MICROBIOME IN ART& Need of Probiotics Dr Sharda Jain Dr Jyoti Agarwal WHAT IS MICROBIOME ? Reproductive system comprises of number of microbes There number is more than total cells of Genital Tract These microbes play an important role in maintaining the homeostasis & normal functioning of the Genital Tract system

1. MICROBIOME IN ART
& Need of Probiotics
DR SHARDA JAIN
DR JYOTI AGARWAL
…Caring hearts, healing hands

2. Over 350 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. WHAT IS MICROBIOME ?
• Reproductive system comprises of number of
microbes
• There number is more than total cells of Genital
Tract
• These microbes play an important role in
maintaining the homeostasis & normal
functioning of the Genital Tract
system

4. AMAZING FACT
The Human Microbiome Project has shown that
the human body contains over 10 times more
microbial cells than human cells that can
significantly affect human physiology & Health
They are also K/A second genome.

5. Vaginal microbiological environment
Is predominated by the Lactobacillus Species,
which secrete lactic acid making the vaginal Ph
acidic & thus preventing the pathological
infection
Whenever pH is altered, restoration of
microbiota is very important

6. What about Uterus ?
• Healthy uterine cavity is STERILE & This is
maintained by the cervical plug
• This cervical plug provides an impermeable
barrier to bacterial ascension from the vagina

7. Sterile in Uterus Vaginal Smeared all over Microbiome

8. Clinical Evidence
In ART & Recurrent Implantation
failure

9. FERTILITY & MICROBIOME
Microbiological composition of vagina greatly
influences Fertility & Outcomes of Fertility
Treatment
Bacteroal Vaginosis has been associated with
poor pregnancy rates in IVF cycles

10. SUCCESS IN IVF & MICROBIOME
Composition of the vaginal Microbiome on the day of
Embryo Transfer in women undergoing IVF was
studied and it was found that
“A Lower Vaginal Microbiome Diversity Index
correlated with a better live birth rate”

11. NGS
• The vaginal mocrobiome can be analyzed both by
culture & Next Generation Sequencing technology
• Advent of Next Generation Sequencing (NGS)
technologies in 2007 gives us far more better
assessment of bacterial composition of the
uterus/vagina /follicular fluid wrt culture
dependent methods

12. RECURRENT IMPLANTATION FAILURE
Endometrial fluid of 35 infertile patients with
RECURRENT IMPLANTATION FAILURE were
analyzed .
In the ENDOMETRIUM lactobacillus sp… Was
the most abundant bacteria detected.
Endometrial microbiota profile was divided
into 2 -- as lactobacillus dominated
non – lactobacillus dominated.

13. A NON LACTOBACILLUS
dominated microbiome
Non lactobacillus dominated (seen in 90%)
group endometrial microbiota significantly
correlated with adverse reproductive outcome
like implantation failure, less ongoing
pregnancy , & miscarriage

14. FOLLICULAR FLUID IS NOT STERILE
FOLLICULAR Fluid has diverse micro-organisms
like Propionibacterium sp., Streptococcus sp.
Actionomyces spp., Staphylococcus spp. &
Bifido bacterium sp and is related to Adverse
IVF OUTCOME

15. SEMINAL FLUID
Have not significantly demonstrated the abnormal
pathogens & studies have not shown any relationship
of abnormal microbiome with the abnormal semen
parameters
So the evidence is UNCERTAIN regarding the treatment
of abnormal semen parameters with Probiotics

16. WHAT PROBIOTICS CAN DO ?
• Restore Healthy micro biome.
• Pro fertility Potential .
• Prevent Oxidative Damage of Sperm &
Maintains viability

17. CURRENT EVIDENCE OF PROBIOTICS
Data is currently unclear with respect
•to use of probiotics &
• use of prophylactic antibiotic
in reducing abnormal pathogens & promoting
the growth of lactobacillus species in the
Female Reproductive Tract to improve the
success of ART cycle

18. BIOFILMS
• Biofilms are communities of micro-organism
that attach to each other & to surfaces
• The BACTERIAL VAGINOSIS biofilm are
associated with Lower concentration of
Lactobacilli
• Biofilm related infections may be persistent
& women with Bacterial Vaginosis tend to
have high rates of recurrent failure …..

19. Ovarian Stimulation & Microbiomes
Vaginal microbiome has been shown to change
during the controlled ovarian hyper stimulation
required in IVF
This may represent yet another argument for
cryopreservation of embryos & subsequent frozen
ET in a more physiologic state

20. 20
X
X
XStorage :
Maintain Cold Chain .
Store between 2-8 0C.
Do not Freeze.
Why Cold Chain?
To increase probiotic survival
Front-loading refrigerator with separate
freezing compartment on top. (Source:
WHO, 2004, as Figure 6.1, p.18)

21. WARNINGS AND PRECAUTIONS
• Do not use if the packaging is broken or
damaged
• Avoid douching during treatment
• Do not ingest (Only for Vaginal Use)
• Avoid intra-vaginal antibiotics during
treatment
• Compatible with condoms and other
physical barrier methods without any
interference in intercourse
• No major side effect or over dosage has
been reported

22. LET’S RECAP PROBIOTICS
if at all it has to be used in
ART.

23. TO CONCLUDE ……
• There is a definite relationship between the
reproductive tract microbiome as cause of infertility &
outcome of ART cycle.
• Presence of bacterial vaginosis has poor pregnancy rate in
ART cycle
• Lactobacillus predominance in the reproductive tract has good
pregnancy outcome in ART cycle.
• Next generation sequencing ( NGS ) techniques for the
uterine microbiome is better than conventional cultures.
• To date , there are limited outcome data in relation to IVF

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