Effect of vaginal microbiota disorder on pregnancy outcomes in frozen-thawed embryo transfer patients:a retrospective cohort study
Objective To explore the effect of vaginal microbiota disorder on pregnancy outcomes in the first-time frozen-thawed embryo transfer(FET)patients and perinatal outcomes in single pregnancy live delivery patients.Methods The clinical data of 2 299 cycles of FET patients in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2021 to December 2022 were collected in a retrospective cohort study.According to the types of dominant bacteria in the vaginal microbiota before transplantation,they were divided into three groups:control group(dominant bacteria were Lactobacillus,which was Gram positive bacteria,1 849 cycles),the Gram negative bacilli group(191 cycles),and the Gram positive cocci group(259 cycles).Baseline data and pregnancy outcomes were compared among the three groups.The perinatal outcomes of select single pregnancy live birth FET patients who met the inclusion criteria were further analyzed among the three groups.The main observation indicators were live birth rate,miscarriage rate,and preterm birth rate.A multivariate logistic regression model was used to control confounding factors in the main observation indicators,and to analyze the relationship between dominant bacterial types in the vaginal microbiota and live birth rate,miscarriage rate,and preterm birth rate.Results The difference in endometrial thickness on the day of transplantation among control group,Gram negative bacilli group,and Gram positive cocci group was statistically significant[(9.38±1.58)mm,(9.56±1.70)mm,and(9.84±1.74)mm,respectively,P＜0.001].In the endometrium preparation methods,the proportion of down-regulation+artificialcycle patients in the Gram positive cocci group was higher than that in control group,and the difference was statistically significant[13.13％(34/259)and 7.46％(138/1 849),respectively,P＜0.016 7].In the pregnancy outcomes,there was a statistically significant difference in live birth rate among control group,Gram negative bacilli group,and Gram positive cocci group[49.86％(922/1 849),49.21％(94/191)and 41.70％(108/259),respectively,P=0.048].The live birth rate of the Gram positive cocci group was lower than that of control group,and the difference between the two groups was statistically significant(P＜0.016 7).There were no statistically significant differences in other pregnancy outcomes and perinatal outcomes of single pregnancy live birth FET patients(all P＞0.05).The multivariate logistic regression model corrected for female age,infertility years,basal follicle stimulating hormone,anti-Müllerian hormone,proportion of single embryo transfer,proportion of single blastocyst transfer,endometrial thickness on transfer day,and endometrial preparation methods,Gram positive cocci were independent risk factors for live brith after FET transplantation(aOR=0.73,95％CI:0.55-0.95,P=0.021).Conclusion The dominant bacteria in the vaginal microbiota before embryo transfer are Gram positive cocci,which may be related to a decrease in live birth rate in first-time FET patients,but not significantly related to the perinatal outcomes.
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