Eckert Linda O, Moore Donald E, Patton Dorothy L, Agnew Kathy J, Eschenbach David A
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98104, USA.
Infect Dis Obstet Gynecol. 2003;11(1):11-7. doi: 10.1155/S1064744903000024.
The aim of this study was investigate the impact of vaginal flora and vaginal inflammation on conception and early pregnancy loss following in-vitro fertilization (IVF).
We enrolled 91 women who were undergoing IVF. At embryo transfer (ET), all of the women had quantitative vaginal culture, ET catheter-tip culture, and vaginal Gram stain scored for bacterial vaginosis and quantitated for polymorphonuclear leukocytes (PMNs). Conception and early pregnancy loss were compared with culture and Gram stain results. Statistical analyses included the Chi-square test, Fisher's exact test and the Mann-Whitney U-test.
The overall live birth rate (LBR) was 30% (27/91), and the rate of early pregnancy loss was 34% (14/41). In women with bacterial vaginosis, intermediate flora and normal flora, the conception rates were 30% (3/10), 39% (12/31) and 52% (26/50), respectively (p = 0.06 for trend). Early pregnancy loss occurred in 33% (1/3), 42% (5/12) and 31% (8/26) of women, respectively (p = 0.06, comparing intermediate and normal flora). The vaginal log concentration of hydrogen peroxide-producing lactobacilli was 7.3 +/- 1.7 in women with a live birth (n = 27) and 4.9 +/- 2.5 in those with early pregnancy loss (n = 14) (p = 0.1).
IVF patients with bacterial vaginosis and with a decreased vaginal log concentration of hydrogen peroxide-producing lactobacilli may have decreased conception rates and increased rates of early pregnancy loss. A larger prospective treatment trial designed to evaluate the impact on IVF outcomes of optimizing the vaginal flora prior to IVF may be warranted.
本研究旨在调查阴道菌群和阴道炎症对体外受精（IVF）后受孕及早期妊娠丢失的影响。
我们招募了91名接受IVF的女性。在胚胎移植（ET）时，所有女性均进行了阴道定量培养、ET导管尖端培养以及阴道革兰氏染色，以评估细菌性阴道病并对多形核白细胞（PMN）进行定量。将受孕和早期妊娠丢失情况与培养及革兰氏染色结果进行比较。统计分析包括卡方检验、费舍尔精确检验和曼-惠特尼U检验。
总体活产率（LBR）为30%（27/91），早期妊娠丢失率为34%（14/41）。在患有细菌性阴道病、中间型菌群和正常菌群的女性中，受孕率分别为30%（3/10）、39%（12/31）和52%（26/50）（趋势p = 0.06）。早期妊娠丢失分别发生在33%（1/3）、42%（5/12）和31%（8/26）的女性中（比较中间型和正常菌群时p = 0.06）。活产女性（n = 27）阴道中产过氧化氢乳酸杆菌的对数浓度为7.3±1.7，早期妊娠丢失女性（n = 14）为4.9±2.5（p = 0.1）。
患有细菌性阴道病且阴道中产过氧化氢乳酸杆菌对数浓度降低的IVF患者可能受孕率降低且早期妊娠丢失率增加。可能有必要进行一项更大规模旨在评估IVF前优化阴道菌群对IVF结局影响的前瞻性治疗试验。
