Relationship of abnormal vaginal flora, proinflammatory cytokines and idiopathic infertility in women undergoing IVF.
OBJECTIVE
To investigate the prevalence of bacterial vaginosis (BV) and abnormal bacterial vaginal flora in an infertile population and correlate with cervical cytokine production and in vitro fertilization (IVF) outcome.


METHODS
In a blinded study, 331 asymptomatic IVF patients were evaluated for BV, abnormal vaginal flora and cervical cytokine production (interleukin 1 beta [IL-1 beta] and IL-8) on the day of oocyte retrieval. All patients received tetracycline prophylaxis at the time of oocyte retrieval.


RESULTS
BV was identified in 4.2% (14/331) of the patients. Patients with idiopathic infertility were more likely to have BV than were women with other causes of infertility (P = .02 vs. male factor, P = .03 vs. tubal factor and P < .01 vs. endometriosis-associated infertility). Patients with abnormal vaginal flora had higher cervical IL-1 beta and IL-8 cytokine levels as compared to patients with normal vaginal flora. IL-1 beta and IL-8 levels in the study subjects correlated highly. No differences were detected in IVF outcome parameters based on the vaginal flora determined at the time of retrieval.


CONCLUSIONS
Abnormal vaginal flora, including that causing BV, is associated with elevated cervical levels of IL-1 beta and IL-8. The induction of proinflammatory cytokines by an altered vaginal ecosystem may be a previously unrecognized cause of idiopathic infertility.
Spandorfer
S D
SD
Center for Reproductive Medicine and Infertility and Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, New York, USA.
Neuer
A
A
Giraldo
P C
PC
Rosenwaks
Z
Z
Witkin
S S
SS
D000328:Adult; D002584:Cervix Uteri / Q000276:immunology*; D016207:Cytokines / Q000276:immunology*; D004624:Embryo Transfer; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005307:Fertilization in Vitro; D006194:Gardnerella vaginalis / Q000302:isolation & purification; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D007375:Interleukin-1 / Q000276:immunology; D016209:Interleukin-8 / Q000276:immunology; D019535:Mycoplasma hominis / Q000302:isolation & purification; D009518:New York / Q000453:epidemiology; D011247:Pregnancy; D018873:Pregnancy Rate; D015995:Prevalence; D014621:Vagina / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000276:immunology
D016207:Cytokines; D007375:Interleukin-1; D016209:Interleukin-8