Objective

To examine the association between cultivable vaginal Lactobacillus and fecundability in Kenyan women attempting nonmedically assisted conception.

Design

Prospective preconception cohort.

Setting

Nairobi and Mombasa, Kenya.

Patient(s)

Women trying to conceive who reported ≤3 months of pre-enrollment conception attempt time.

Intervention(s)

Cultivable Lactobacillus (primary), Lactobacillus morphotypes on Gram stain (secondary).

Main Outcome Measure(s)

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).

Result(s)

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).

Conclusion(s)

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.

中文翻译：

---

可培养的阴道乳杆菌与试图怀孕的肯尼亚妇女的生育能力无关

客观的

旨在检查可培养的阴道乳杆菌与尝试非医学辅助受孕的肯尼亚妇女的生育能力之间的关联。

设计

前瞻性先入之见队列。

环境

肯尼亚内罗毕和蒙巴萨。

患者）

报告登记前受孕尝试时间≤3 个月的试图受孕的女性。

干预措施

可培养的乳杆菌（初级），革兰氏染色（次级）上的乳杆菌形态。

主要观察指标）

参与者报告了末次月经的第一天和最近的性行为，进行了妊娠试验，并在≤6个月的孕前访视中提供了阴道标本样本进行乳酸菌培养和革兰氏染色。结果是受孕能力——每个月经周期的怀孕概率。使用比例概率模型估计每次妊娠试验前就诊时革兰氏染色上可培养的乳酸杆菌和乳酸杆菌形态型之间的关联，并使用比例概率模型生成繁殖力比 (FRs)。

结果）

共有 458 名女性贡献了 1,376 个月经周期。在入组时，65.3%（n = 299）的参与者有可培养的乳杆菌，47.4%（n = 217）的参与者有可培养的产生过氧化氢的乳杆菌，64.6%（n = 296）的参与者在革兰氏染色中检测到乳杆菌。在未经调整的分析中，前次就诊时可培养的乳杆菌与繁殖力之间没有关联（FR，0.92；95% CI，0.73–1.16）；调整年龄、无安全套性行为频率和研究地点后，结果相似（调整后的 FR，0.92；95% CI，0.72–1.18）。之前访问时革兰氏染色的乳酸杆菌与适度较高的繁殖力相关（调整后的 FR，1.18；95% CI，0.92–1.51）。

结论

可培养的乳杆菌与生育能力无关，尽管在革兰氏染色法上检测到的乳杆菌形态与生育能力的增加有一定关联。阴道乳杆菌与生育力之间的关系可能具有物种特异性。