Figure 1.
The most prevalent microbial species detected from the left and right follicular fluids and vagina from women in this study.
1 A–E The most prevalent microbial species detected from the left and right follicular fluids and vagina from women in this study are stratified based on the diagnosed cause of infertility. Bars represent one standard error.
Table 1.
Number of women with colonized or contaminated follicular fluid and the causes of infertility.
Figure 2.
The most prevalent microbial species detected within the left or right follicular fluid and vagina in women with colonized or contaminated follicular fluid.
Lactobacillus spp., Actinomyces spp. and Propionibacterium spp. were detected more often in the colonized left follicular fluids than in the contaminated left follicular fluids (p<0.01, p<0.05 and p<0.05 respectively). Actinomyces spp. and Propionibacterium spp. were identified more often in colonized than in contaminated follicular fluids (p<0.05), while Peptostreptococcus spp. were isolated more frequently from contaminated follicular fluids from the right ovarian follicles (p<0.05). The vaginal swabs from women with colonized follicular fluid had a higher number of Lactobacillus spp. isolated (p<0.01) and also a higher number bacterial isolates when compared to women with contaminated follicular fluid specimens (p<0.05); however, the same species were detected in both groups of women.
Table 2.
A comparison of IVF outcomes for women with different causes of infertility and colonized or contaminated follicular fluid.
Figure 3.
Heat map depicting IVF outcomes for fertile and infertile women with microorganisms detected from genital tract secretions during IVF cycles.
Standard microbiological culture techniques were used to isolate and identify resident microorganisms from clinical specimens obtained from 262 women. Data represents the results obtained from culturing 262 vaginal swabs and 462 follicular fluids. All specimens were cultured on/in a range of microbiological culture media and broth. The heat map consists of a graphical two-dimensional matrix of colored squares, where each square represents the combined observations of the microorganisms isolated from all samples in each etiological cohort. The color of the square is dependent on the composition of the microorganisms at each anatomical site (FFL – left follicular fluid, FFR – right follicular fluid, VS – vaginal swab). Dark green squares represent specimens where only Lactobacillus spp. were isolated, light green squares represent specimens elaborating lactobacilli plus aerobic bacteria and/or microaerophilic bacteria. Light orange squares were used when Lactobacillis spp. were isolated alongside aerobic bacteria and/or microaerophilic bacteria, and/or anaerobic bacteria. Dark orange shading was used when only aerobic bacteria and/or microaerophilic bacteria were present but lactobacilli were absent and finally, red shading was used only if anaerobic species were the sole microbial isolates from the clinical specimen. The squares were ordered firstly by additional categorical data including the cause of infertility, as well as whether the microorganisms were defined as colonizers or contaminants at each site, and secondly by the IVF outcomes for fertilization rate, embryo discard rate, embryo transfer rate, pregnancy rate and live birth rate on the two axes. The combination of the three datasets into the one matrix allowed the cause of infertility, the resident microorganisms and the IVF outcomes to be visually examined and related to one another. Figure 3A represents the positive IVF outcomes and has an overall cooler appearance (green – light orange), whilst Figure 3B represents the negative IVF outcomes and has an overall warmer appearance, being predominantly dark orange to red. In black shaded squares, no relationship was evident between the microbial groupings, the cause of infertility, and the IVF outcomes.
Table 3.
Heat map key to shading based on microbial composition within the sample.