陰道細菌感染者IVF懷孕率較低(9%)
陰道細菌感染菌種: Bacterial vaginosis, Gardnerella vaginalis and Atopobium vagina

Hum Reprod. 2016 Feb 23. pii: dew026. [Epub ahead of print]

Abnormal vaginal microbiota may be associated with poor reproductive outcomes: A prospective study in IVF patients.

Haahr T1, Jensen JS2, Thomsen L1, Duus L3, Rygaard K4, Humaidan P5.

Author information

Abstract

STUDY QUESTION:

What is the diagnostic performance of qPCR assays compared with Nugent scoring for abnormal vaginal microbiota and for predicting the success rate of IVF treatment?

SUMMARY ANSWER:

The vaginal microbiota of IVF patients can be characterized with qPCR tests which may be promising tools for diagnosing abnormal vaginal microbiota and for prediction of clinical pregnancy in IVF treatment.

WHAT IS KNOWN ALREADY:

Bacterial vaginosis (BV) is a common genital disorder with a prevalence of approximately 19% in the infertile population. BV is often sub-clinical with a change of the vaginal microbiota from being Lactobacillus spp. dominated to a more heterogeneous environment with anaerobic bacteria, such as Gardnerella vaginalis and Atopobium vaginae. Few studies have been conducted in infertile women, and some have suggested a negative impact on fecundity in the presence of BV.

STUDY DESIGN, SIZE, DURATION:

A cohort of 130 infertile patients, 90% Caucasians, attending two Danish fertility clinics for in vitro fertilization (IVF) treatment from April 2014-December 2014 were prospectively enrolled in the trial.

PARTICIPANTS/MATERIALS, SETTING AND METHODS:

Vaginal swabs from IVF patients were obtained from the posterior fornix. Gram stained slides were assessed according to Nugent's criteria. PCR primers were specific for four common Lactobacillus spp., G. vaginalis and A. vaginae. Threshold levels were established using ROC curve analysis.

MAIN RESULTS AND THE ROLE OF CHANCE:

The prevalence of BV defined by Nugent score was 21% (27/130), whereas the prevalence of an abnormal vaginal microbiota was 28% (36/130) defined by qPCR with high concentrations of Gardnerella vaginalis and/or Atopobium vaginae. The qPCR diagnostic approach had a sensitivity and specificity of respectively 93% and 93% for Nugent-defined BV. Furthermore, qPCR enabled the stratification of Nugent intermediate flora. Eighty-four patients completed IVF treatment. The overall clinical pregnancy rate was 35% (29/84). Interestingly, only 9% (2/22) with qPCR defined abnormal vaginal microbiota obtained a clinical pregnancy (P = 0.004).