The Center for Reproductive Medicine, Obstetrics and Gynecology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
Joint International Research Lab for Reproduction and Development of Ministry of Education of China, Chongqing Medical University, Chongqing, 400010, China.
Ann Clin Microbiol Antimicrob. 2024 May 30;23(1):49. doi: 10.1186/s12941-024-00710-6.
Chronic endometritis (CE) is associated with poor reproductive outcomes, yet the role of endometrial microbiota in patients with recurrent implantation failure (RIF) and CE remains unclear. This study aims to characterize endometrial microbiota in RIF patients with CE and assess its implications for reproductive outcomes.
In this prospective study, we enrolled RIF patients both with and without CE. Endometrial and cervical samples were collected for 16 S rRNA gene sequencing. Microbiota composition was compared between groups using diversity indices, phylum, and genus-level analysis. Canonical correlation analysis (CCA) and Spearman's correlation coefficients were used to assess relationships between CE, reproductive outcomes, and microbiota. Predictive functional profiling was performed to evaluate metabolic pathways associated with CE.
Endometrial microbiota in CE patients exhibited greater diversity and evenness compared to non-CE patients. Principal coordinates analysis (PCoA) revealed distinct clustering between CE and non-CE groups. Linear discriminant analysis (LDA) identified Proteobacteria, Aminicenantales, and Chloroflexaceae as characteristic of CE, while Lactobacillus, Acinetobacter, Herbaspirillum, Ralstonia, Shewanela, and Micrococcaceae were associated with non-CE. CCA demonstrated associations between CE, adverse reproductive outcomes, and specific bacterial taxa. Microbial metabolic pathways significantly differed between CE and non-CE groups, with enrichment in pathways related to cofactors, vitamins, secondary metabolites, and the immune system in CE patients.
RIF patients with CE exhibit distinct endometrial microbiota compositions associated with adverse reproductive outcomes. The increased microbial diversity and altered metabolic pathways in CE suggest a potential correlation with reproductive outcomes, although further studies are necessary to elucidate the causal relationship between microbiota alterations and fertility. Modulating the endometrial microbiome may represent a novel therapeutic strategy to improve IVF outcomes in patients with CE.
慢性子宫内膜炎（CE）与不良生殖结局相关，但在复发性种植失败（RIF）合并 CE 患者中，子宫内膜微生物组的作用尚不清楚。本研究旨在探讨 RIF 合并 CE 患者的子宫内膜微生物组特征，并评估其对生殖结局的影响。
本前瞻性研究纳入了 RIF 合并 CE 患者和 RIF 不合并 CE 患者。采集子宫内膜和宫颈样本进行 16S rRNA 基因测序。采用多样性指数、门和属水平分析比较两组间的微生物群落组成。采用典范对应分析（CCA）和 Spearman 相关系数评估 CE、生殖结局和微生物组之间的关系。采用预测功能分析评估与 CE 相关的代谢途径。
CE 患者的子宫内膜微生物组多样性和均匀度高于非 CE 患者。主坐标分析（PCoA）显示 CE 组和非 CE 组间存在明显聚类。线性判别分析（LDA）鉴定出 Proteobacteria、Aminicenantales 和 Chloroflexaceae 是 CE 的特征菌属，而 Lactobacillus、Acinetobacter、Herbaspirillum、Ralstonia、Shewanella 和 Micrococcaceae 与非 CE 相关。CCA 显示 CE、不良生殖结局与特定细菌类群之间存在关联。CE 组和非 CE 组的微生物代谢途径存在显著差异，CE 患者中与辅因子、维生素、次生代谢物和免疫系统相关的途径明显富集。
RIF 合并 CE 患者的子宫内膜微生物组组成与不良生殖结局相关。CE 患者中微生物多样性增加和代谢途径改变提示其与生殖结局可能存在相关性，但需要进一步研究阐明微生物组改变与生育能力之间的因果关系。调节子宫内膜微生物组可能是改善 CE 患者 IVF 结局的一种新的治疗策略。
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