancy development during in vitro fertilization treatment-A meta-analysis. J Gynecol Obstet Hum Reprod 2019; 48:223-229. [PMID: 30685426 DOI: 10.1016/j.jogoh.2019.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/22/2019] [Indexed: 01/06/2023]
Abstract
An abnormal vaginal microbiota composition has been shown to lead to pre-term births, miscarriage, and problems with conceiving. Studies have suggested that dysbiosis reduces successful early pregnancy development during IVF. However, conflicting reports exist. This meta-analysis aims to answer the following question: what is the aggregated effect found by studies investigating the influence of the vaginal microbiota composition on early pregnancy rates after IVF treatment? A systematic review was performed using the Medline and EMBASE databases, using search terms for healthy vaginal microbiota, abnormal vaginal microbiota, fertility and pregnancy. The search resulted in six included articles. Of these, all six were used for further meta-analysis. The main outcome measures were the clinical pregnancy rate, determined through ultrasound proven fetal heartbeat and/or hCG results before 10 weeks gestation, in relation to the vaginal microbiota composition. We found a correlation between abnormal vaginal microbiota and lower rates of early pregnancy development after IVF treatment (OR = 0.70, 95% CI = 0.49 - 0.99). One study showed the reverse correlation. However, heterogeneity between study methodologies in various forms was found. In conclusion, women with an abnormal vaginal microbiota are roughly 1.4 times less likely to have a successful early pregnancy development after IVF treatment when compared to women with normal microbiota.
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Affiliation(s)
- M Singer
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Tubascan, spin-off at the Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands.
| | - M Borg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Institute of Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Tubascan, spin-off at the Department of Medical Microbiology and Infection Control, Amsterdam UMC: Vrije Universiteit, Amsterdam, the Netherlands; Institute of Public Health Genomics, Department of Genetics and Cell Biology, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands
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8
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Bracewell-Milnes T, Saso S, Nikolaou D, Norman-Taylor J, Johnson M, Thum MY. Investigating the effect of an abnormal cervico-vaginal and endometrial microbiome on assisted reproductive technologies: A systematic review. Am J Reprod Immunol 2018; 80:e13037. [DOI: 10.1111/aji.13037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/25/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Timothy Bracewell-Milnes
- Division of Surgery and Cancer; Institute of Developmental Reproductive & Developmental Biology; Imperial College London; London UK
| | - Srdjan Saso
- Division of Surgery and Cancer; Institute of Reproductive & Developmental Biology; Imperial College London; London UK
| | - Dimitrios Nikolaou
- Assisted Conception Unit; Chelsea and Westminster Hospital Campus; London UK
| | | | - Mark Johnson
- Division of Surgery and Cancer; Institute of Developmental Reproductive & Developmental Biology; Imperial College London; London UK
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9
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Haahr T, Zacho J, Bräuner M, Shathmigha K, Skov Jensen J, Humaidan P. Reproductive outcome of patients undergoing in vitro fertilisation treatment and diagnosed with bacterial vaginosis or abnormal vaginal microbiota: a systematicPRISMAreview and meta‐analysis. BJOG 2018; 126:200-207. [DOI: 10.1111/1471-0528.15178] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 12/20/2022]
Affiliation(s)
- T Haahr
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- The Fertility Clinic Skive Skive Regional Hospital Skive Denmark
| | - J Zacho
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- The Fertility Clinic Skive Skive Regional Hospital Skive Denmark
| | - M Bräuner
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- The Fertility Clinic Skive Skive Regional Hospital Skive Denmark
| | - K Shathmigha
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- The Fertility Clinic Skive Skive Regional Hospital Skive Denmark
| | - J Skov Jensen
- Microbiology and Infection Control Statens Serum Institut Copenhagen Denmark
| | - P Humaidan
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- The Fertility Clinic Skive Skive Regional Hospital Skive Denmark
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10
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Moini A, Mohammadi Yeganeh L, Shiva M, Ahmadieh M, Salman Yazdi R, Hasani F, Bagheri Lankarani N, Sanati A. Bacterial vaginosis and the risk of early miscarriage in women undergoing intracytoplasmic sperm injection cycles: a prospective cohort study. HUM FERTIL 2017; 21:263-268. [PMID: 28738736 DOI: 10.1080/14647273.2017.1353709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study aimed to assess the possible association of bacterial vaginosis (BV) and early miscarriage in 408 women undergoing intracytoplasmic sperm injection (ICSI) for reasons of male infertility. A vaginal sample was obtained before oocyte retrieval and evaluated for BV-associated bacteria using the Nugent scoring system. The primary outcome was early miscarriage and the secondary outcomes included implantation, pregnancy, late miscarriage, preterm delivery and live birth rates. Chi-square, ANOVA, relative risk and odds ratio were used for data analysis where appropriate. The prevalence of BV was estimated as 7.3%. From 336 patients who had embryo transfer, 138 patients (41.1%) conceived. A total of 17% (n = 23) of pregnant women miscarried during the first trimester: 15 patients (15%) were normal, 4 (17.4%) were intermediate and 4 (26.7%) patients had BV (p = 0.52). The relative risk of early miscarriage in BV patients compared to the non-BV and intermediate group was 1.77 (0.68-4.64, 95% CI). Implantation, pregnancy, preterm delivery and live birth rates were comparable between groups. We conclude that BV does not appear to have an adverse impact on outcomes in women being treated with ICSI for male factor infertility and is not associated with miscarriage and preterm birth.
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Affiliation(s)
- Ashraf Moini
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Ladan Mohammadi Yeganeh
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Marzieh Shiva
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Malihe Ahmadieh
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Reza Salman Yazdi
- b Department of Andrology , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Fatemeh Hasani
- c Department of Embryology , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Narges Bagheri Lankarani
- d Department of Epidemiology and Reproductive Health , Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
| | - Azam Sanati
- a Department of Endocrinology and Female Infertility , Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine , Tehran , Iran
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11
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Eldivan Ö, Evliyaoğlu Ö, Ersoy E, Aksu G, Dilbaz S, Göktolga Ü. Does screening for vaginal infection have an impact on pregnancy rates in intracytoplasmic sperm injection cycles? Turk J Obstet Gynecol 2016; 13:11-15. [PMID: 28913082 PMCID: PMC5558349 DOI: 10.4274/tjod.56563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/20/2016] [Indexed: 12/01/2022] Open
Abstract
Objective: Assisted reproduction techniques have become widespread worldwide. Considering their costs, physicians endeavor to improve pregnancy rates. Infections are one of the disrupting problems in this arena. We aimed to investigate the effects of screening for vaginal infection on pregnancy rates in intracytoplasmic sperm injection cycles. Materials and Methods: One hundred twenty patients randomized into two groups for this study. Patients were screened for vaginal infections in group 1, and no screening was performed in group 2. The assisted reproduction outcomes were investigated and compared between the two groups. Results: There was no significant difference between ages, or durations and causes of infertility of patients who conceived and of those who did conceive. Forty-five patients in group 1, and 40 patients in group 2 reached the embryo transfer stage. The rates of conception were 23.5% (n=4) in culture-positive patients (n=17), and 42.9% (n=12) in culture-negative patients (n=28) in group 1. There was no significant difference among patients who were not screened, screen-positive, and screen-negative, in terms of pregnancy rates. None of the patients had Neisseria gonorrhoeae or Trichomonas vaginalis. Bacterial vaginosis was detected in 13 patients, and both bacterial vaginosis and Chlamydia trachomatis were detected in 4 patients. Three of 4 patients who conceived screen-positive and 8 of 12 patients who conceived screen-negative delivered healthily at term. Conclusion: No significant difference was found between patients who were sampled for culture and patients who were not sampled in terms of pregnancy rates. Also, no difference was found between the patients who were culture-negative and patients who were treated with antimicrobials after a culture positive result. Further larger studies are warranted to clarify this issue.
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Affiliation(s)
- Özlem Eldivan
- Etlik Zübeyde Hanım Women's Healthcare Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Özlem Evliyaoğlu
- Etlik Zübeyde Hanım Women's Healthcare Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Ebru Ersoy
- Etlik Zübeyde Hanım Women's Healthcare Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Gönül Aksu
- Etlik Zübeyde Hanım Women's Healthcare Education and Research Hospital, Clinic of Microbiology, Ankara, Turkey
| | - Serdar Dilbaz
- Etlik Zübeyde Hanım Women's Healthcare Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Ümit Göktolga
- Etlik Zübeyde Hanım Women's Healthcare Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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12
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Durugbo II, Nyengidiki TK, Bassey G, Wariso KT. Bacterial vaginosis among women with tubal factor infertility in Nigeria. Int J Gynaecol Obstet 2015; 131:133-6. [PMID: 26341172 DOI: 10.1016/j.ijgo.2015.05.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/26/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the prevalence of bacterial vaginosis among women with tubal factor infertility. METHODS A cross-sectional prospective study of women with tubal factor infertility was conducted at a Nigerian teaching hospital between March and September 2014. An equal number of fertile women attending the family planning clinic were recruited as controls. Interviews were conducted to collect data on sociodemographic characteristics, history and characteristics of vaginal discharge, knowledge, and practices. Bacterial vaginosis was diagnosed using the Amsel criteria. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine predisposing factors. RESULTS Overall, 178 women with tubal factor infertility were recruited. Bacterial vaginosis was noted in 50 (28.1%) of these women, compared with 14 (7.9%) of 178 fertile women (P < 0.001). Patients with tubal factor infertility had an increased risk of bacterial vaginosis when they were of low socioeconomic class (OR 11.89; 95% CI 5.20-27.69), practiced vaginal douching (OR 19.15; 95% CI 7.26-47.75), used vaginal drying agents (OR 17.04; 95% CI 6.91-43.24), had an early sexual debut (OR 32.08; 95% CI 12.02-88.89), and had a history of sexually transmitted infections (OR 12.42; 95% CI 5.36-29.35). CONCLUSION The prevalence of bacterial vaginosis was high among patients with tubal factor infertility. Socioeconomic and cultural factors contribute to the risk of the condition.
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Affiliation(s)
- Innocent I Durugbo
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Tamunomie K Nyengidiki
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
| | - Goddy Bassey
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Kennedy T Wariso
- Department of Microbiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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13
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Tansarli GS, Kostaras EK, Athanasiou S, Falagas ME. Prevalence and treatment of aerobic vaginitis among non-pregnant women: evaluation of the evidence for an underestimated clinical entity. Eur J Clin Microbiol Infect Dis 2013; 32:977-84. [PMID: 23443475 DOI: 10.1007/s10096-013-1846-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
We sought to evaluate the evidence on the prevalence of aerobic vaginitis (AV) among symptomatic non-pregnant women, as well as the treatment administered for this clinical entity. The PubMed and Scopus databases were systematically searched. Sixteen studies met the inclusion criteria, 11 of which reported on the prevalence of possible AV, two on the prevalence of diagnosed AV, and three on the treatment and outcomes of women with diagnosed AV. The prevalence of diagnosed AV varied from 5 to 10.5 %. Streptococcus spp., Staphylococcus aureus, and coagulase-negative staphylococci were the most commonly identified Gram-positive pathogens among women with possible AV, with prevalences of up to 58.7, 41.7, and 37.4 %, respectively, while Escherichia coli was the most common Gram-negative pathogen identified, with a prevalence of up to 23 % among symptomatic women. Regarding antibiotic treatment for AV, the antibiotic schemes administered, which mainly consisted of suppositories of aminoglycosides, showed good effectiveness without serious adverse events provided by any of the included studies. The currently available data suggest that the prevalence of AV is not negligible, while the prevalence of possible AV is considerable. Well-designed studies comparing the prevalence of aerobic pathogens between symptomatic and asymptomatic women are warranted.
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Affiliation(s)
- G S Tansarli
- Alfa Institute of Biomedical Sciences AIBS, 9 Neapoleos Street, 151 23 Marousi, Athens, Greece
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14
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Current world literature. Curr Opin Obstet Gynecol 2012; 24:470-8. [PMID: 23154665 DOI: 10.1097/gco.0b013e32835ae910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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