Endometrial microbiota in infertile women with and without chronic endometritis as diagnosed using a quantitative and reference range-based method.

Abstract

OBJECTIVE\nTo systematically compare the endometrial microbiota in infertile women with and without chronic endometritis (CE), as diagnosed by a quantitative and reference range-based method.\n\n\nDESIGN\nCase-control observational study.\n\n\nSETTING\nUniversity-affiliated hospital.\n\n\nPATIENT(S)\nOne hundred and thirty infertile women.\n\n\nINTERVENTION(S)\nEndometrial biopsy and fluid (uterine lavage, UL) collected precisely 7\xa0days after LH surge, with plasma cell density (PCD) determined based on Syndecan-1 (CD138)-positive cells in the entire biopsy section and culture-independent massively parallel sequencing of the 16S ribosomal RNA gene performed on both the CE and non-CE endometrial fluid samples.\n\n\nMAIN OUTCOME MEASURE(S)\nRelative abundance of bacterial taxa.\n\n\nRESULT(S)\nChronic endometriosis was diagnosed if the PCD was above the 95th percentile (>5.15\xa0cells per 10\xa0mm2) of the reference range in fertile control subjects. With this stringent diagnostic criterion, 12 women (9%) were diagnosed with CE. Sequencing was successfully performed on all endometrial samples obtained by UL) (CE, n = 12; non-CE, n = 118). The median relative abundance of Lactobacillus was 1.89% and 80.7% in the CE and non-CE microbiotas, respectively. Lactobacillus crispatus was less abundant in the CE microbiota (fold-change, range: 2.10-2.30). Eighteen non-Lactobacillus taxa including Dialister, Bifidobacterium, Prevotella, Gardnerella, and Anaerococcus were more abundant in the CE microbiota (fold-change, 2.10-18.9). Of these, Anaerococcus and Gardnerella were negatively correlated in relative abundance with Lactobacillus (SparCC correlation magnitude, range: 0.142-0.177).\n\n\nCONCLUSION(S)\nChronic endometriosis was associated with a statistically significantly higher abundance of 18 bacterial taxa in the endometrial cavity.\n\n\nCLINICAL TRIALS REGISTRY NUMBER\nChiCTR-IOC-16007882.