Microbial colonization of follicular fluid: alterations in cytokine expression and adverse assisted reproduction technology outcomes

Elise Pelzer, Elise S Pelzer, John A Allan, John Allan, Kelly Cunningham, Kerrie Mengersen, Janet M Allan, Tara Launchbury, Kenneth W. Beagley, Kenneth Beagley, Christine L Knox
Human Reproduction · 2011 · vol. 26(7) , pp. 1799–1812 · doi:10.1093/humrep/der108 · PMID:21511711 · W2122215451
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This study found that microorganisms colonizing follicular fluid, and their associated cytokine expression, correlate with decreased fertilization and pregnancy rates in assisted reproduction technology patients.

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Abstract

BACKGROUND: Previous studies have measured cytokines expressed within follicular fluid and compared the profiles with the aetiology of infertility and/or successful or unsuccessful assisted reproduction technology (ART) outcomes. METHODS: In this study, 71 paired follicular fluid and vaginal secretions collected from ART patients were cultured to detect microorganisms and tested for the presence of cytokines. Patient specimens were selected for assay based on two criteria: whether the follicular fluid specimen was colonized (with microorganisms prior to oocyte retrieval) or contaminated by vaginal flora and; the aetiology of infertility. Patients included fertile women (with infertile male partners; n = 18), women with endometriosis (n = 16) or polycystic ovary syndrome (PCOS, n = 14), or couples with a history of genital tract infection (n = 9) or idiopathic infertility (n = 14). RESULTS: Microorganisms and cytokines were detected within all tested specimens. Colonizing microorganisms in follicular fluid were associated with: decreased fertilization rates for fertile women (P = 0.005), women with endometriosis (P = 0.0002) or PCOS (P = 0.002) compared with women whose follicular fluid was contaminated at the time of oocyte retrieval and with decreased pregnancy rates for couples with idiopathic infertility (P = 0.001). A single cytokine was discriminatory for women with an idiopathic aetiology of infertility (follicular fluid interleukin (IL)-18). Unique cytokine profiles were also associated with successful fertilization (IL-1α, IL-1β, IL-18 and vascular endothelial growth factor). CONCLUSIONS: Follicular fluid is not sterile. Microorganisms colonizing follicular fluid and the ensuing cytokine response could be a further as yet unrecognized cause and/or predictor of adverse ART outcomes and infertility.

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Condition tags

endometriosisinfertility

MeSH descriptors

Cytokines Follicular Fluid Infertility, Female Reproductive Techniques, Assisted Adult Cytokines Female Follicular Fluid Follicular Fluid Humans Infertility, Female Infertility, Female Infertility, Female Oocyte Retrieval Treatment Outcome Vagina Vagina Vagina

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References (55)

Cited by (8)

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