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Non-Lactobacillus dominance of the vagina is associated with reduced live birth rate following IVF/ICSI: a propensity score-matched cohort study

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Whether the dominant status of vaginal Lactobacillus is associated with IVF/ICSI outcomes.

Methods

This is a propensity score-matched retrospective cohort study consists of 2285 women undergoing their first fresh autologous IVF cycles. We divided the patients into the Lactobacillus-dominant group and non-Lactobacillus-dominant group based on the abundance of Lactobacillus in Gram-stained vaginal smear examined by microscopy. We compared IVF outcomes between the two groups. We matched Lactobacillus-dominant women with non-Lactobacillus-dominant women by propensity score (PS) to reduce the impact of confounding factors. We evaluated the effect of vaginal Lactobacillus on live birth using univariate and multivariate analysis models. We also conducted interaction and stratified analyses.

Results

Compare to the Lactobacillus-dominant group, the biochemical pregnancy rate (50.12% vs. 57.61%, P = 0.03), clinical pregnancy rate (40.98% vs. 50.82%, P < 0.01), and live birth rate (31.83% vs. 41.22%, P < 0.01) were significantly lower in the non-Lactobacillus-dominant group, the preclinical pregnancy loss rate (18.22% vs. 11.79%, P = 0.05) and preterm birth rate (33.09% vs. 21.59%, P = 0.02) were significantly higher in the non-Lactobacillus-dominant group. However, the miscarriage rate (18.86% vs. 15.67%, P = 0.40) and ectopic pregnancy rate (1.41% vs.1.64%, P = 0.78) were similar between the two groups. Loss dominance of Lactobacillus in the vagina was an independent risk factor for live birth (OR 0.66, 95% CI 0.50–0.88).

Conclusions

Loss dominance of Lactobacillus in the vagina negatively affects IVF outcomes by decreasing the chances of pregnancy and live birth, increasing risks of preclinical pregnancy loss and preterm birth.

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Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

IVF:

In-vitro fertilization

ICSI:

Intracytoplasmic sperm injection

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Authors and Affiliations

  1. Department of Reproductive Medicine Center, Xiangya Hospital of Central South University, Changsha, 410008, China

    Hong Zeng, Raed Kaser Abdullah, Lei Zhang & Nenghui Liu

  2. Department of Reproductive Medicine Center, Foshan Maternal and Child Health Care Hospital, Southern Medical University, Foshan, 528000, Guangdong, China

    Hong Zeng

  3. Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, China

    Dongmei He

  4. Department of Gynecology and Obstetrics, The Fourth Changsha Hospital, Changsha, 410000, China

    Lian Hu

  5. Changsha Central Hospital, Nanhua University, Changsha, 410004, China

    Binyuan Jiang & Hebin Xie

Authors
  1. Hong Zeng
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  2. Dongmei He
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  3. Lian Hu
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  4. Raed Kaser Abdullah
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  5. Lei Zhang
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  6. Binyuan Jiang
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  7. Hebin Xie
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  8. Nenghui Liu
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Contributions

HZ designed the study, performed the statistical analyses, drafted the manuscript, tables and figures; HX performed the statistical analyses, revised the tables and figures; RKA and LH collected and organized the data. DH, LZ and BJ collected the participants’ information, revised the manuscript; NL and HX designed the study and revised the manuscript.

Corresponding authors

Correspondence to Hebin Xie or Nenghui Liu.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethics approval

The Ethics Committee of Xiangya Hospital approved this study.

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Since this was a retrospective analysis of data routinely collected from treatments and patients, the informed consensus was not required.

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Since this was a retrospective analysis of data routinely collected from treatments and patients, consent for participation was not applicable.

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Since this was a retrospective analysis of data routinely collected from treatments and patients, consent for publication was not applicable.

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Zeng, H., He, D., Hu, L. et al. Non-Lactobacillus dominance of the vagina is associated with reduced live birth rate following IVF/ICSI: a propensity score-matched cohort study. Arch Gynecol Obstet 305, 519–528 (2022). https://doi.org/10.1007/s00404-021-06171-y

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  • DOI: https://doi.org/10.1007/s00404-021-06171-y

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