Microbial colonization of human follicular fluid and adverse outcome on in vitro fertilization cases in Kamal al-Samarrai ' s Hospital for fertility and In vitro fertilization treatment in Baghdad , Iraq 2016 * lnas

Background: There are various assisted reproductive technologies such as in vitro fertilization for treatment of infertility, So IVF culture system is not a sterile system. Not only is the environment we work in full of bacteria, fungi and viruses, but our patient’s bodies (follicular aspirates, semen and the vaginal and cervical regions for egg retrieval and embryo transfer) also contain microbes, this can lead to adverse pregnancy outcome after IVF. Objectives: To demonstrated differences in women with colonized and contaminated follicular fluid and estimate the prevalence of the possible risk factors for developing microbial colonization of the follicular fluid. Methodology: A cross sectional study was conducted during the period from 1 st of June 2015 to 30 th of March 2016 in Kamal al-Samarrai's Hospital for fertility and IVF treatment in the Baghdad city. A purposive sampling technique was used to collect data, there were 106 women underwent in vitro fertilization that were consented and interviewed directly, using a questionnaire form prepared for the study as well as reviewing their medical records. From each woman who underwent in vitro fertilization and had a pregnancy test positive, two samples (High vaginal swab and Follicular fluid sample)were collected at the time of oocyte retrieval and sent to the hospital laboratory for culture, then the patients had been followed by phone or when they come to outpatient clinic at the end of their first trimester, for 1 st trimester outcome to identify if the female is still pregnant or had abortion. A descriptive statistics (frequency and percentages tables, pie and bar charts) and inferential statistics (A chi square or Fisher Exact test and T test) were used for data analysis. Results: A total of 106 studied pregnant women underwent in vitro fertilization, 57(54%) women got abortion at their first trimester; women who had colonized follicular fluid 95.2% got abortion at their 1 st trimester. There was a significant association between follicular fluid colonization and residence, secondary infertility. First trimester abortion, tend to occur more in women who live in rural areas, who had history of secondary infertility, women who underwent ovulation induction. The most common cause of infertility was endometriosis 34.9%followed by PCOS 27.3%, genital tract infection 25.4%, male factor 7.5%, idiopathic 4.7%. Culture analyses revealed that cultivable bacterial species were present in 21(45.7%)of follicular fluids tested, Lactobacillus and staphylococcus comprised 8(38.1%) respectively; other bacteria comprised 44.4%, 4.8% which include streptococcus, Actinomyces respectively. No single species tend to be associated more with first trimester abortion. Conclusions : The women who had colonized follicular fluid tend to get abortion at their first trimester more than women whose follicular fluid categorized as contaminated. No single species of bacteria tend to associated more with first trimester abortion. Women may benefit from microbial screening of vaginal swabs prior to IVF cycle, to detect microorganisms or by culturing the follicular fluid collected at the time of transvaginal oocyte retrieval for the presence of microorganisms. Treatment with antimicrobials may increase IVF treatment success. Keys words: Fertility, Follicular Fluid, In Vitro Fertilization, Microbial Colonization, Outcome -------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 07-05-2018 Date of acceptance: 22-05-2018 ------------------------------------------------------------------------------------------------------------------------------------Microbial colonization of human follicular fluid and adverse outcome on in vitro fertilization cases . DOI: 10.9790/0853-1705098087 www.iosrjournals. org 81 | Page