[Abnormal bacterial colonisation of the vagina and implantation during assisted reproduction].
OBJECTIVE
To evaluate the efficiency of our treatment of vaginal infection for couples included in an IVF program.


METHODS
Microbiologic screening of vaginal flora and semen has been performed one month prior to in vitro fertilization for 951 couples in 2000. Antibiotic treatment was prescribed in case of positive culture.


RESULTS
Positive microbial growths were observed from endocervical and vaginal cultures in 218 women (22.9%). The clinical pregnancy rate was 30.29% in the group of patients without growth and 30.27% in the group with positive microbial growth. The implantation rate was significantly diminished in case of bacterial growth: 14.6 compared to 19.3% (P <0.02) for sterile endocervical culture. Five main bacterial species were found at the cervical level: Candida albicans (69 cases), Ureaplasma urealyticum (49 cases), Gardnerella vaginalis (43 cases), Streptococcus B or D (24 cases) and Escherichia coli (22 cases). Positive cultures from both vagina and semen were observed for 77 couples whose clinical pregnancy rate was 19.5 vs 36.2% in case of vaginal infection alone (P <0.01) with a spontaneous miscarriage rate of 46.7 compared to 17.6% (P <0.01).


CONCLUSIONS
Endocervical microorganisms, even treated with adapted antibiotics, may affect embryonic implantation. Positive culture from both female and male partner may enhance this negative effect. In this case, the best strategy would be to cancel the IVF treatment.
Wittemer
C
C
Service de biologie de la reproduction, centre d'AMP, CMCO-SIHCUS, 19, rue Louis-Pasteur, BP 120, 67303 Schiltigheim cedex, France. christiane.wittemer@wanadoo.fr
Bettahar-Lebugle
K
K
Ohl
J
J
Rongières
C
C
Viville
S
S
Nisand
I
I
D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002181:Candidiasis, Vulvovaginal / Q000150:complications / Q000188:drug therapy; D002584:Cervix Uteri / Q000382:microbiology*; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012098:Reproduction; D012661:Semen / Q000382:microbiology*; D014621:Vagina / Q000382:microbiology*