Effective of metronidazole to bacterial flora in vagina and the impact of microbes on live birth rate during intracytoplasmic sperm injection (ICSI)

Purpose The aim of this study was to investigate the impact of bacterial vaginal flora on life-birth rate during ICSI and influence of metronidazole as antibiotic treatment course before ICSI. Method We enrolled 71 women who were undergoing ICSI. At embryo transfer (ET), all of the women had quantitative vaginal culture, ET catheter-tip culture, and vaginal Gram stain scored for bacterial vaginosis. Results The overall live birth rate (LBR) was 36.6% (26/71), and the rate of early pregnancy loss was 13% (4/30). In women with bacterial vaginosis, intermediate flora and normal flora, the conception rates were 35% (9/26), 42% (14/33) and 58% (7/12), respectively ( p = 0.06 for trend). Metronidazole effect to bacterial flora in vaginal. The predominant species isolated from the tip of the embryo transfer catheter in negative pregnancy was Staphylococcus epidermidis (7 vs. 15.2%), and Streptococcus viridians (11 vs. 24%). Conclusions Woman with bacterial vaginosis and with a decreased vaginal concentration of hydrogen peroxide-producing lactobacilli may have decreased conception rates and increased rates of failed pregnancy. A larger prospective treatment trial designed to evaluate the impact on ICSI outcomes of optimizing the vaginal flora prior to ICSI may be warranted.