The Role of Asymptomatic Bacterial Vaginosis in Women Undergoing Intracytoplasmic Sperm Injection in Predicting Successful Pregnancy


Background:Bacterial vaginosis (BV)is a polymicrobial clinical syndrome resultingfrom replacement of the normal hydrogen peroxide producing Lactobacillussp. BV is the most common lower genital tract disorder among women ofreproductive age (pregnant and non-pregnant) and the most prevalent cause ofvaginal discharge and malodor.Objectives:To study the role of asymptomatic bacterial vaginosis on outcome inpatients undergoing ICSI.Patients and Methods:This prospective study was undertaken in the High Instituteof Infertility Diagnosis and Assisted Reproductive Techniques / Al-NahrainUniversity. During the period from September 2017 – April 2018. A total of 100infertile women .All of them were underwent controlled ovarian hyper stimulationfor intra cytoplasmic sperm injection cycle. Antagonist oocyte maturationused as ovulation induction protocol in all the cases. Assessment of oocyte maturationand embryo quality is done to the all the cases, bacterial vaginosis smearwas collected on the day of oocyte retrieval. B.V. smear diagnosis by Amsel’sCriteria and Nugent’s Scoring.Results: TThere was no significant difference in mean age of pregnant andnon-pregnant ladies, 29.40 ±6.47 years versus 30.78±6.84 years, respectively(P= 0.333).In addition the frequency of women under 35 years age was comparablein the two groups with no statistical significant difference, 34 (79.1%) versus33 (73.3%), respectively (P = 0.528). Wide variation and non-normal distributionwas the role followed by the duration of infertility concerning sub-fertilewomen participating in this study. However, no significant difference was observedin the duration of infertility between pregnant and non-pregnant ladies,6.00 (5.00) years versus 6.00 (5.00) years (P = 0.289). Comparison of basal hormonallevels between pregnant and non-pregnant groups revealed no significantdifference despite the presence of some minor differences in mean hormonallevels between the two groups (P> 0.05). Comparison of oocytes characteristicsbetween pregnant and non-pregnant ladies was conducted and revealed no significantdifference in mean total number retrieved oocyte (TNO), ruptured oocytes(RO), abnormal oocyte (AO), germinal vesicle oocyte (GV), metaphase I oocyteand metaphase II oocytes (P > 0.05), table Mean total number retrieved oocyte(TNO), ruptured oocytes (RO), abnormal oocyte (AO), germinal vesicle oocyte(GV), metaphase I oocyte and metaphase II oocytes was 10.81 ±4.95 versus 10.42±6.30, 0.44 ±0.73 versus 0.36 ±0.65, 1.09 ±1.56 versus 0.84 ±2.00, 0.91 ±1.00 versus0.89 ±1.47, 1.51 ±1.49 versus 2.04 ±2.09 and 6.84 ±4.01 versus 6.22 ±3.91 in pregnant andnon-pregnant groups, respectively. Mean fertilization rate was higher in pregnant ladies thanthat of non-pregnant ladies, 62.19 ±22.23 versus 57.59 ±24.95, respectively; however, the differencewas no statistically significant (P = 0.365).Mean grade I embryo number was also significantlyhigher in pregnant women than that of non-pregnant women, 2.53 ±1.53 versus 1.89±1.27, respectively (P = 0.034), Mean grade II embryo number was 0.86 ±1.52 versus 0.89±1.28 in pregnant and non-pregnant ladies, respectively and the difference was not significant(P = 0.925), moreover the difference in mean grade III embryo number between pregnant andnon-pregnant women was insignificant (P = 0.321), 0.30 ±1.01 versus 0.31 ±0.50, respectively.Rate of asymptomatic bacterial vaginosis as determined by gram stain, whiff test, wet mountand Amsel’s criteria was 32.6 % in pregnant women compared to 73.3% in non-pregnantgroup, being highly significant higher in those women who failed to get pregnant (P<0.001).Conclusion: Rate of asymptomatic bacterial vaginosis was 32.6 % in pregnant women comparedto 73.3% in non- pregnant group, being highly significant higher in those women whofailed to get pregnant.