Harroula Mathiopoulou Bilali, BSc, MMedSc
Founder & CEO, Ferticeutics Co., Reproductive Biologist – Corporate Health & Wellness Coach, Ferticeutics Co.
Category:
Failed IVF Cycles
In my personal view, being an infertility specialist for more than 15 years now, I believe that we need to address all those factors, but many times instead of adding more tests, it’s probably better to simplify things a little bit.We start looking for all the factors that I mentioned above, but many times there are two main areas that we forget to consider. There is one new we should start considering more, and it has to do with stress. There is available data that supports the idea that preventing or decreasing maternal stressors may have a positive outcome on pregnancy. Also, ESHRE ( The European Society of Human Reproduction and Embryology) has released a new set of guidelines that included recommendations for lifestyle modifications for recurring pregnancy loss patients. Last but not least, in the last 10 years, the microbiome has become a very important factor in fertility and the success of an IVF procedure. The vaginal microbiome and the endometrial microbiome is often discussed. However, there is a new parameter that every IVF patient should consider checking before starting another IVF procedure, and it is the microbiome of the gut.
The human microbiome is composed of communities of bacteria, viruses and fungi that have greater complexity than the human genome itself. It has an estimated 100 trillion microbes, the bulk of which live in our gut. Large-scale metagenomic projects, such as The European Metagenomics of the Human Intestinal Tract and the Human Microbiome Project, have reported 3.3 million unique protein-encoding genes as compared with the entire human genome, which has around 23 000 genes. These studies have described the beneficial functions of the normal gut microbiota on health down to the genetic level.Why is the microbiome so significant? Why should we start considering it more when we’re talking about infertility or fertility as well?
It’s because the human microbiome has extensive functions such as development of immunity, defence against pathogens, host nutrition including production of short-chain fatty acids important in host energy metabolism, synthesis of vitamins and fat storage as well as an influence on human behaviour making it an essential organ of the body without which we could not function correctly.Since 2003, more and more data and there are many various clinical trials. Harroula shared four of the most interesting ones. It was concluded that not only there are some good microbes in the vagina, we know that the endometrium has its own microbiome as well.
In this study, it was demonstrated that women with Lactobacillus dominated endometrium undergoing IVF have been shown to achieve higher rates of successful implantation (60.7% vs. 23.1%) and life birth (58.8% vs. 6.75%) rates compared to those with non-Lactobacillus dominated endometrium(Gardnerella, Streptococcus and other organisms present).In 2003 and then in 2014, it was mentioned that:
Moreover, vaginal dysbiosis reduces the local defences against sexually transmitted pathogens, and ascension of pathogens up the fallopian tubes can affect reproductive health.A few months ago, Juan Garcia-Velasco et al.,2020 demonstrated that:
Lifestyle changes, especially those that affect nutrition, can lead to changes in the gastrointestinal microbiome and could have a positive impact in infertile patients.
Dysbiosis is defined by an imbalance in bacterial composition, changes in bacterial metabolic activities, or changes in bacterial distribution within the gut (or any other organ). The three types of dysbiosis are: 1. Loss of beneficial bacteria 2. Overgrowth of potentially pathogenic bacteria 3. Laws of overall bacterial diversity In most cases, these types of dysbiosis occur at the same time. Dysbiosis has been associated with diseases such as Inflammatory Bowel Disease (IBD), Obesity, Type 1 and Type 2 Diabetes, Autism, certain gastrointestinal cancers and infertility.It has been shown, in the patients whose endometrium was dominated by the beneficial microbes, it was these patients who had 58.8% versus 6.75% of live birth rate. Therefore, we all should start thinking very seriously about improving our microbiome before any IVF treatment. Another finding was released in 2014, which showed that the endometrial microbiome is very important for two reasons regarding implantation. The first has to do with the procedure of implantation itself and the environment that is created for the embryo to find the perfect environment for implantation and the pregnancy. Besides the perfect environment for the implantation to occur, there is also supporting data that states that a good microbiome, a healthy endometrial microbiome, can also alter the hormone levels such as estradiol and especially progesterone. We need to have a balanced progesterone profile for implantation and a successful pregnancy to occur. The microbiome affects fertility via nutrition and fertility via disease because it can promote inflammation, and it can also increase other increased susceptibility to other diseases that can also harm fertility itself.
In this issue’s, Views and Reviews’ we provide data to suggest that modern preconceptional care should become a key component of reproductive medicine, not only to improve implantation and pregnancy rates but also to reduce perinatal morbidity and mortality, further optimizing the health for mothers and children and setting the states for the child’s adult life.It’s the most crucial period, 3 months before another IVF to optimize everything, it is ‘the window of opportunity’ to improve your lifestyle, your microbiome, sleep patterns, to improve your exercise regime, and that will have a positive impact on fertility.
Disclaimer:
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