Human Reproduction, Vol. 17, No. 2, 337-340,
February 2002
© 2002 European Society of Human Reproduction and Embryology
Bacterial colonization of the uterine cervix and success rate in assisted reproduction: results of a prospective survey
1 Department of Obstetrics and Gynecology and 2 Laboratory for Microbiology, Ha'Emek Medical Center, Afula and 3 Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
BACKGROUND: Overgrowth of bacteria in the birth canal is associated with an increased risk of late miscarriage, preterm labour, post-partum endometritis and low birthweight. Conception rates in assisted reproduction treatments (ART) remain frustratingly low. We examined whether the nature of bacterial flora, found in the uterine cervical canal at embryo transfer, is associated with the rate of conception in ART. METHODS: We sampled for bacteriological culture the cervical canal of 204 patients who underwent embryo transfer. Of these, 139 (68%) were of fresh embryos, following recent vaginal oocyte retrieval and prophylactic antibiotic therapy, and 65 (32%) of frozen–thawed embryos, without any vaginal intervention in the preceding days. Bacteriological work-up included identification, colony count and antibiotic susceptibility profile. Conception was correlated with bacterial type and colony count. RESULTS: In 75 patients (36.8%) sterile cervical cultures or lactobacillus were recorded. Of these 75 patients, 23 (30.7%) conceived, whereas among the 129 in whom any pathogenic micro-organism was recovered only 21 (16.3%) conceived (P = 0.002). No difference in colonization was found between women who underwent frozen–thawed versus fresh embryo transfer (57 and 67% respectively). Any Gram-negative colonization was associated with no conception. All Gram-positive, and 90% of the Gram-negative bacteria, were sensitive to augmentin. CONCLUSIONS: Failure to conceive in ART is significantly associated with bacterial colonization of the uterine cervix.
Key words: antibiotic susceptibility/assisted reproduction technology/bacterial colonization/embryo transfer/uterine cervix
4 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Ha'Emek Medical Centre, Afula 18101, Israel. E-mail: ibs{at}clalit.org.il
Submitted on November 24, 2000; resubmitted on May 4, 2001
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