Vaginal dysbiosis – the association with reproductive outcomes in IVF patients: a systematic review and meta-analysis

Purpose of review The vaginal microbiome has a fundamental role in supporting optimal vaginal, reproductive, and sexual health. Conversely, dysbiosis of the vaginal microbiome is linked to vaginal symptoms and adverse health outcomes. This review summarizes recent literature concerning the role of the vaginal microbiome in health and disease, with a focus on the most common vaginal dysbiosis, bacterial vaginosis. Recent findings Molecular studies have expanded our understanding of the composition of the vaginal microbiome. Lactic acid-producing lactobacilli are an important component of host defences against pathogens, whereas a paucity of lactobacilli is associated with adverse sequelae. Bacterial vaginosis is characterized by low levels of lactobacilli and increased levels of nonoptimal anaerobes; however, the exact cause remains unclear. Furthermore, despite decades of research, bacterial vaginosis recurrence rates following standard treatment are unacceptably high. Strategies to improve bacterial vaginosis cure and promote an optimal lactobacilli-dominated vaginal microbiome are being investigated. Importantly, historical and emerging evidence supports the sexual transmission of bacterial vaginosis, which opens exciting opportunities for novel treatments that incorporate partners. Summary A mechanistic and deeper understanding of the vaginal microbiome in health and disease is needed to inform ongoing development of therapeutics to improve bacterial vaginosis cure. Partner treatment holds promise for improving bacterial vaginosis cure.

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Does intervention with clindamycin and a live biotherapeutic drug containing Lactobacillus crispatus impact the reproductive outcome of IVF patients with abnormal vaginal microbiota: a randomised double-blind, placebo-controlled multicentre trial

Haahr,

Freiesleben,

Jensen

et al. 2024

Preprint

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The aim of the present randomised, double-blind, placebo-controlled trial was to investigate whether antibiotics and live lactobacilli would improve clinical pregnancy rates in IVF patients with abnormal vaginal microbiota (AVM) defined by high quantitative PCR loads of Fannyhessea vaginae and Gardnerella spp. IVF patients were randomised prior to embryo transfer into three parallel groups 1:1:1. Group one (CLLA) received clindamycin 300 mg ×2 daily for 7 days followed by vaginal Lactobacillus crispatus until the day of pregnancy scan, using the investigational drug LACTIN-V. Group two (CLPL) received clindamycin and placebo LACTIN-V, and finally, group three (PLPL) received an identical placebo of both drugs. A total of 1533 patients were screened, and 338 patients were randomised. The clinical pregnancy rate per embryo transfer was 42% (95%CI 32-52%), 46% (95%CI 36-56%) and 45% (95%CI 35-56%) in the CLLA, CLPL, PLPL groups respectively. Thus, treatment of AVM does not improve reproductive outcome. The EudraCT (European Union Drug Regulating Authorities Clinical Trials Database) clinical trial identifier is 2016-002385-31; first registration day 2016-07-11.

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Vaginal dysbiosis – the association with reproductive outcomes in IVF patients: a systematic review and meta-analysis

Cited by 5 publications

References 58 publications

Das Mikrobiom in der Reproduktionsmedizin: Bedeutung und therapeutische Ansätze

Das Mikrobiom in der Reproduktionsmedizin: Bedeutung und therapeutische Ansätze

Unravelling the vaginal microbiome, impact on health and disease

Does intervention with clindamycin and a live biotherapeutic drug containing Lactobacillus crispatus impact the reproductive outcome of IVF patients with abnormal vaginal microbiota: a randomised double-blind, placebo-controlled multicentre trial

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