Wet Mount Microscopy of the Vaginal Milieu Does Not Predict the Outcome of Fertility Treatments: A Cross-sectional Study

Abstract

The aim of the study was to evaluate whether vaginal dysbiosis (bacterial vaginosis [BV] or moderate/severe aerobic vaginitis [AV]/ desquamative inflammatory vaginitis) in women subjected to intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection influences the rates of pregnancy.Materials and Methods: This is a cross-sectional study involving 392 women who underwent IUI or in vitro fertilization/intracytoplasmic sperm injection at a fertility clinic. All had a slide collected for phase contrast wet mount microscopy (WMM), which was classified according to the International Society for the Study of Vulvovaginal Disease recommendations. Correlation between flora patterns and the rate of pregnancy were evaluated.Results: There were no differences in any of the groups in terms of pregnancy rate (biochemical, clinical, at first trimester ultrasound, or live birth) after stratifying for the presence of BV, moderate or severe (ms) AV, BV and/or moderate or severe AV, cytolysis, or abnormal vaginal flora (lactobacillary grade ≥ IIb). The presence of Candida species, cocci, or bacilli morphotypes other than lactobacilli also showed no differences. Conclusions:The vaginal flora assessment by WMM at the time of IUI or oocyte retrieval was not predictive of the success of fertility treatments. The absence of differences may be due to intrinsic limitations of WMM (i.e., identifying only bacterial morphotypes), a positive impact of the treatments in the vaginal flora or because the sperm and embryo transfer is made directly into the uterine cavity, thus overcoming any cervical or vaginal dysbiosis disadvantage. Future studies should focus on the endometrial milieu, rather than in the vaginal and/or cervical one.

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

“…A total of 75 citations were excluded based on title and abstract. Hence, a total of 16 citations [15,16 && , [19][20][21]29,[30][31][32][33][34][35][36][37][38][39] were assessed for eligibility by examination of the full text. Seven studies were removed due to study design [29,[33][34][35][36]38,39] and four were removed as it was not possible to extract pregnancy outcome data for the meta-analysis [30][31][32]37].…”

“…In the repeated literature search, two articles [17 ▪▪ ,22 ▪▪ ] met the eligibility criteria, as the authors of Van den Tweel et al provided data upon request [17 ▪▪ ]. Thus, a total of eight studies were included [15,16 ▪▪ ,17 ▪▪ ,19–21,22 ▪▪ ,23 ▪ ] and added to the 17 studies [4,25–27,44–56] previously included in a systematic review and meta-analysis published by our group [1]. Thus, the present meta-analysis included 25 studies [4,15,16 ▪▪ ,17 ▪▪ ,19–21,22 ▪▪ ,23 ▪ ,25–27,44–56], comprising 6835 IVF patients.…”

“…Thus, a total of eight studies were included [15,16 ▪▪ ,17 ▪▪ ,19–21,22 ▪▪ ,23 ▪ ] and added to the 17 studies [4,25–27,44–56] previously included in a systematic review and meta-analysis published by our group [1]. Thus, the present meta-analysis included 25 studies [4,15,16 ▪▪ ,17 ▪▪ ,19–21,22 ▪▪ ,23 ▪ ,25–27,44–56], comprising 6835 IVF patients. The full selection of the studies is shown in the flow diagram, Fig.…”

“…Seventeen publications were based on microscopy [15,16 ▪▪ ,21,23 ▪ ,25–27,44–53], and in these studies the BV prevalence was 17% (1007/6026) whereas the overall BV prevalence was 24% (323/1339) for molecular methods. The timing of sampling was different across the included studies.…”

Vaginal Leptothrix: An Innocent Bystander?

“…Group B consisted of women from the following four studies of our group: (1) performed to validate a molecular test for the diagnosis of vaginitis [10], (2) evaluated the impact of vaginal flora on fertility treatments [11], (3) evaluated the vaginal flora by WMM in women living with human immunodeficiency virus (HIV) [12], and (4) an ongoing study, which evaluated the impact of methylation in a cervical cancer screening program and correlated WMM and cervical intraepithelial neoplasia. In all studies included in group B, pregnancy was an exclusion criterion.…”