Debate 6: Microbiome Testing is Indicated for Implantation Failure in 2023
Authors: Hull Mary Louise , Li Rong 
Published: January 2024

Motion: For

Uninvestigated Recurrent Implantation Failure (RIF) has a significant cost, can waste embryos with the potential for life and leads to empirical therapies such as the use of steroids.

Chronic Endometritis (CE) is a known cause of RIF is diagnosed by presence of plasma cells and worsens if steroids suppress the protective immune system response. Identifying plasma cells in endometrial tissue samples requires histological expertise, special staining and there is variation in numbers between tissue sections and microscope fields. Furthermore, culturing bacteria from low biomass environments like the endometrium is difficult and will not identify anaerobes and other fastidious organisms.

The molecular technique of sequencing the 16S ribosome enables the identification of microbes that can create a hostile environment for embryos. There is clear evidence that some microbes and microbiome signatures are associated with RIF and that changing the microbiome is associated with higher implantation rates. There are established and emerging treatments for an aberrant microbiome that include antibiotic therapy, probiotics, faecal transplantation, and curettage.

The more diagnostic information we can obtain to determine the cause of our patients RIF and then design specific, targeted treatments that are effective, the better their pregnancy outcomes will be.

It is useful to test the microbiome and will only become more useful as this technology improves.

Motion: Against

The microbiome is closely related to women’s reproductive health, and therefore microbiome testing is becoming increasingly important in the field of reproductive medicine, especially in guiding assisted reproduction treatments such as infertility. The human microbiome is a collection of all microorganisms that exist on or within human tissues and fluids, as well as the corresponding anatomical sites where they are located, including the female reproductive tract, gastrointestinal tract, skin, semen, saliva, oral mucous membranes, etc., of which the ones that are most relevant to the study of female infertility mainly include the female reproductive tract flora and gastrointestinal tract flora.

Several studies have shown that the composition of the microbiota in the female reproductive tract may affect embryo implantation and pregnancy success. An imbalanced or dysbiased microbiome of the female reproductive tract flora may lead to inflammation, altered immune responses, and hinder the optimal conditions needed for successful embryo implantation. Microbiome Testing can be accomplished through a variety of technologies, such as next-generation sequencing, which allows for a comprehensive analysis of microbial composition. Thus, microbiome testing that involves analyzing the microbial community in the female reproductive tract for imbalance or dysbiosis is a breakthrough point with great potential to aid in the treatment of recurrent implantation failure.

For recurrent implantation failures, microbiome testing can help fertility specialists tailor a personalized treatment plan. By understanding an individual’s specific microbial profile, physicians can make informed decisions about potential interventions such as antibiotic therapy, probiotics, or other microbial modulation therapies. Of course, the use of microbiome testing should be carefully considered on a case-by-case basis and should be used in conjunction with other diagnostic tools and assessments to provide optimal treatment for patients with implantation failure.