Comparison of Microbial Abundance and Diversity in Uterine and Peritoneal Fluid in Infertile Patients with or Without Endometriosis

Overview

Journal BMC Womens Health

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2024 Feb 29

PMID 38424540

Authors

Jue Zhu

Yichen Chen

Huan Chen

Yuhui Sun

Lifeng Yan

Miaohua Zhu

Liang Chen

Qiming Wang

Jing Zhang

Affiliations

Soon will be listed here.

Abstract

Introduction: Endometriosis (EM) is a multifactorial disease that affects 10 - 15% of women of reproductive age. Additionally, 30-50% of women with EM suffer from infertility. The mechanism of infertility caused by EM has not yet been consistently explained. In recent years, studies have shown a link between infertility associated with EM and changes in the reproductive tract microbiota.

Methods: In this study, we involved 26 EM patients (8 cases of stage I-II and 18 cases of stage III-IV) and 31 control subjects who were tubal obstruction-related infertility (TORI). The samples from peritoneal fluid (PF) and uterine fluid (UF) were collected and sequenced by 16 S rRNA amplicon.

Results: In the comparison of microbial diversity, we found no significant differences in the microbial diversity of PF and UF between patients with stage I-II EM and those with TORI. However, there was a significant difference in microbial diversity among patients with stage III-IV EM compared to the previous two groups. Lactobacillus decreased in PF of EM compared to the control group, while it increased in UF. In PF, the abundance of Pseudomonas, Enterococcus, Dubosiella and Klebsiella was significantly higher in patients with stage III-IV compared to TORI patients. And in UF, the main differences existed between stage I-II EM compared to the other two groups. The abundance of pontibacter, aquabacterium, Rikenellaceae and so on at the genus level was significantly enriched in the EM patients with stage I-II. In the analysis based on KEGG database, EM may affect the receptivity related pathways of the endometrium by influencing changes in the uterine microbiota.

Conclusion: Our results indicated that as EM progresses, the microorganisms in UF and PF keep changing. These changes in the microbiota, as well as the resulting alternations in gene functional classification, may play an important role in the infertility associated with EM.

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Correction: Comparison of microbial abundance and diversity in uterine and peritoneal fluid in infertile patients with or without endometriosis.

Zhu J, Chen Y, Chen H, Sun Y, Yan L, Zhu M BMC Womens Health. 2024; 24(1):339.

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References

Mori T, Ito F, Koshiba A, Kataoka H, Takaoka O, Okimura H . Local estrogen formation and its regulation in endometriosis. Reprod Med Biol. 2019; 18(4):305-311. PMC: 6780031. DOI: 10.1002/rmb2.12285. View

Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, DHooghe T . High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2008; 92(1):68-74. DOI: 10.1016/j.fertnstert.2008.04.056. View

Mahmood T, Templeton A . Prevalence and genesis of endometriosis. Hum Reprod. 1991; 6(4):544-9. DOI: 10.1093/oxfordjournals.humrep.a137377. View

Prescott J, Farland L, Tobias D, Gaskins A, Spiegelman D, Chavarro J . A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod. 2016; 31(7):1475-82. PMC: 4901880. DOI: 10.1093/humrep/dew085. View

Sanchez A, Vigano P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M . The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2013; 20(2):217-30. DOI: 10.1093/humupd/dmt053. View

Bonavina G, Taylor H . Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol (Lausanne). 2022; 13:1020827. PMC: 9643365. DOI: 10.3389/fendo.2022.1020827. View

DAlterio M, Giuliani C, Scicchitano F, Lagana A, Oltolina N, Sorrentino F . Possible role of microbiome in the pathogenesis of endometriosis. Minerva Obstet Gynecol. 2021; 73(2):193-214. DOI: 10.23736/S2724-606X.21.04788-2. View

Wei W, Zhang X, Tang H, Zeng L, Wu R . Microbiota composition and distribution along the female reproductive tract of women with endometriosis. Ann Clin Microbiol Antimicrob. 2020; 19(1):15. PMC: 7161132. DOI: 10.1186/s12941-020-00356-0. View

Yuan W, Wu Y, Chai X, Wu X . The colonized microbiota composition in the peritoneal fluid in women with endometriosis. Arch Gynecol Obstet. 2022; 305(6):1573-1580. DOI: 10.1007/s00404-021-06338-7. View

10.

Ata B, Yildiz S, Turkgeldi E, Perez Brocal V, Dinleyici E, Moya A . The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls. Sci Rep. 2019; 9(1):2204. PMC: 6379373. DOI: 10.1038/s41598-019-39700-6. View

11.

Muzii L, Di Tucci C, Galati G, Mattei G, Pietrangeli D, Di Donato V . The role of microbiota in female fertility and infertility. Minerva Obstet Gynecol. 2022; 74(5):419-433. DOI: 10.23736/S2724-606X.22.04915-6. View

12.

Liang J, Li M, Zhang L, Yang Y, Jin X, Zhang Q . Analysis of the microbiota composition in the genital tract of infertile patients with chronic endometritis or endometrial polyps. Front Cell Infect Microbiol. 2023; 13:1125640. PMC: 10240353. DOI: 10.3389/fcimb.2023.1125640. View

13.

Wang L, He L, Chen J, Wei S, Xu H, Luo M . HPV and vaginal microecological disorders in infertile women: a cross-sectional study in the Chinese population. Virol J. 2022; 19(1):137. PMC: 9406277. DOI: 10.1186/s12985-022-01869-0. View

14.

Wee B, Thomas M, Sweeney E, Frentiu F, Samios M, Ravel J . A retrospective pilot study to determine whether the reproductive tract microbiota differs between women with a history of infertility and fertile women. Aust N Z J Obstet Gynaecol. 2017; 58(3):341-348. DOI: 10.1111/ajo.12754. View

15.

Deshmukh H, Way S . Immunological Basis for Recurrent Fetal Loss and Pregnancy Complications. Annu Rev Pathol. 2018; 14:185-210. PMC: 6566855. DOI: 10.1146/annurev-pathmechdis-012418-012743. View

16.

Fei H, Hou J, Wu Z, Zhang L, Zhao H, Dong X . Plasma metabolomic profile and potential biomarkers for missed abortion. Biomed Chromatogr. 2016; 30(12):1942-1952. DOI: 10.1002/bmc.3770. View

17.

Nossa C, Oberdorf W, Yang L, Aas J, Paster B, DeSantis T . Design of 16S rRNA gene primers for 454 pyrosequencing of the human foregut microbiome. World J Gastroenterol. 2010; 16(33):4135-44. PMC: 2932916. DOI: 10.3748/wjg.v16.i33.4135. View

18.

Franasiak J, Werner M, Juneau C, Tao X, Landis J, Zhan Y . Endometrial microbiome at the time of embryo transfer: next-generation sequencing of the 16S ribosomal subunit. J Assist Reprod Genet. 2015; 33(1):129-36. PMC: 4717132. DOI: 10.1007/s10815-015-0614-z. View

19.

Moreno I, Codoner F, Vilella F, Valbuena D, Martinez-Blanch J, Jimenez-Almazan J . Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016; 215(6):684-703. DOI: 10.1016/j.ajog.2016.09.075. View

20.

Medina-Bastidas D, Camacho-Arroyo I, Garcia-Gomez E . Current findings in endometrial microbiome: impact on uterine diseases. Reproduction. 2022; 163(5):R81-R96. DOI: 10.1530/REP-21-0120. View