title: Bacterial colonization of the uterine cervix and success rate in assisted reproduction: results of a prospective survey.
abstract: BACKGROUND
  Overgrowth of bacteria in the birth canal is associated with an increased risk of late miscarriage, preterm labour, post-partum endometritis and low birthweight. Conception rates in assisted reproduction treatments (ART) remain frustratingly low. We examined whether the nature of bacterial flora, found in the uterine cervical canal at embryo transfer, is associated with the rate of conception in ART.
  
  
  METHODS
  We sampled for bacteriological culture the cervical canal of 204 patients who underwent embryo transfer. Of these, 139 (68%) were of fresh embryos, following recent vaginal oocyte retrieval and prophylactic antibiotic therapy, and 65 (32%) of frozen-thawed embryos, without any vaginal intervention in the preceding days. Bacteriological work-up included identification, colony count and antibiotic susceptibility profile. Conception was correlated with bacterial type and colony count.
  
  
  RESULTS
  In 75 patients (36.8%) sterile cervical cultures or lactobacillus were recorded. Of these 75 patients, 23 (30.7%) conceived, whereas among the 129 in whom any pathogenic micro-organism was recovered only 21 (16.3%) conceived (P = 0.002). No difference in colonization was found between women who underwent frozen-thawed versus fresh embryo transfer (57 and 67% respectively). Any Gram-negative colonization was associated with no conception. All Gram-positive, and 90% of the Gram-negative bacteria, were sensitive to augmentin.
  
  
  CONCLUSIONS
  Failure to conceive in ART is significantly associated with bacterial colonization of the uterine cervix.
authors.affiliation: Department of Obstetrics and Gynecology, Afula, Israel.
authors.forename: Raed
authors.initials: R
authors.lastname: Salim
authors.forename: Izhar
authors.initials: I
authors.lastname: Ben-Shlomo
authors.forename: Raul
authors.initials: R
authors.lastname: Colodner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Keness
authors.forename: Eliezer
authors.initials: E
authors.lastname: Shalev
mesh_terms: D000328:Adult; D001419:Bacteria / Q000254:growth & development*; D002584:Cervix Uteri / Q000382:microbiology*; D015169:Colony Count, Microbial; D004624:Embryo Transfer; D005260:Female; D005306:Fertilization; D005615:Freezing; D006090:Gram-Negative Bacteria / Q000254:growth & development / Q000302:isolation & purification; D006801:Humans; D007778:Lactobacillus / Q000254:growth & development / Q000302:isolation & purification; D012099:Reproductive Techniques; D016896:Treatment Outcome