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PLoS One. 2018 Jan 9;13(1):e0191047. doi: 10.1371/journal.pone.0191047. eCollection 2018.

Microbiota-based analysis reveals specific bacterial traits and a novel strategy for the diagnosis of infectious infertility.

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Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Schleswig-Holstein, Germany.
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany.
Department of Obstetrics and Gynecology, University Hospital Mannheim, Mannheim, Baden-Wuertemberg, Germany.
Berlin Department of Public Health, Center for Sexual Health, Berlin, Berlin, Germany.
Max Planck Institute for Evolutionary Biology, Ploen, Schleswig-Holstein, Germany.
Outpatient Medical Care for Gynecology, Luebeck, Schleswig-Holstein, Germany.
Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Luebeck, Schleswig-Holstein, Germany.
Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Schleswig-Holstein, Germany.
Institute for Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Schleswig-Holstein, Germany.


Tubal factor infertility (TFI) accounts for more than 30% of the cases of female infertility and mostly resides from an inflammatory process triggered by an infection. Clinical appearances largely differ, and very often infections are not recognized or remain completely asymptomatic over time. Here, we characterized the microbial pattern in females diagnosed with infectious infertility (ININF) in comparison to females with non-infectious infertility (nININF), female sex workers (FSW) and healthy controls (fertile). Females diagnosed with infectious infertility differed significantly in the seroprevalence of IgG antibodies against the C. trachomatis proteins MOMP, OMP2, CPAF and HSP60 when compared to fertile females. Microbiota analysis using 16S amplicon sequencing of cervical swabs revealed significant differences between ININF and fertile controls in the relative read count of Gardnerella (10.08% vs. 5.43%). Alpha diversity varies among groups, which are characterized by community state types including Lactobacillus-dominated communities in fertile females, an increase in diversity in all the other groups and Gardnerella-dominated communities occurring more often in ININF. While all single parameters did not allow predicting infections as the cause of infertility, including C. trachomatis IgG/IgA status together with 16S rRNA gene analysis of the ten most frequent taxa a total of 93.8% of the females were correctly classified. Further studies are needed to unravel the impact of the cervical microbiota in the pathogenesis of infectious infertility and its potential for identifying females at risk earlier in life.

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