Abstract
Understanding what happens at the time of embryo implantation has been the subject of significant research. Investigators from many differing fields including maternal fetal medicine, microbiology, genetics, reproductive endocrinology and immunology have all been studying the moment the embryo interacts with the maternal endometrium. A perfect relationship between the uterus and the embryo, mediated by a tightly controlled interaction between the embryo and the endometrium, is required for successful implantation. Any factors affecting this communication, such as altered microbiome may lead to poor reproductive outcomes. Current theories suggest that altered microbiota may trigger an inflammatory response in the endometrium that affects the success of embryo implantation, as inflammatory mediators are tightly regulated during the adhesion of the blastocyst to the epithelial endometrial wall. In this review, we will highlight the various microbiome found during the periconceptual period, the microbiomes interaction with immunological responses surrounding the time of implantation, its effect on implantation, placentation and ultimately maternal and neonatal outcomes.
Highlights
The human body is colonized with over ten times more bacteria than the number of cells [1]
This study found multiple phyla in the placental microbiome namely Firmicutes, Tenericutes, Proteobacteria, Bacteroidetes, and Fusobacteria
It is known that inflammation may contribute to placental damage and that any maternal disease state that can lead to utero-placental hypoxia, like preeclampsia, can result in the development of intrauterine growth restriction
Summary
The human body is colonized with over ten times more bacteria than the number of cells [1]. Most prior medical research has been focused on disease causing bacteria and only recently, has there been a coordinated focus on studying the resident bacteria, viruses, and fungi collectively called the microbiome. Prior microbiome studies utilized either culture or 16S sequence-based technology in determining the bacterial environment. Work describing the reproductive microbiome came from culture-based approaches [3]. Data from the generation sequencing of the vaginal microbiome show that many organisms are not identified when culture only based approaches are utilized [4]. Studies suggested only about 1–2% of bacteria that is present can be picked up on culture [5], while recent studies using generation sequencing suggest 20–60% depending on body site [1].
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