Bacterial Vaginosis: An Underestimated Cause of Unexplained Infertility

Bacterial Vaginosis (BV) characterized by symptoms of vaginal malodor and slightly too moderately increased white discharge, which appears homogeneous, with low viscosity and smoothly coats vaginal mucosa. The vaginal fluid of women with bacterial vaginosis is characterized by markedly increase prevalence and concentration of G. vaginalis, Mycoplasma hominis and several anaerobic bacteria's. The normal acidic lactobacilli is the constitute most of the normal vaginal flora and help to protect against certain cervical and vaginal infections. L. gasseri, L crispatus produce large amounts of H2O2 and inhibits the growth of G. vaginalis while L. rhamnosus increases colonization of lactobacilli and decreases the recurrence of BV. Studies have reported a high prevalence of BV in both non-tubal and unexplained infertility. The most common oral treatment for BV in both pregnant and non-pregnant women is metronidazole. Therapy with metronidazole or clindamycin alters the vaginal flora and predisposes the patient to development of vaginal candidiasis. Recurrence rate of BV remains high with use of antimicrobials and such treatments are not designed to restore the lactobacilli. Antimicrobial drug resistance remains a root cause for BV recurrence. Probiotic supplementation as part of a broader lifestyle intervention aimed at improving fertility as the potential for side effects is nearly nonexistent, and there are reasons to think that it could be helpful.