الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infertility is a complex medical condition that significantly impacts couples, both emotionally and financially. ART have been utilized worldwide to reduce the rate of infertility. Despite the improvements in ART, the success rates of conceiving remain relatively low. The main factor that hinders the success of IVF-ET is the failure of embryo implantation even when satisfactory analysis of embryo morphology and appropriate evaluation of endometrial characteristics are conducted. This suggests that there are additional factors that can disrupt the process of ICSI embryo implantation. The genital infections are among the many potential reasons that can contribute to unsuccessful implantation after ICSI.
The present study aimed to:
1) Identify the bacterial cervical microorganisms in the asymptomatic women undergoing ICSI at the time of the ET.
2) Investigate whether the presence of these cervical microorganisms alters the outcome of ICSI.
The study was conducted over a period of 9 months from June 2021 through February 2022. It included 220 infertile women attending a private center of in-vitro fertilization in Alexandria. They were subjected to a process of embryo transfer as a part of their IVF-ICSI treatment. They had no clinical manifestations suggestive of vaginitis or cervicitis.
Standard bacteriological culture methods were employed to identify and detect potential genital pathogens. RT- PCR was used to specifically identify and detect U. urealyticum and M. hominis in the collected samples. Two weeks after the ET, a pregnancy test was conducted to classify the participants into two groups: ICSI-positive and ICSI-negative.
The results of the present study revealed that:
1. An overall ICSI success rate of 60.9%, with 134 women achieving pregnancy following successful implantation.
2. The mean age of women in the ICSI-positive group was 28.2 years compared to 30.8 years in the ICSI-negative group. The difference in the mean age between the two groups was statistically significant.
3. Each additional year of age was associated with 1.1 to 1.16 times higher risk of ICSI failure after controlling infections and embryo grade.
4. The infection rate was lower in the ICSI positive group (82.1%) compared to the ICSI negative group (90.7%), but this difference was not statistically significant.
5. Embryo grade A represented 98.5% and 93.0% among the ICSI positive and negative groups, respectively with no statistically significance.
6. The prevalence of lactobacilli colonization was significantly higher in non-infected (78%) than in infected cases (35%)
7. The Lactobacilli spp. was more prevalent in the ICSI positive group (43.3%) than the ICSI negative group (37.2%) without statistical significance.
8. Most of the studied participants (85%) were infected with at least one bacterial organism (excluding lactobacilli).
9. The most common pathogenic bacterial organisms observed were M. hominis, U. urealyticum., Klebsiella spp., and Enterococci spp., with prevalence rates of 44.5%, 41.2%, 40.9%, 25.0%, and 21.4%, respectively, these organisms were more prevalent in the ICSI negative group than the ICSI positive group but none of them reached statistical significance.
10. Initial simple logistic regression revealed significant associations of Enterococci spp. and U. urealyticum. with higher risk for ICSI failure (OR: 12, p = .049 and OR: 4.5, p = .049, respectively). In adjusted models, none of the individual bacterial species showed increased risk for ICSI failure . Notably, Enterococci spp. and/or M. hominis and/or U. urealyticum were linked to lower ICSI success rates.
11. The group composed of Enterococci spp. and/or U. urealyticum. alone showed a significantly lower ICSI success rate (52.1%) compared to non-infected participants (75%). The Infection with these organisms showed significant increased risk (2.79 times) of ICSI failure compared to non-infected participants.
12. The group composed of Enterococci spp. and/or M. hominis and/or U. urealyticum showed a significantly lower ICSI success rate (54.7%) compared to non-infected participants (75%). Participants with combined infection with these organisms had 2.6 times higher likelihood of ICSI failure compared to non-infected participants.
13. The sequential substitution of one of the three organisms in the main group by one of the remaining organisms showed no significant results.
14. The sequential addition of one of those remaining organisms to the combination of the group of Enterococci spp. and/or M. hominis and/or U. urealyticum had no increased risk for ICSI failure. None of the combinations had a higher AOR than the combination made up of Enterococci spp. and/or M. hominis and/or U. urealyticum suggesting that their effects were mainly attributed to that group.
It can be concluded from the present study that:
1) There was a significant association between increasing age and ICSI failure.
2) The infection rate was lower in the ICSI positive group compared to the ICSI negative group but this difference was not statistically significant .
3) The prevalence of Lactobacilli spp. colonization was significantly higher in non-infected than in infected cases.
4) The Lactobacilli spp. was more prevalent in the ICSI positive group than the ICSI negative group.
5) No significant effect for each bacterial species alone was detected on ICSI failure.
6) Three organisms were associated with the least ICSI success rates (Enterococci spp. and/or M. hominis and/or U. urealyticum.)
7) The group composed of Enterococci spp. and/or U. urealyticum alone showed a significantly lower ICSI success rate compared to non-infected participants.
8) Infection with Enterococci spp. and/or U. urealyticum was significantly associated with 2.79 times the likelihood of ICSI failure in non-infected participants.
9) Participants with combined infection with Enterococci spp. and/or M. hominis and/or U. urealyticum had 2.6 times higher likelihood of ICSI failure compared to non-infected participants.
10) The sequential substitution of any one of the three organisms within the main group with one of the remaining organisms yielded insignificant outcomes.
11) Addition of one of the remaining organisms to the combination comprising Enterococci spp. and/or M. hominis and/or U. urealyticum did not exhibit a higher risk of ICSI failure.
from the results of the present study, the following recommendations are suggested:
• Collaboration between clinical microbiologists, infectious disease specialists, and reproductive medicine experts is recommended to establish standardized protocols for the microbiological testing and management in infertility cases before ART procedures.
• Screening for genital organisms, particularly Enterococci spp., M. hominis, U. urealyticum prior to undergoing ICSI, followed by proper management is recommended.
• Further studies with a larger sample size are recommended to assess the effect of sole infection with each bacterial species on ICSI failure.