A large percentage of women cannot achieve pregnancy through IVF despite the transfer of good quality or chromosomally normal (after performing a preimplantation genetic diagnosis) embryos. Knowing that the quality of embryos is the main factor of implantation, in the case of failed implantations the environment of the intrauterine cavity should also be investigated.

What is the endometrial microbiome?

The endometrial microbiome is defined as the total number of microbes that live and grow in the endometrium. The existence of microbes in the endometrium should not be surprising, since microorganisms are found all over the human body, which collectively are called the microbiome of the human body. The bacteria of the microbiome help the proper functioning of the specific organ.

Although for several years it was a strong belief that the uterus was a sterile, germ-free environment, it has now been proven that this is not the case. Thus, the endometrium is colonized by microorganisms that contribute to its proper functioning and to the protection of the uterus from various infections. In addition, in cases of pregnancy it helps in the successful implantation of the embryo and later on in the formation of the placenta.

How does the endometrial microbiome contribute to infertility ?

The endometrium is normally colonized only by lactobacilli, which have a protective role. If the microflora of the endometrium is disturbed from other microorganisms, then various gynecological problems are caused such as endometritis, pelvic inflammatory disease (PID), endometrial cancer, but also infertility leading to failed embryo implantations and subsequent miscarriages. A dysbiotic environment in the endometrium, even if it leads to a successful, implantation cannot create the appropriate conditions for the development of the embryo. The endometrium must be absolutely healthy to achieve pregnancy in cases of assisted reproduction.

Endometritis & Infertility

As mentioned above, disorders of the endometrial microbiome can cause endometritis. Endometritis is a chronic inflammation of the uterine cavity.This inflammation causes a decrease in the receptivity of the uterus and reduces the number of fertile days. Also, chronic endometritis affects the intensity of uterine contractions, which makes it impossible for the embryo to implant.

Microbiome: How is it collected and tested?

The sample of the endometrial microbiome is collected either with the help of a biopsy in office basis or during a diagnostic hysteroscopy. The sample collection at the physician’s office must take place on a specific day of the cycle. Subsequently, a molecular examination of the microbiome is carried out for both the qualitative and quantitative determination of the microbes that consist the microflora of the endometrium.

In which cases should the endometrial microbiome be examined?

The study of the endometrial microbiome is one of the most modern ways of investigating a couple’s infertility. The endometrial microbiome should be examined in the following cases:

Presence of unexplained infertility
Recurrent UTIs caused by Ureaplasma or Chlamydia
Repeated early miscarriages
Repeated failures to implant good quality embryos

Treatment of endometrial microbiome disorders

If and when the examination of the microbiome endometrium indicates dysbiosis, the administration of antibiotic treatment is necessary. In addition to antibiotic treatment, probiotics can be administered, aiming to to strengthen the microbiome in the case of poor growth.

Endometrial microbiome examination provides several answers in cases of investigation of female fertility. The Obstetrician-Gynecologist Melina Stasinou, having extensive experience and expertise in Microsurgery of Female Reproduction and assisted reproduction, is available for any question regarding the microbiome of the endometrium. Dr. Stasinou prioritizes the needs of her patients and applies the most modern and safe protocols for treating female infertility. Contact us and book your appointment.