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The association between vaginal microbiota and female infertility: a systematic review and meta-analysis

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Abstract

Purpose

This study aimed to explore the association between vaginal microbiota and infertility.

Methods

We searched a range of electronic databases for appropriate articles, including PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure (CNKI), and Wanfang, from inception to 8th September 2019. Identified articles were then screened using strict inclusion and exclusion criteria. By referring to Tamarelle’s method, we divided vaginal microbiota into two categories: low-Lactobacillus vaginal microbiota (LL-VMB) and high-Lactobacillus vaginal microbiota (HL-VMB). Patients were defined as HL-VMB if they had a Nugent score of 0–3, a negative Amesel/Spiegel’s test, or if the vaginal community status was dominated by either L. crispatus, L. iners, L. gasseri and L. jensenii via 16S rRNA sequencing. Otherwise, cases were regarded as LL-VMB. Statistical analyses were performed with STATA 13.0 statistical software. Effect estimates are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Fifteen articles were included in our final analysis. The HL-VMB was negatively related to infertility; a fixed model showed that the pooled OR was 0.83 (95% CI 0.77–0.90). There was no significant publication bias, as determined by Begg’s test (P = 0.488) and Egger’s test (P = 0.652). Using a random effect model, the pooled OR for intermediate bacterial vaginitis (BV) and infertility was 1.39 (95% CI 1.10–1.76) and the pooled OR for positive BV was 1.72 (95% CI 1.10–2.69). Subgroup and sensitivity analyses further demonstrated that the associations identified were stable. However, the acquired evidence was not sufficient to make inferences with regards to the mechanisms underlying these relationships.

Conclusion

This systematic review and meta-analysis identified a negative correlation between HL-VMB and female infertility. However, due to a variety of limitations, the evidence acquired does not allow us to identify the specific mechanisms underlying this association. Further high-quality studies are needed to verify the causal relationship and explore the molecular mechanisms involved.

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Abbreviations

BV:

Bacterial vaginitis

CI:

Confidence interval

CST:

Community status type

HL-VMB:

High-Lactobacillus vaginal microbiota

LL-VMB:

Low-Lactobacillus vaginal microbiota

NGS:

Next-generation sequencing

OR:

Odds ratio

PCOS:

Polycystic ovary syndrome

PID:

Pelvic inflammatory disease

STI:

Sexually transmitted infections

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Funding

This work was supported by National Natural Science Foundation of China (Grant no. 81872634) and Scientific Research Foundation of Graduate School of Southeast University (Grant no. YBPY1983).

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Authors and Affiliations

  1. Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 dingjiaqiao road, gulou district, Nanjing, 210009, Jiangsu, China

    Xiang Hong, Jun Ma, Jiechen Yin, Jia Geng, Hongxia Zhao, Mengwen Zhu, Meng Ye, Xiaoyue Zhu, Yan Xuan & Bei Wang

  2. Mount Sinai Health System, New York, NY, USA

    Shenghao Fang

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  1. Xiang Hong
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  2. Jun Ma
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  3. Jiechen Yin
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Contributions

Literature search and screening: XH, JM, JY and BW; data extraction: XH, JY, JG and BW; data analysis: XH, HZ, MZ and XZ; results visualization: XH, MY and YX; manuscript draft and modification: XH, S.F, JM and BW; funding acquirement: BW. All authors reviewed the final version of the manuscript and approve it for publication.

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Correspondence to Bei Wang.

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More original data can be obtained from Prof. Wang: wangbeilxb@163.com.

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Hong, X., Ma, J., Yin, J. et al. The association between vaginal microbiota and female infertility: a systematic review and meta-analysis. Arch Gynecol Obstet 302, 569–578 (2020). https://doi.org/10.1007/s00404-020-05675-3

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