Liversedge N H, Turner A, Horner P J, Keay S D, Jenkins J M, Hull M G
Department of Obstetrics and Gynaecology, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, Public Health Laboratory, Bristol , UK.
Hum Reprod. 1999 Sep;14(9):2411-5. doi: 10.1093/humrep/14.9.2411.
There is growing evidence that the pathogenic effects of bacterial vaginosis may not be confined to the lower genital tract. Possible associations with infertility and effects on fertilization and implantation were studied in patients undergoing in-vitro fertilization (IVF) treatment. High vaginal swabs taken at the time of oocyte collection were assessed by Gram staining. The prevalence of bacterial vaginosis and of intermediate and normal flora in 301 patients was 25.6, 14.0 and 60.4% respectively. Bacterial vaginosis was more prevalent in patients with tubal (31.5%, n = 149) compared with non-tubal (19.7%, n = 152) infertility (odds ratio (OR) 1.87, CI 1.11-3.18, P = 0.02). Bacterial vaginosis did not have an adverse effect on fertilization rate. Further, no significant difference in implantation rates was seen when comparing bacterial vaginosis (15. 8%, OR 1.03, CI 0.66-1.61) and intermediate flora (13.1%, OR 0.82, CI 0.45-1.52) with normal flora (15.5%). Though confidence intervals around the observations were relatively wide, the findings suggest that routine screening for bacterial vaginosis in the hope of improving the success of IVF treatment is not justified. The prevention of complications in pregnancy associated with bacterial vaginosis might be a more relevant indication for screening at the time of IVF treatment, in particular patients with tubal disease, if treatment were shown to be effective for that particular purpose. However, antibiotic treatment before IVF has been shown to be positively disadvantageous for IVF by encouraging other organisms.
越来越多的证据表明，细菌性阴道病的致病作用可能并不局限于下生殖道。研究人员对接受体外受精（IVF）治疗的患者进行了研究，探讨其与不孕症的可能关联以及对受精和着床的影响。在采集卵母细胞时采集的高阴道拭子通过革兰氏染色进行评估。301例患者中细菌性阴道病、中间菌群和正常菌群的患病率分别为25.6%、14.0%和60.4%。与非输卵管性不孕患者（19.7%，n = 152）相比，输卵管性不孕患者（31.5%，n = 149）中细菌性阴道病更为普遍（优势比（OR）1.87，可信区间（CI）1.11 - 3.18，P = 0.02）。细菌性阴道病对受精率没有不良影响。此外，将细菌性阴道病（15.8%，OR 1.03，CI 0.66 - 1.61）和中间菌群（13.1%，OR 0.82，CI 0.45 - 1.52）与正常菌群（15.5%）进行比较时，着床率没有显著差异。尽管观察结果的可信区间相对较宽，但这些发现表明，为提高IVF治疗成功率而进行细菌性阴道病的常规筛查是不合理的。预防与细菌性阴道病相关的妊娠并发症可能是IVF治疗时进行筛查的更相关指征，特别是对于输卵管疾病患者，如果证明治疗对该特定目的有效。然而，IVF前使用抗生素治疗已被证明对IVF有负面影响，因为它会促进其他微生物生长。
