Abstract
Our previous study reported microorganisms in human follicular fluid. The objective of this study was to test human follicular fluid for the presence of microorganisms and to correlate these findings with the in vitro fertilization (IVF) outcomes. In this study, 263 paired follicular fluids and vaginal swabs were collected from women undergoing IVF cycles, with various causes for infertility, and were cultured to detect microorganisms. The cause of infertility and the IVF outcomes for each woman were correlated with the microorganisms detected within follicular fluid collected at the time of trans-vaginal oocyte retrieval. Microorganisms isolated from follicular fluids were classified as: (1) ‘colonizers’ if microorganisms were detected within the follicular fluid, but not within the vaginal swab (at the time of oocyte retrieval); or (2) ‘contaminants’ if microorganisms detected in the vagina at the time of oocyte retrieval were also detected within the follicular fluid. The presence of Lactobacillus spp. in ovarian follicular fluids was associated with embryo maturation and transfer. This study revealed microorganisms in follicular fluid itself and that the presence of particular microorganisms has an adverse affect on IVF outcomes as seen by an overall decrease in embryo transfer rates and pregnancy rates in both fertile and infertile women, and live birth rates in women with idiopathic infertility. Follicular fluid microorganisms are a potential cause of adverse pregnancy outcomes in IVF in both infertile women and in fertile women with infertile male partners.
Highlights
The presence of opportunistic pathogens in the lower female reproductive tract has been associated with adverse pregnancy outcomes after both natural and in vitro fertilization (IVF) conceptions [1] and we have demonstrated differences in women with colonized and contaminated follicular fluid [2]
One woman had no microorganisms detected in her follicular fluid by either traditional culture or molecular microbiology techniques, and her IVF outcome results were excluded from further analysis
For the remaining 262 women, the microorganisms identified in follicular fluid were analyzed to determine if there was a relationship between the microbial flora and IVF outcomes
Summary
The presence of opportunistic pathogens in the lower female reproductive tract has been associated with adverse pregnancy outcomes after both natural and IVF conceptions [1] and we have demonstrated differences in women with colonized and contaminated follicular fluid [2]. Cottell et al [6] analyzed the effect of microorganisms from the IVF culture system as a whole by pooling the results obtained for each specimen type (follicular fluid, oocyte retrieval needle washes, semen and culture media) and seeking associations between these results and IVF outcomes and concluded that there were no detrimental effects. Cottell reported a significant decrease in the number of oocytes retrieved from women when microorganisms were isolated from their follicular fluid. We identified the microorganisms in follicular fluids and vaginal swabs and correlated these with IVF outcomes
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