Uterine microbiota and implantation failure: is there a link?


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Abstract

Aim. To investigate the impact of uterine microbiota on the success of embryo implantation in assisted reproductive technologies. Materials and methods. The study included 130 infertile women, who were divided into three groups. Group I (n=39) included women with the first IVF attempt. Group II (n=27) comprised patients with recurrent implantation failure following embryo transfer in the ovarian stimulation cycle. Group III (n=64) included patients with recurrent implantation failure following embryo transfer in a cryocycle. All patients underwent microbiological examination of the cervical canal discharge and samples obtained from embryo transfer catheter tips after an embryo transfer into the uterine cavity. Also, 30 samples were taken from the uterine cavity for high-throughput sequencing studies. Results. The study findings suggest that the uterine cavity is not sterile. Forty-four types of microorganisms were identified, including 26 types of opportunistic microorganisms (OpM) and 18 types of commensals (14 types of lactobacilli and four types of bifidobacteria). Obligate anaerobic microorganisms and Gardnerella vaginalis culture positivity rates were statistically significantly higher in group I compared with group III (strict anaerobes15.4 and 1.6%; G. vaginalis 12.8 and 1.6%, respectively) (p<0.05). However, this fact did not negatively affect the pregnancy rate, which was highest in group I (51.3%). Among women with recurrent implantation failure, it was 29.6 and 35.9%, respectively. Conclusion. The presence of low and moderate titers (103-105 CFU/ml) of OpM in the uterine cavity and cervical canal did not affect pregnancy rates in the study cohort. In 87.9% of patients, the microflora of the uterine cavity and cervical canal had different compositions. This observation suggests the possibility of the formation of an independent uterine microbiota. The uterine microbiota is characterized by less species diversity compared to the microbiota of the cervical canal.

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About the authors

Lela K. Keburiya

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: tati-keburiya@yandex.ru
Ph.D. Student at the Department of Assisted Technologies for the Treatment of Infertility

Veronika Yu. Smol’nikova

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_smolnikova@oparina4.ru
Dr. Med. Sci., Leading Researcher at the Department of Assisted Technologies for the Treatment of Infertility

Tatiana V. Priputnevich

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_priputnevich@oparina4.ru
Dr. Med. Sci., Director of the Institute of Microbiology, Antimicrobial therapy and Epidemiology

Vera V. Murav’eva

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_muravieva@oparina4.ru
Ph.D. (bio), Researcher at the Institute of Microbiology, Antimicrobial therapy and Epidemiology

Dmitry Yu. Trofimov

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: d_troflmov@oparina4.ru
Dr. Bio. Sci., Director of the Institute of Reproductive Genetics

Ekaterina S. Shubina

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: j_shubina@oparina4.ru
Ph.D. (bio), Head of the Laboratory of Genomic Analysis

Taisya O. Kochetkova

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_kochetkova@oparina4.ru
Biologist at the Laboratory of Molecular Genetics

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