Title : "Fertility, IVF, chronic endometritis and endometrial microbioma are we doing things the right way?"
Abstract:
The exploration and management of infertility are evolving daily thanks to advances in understanding and in exploration and treatment techniques. However, the place of endometrial assessment is not well defined in the decision-making pathway of IVF. In the different international guidelines, ultrasound is sufficient for the endometrial exploration, and normal ultrasound aspect is sufficient to conclude that endometrium is normal and so receptive. In these different recommandations, exclusion of dysbiosis and chronic endometritis is not mandatory before classing the couple as unexplained infertility. So patients presenting a severe dysbiosis or a severe chronic endometritis can be classified as unexplained infertilities according to actual guidelines. According to current recommendations for the management of unexplained infertility, it is accepted that the first step is to proceed with intrauterine inseminations. If these inseminations fail, the couple should move on to in vitro fertilization. Several couples will undergo in vitro fertilization without exploring chronic endometritis or endometrial dysbiosis. Current evidence supports the association of lactobacillus dominance with endometrial homeostasis and favorable reproductive outcomes. Dysbiosis, characterized by increased microbial diversity and enrichment of anaerobic taxa is linked to chronic endometritis, implantation failure, and adverse IVF results. We present a series of couples presenting with a history of one ore more unsuccessful attempts of IVF. These patients were classified as unexplained infertility. We explored these patients for dysbiosis by endocervical microbioma analysis and they were screened for chronic endometritis with hysterocopy, endometrial biopsies and plasmocyte search and count on biopsies using immunohistochimy technics. In these series of patients, natural pregnancies were achieved after treatment for chronic endometritis or endometrial dysbiosis, after previously having failures in one or more IVF attempts. Through this work, we show the importance of endometrial microbioma assessment and search for severe chronic endometritis in the management of infertility in general, and specially in the evaluation prior to IVF.
