Cultivable vaginal Lactobacillus is not associated with fecundability in Kenyan women attempting to conceive

• Published in: Fertility and sterility Vol. 117; no. 3; pp. 603 - 611
• Main Authors: Lokken, Erica M., Jisuvei, Clayton, Hughes, James P., Mandaliya, Kishor, Manhart, Lisa E., Mwinyikai, Khamis, Muller, Charles H., Jaoko, Walter, Kinuthia, John, McClelland, R. Scott
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: Adult; Cohort Studies; fecundability; Female; fertility; Fertility - physiology; Fertilization - physiology; Humans; Kenya - epidemiology; Lactobacillus; Lactobacillus - isolation & purification; Middle Aged; preconception; Preconception Care - methods; Preconception Care - trends; Pregnancy; Prospective Studies; Time-to-Pregnancy - physiology; Vagina - microbiology; vaginal microbiota; Young Adult; Kenya; fecundability; vaginal microbiota; preconception; fertility; Lactobacillus
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2021.11.032

To examine the association between cultivable vaginal Lactobacillus and fecundability in Kenyan women attempting nonmedically assisted conception. Prospective preconception cohort. Nairobi and Mombasa, Kenya. Women trying to conceive who reported ≤3 months of pre-enrollment conception attempt time. Cultivable Lactobacillus (primary), Lactobacillus morphotypes on Gram stain (secondary). Participants reported the first day of their last menstrual period and recent sexual behavior, underwent pregnancy testing, and provided vaginal specimen samples for Lactobacillus culture and Gram stain at ≤6 monthly preconception visits. The outcome was fecundability—the per-menstrual cycle probability of pregnancy. Associations between cultivable Lactobacillus and Lactobacillus morphotypes on Gram stain at the visit before each pregnancy test and fecundability were estimated using proportional probabilities models to generate fecundability ratios (FRs). A total of 458 women contributed 1,376 menstrual cycles. At enrollment, 65.3% (n = 299) of participants had cultivable Lactobacillus, 47.4% (n = 217) had cultivable hydrogen peroxide producing Lactobacillus, and 64.6% (n = 296) had Lactobacillus detected on Gram stain. In unadjusted analysis, there was no association between cultivable Lactobacillus at the prior visit and fecundability (FR, 0.92; 95% CI, 0.73–1.16); results were similar after adjustment for age, frequency of condomless sex, and study site (adjusted FR, 0.92; 95% CI, 0.72–1.18). Lactobacillus on Gram stain at the visit prior was associated with modestly higher fecundability (adjusted FR, 1.18; 95% CI, 0.92–1.51). Cultivable Lactobacillus was not associated with fecundability, although Lactobacillus morphotypes detected on Gram stain were somewhat associated with increased fecundability. The relationship between vaginal Lactobacillus and fecundity may be species-specific. Lactobacillus vaginales cultivables no están asociados a fecundidad en mujeres de Kenia intentando concebir. Examinar la asociación entre lactobacillus vaginales cultivables y la fecundidad en mujeres de Kenia intentando concebir sin asistencia médica. cohorte prospectiva preconcepcional. Nairobi y Mombasa, Kenia. mujeres tratando de concebir que reportaron ≤ 3 meses de pre-enrolamiento intentando concebir. Lactobacillus cultivables (primario), morfotipos de Lactobacillus bajo tinción de Gram (secundario). Participantes reportaron el primer día del último ciclo menstrual y su reciente conducta sexual, realización de test de embarazo, y proveyeron muestras vaginales para cultivo de especímenes de lactobacillus y tinción de Gram en ≤ 6 visitas preconcepcionales mensuales. El resultado fue la fecundidad: la probabilidad de embarazo por ciclo menstrual. Asociaciones entre Lactobacillus cultivables y morfotipos de lactobacillus bajo la tinción de Gram en la visita previa a cada test de embarazo y fecundidad fueron estimados usando modelos de probabilidades proporcionales para generar tasas de fecundidad (FR). Un total de 458 mujeres contribuyeron a 1,376 ciclos menstruales. En el enrolamiento, 65.3% (n ¼ 299) de los participantes tuvieron Lactobacillus cultivables, 47.4% (n ¼ 217) tuvieron Lactobacillus cultivables productores de hidrogeno peroxidasa, y 64.6% (n ¼ 296) tuvieron detección de Lactobacillus con tinción de Gram. En análisis no ajustados, no hubo asociación entre Lactobacillus cultivables en la visita previa y la fecundidad (FR 0.92; 95% CI, 0.73-1.16); los resultados fueron similares después de ajustar por edad, frecuencia de sexo sin preservativo, y sitio de estudio (tasa ajustada de FR, 0.92; 95 % CI, 0.72- 1.18). Lactobacillus en la tinción de Gram en la visita previa fueron asociados con una fecundidad modestamente más alta (tasa ajustada FR, 1.18; 95% CI 0.92-1.51). Lactobacillus cultivables no fueron asociados con fecundidad, sin embargo, morfotipos de Lactobacillus detectados bajo tinción de Gram fueron de alguna manera asociados con incrementos de la fecundidad. La relación entre Lactobacillus vaginales y fecundidad podría ser especie específica.