Study of the cervical and vaginal microbiota in women with intrauterine pathology and infertility

• Published in: Reproductive health of woman (Online) 2023-09 (6), p.76-81
• Main Authors: Shurpyak, S.O., Yarmola, I.M., Pyrohova, V.I.
• Format: Article
• Language: English
• ISSN: 2708-8723; 2708-8731
• DOI: 10.30841/2708-8731.6.2023.290000

The widespread introduction of hysteroscopy into clinical practice has significantly expanded the possibilities of diagnosis the causes of infertility. Almost 25% of patients with infertility are diagnosed with intrauterine pathology during hysteroscopy, which is not always identified during ultrasonography and/or hysterosalpingography. The World Health Organization recommends the use of office hysteroscopy in all cases of suspected intrauterine pathology. Among all complications of hysteroscopy, the frequency of which ranges from 0.4 to 6.0%, infectious and inflammatory complications occur most often (0.6-2.5%). Intrauterine interventions disturb the “cervical” protective barrier, which, in the presence of dysbiotic or inflammatory processes of the genital tract, increases the risk of complications. In view of the increase in the frequency of intrauterine pathology, and, accordingly, the frequency of diagnostic and operative intrauterine interventions in women of reproductive age, the development of algorithms for the prevention of infectious and inflammatory complications is relevant.The objective: to investigate the state of the cervical and vaginal microbiota of women of reproductive age with intrauterine pathology and infertility who are preparing for hysteroscopy.Materials and methods. 45 women aged 26 to 45 years (main group) and 30 women of the same age without gynecological pathology (comparison group) were examined before hysteroscopy. A comprehensive study of the state of the cervical and vaginal microbiota, diagnosis of infection with sexually transmitted pathogens, included pH-metry of vaginal contents, bacterioscopic examination of vaginal smears, and polymerase chain reaction (PCR).Results. Indications for hysteroscopy were chronic abnormal uterine bleeding (13.3%), endometrial hyperplasia (8.9%); suspicion of endometrial polyps (8.9%), submucosal myoma (8.9%) or uterine malformations (17.8%); infertility of unclear origin (42.2%). In patients of the main group, inflammatory and dysbiotic processes of the lower part of the genital organs in the anamnesis occurred 5.6 times more often. In 22.2% of the patients of the main group, the normal vaginal pH level was determined (3.8–4.5) versus 60.0% of the women of the comparison group (p