The influence of bacterial vaginosis on in-vitro fertilization and embryo implantation during assisted reproduction treatment

There is growing evidence that the pathogenic effects of bacterial vaginosi s may not be confined to the lower genital tract, Possible associations wit h infertility and effects on fertilization and implantation were studied in patients undergoing in-vitro fertilization (IVF) treatment. High vaginal s wabs taken at the time of oocyte collection were assessed by Gram staining. The prevalence of bacterial vaginosis and of intermediate and normal flora in 301 patients was 25.6, 14.0 and 60.4% respectively. Bacterial vaginosis was more prevalent in patients with tubal (31.5%, n = 149) compared with n on-tubal (19.7%, n = 152) infertility (odds ratio (OR) 1.87, CI 1.11-3.18, P = 0.02), Bacterial vaginosis did not have an adverse effect on fertilizat ion rate. Further, no significant difference in implantation rates was seen when comparing bacterial vaginosis (15.8%, OR 1.03, CI 0.66-1.61) and inte rmediate flora (13.1%, OR 0.82, CI 0.45-1.52) with normal flora (15.5%). Th ough confidence intervals around the observations mere relatively wide, the findings suggest that routine screening for bacterial vaginosis in the hop e of improving the success of IVF treatment is not justified. The preventio n of complications in pregnancy associated with bacterial vaginosis might b e a more relevant indication for screening at the time of IVF treatment, in particular patients with tubal disease, if treatment were shown to be effe ctive for that particular purpose. However, antibiotic treatment before IVF has been shown to be positively disadvantageous for IVF by encouraging oth er organisms.