The Prevalence of Bacterial Vaginosis among Infertile Iraqi Women and Subsequent ICSI outcome


  • Saja F. Faisal High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq
  • Wasan A. Abdul Hameed High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq
  • Sarab H. Abdulhussain The High Institute for Infertility Diagnosis and Assisted Reproductive Technologies
  • Estabraq Alwasiti Department of Biochemistry, College of Medicine, Al Nahrain University, Baghdad, Iraq



Bacterial vaginosis, Vaginal microbiota, Gardnerella vaginalis, ICSI


The vaginal microbial makeup has a substantial impact on women's health.
The typical vaginal microbial profile in healthy women of reproductive age
comprises aerobic, facultatively anaerobic, as well as obligately anaerobic
organisms. However, the optimal vaginal microbiota is dominated by
lactobacilli and is thought to defend against pathogenic microbial colonization
and infection by producing lactic acid, antimicrobial metabolites, and
lowering immune system activation. Recent research has come up with the
term "molecular bacterial vaginosis (BV)" to describe non-optimal vaginal
microbiota that is low in Lactobacillus species (spp.) and has a lot of
facultative and absolute anaerobic bacteria specifically Gardnerella vaginalis.
In the context of IVF, BV has been linked to infertility. The study comprised
forty-six women to explore the vaginal and follicular microbiota of
asymptomatic infertile Iraqi women starting an ICSI trial. At the time of ova
pick-up, a high vaginal swab and follicular fluid were acquired from each
instance for DNA extraction to test for the presence of microorganisms by the
use of a real-time PCR special commercial kit. In conclusion, molecular
technologies have offered a more thorough view into the vaginal microbiota,
which may explain why vaginal dysbiosis shifts during the ICSI-ET
treatment. Even though the majority of women have no clinically visible
infection, the fact is that they have an aberrant vaginal micro-ecology profile.
Nevertheless, isolating microorganisms from follicular fluid did not reduce
the likelihood of fertilization or the pregnancy rate during ICSI cycles.


Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021; 224(3):251–7. DOI: 10.1016/j.ajog.2020.10.019.

Sherrard J, Wilson J, Donders G, Mendling W, Jensen JS. European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. International Journal of STD & AIDS. 2018 Nov; 29(13):1258-72. DOI: 10.1177/0956462418785451.

Muzny CA, Taylor CM, Swords WE, Tamhane A, Chattopadhyay D, Cerca N, et al. An Updated Conceptual Model on the Pathogenesis of Bacterial Vaginosis. J Infect Dis. 2019; 220(9):1399–405. DOI: 10.1093/infdis/jiz342.

Kunze AN, Larsen B. Current Concepts of Gardnerella vaginalis Biofilm: Significance in Bacterial Vaginosis. Open Journal of Obstetrics and Gynecology. 2019 Dec 18; 9(12):1569. DOI: 10.4236/ojog.2019.912153.

Aldunate M, Srbinovski D, Hearps AC, Latham CF, Ramsland PA, Gugasyan R, Cone RA, Tachedjian G. Antimicrobial and immune-modulatory effects of lactic acid and short-chain fatty acids produced by vaginal microbiota associated with eubiosis and bacterial vaginosis. Frontiers in physiology. 2015 Jun 2; 6:164. DOI: 10.3389/fphys.2015.00164.

Gupta, S., Kakkar, V., and Bhushan, I. Crosstalk between the vaginal microbiome and female health: a review. Microb. Pathog. 2019; 136:103696. DOI: 10.1016/j.micpath.2019.103696.

Beebout CJ, Eberly AR, Werby SH, et al. Respiratory heterogeneity shapes biofilm formation and host colonization in uropathogenic Escherichia coli. MBio 2019; 10. DOI: 10.1128/mBio.02400-18.

Muzny CA, Lensing SY, Aaron KJ, Schwebke JR. The incubation period and risk factors support the sexual transmission of bacterial vaginosis in women who have sex with women. Sexually transmitted infections. 2019 Nov 1; 95(7):511-5. DOI: 10.1136/sextrans-2018-053824.

McKinnon LR, Achilles SL, Bradshaw CS, Burgener A, Crucitti T, Fredricks DN, et al. The Evolving Facets of Bacterial Vaginosis: Implications for HIV Transmission. AIDS Res Hum Retroviruses. 2019; 35(3):219–28. DOI: 10.1089/AID.2018.0304.

Haahr T, Humaidan P, Elbaek HO, Alsbjerg B, Laursen RJ, Rygaard K, Johannesen TB, Andersen PS, Ng KL, Jensen JS. Vaginal microbiota and in vitro fertilization outcomes: development of a simple diagnostic tool to predict patients at risk of a poor reproductive outcome. The Journal of Infectious Diseases. 2019 May 5; 219(11):1809-17. DOI: 10.1093/infdis/jiy744.

Skafte-Holm A, Humaidan P, Bernabeu A, Lledo B, Jensen JS, Haahr T. The association between vaginal dysbiosis and reproductive outcomes in sub-fertile women undergoing IVF-treatment: a systematic PRISMA review and meta-analysis. Pathogens. 2021 Mar; 10(3):295.

Haahr T, Freiesleben NC, Pinborg A, Nielsen HS, Hartvig V, Mikkelsen AL, Parks T, Uldbjerg N, Jensen JS, Humaidan P. Effect of clindamycin and a live biotherapeutic on the reproductive outcomes of IVF patients with abnormal vaginal microbiota: protocol for a double-blind, placebo-controlled multicentre trial. BMJ Open. 2020 Oct 13; 10(10):e035866. DOI: 10.1136/bmjopen-2019-035866.

Li, M. et al. ‘Presence of Chlamydia trachomatis and Mycoplasma spp., but not Neisseria gonorrhoeae and Treponema pallidum, in women undergoing an infertility evaluation: high prevalence of tetracycline resistance gene tet(M)’, AMB Express. 2017; 7(1). DOI: 10.1186/s13568-017-0510-2.

Muzny, C. A. and Schwebke, J. R. (2021) ‘Asymptomatic Bacterial Vaginosis: To Treat or Not to Treat? ’, ‘HHS Public Access ’, 22(12), pp. 1–15.

Verwijs MC, Agaba SK, Darby AC, van de Wijgert JH. Impact of oral metronidazole treatment on the vaginal microbiota and correlates of treatment failure. American journal of obstetrics and gynecology. 2020 Feb 1; 222(2):157-e1. DOI: 10.1016/j.ajog.2019.08.008.

Usman, S. F. et al. ‘The presence of microorganisms in follicular fluid and its effect on the outcome of in vitro fertilization-embryo transfer (IVF-ET) treatment cycles’, PLoS ONE. 2021; 16 (2 February), pp. 1–13. DOI: 10.1371/journal.pone.0246644.



How to Cite

Faisal SF, Abdul Hameed WA, Abdulhussain SH, Alwasiti E. The Prevalence of Bacterial Vaginosis among Infertile Iraqi Women and Subsequent ICSI outcome. IJEIR [Internet]. 2023 Nov. 8 [cited 2024 Apr. 20];13(2):63-77. Available from: