Comparison of Vaginal Microbiome in Fertile Women Versus Those With Infertility at Kenyatta National Hospital: (a Comparative Cross-sectional Study)

Abstract

Background: The desire to have children is powerful & widespread but for a sizable population it is not easily fulfilled. Infertility concerns are rising globally, the average infertility rate worldwide is about 10% of the population. The current fertility rate is 3.416 births per woman which is a 1.5% decline from 2019. Approximately 4.2m Kenyans have infertility. Vaginal health may be an overall reflection of reproductive health. The composition of vaginal microbiome is thought to influence fertility and outcomes of fertility treatment. Previous studies defining the vaginal microbiome show Lactobacillus spp. Dominance and disruption in this or any vaginal dysbiosis has shown increased prevalence of bacterial vaginosis which has been found predominantly in the infertile population. Previously used culture and PCR techniques are not as comprehensive and detailed as novel metagenomic tests. With the use of NGS it is possible to encompass an entire microbial community and define the genome. By studying the vaginal microbiome, we hope to achieve a deeper understanding of its mechanics in infertility and implement protocols that help improve fertility and pregnancy outcomes. Aim: To identify and compare the vaginal microbiome in fertile women versus those with infertility. Method: It will be a comparative cross-sectional study done at the KNH, in women of age group 25-37. A high vaginal swab was taken from a group of well women attending Family Planning clinic at KNH compared with another group of women attending infertility clinic at the same hospital. DNA extraction was done from the HVS samples and subsequently 16s rRNA sequencing using PCR and illumina miseq protocols was conducted. Analysis was done using QIIME. Vaginal Ph was also obtained using ph strips and compared in the two groups then analysed using the chi square test. Questionnaries were also used for a subanalysis of sociodemographic factors that may affect the microbiome in the two groups which were analysed using students t-test Results: The Vaginal Microbiome in the two populations was dominantly L.iners (CST 3) and CST4. The relative abundance of CST3 was higher in the fertile group(62) compared to the infertile group(57) however the difference was not statistically significant. P value(0.73) A higher relative abundance of non Lactobacillus dominant CST 4 was seen in infertile group versus fertile yet difference was not significant. (P value-0.62) The Overall distribution of the community state types between the two groups was not statistically significant Conclusion: This study confirms the microbial pattern of the black population as CST 3 & CST4 dominant. Although the difference is not statistically significant it is important to note the relative abundance of lactobacillus spp. was higher in the fertile group & non lactobacillus dysbiosis pattern was higher in the infertile group.