Abstract
Background
Assisted reproduction techniques (ART), such as intracytoplasmic sperm injection (ICSI), have gained widespread use globally. Given the expenses associated with these procedures, physicians are continuously working to enhance pregnancy rates and increase the chances of successful outcomes for patients. However, genital infections pose a significant challenge in this field. Infections can disrupt the reproductive process and negatively impact the success of ART. The aim of the present study was to evaluate the impact of bacterial genital tract infections on the implantation success in asymptomatic women undergoing ICSI through identifying the bacterial genital microorganisms at the time of the embryo transfer and investigating whether the presence of these genital microorganisms alters the outcome of ICSI.
Methods
A total of 220 infertile women aged from 23 to 38 years at the time of the embryo transfer during IVF- ICSI were enrolled in the study. They had no clinical symptoms suggestive of vaginitis or cervicitis. Both vaginal and endocervical swabs were collected from each participant. Standard bacteriological culture methods were employed to detect and identify potential genital pathogens. Real-time PCR was used to specifically detect and identify Ureaplasma urealyticum and Mycoplasma hominis in the collected samples. Two weeks after the embryo transfer, a pregnancy test was conducted to identify the ICSI outcome.
Results
The infection rate was lower in the ICSI positive group (82.1%) compared to the ICSI negative group (90.7%), but this difference was not statistically significant. The Lactobacilli spp. was more prevalent in the ICSI positive group (43.3%) than the ICSI negative group (37.2%). The most prevalent pathogenic bacterial organisms were M. hominis, U. urealyticum, Klebsiella, Enterococci spp and E coli. Three organisms were associated with the least ICSI success rates (Enterococci spp. and/or M. hominis and/or U. urealyticum). Infection with Enterococci spp. and/or U. urealyticum was significantly associated with 2.79 times the likelihood of ICSI failure in non-infected participants, also combined infection with Enterococci spp. and/or M. hominis and/or U. urealyticum showed 2.6 times higher risk of ICSI failure.
Conclusion
The results demonstrated the association of definite bacterial pathogens with reduced levels of vaginal lactobacilli. The presence of E. faecalis and/or U. urealyticum and/or M. hominis in genital samples of infertile women was predictive for a negative outcome of ICSI.