Abstract
ObjectivesTo determine if the presence of microorganisms in follicular fluid of women undergoing in vitro fertilization-embryo transfer (IVF-ET) adversely affects the outcome of the treatment cycles.MethodsFollicular fluid was collected from 86 women enrolled for IVF-ET at the National Hospital, Abuja from June 1, 2018 to December 1, 2018. Microscopy imaging and cultures were performed to identify bacteria and fungi in the follicular fluid and the vagina. Women with follicular fluid microorganisms were the test group while the controls were those without follicular fluid microorganisms. Fertilization and pregnancy rates were subsequently determined and their association with the presence of follicular fluid microorganisms was assessed using univariable and multivariable logistic regression modelling.ResultsThe mean age and mean Body Mass Index (BMI) of the participants were 35(± 3.5) years and 28(± 4.9) kg/m2 respectively. Bacteria and fungi were isolated in 17% of the follicular fluid samples collected (n = 15/86). Most common isolates were Streptococcus spp. (n = 4/15), Staphylococcus aureus (n = 7/15), Enterococcus spp. (n = 4/15), Lactobacillus species (n = 2/15) and Candida albicans (n = 2/15). There was no statistically significant difference in the fertilization rates (adjusted odds ratio [AdjOR] 0.55, 95% confidence interval [CI] 0.04–7.34; P = 0.10) and pregnancy rates (AdjOR 4.02, 95% CI 0.56–28.92; P = 0.19) between the group of women with positive follicular fluid bacterial /fungal colonization as compared against those with negative follicular fluid colonization.ConclusionIsolation of microorganisms from follicular fluid did not adversely affect fertilization and pregnancy rates following IVF-ET treatment cycles at the fertility centre of National Hospital, Abuja.
Highlights
Until recently, the site of conception and fetal growth was believed to be sterile and that the baby was first exposed to microorganisms only during birth [1]
There was no statistically significant difference in the fertilization rates and pregnancy rates (AdjOR 4.02, 95% CI 0.56–28.92; P = 0.19) between the group of women with positive follicular fluid bacterial /fungal colonization as compared against those with negative follicular fluid colonization
Contaminants have been defined as microorganisms present in both the FF and the vaginal samples collected of the same woman; while colonizers are microorganisms detected within the follicular fluid, but not within the vaginal sample [2, 7]
Summary
The site of conception and fetal growth (upper genital tract) was believed to be sterile and that the baby was first exposed to microorganisms only during birth [1]. The human follicular fluid (FF) which is the microenvironment of the oocyte during its development and maturation, is a semi-viscous, hypocoagulable fluid comprising a wide variety of biologically active molecules [4]. It is a product of transfer of plasma constituents across the blood-follicular barrier and the secretory activity of granulosa and theca cells [5]. Contaminants have been defined as microorganisms present in both the FF (upper genital tract) and the vaginal (lower genital tract) samples collected of the same woman; while colonizers are microorganisms detected within the follicular fluid, but not within the vaginal sample [2, 7]. Microorganisms that are commonly found to be colonizing the follicular fluid were normal flora of the vagina (Lactobacillus spp.), gastrointestinal tract (Bifidobacterium spp., enteric bacteria, S. agalactiae), skin (Staphylococcus spp.) and oral mucosa (Streptococcus spp.) [8]
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