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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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Väinämö S, Saqib S, Kalliala I, Kervinen K, Luiro K, Niinimäki M, Halttunen-Nieminen M, Virtanen S, Nieminen P, Salonen A, Holster T. Longitudinal analysis of vaginal microbiota during IVF fresh embryo transfer and in early pregnancy. Microbiol Spectr 2023; 11:e0165023. [PMID: 37882794 PMCID: PMC10715154 DOI: 10.1128/spectrum.01650-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
IMPORTANCE Infertility is a global public health issue which leads many couples to seek fertility treatments, of which in vitro fertilization (IVF) is considered to be the most effective. Still, only about one-third of the women achieve live birth after the first IVF embryo transfer (IVF-ET). Factors affecting embryo implantation are poorly known, but the female reproductive tract microbiota may play a key role. Our study confirms the beneficial role of vaginal lactobacilli, especially Lactobacillus crispatus, in the probability of achieving clinical pregnancy and live birth following IVF-ET. Our findings regarding the intra-individual shift of vaginal microbiota between non-pregnancy and pregnancy states are novel and provide new information about the dynamics of microbiota in the early steps of human reproduction. These findings may help clinicians in their attempts to optimize the conditions for ET by microbiota screening or modulation and timing the ET when the microbiota is the most favorable.
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Affiliation(s)
- Sofia Väinämö
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Schahzad Saqib
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Kalliala
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Kaisa Kervinen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisu Luiro
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mervi Halttunen-Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Virtanen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tiina Holster
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Kadogami D, Kimura F, Hanada T, Tsuji S, Nakaoka Y, Murakami T, Morimoto Y. Impact of Lactobacillus in the uterine microbiota on in vitro fertilization outcomes. J Reprod Immunol 2023; 160:104138. [PMID: 37717556 DOI: 10.1016/j.jri.2023.104138] [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: 06/08/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
Abundant intrauterine Lactobacillus is associated with good in vitro fertilization (IVF) outcomes; however, whether specific species of Lactobacillus have any benefit remains unclear. So we examine the effect of Lactobacillus on the clinical outcomes of IVF at the species level. Uterine microbiota were classified as either Lactobacillus-dominant (LD) or non-Lactobacillus-dominant. In the LD group, we further investigated the clinical results for each Lactobacillus species and evaluated them in relation to IVF outcomes. In Uterine microbiome analysis, Lactobacillus was the most abundant, with the four species of L. crispatus, L. iners, L. gasseri, and L. jensenii accounting for the great majority. We compared the clinical outcomes of single frozen-thawed embryo transfer conducted by Lactobacillus species and found that the implantation rate was lowest in those in whom L. iners was dominant. This study is the first to conduct a species-level analysis of the uterine microbiota and report on a detailed investigation of Lactobacillus, which was believed to be particularly helpful for pregnancy.
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Affiliation(s)
- Daisuke Kadogami
- IVF Namba Clinic, 1-17-28 Minamihorie, Nishi-ku, Osaka 550-0015, Japan.
| | - Fuminori Kimura
- Department of Obstetrics & Gynecology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tetsuro Hanada
- Department of Obstetrics & Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics & Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yoshiharu Nakaoka
- IVF Namba Clinic, 1-17-28 Minamihorie, Nishi-ku, Osaka 550-0015, Japan
| | - Takashi Murakami
- Department of Obstetrics & Gynecology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yoshiharu Morimoto
- HORAC Grand Front Osaka Clinic, 15th Floor, Grand Front Osaka Tower B, 3-1 Ofuka-cho, Kita-ku, 530-0011 Osaka, Japan
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Di Pierro F, Sinatra F, Cester M, Da Ros L, Pistolato M, Da Parè V, Fabbro L, Maccari D, Dotto S, Sossai S, Fabozzi G, Bertuccioli A, Cazzaniga M, Recchia M, Zerbinati N, Guasti L, Baffoni A. Effect of L. crispatus M247 Administration on Pregnancy Outcomes in Women Undergoing IVF: A Controlled, Retrospective, Observational, and Open-Label Study. Microorganisms 2023; 11:2796. [PMID: 38004807 PMCID: PMC10673025 DOI: 10.3390/microorganisms11112796] [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: 10/02/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
The aim of our study was to retrospectively evaluate whether the oral administration of L. crispatus (M247) could increase pregnancy and live birth rates in women undergoing assisted reproductive technology procedures. Enrolled women (N = 160) were divided into two groups: treated (N = 80) or untreated (N = 80) with the probiotic strain. The odds ratio (OR) for a treated woman to have a clinical pregnancy (CP) was 1.56. In women aged 30-40 years, M247 increased the probability of a CP in correlation with the progressive rise in BMI, reaching 47% (35% in controls) with a BMI of 35 (OR: 2.00). The CAID statistics showed that in a woman of the blastocyst subgroup, below 43 years, with a BMI over 18.6, treatment with M247 increased the chance of a CP from 28.4% to 44.5% (OR: 2.08; p < 0.05). Considering live births, the rate of the probiotic group was 12.5% versus 7.5% (OR: 1.76). Considering only the blastocyst subgroup, the treatment increased the number of live births by 200% (OR: 3.64; p = 0.05). As confirmed also by statistical indices NNT, NNH, and LHH, the use of M247 demonstrated a risk-benefit ratio to the full advantage of the benefits.
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Affiliation(s)
- Francesco Di Pierro
- Scientific & Research Department, Velleja Research, 20125 Milan, Italy
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy (L.G.)
| | | | | | - Lucia Da Ros
- U.O.S.D. PMA Conegliano Hospital, 31100 Treviso, Italy
| | | | - Vania Da Parè
- U.O.S.D. PMA Conegliano Hospital, 31100 Treviso, Italy
| | - Laura Fabbro
- U.O.S.D. PMA Conegliano Hospital, 31100 Treviso, Italy
| | | | - Silvia Dotto
- U.O.S.D. PMA Conegliano Hospital, 31100 Treviso, Italy
| | - Sara Sossai
- U.O.S.D. PMA Conegliano Hospital, 31100 Treviso, Italy
| | - Gemma Fabozzi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, 00197 Rome, Italy
- IVIRMA Global Research Alliance, B-WOMAN, 00197 Rome, Italy
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, 00185 Rome, Italy
| | - Alexander Bertuccioli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy;
| | | | - Martino Recchia
- Medistat, Unit of Clinical Epidemiology and Biostatistics, Mario Negri Institute Alumni Association (MNIAA), 20156 Milan, Italy
| | - Nicola Zerbinati
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy (L.G.)
| | - Luigina Guasti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy (L.G.)
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Ge YM, Lu JC, Xu YH, Tang SS, Zhi SS, Liang YJ. Correlations of joint detection of 22 vaginal microbes with routine examination results of vaginal secretions and assisted reproductive outcomes. Diagn Microbiol Infect Dis 2023; 106:115940. [PMID: 37011545 DOI: 10.1016/j.diagmicrobio.2023.115940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
The correlations of joint detection of 22 vaginal microbes with routine examination results of vaginal secretions and assisted reproductive outcomes were investigated. There were 37 samples with abnormal vaginal microecology in 107 vaginal secretion samples. The top 5 detection rates of microorganisms were Ureaplasma urealyticum (73.83%), Prevotella sp. (70.09%), Gardnerella vaginalis (53.27%), L. crispatus (52.34%) and L. inerts (51.40%). When the levels of Bacillus and hydrogen peroxide in vaginal secretions decreased or pH increased, the abnormal rates of vaginal microecology increased significantly (P < 0.01). The clinical pregnancy rate (53.66%, 22/41) in the women with normal vaginal microecology was higher than that (37.5%, 9/24) with abnormal vaginal microecology. In conclusions, the joint detection of 22 vaginal microbes can quickly and effectively determine whether the vaginal microecology is normal or not. The evaluation of vaginal microecology may be valuable in predicting the assisted reproductive outcomes of infertile women.
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Genital Microbiota and Outcome of Assisted Reproductive Treatment-A Systematic Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111867. [PMID: 36431002 PMCID: PMC9693990 DOI: 10.3390/life12111867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
The balance between different bacterial species is essential for optimal vaginal health. Microbiome includes the host genome along with microorganism genomes and incorporates the biotic and abiotic factors, reflecting the habitat as a whole. A significant difference exists in the composition and number of the human microbiota in healthy individuals. About one-tenth of the total body microbiota exists in the urogenital tract and these can be identified by microscopy and culture-based methods, quantitative PCR, next generation and whole genome sequencing. The trend of delaying the planning of pregnancy to a later age nowadays has resulted in magnifying the use of assisted reproductive treatment (ART). Hence, genital microbiota and its impact on fertility has generated immense interest in recent years. In this systematic review, we searched the available evidence on the microbiota of the genital tract in women undergoing ART and studied the outcomes of IVF in different microbial compositions. Despite the inconsistency of the studies, it is evident that vaginal, cervical and endometrial microbiota might play a role in predicting ART outcomes. However, there is no clear evidence yet on whether the diversity, richness, quantity, or composition of species in the maternal genital tract significantly affects the outcomes in ARTs.
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Genetic Elements Orchestrating Lactobacillus crispatus Glycogen Metabolism in the Vagina. Int J Mol Sci 2022; 23:ijms23105590. [PMID: 35628398 PMCID: PMC9141943 DOI: 10.3390/ijms23105590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
Glycogen in the female lower reproductive tract is a major carbon source for colonization and acidification by common vaginal Lactobacillus species, such as Lactobacillus crispatus. Previously, we identified the amylopullulanase encoding gene pulA of Lactobacillus crispatus to correlate with the ability to autonomously utilize glycogen for growth. Here, we further characterize genetic variation and differential regulation of pulA affecting the presence of its gene product on the outer surface layer. We show that alpha-glucan degrading activity dissipates when Lactobacillus crispatus is grown on glucose, maltose and maltotriose, in agreement with carbon catabolite repression elements flanking the pulA gene. Proteome analysis of the S-layer confirmed that the amylopullulanase protein is highly abundant in an S-layer enriched fraction, but not in a strain with a defective amylopullulanase variant or in an amylopullulanase-sufficient strain grown on glucose. In addition, we provide evidence that Lactobacillus crispatus pulA mutants are relevant in vivo, as they are commonly observed in metagenome datasets of human vaginal microbial communities. Analysis of the largest publicly available dataset of 1507 human vaginal metagenomes indicates that among the 270 samples that contain a Lactobacillus crispatuspulA gene, 62 samples (23%) had a defective variant of this gene. Taken together, these results demonstrate that both environmental, as well as genetic factors explain the variation of Lactobacillus crispatus alpha-glucosidases in the vaginal environment.
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Lokken EM, Jisuvei C, Hughes JP, Mandaliya K, Manhart LE, Mwinyikai K, Muller CH, Jaoko W, Kinuthia J, Scott McClelland R. Cultivable vaginal Lactobacillus is not associated with fecundability in Kenyan women attempting to conceive. Fertil Steril 2022; 117:603-611. [PMID: 35058047 PMCID: PMC8885891 DOI: 10.1016/j.fertnstert.2021.11.032] [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: 07/29/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association between cultivable vaginal Lactobacillus and fecundability in Kenyan women attempting nonmedically assisted conception. DESIGN Prospective preconception cohort. SETTING Nairobi and Mombasa, Kenya. PATIENT(S) Women trying to conceive who reported ≤3 months of pre-enrollment conception attempt time. INTERVENTION(S) Cultivable Lactobacillus (primary), Lactobacillus morphotypes on Gram stain (secondary). MAIN OUTCOME MEASURE(S) Participants reported the first day of their last menstrual period and recent sexual behavior, underwent pregnancy testing, and provided vaginal specimen samples for Lactobacillus culture and Gram stain at ≤6 monthly preconception visits. The outcome was fecundability-the per-menstrual cycle probability of pregnancy. Associations between cultivable Lactobacillus and Lactobacillus morphotypes on Gram stain at the visit before each pregnancy test and fecundability were estimated using proportional probabilities models to generate fecundability ratios (FRs). RESULT(S) A total of 458 women contributed 1,376 menstrual cycles. At enrollment, 65.3% (n = 299) of participants had cultivable Lactobacillus, 47.4% (n = 217) had cultivable hydrogen peroxide producing Lactobacillus, and 64.6% (n = 296) had Lactobacillus detected on Gram stain. In unadjusted analysis, there was no association between cultivable Lactobacillus at the prior visit and fecundability (FR, 0.92; 95% CI, 0.73-1.16); results were similar after adjustment for age, frequency of condomless sex, and study site (adjusted FR, 0.92; 95% CI, 0.72-1.18). Lactobacillus on Gram stain at the visit prior was associated with modestly higher fecundability (adjusted FR, 1.18; 95% CI, 0.92-1.51). CONCLUSION(S) Cultivable Lactobacillus was not associated with fecundability, although Lactobacillus morphotypes detected on Gram stain were somewhat associated with increased fecundability. The relationship between vaginal Lactobacillus and fecundity may be species-specific.
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Affiliation(s)
- Erica M Lokken
- Department of Global Health, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| | - Clayton Jisuvei
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - Lisa E Manhart
- Department of Global Health, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington, Seattle, WA
| | - Khamis Mwinyikai
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | | | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya,Obstetrics & Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
| | - R Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington, Seattle, WA,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya,Department of Medicine, University of Washington, Seattle, WA
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Roshong A, Pier B. A Comparison of Prostaglandin Profile in Human Follicular Fluid Between White and Black/Hispanic Women. Reprod Sci 2022; 29:2039-2042. [PMID: 35233737 DOI: 10.1007/s43032-022-00893-3] [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: 01/05/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
The aim of the study is to compare prostaglandin (PG) profiles in human follicular fluid between White and Black/Hispanic women using data from a previously published study. A retrospective cohort study of 5 White and 5 Black/Hispanic women who underwent oocyte retrieval was conducted. Human follicular fluid was obtained from the first follicle entered at time of oocyte retrieval for patients undergoing in vitro fertilization cycles (IVF). PG levels were compared using mass spectroscopy with known standards to quantify PG levels. Five White women were matched with 5 Black/Hispanic women with diagnosis. Both cohorts had similar levels of age, body mass index, and IVF cycle characteristics. There were no statistical differences in PG profiles (PGE2, PGF1α, PGF2α, or 8 iso-PGF1α). In this small repeat analysis of previously studied data, there were no differences noted in PG profiles in follicular fluid. Larger studies are needed to verify this finding. This study further demonstrates the lack of representation of minority patients in studies.
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Affiliation(s)
- Anne Roshong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Bruce Pier
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA.
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Okwelogu SI, Ikechebelu JI, Agbakoba NR, Anukam KC. Microbiome Compositions From Infertile Couples Seeking In Vitro Fertilization, Using 16S rRNA Gene Sequencing Methods: Any Correlation to Clinical Outcomes? Front Cell Infect Microbiol 2021; 11:709372. [PMID: 34660337 PMCID: PMC8517523 DOI: 10.3389/fcimb.2021.709372] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Bacterial infections are usually suspected in infertile couples seeking IVF with no clear understanding of the microbial compositions present in the seminal fluids and vaginal niche of the patients. We used next-generation sequencing technology to correlate microbiota compositions with IVF clinical outcomes. Methods Thirty-six couples were recruited to provide seminal fluids and vaginal swabs. Bacterial DNA was extracted, and V4 region of the 16S rRNA was amplified and sequenced in a pair-end configuration on the Illumina MiSeq platform rendering 2 × 150 bp sequences. Microbial taxonomy to species level was generated using the Greengenes database. Linear discriminant analysis (LDA) effect size (LEfSe) was used to identify biologically and statistically significant differences in relative abundance. Results Seminal fluid microbiota compositions had lower bacterial concentrations compared with the vagina, but species diversity was significantly higher in seminal fluid samples. Azoospermic subjects had more relative abundance of Mycoplasma and Ureaplasma. In Normospermic semen, Lactobacillus (43.86%) was the most abundant, followed by Gardnerella (25.45%), while the corresponding vaginal samples, Lactobacillus (61.74%) was the most abundant, followed by Prevotella (6.07%) and Gardnerella (5.86%). Conclusions Semen samples with positive IVF were significantly colonized by Lactobacillus jensenii (P=0.002), Faecalibacterium (P=0.042) and significantly less colonized by Proteobacteria, Prevotella, Bacteroides, and lower Firmicutes/Bacteroidetes ratio compared with semen samples with negative IVF. Vaginal samples with positive IVF clinical outcome were significantly colonized by Lactobacillus gasseri, less colonized by Bacteroides and Lactobacillus iners. This study has opened a window of possibility for Lactobacillus replenishments in men and women before IVF treatment.
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Affiliation(s)
- Somadina I Okwelogu
- Department of Medical Laboratory Science, Faculty of Health Sciences & Technology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Joseph I Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Nneka R Agbakoba
- Department of Medical Laboratory Science, Faculty of Health Sciences & Technology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Kingsley C Anukam
- Department of Medical Laboratory Science, Faculty of Health Sciences & Technology, Nnamdi Azikiwe University, Nnewi, Nigeria.,Department of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Research and Development, Uzobiogene Genomics, London, ON, Canada
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12
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Wang R, Zhou G, Wu L, Huang X, Li Y, Luo B, Zhu H, Huang W. The Microbial Composition of Lower Genital Tract May Affect the Outcome of in vitro Fertilization-Embryo Transfer. Front Microbiol 2021; 12:729744. [PMID: 34659157 PMCID: PMC8518997 DOI: 10.3389/fmicb.2021.729744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: This work was conducted in order to study the effect of the lower genital tract (vaginal and cervical canal) microbiota on pregnancy outcomes of reproductive-aged women receiving embryo transfer. Study design: A total of 150 reproductive-aged patients who received the first fresh in vitro fertilization-embryo transfer (IVF-ET) were included in the study. Samples from the vagina and cervical site of each patient were collected separately using sterile swabs before ET. Genomic DNA was pyrosequenced for the V3–V4 regions of the 16S ribosomal RNA gene. Further bioinformatics analysis was performed using QIIME and R package. Pregnancy outcomes were followed and analyzed to compare differences in microbial composition. Results: The cervical microbiota had a higher Shannon index than the vaginal microbiota, and the microbial composition was different between the two sites. However, the Sorenson index between the two sites within the same individual was 0.370 (0.309–0.400). A total of 89 patients achieved clinical pregnancy after ET, while 61 failed. The Shannon indices and the microbial community of both vaginal and cervical microbiota between pregnant and non-pregnant groups were not significantly different. The relative abundance of Lactobacillus in the vagina and cervical canal did not differ between the two groups. Linear discriminant analysis, random forest analysis, and receiver-operating characteristic curve analysis showed that Bifidobacterium, Prevotella, and Lactobacillus iners in the vagina, as well as Solanum torvum, Fusobacterium, and Streptococcus in the cervix, may be negatively associated with clinical pregnancy after IVF. Conclusion: The cervical microbiota was more diverse than the vaginal microbiota, but because of anatomical continuity, there was a correlation between the two sites. The microbial composition of the vagina and cervical canal may influence the outcome of IVF-ET, but more samples are needed to verify this conclusion.
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Affiliation(s)
- Ruiying Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Guojun Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Lukanxuan Wu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Xin Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Yujing Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Bin Luo
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Huili Zhu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
| | - Wei Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
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13
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Koedooder R, Maghdid DM, Beckers NGM, Schoenmakers S, Kok DJ, Laven JSE. Dynamics of the urinary microbiome in pregnancy and the coincidental predictive value of the microbiota for IVF/IVF-ICSI outcome. Reprod Biomed Online 2021; 43:871-879. [PMID: 34656437 DOI: 10.1016/j.rbmo.2021.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022]
Abstract
RESEARCH QUESTION What is the impact of clinical pregnancy on the composition of the urinary microbiota? DESIGN Eighty-five women receiving IVF, without or with intracytoplasmic sperm injection (ICSI) treatment were enrolled in a prospective observational study performed in 2008. Approximately 14 weeks before the start of hormonal treatment and embryo transfer, a midstream urine sample was obtained, followed by an additional sample 16 weeks after embryo transfer. The microbial composition was determined by polymerase chain reaction of the V1-V3 regions of the 16S rRNA bacterial gene. Clinical pregnancy data were collected after the first IVF/IVF-ICSI cycle and 1 year later. RESULTS A significant decrease in the abundance of Lactobacillus species as well as a significant increase in that of Staphylococcus species was observed in women who became pregnant after IVF/IVF-ICSI treatment (both P < 0.0001). In addition, based on the composition of the pretreatment microbiome it was possible to identify women with a lower likelihood of achieving clinical pregnancy after IVF/IVF-ICSI treatment. The resulting prediction model was validated in another 27 women who did not become pregnant during the first cycle and received additional IVF/IVF-ICSI cycle(s) or frozen embryo transfer(s). The model predicted the women with no clinical pregnancy after IVF/IVF-ICSI treatment with a sensitivity of 0.42 and a specificity of 1.00. CONCLUSIONS The data primarily showed that clinical pregnancy results in significant changes in the abundance and diversity of the urinary microbiota. Coincidentally, it was discovered that the urinary microbiome composition before IVF/IVF-ICSI treatment can potentially be used as a predictor of clinical pregnancy.
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Affiliation(s)
- Rivka Koedooder
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Delshad M Maghdid
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicole G M Beckers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands; Present address: MC Kinderwens Leiderdorp, Viva Neo Medical Center, Leiderdorp, The Netherlands
| | - Sam Schoenmakers
- Division Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dik J Kok
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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14
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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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15
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Non-Lactobacillus dominance of the vagina is associated with reduced live birth rate following IVF/ICSI: a propensity score-matched cohort study. Arch Gynecol Obstet 2021; 305:519-528. [PMID: 34370072 DOI: 10.1007/s00404-021-06171-y] [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: 10/19/2020] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Whether the dominant status of vaginal Lactobacillus is associated with IVF/ICSI outcomes. METHODS This is a propensity score-matched retrospective cohort study consists of 2285 women undergoing their first fresh autologous IVF cycles. We divided the patients into the Lactobacillus-dominant group and non-Lactobacillus-dominant group based on the abundance of Lactobacillus in Gram-stained vaginal smear examined by microscopy. We compared IVF outcomes between the two groups. We matched Lactobacillus-dominant women with non-Lactobacillus-dominant women by propensity score (PS) to reduce the impact of confounding factors. We evaluated the effect of vaginal Lactobacillus on live birth using univariate and multivariate analysis models. We also conducted interaction and stratified analyses. RESULTS Compare to the Lactobacillus-dominant group, the biochemical pregnancy rate (50.12% vs. 57.61%, P = 0.03), clinical pregnancy rate (40.98% vs. 50.82%, P < 0.01), and live birth rate (31.83% vs. 41.22%, P < 0.01) were significantly lower in the non-Lactobacillus-dominant group, the preclinical pregnancy loss rate (18.22% vs. 11.79%, P = 0.05) and preterm birth rate (33.09% vs. 21.59%, P = 0.02) were significantly higher in the non-Lactobacillus-dominant group. However, the miscarriage rate (18.86% vs. 15.67%, P = 0.40) and ectopic pregnancy rate (1.41% vs.1.64%, P = 0.78) were similar between the two groups. Loss dominance of Lactobacillus in the vagina was an independent risk factor for live birth (OR 0.66, 95% CI 0.50-0.88). CONCLUSIONS Loss dominance of Lactobacillus in the vagina negatively affects IVF outcomes by decreasing the chances of pregnancy and live birth, increasing risks of preclinical pregnancy loss and preterm birth.
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16
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Aly J, Plowden TC, Christy AY. Factors contributing to persistent disparate outcomes of in vitro fertilization treatment. Curr Opin Obstet Gynecol 2021; 33:335-342. [PMID: 34101661 DOI: 10.1097/gco.0000000000000726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Disparate healthcare outcomes are ubiquitous and occur across all fields of medicine, specifically for racial and ethnic minorities. Within reproductive health, minority women face disparate access to care, particularly infertility services, poor outcomes of fertility treatment, alarmingly higher rates of maternal morbidity and mortality as well as higher rates of preterm birth, lower live birth rates when they conceive spontaneously or when they conceive with assisted reproductive technology. The objective of this review is to highlight factors contributing to the persistent racial/ethnic disparities in in vitro fertilization (IVF) outcomes. RECENT FINDINGS Recent studies document poorer outcomes after IVF treatment. Black women have been shown to have lower live birth rates following IVF treatment for more than 15 years. SUMMARY In an effort to better understand these negative outcomes, scientists and clinicians have investigated possible biological contributing factors including the vaginal microbiome, differences in oocyte quality, embryo viability, endometrial factors, and hormonal differences. Multiple social/cultural factors also play a role including access to care, particularly for people with low income, patient (mis)education, and medical racism/bias.
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Affiliation(s)
- Jasmine Aly
- Program in Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Torie C Plowden
- Department of Gynecologic Surgery and Obstetrics, Womack Army Medical Center, Fort Bragg, North Carolina
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17
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Karaer A, Doğan B, Günal S, Tuncay G, Arda Düz S, Ünver T, Tecellioğlu N. The vaginal microbiota composition of women undergoing assisted reproduction: a prospective cohort study. BJOG 2021; 128:2101-2109. [PMID: 34053157 DOI: 10.1111/1471-0528.16782] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of vaginal microbiota on pregnancy outcomes in women undergoing assisted reproduction. DESIGN A prospective cohort study. SETTING A university-based assisted reproductive technology (ART) centre. POPULATION 223 women undergoing ART treatment. METHODS Prior to embryo transfer, vaginal samples were collected from the posterior fornix. Vaginal microbiota identification was carried out using next-generation sequencing and categorised according to the V3-V4 hypervariable region in the 16S rRNA gene region. MAIN OUTCOME MEASURES ART clinical outcomes (implantation, clinical pregnancy rates and live birth rates). RESULTS The live birth rate in women with community state type (CST)-I (39%) was higher than that in women with CST-III (21.5%) but the difference was not statistically significant (P = 0.052). The relative abundance of Lactobacillus was lower in women who failed to become pregnant (NP group) (67.71%) than in women who became pregnant (PR group) (79.72%). However, this difference was not statistically significant (P = 0.06). In the NP group, the relative abundance of Streptococcus (7.81%) and Gardnerella (9.40%) was higher than that in the PR group (relative abundance of Streptococcus and Gardnerella was 2.28% and 5.56%, respectively). The abundance of Streptococcus was found to be statistically significantly different between the two study groups (P = 0.014). Linear discriminant analysis (LDA) further validated that Streptococcus had the highest contribution (LDA score >4.0) to the difference between these two groups. CONCLUSIONS Streptococcus has the highest contribution to the distinction between the PR and NP groups. TWEETABLE ABSTRACT A relatively high abundance of Streptococcus in the vaginal microbiota may be associated with a lower ART success rate.
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Affiliation(s)
- A Karaer
- Reproductive Science & Advanced Bioinformatics Application & Research Centre, Inonu University, Malatya, Turkey.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, School of Medicine, Inonu University, Malatya, Turkey
| | - B Doğan
- Reproductive Science & Advanced Bioinformatics Application & Research Centre, Inonu University, Malatya, Turkey.,Department of Biomedical Engineering, School of Engineering, Inonu University, Malatya, Turkey
| | - S Günal
- Reproductive Science & Advanced Bioinformatics Application & Research Centre, Inonu University, Malatya, Turkey.,Department of Pharmaceutical Microbiology, School of Pharmacy, Inonu University, Malatya, Turkey
| | - G Tuncay
- Reproductive Science & Advanced Bioinformatics Application & Research Centre, Inonu University, Malatya, Turkey.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, School of Medicine, Inonu University, Malatya, Turkey
| | - S Arda Düz
- Reproductive Science & Advanced Bioinformatics Application & Research Centre, Inonu University, Malatya, Turkey.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, School of Medicine, Inonu University, Malatya, Turkey
| | - T Ünver
- Department of Pharmaceutical Microbiology, School of Pharmacy, Inonu University, Malatya, Turkey
| | - N Tecellioğlu
- Reproductive Science & Advanced Bioinformatics Application & Research Centre, Inonu University, Malatya, Turkey.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, School of Medicine, Inonu University, Malatya, Turkey
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18
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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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Haahr T, Freiesleben NLC, Pinborg A, Nielsen HS, Hartvig V, Mikkelsen AL, Parks T, Uldbjerg N, Jensen JS, Humaidan P. Effect of clindamycin and a live biotherapeutic on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: protocol for a double-blind, placebo-controlled multicentre trial. BMJ Open 2020; 10:e035866. [PMID: 33051228 PMCID: PMC7554508 DOI: 10.1136/bmjopen-2019-035866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Recent studies in in vitro fertilisation (IVF) patients have associated abnormal vaginal microbiota (AVM) with poor clinical pregnancy rates of 6%-9% per embryo transfer. The biological plausibility for this finding is hypothesised to be ascending infection to the endometrium which in turn hampers embryo implantation. New molecular based diagnosis may offer advantages compared to microscopical diagnosis of AVM which has huge inter-study variability ranging from 4 to 38%; however, the important question is whether screening and treatment of AVM would improve reproductive outcomes in IVF patients. Herein, we describe a protocol for an ongoing double-blind, placebo-controlled multicentre trial of IVF patients diagnosed with AVM and randomised in three parallel groups 1:1:1. METHODS AND ANALYSIS This is a drug intervention study where IVF patients will be screened for AVM, using a qPCR assay targeting Atopobium vaginae and Gardnerella vaginalis. If positive, patients will be randomised to one of the three study arms. The first arm consists of clindamycin 300 mg ×2 daily for 7 days followed by vaginal Lactobacillus crispatus CTV-05 until clinical pregnancy scan week 7-9. The second arm consists of clindamycin and placebo L. crispatus CTV-05, whereas patients in the third arm will be treated with placebo/placebo. We used a superiority design to estimate that active treatment in both arms will increase the primary outcome, clinical pregnancy rate per embryo transfer, from 20% to 40%. A potential difference between the two active arms was considered exploratory. With a power of 80% and an alpha at 5%, the sample size is estimated to be 333 patients randomised. A pre-planned interim analysis is scheduled at 167 patients randomised. ETHICS AND DISSEMINATION All patients have to give informed consent. Dissemination of results is ensured in clinical trial agreements whether they be positive or not. Ethics committee, Central Denmark Region approved this protocol. TRIAL REGISTRATION NUMBER ICH-GCP monitored trial, EudraCT 2016-002385-31; Pre-results.
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Affiliation(s)
- Thor Haahr
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | | | - Anja Pinborg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Anne-Lis Mikkelsen
- The Fertility Clinic, Sjællands Universitetshospital Køge, Koge, Sjaelland, Denmark
| | | | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Jørgen Skov Jensen
- Department of Reproductive Microbiology, Statens Serum Institute, Copenhagen, Denmark
| | - Peter Humaidan
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
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20
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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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García-Velasco JA, Budding D, Campe H, Malfertheiner SF, Hamamah S, Santjohanser C, Schuppe-Koistinen I, Nielsen HS, Vieira-Silva S, Laven J. The reproductive microbiome - clinical practice recommendations for fertility specialists. Reprod Biomed Online 2020; 41:443-453. [PMID: 32753361 DOI: 10.1016/j.rbmo.2020.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
The interest in and understanding of the human microbiome has grown remarkably over recent years. Advances in molecular techniques have allowed researchers to identify and study the microbiota and also use this information to develop therapeutic solutions for a spectrum of conditions. Alongside the growing interest in the microbiome, societal changes have resulted in many couples looking to start families later in life, therefore increasing the demand for assisted reproductive technologies. Combining these trends, it makes sense that clinicians are eager to understand and exploit the microbiome of their patients, i.e. the reproductive microbiome, in order to help them achieve their goal of becoming parents. This paper aims to provide an overview of the current and future research into the reproductive microbiome in relation to fertility and also share clinical practice recommendations for physicians who are new to this field or unsure about how they can utilise what is known to help their patients.
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Affiliation(s)
- Juan A García-Velasco
- Department of Reproductive Endocrinology and Infertility, IVI Madrid, Rey Juan Carlos University, Madrid 28023, Spain.
| | | | | | | | - Samir Hamamah
- Centre Hospitalier Universitaire de Montpellier, Service Biologie de la Reproduction, 34295 Montpellier, Inserm U1203, France
| | | | - Ina Schuppe-Koistinen
- Karolinska Institutet, Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Stockholm 171 77, Sweden
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre 2650, Denmark
| | - Sara Vieira-Silva
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven 3000, Belgium; Center for Microbiology, VIB, Leuven, Belgium
| | - Joop Laven
- Erasmus MC, University Medical Center Rotterdam, Division of Reproductive Medicine, Rotterdam 3015 GD, the Netherlands
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Stout MJ, Wylie TN, Gula H, Miller A, Wylie KM. The microbiome of the human female reproductive tract. CURRENT OPINION IN PHYSIOLOGY 2020. [DOI: 10.1016/j.cophys.2019.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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23
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Neues und praktisch Relevantes der gynäkologischen Endokrinologie, Reproduktionsmedizin und Pränatalmedizin – Teil 2. GYNAKOLOGISCHE ENDOKRINOLOGIE 2019. [DOI: 10.1007/s10304-019-0253-z] [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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