Comparison of the Uterine Microbiome in Women with Primary Infertility and Endometriosis and Women with Infertility Due to Male Factors at Dr. Soetomo General Hospital, Surabaya, 2025

Endometriosis is a common gynecological disorder affecting women of reproductive age and is closely associated with infertility and chronic pelvic pain. The involvement of inflammatory pathways in the development of endometriosis has led to the hypothesis that microorganisms and their metabolites contribute to disease progression. These microorganisms may reach the pelvic cavity through translocation from the gastrointestinal tract or via ascending migration from the vagina. This study aimed to analyze the characteristics and composition of the uterine microbiome in women with primary infertility associated with endometriosis and to compare them with women experiencing infertility due to male factors. The study also sought to identify differences in microbial colonization patterns that may contribute to the pathogenesis of infertility. An observational cross-sectional study was conducted at the Gynecological Endocrinology Clinic and Graha Amerta Clinic of Dr. Soetomo General Hospital between June and September 2025. A total of 70 participants were recruited using purposive sampling, comprising 35 women with primary infertility and endometriosis and 35 women with infertility due to male factors. All participants underwent uterine swab sampling for uterine microbiome analysis. Data were analyzed using logistic regression analysis. Distinct differences in uterine microbiome composition were observed between the two groups. Among women with endometriosis, Staphylococcus aureus was present in 28.57% of cases, whereas Streptococcus agalactiae was found in 2.85%. In the male factor infertility group, Staphylococcus aureus was detected in 5.71% of participants, while Streptococcus agalactiae was identified in 22.85%. Logistic regression analysis demonstrated that Staphylococcus aureus was strongly associated with endometriosis-related infertility (OR 6.60; 95% CI 1.33-32.84). Women with primary infertility due to endometriosis exhibit a distinct uterine microbiome profile compared with those experiencing infertility due to male factors. These findings support a potential role of the uterine microbiome in the pathophysiology of infertility and warrant further investigation.