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A NON-LACTOBACILLUS DOMINATED ENDOMETRIAL MICROBIOTA LOWERS IMPLANTATION AND PREGNANCY RATES
Vaginal microbiota (VMB) composition is dominated by Lactobacillus which represents 90-95% of vaginal bacteria. The four most abundant species detected in vaginal tract are Lactobacillus crispatus, Lactobacillus iners, Lactobacillus jensenii and Lactobacillus gasseri .
The importance of Lactobacillus specifically Lactobacillus crispatus is linked to its ability to synthesize lactic acid (2-Hydroxypropanoic acid) by anaerobic fermentation, produced from vaginal epithelial cells. Estradiol (E2) controls lactic acid production that contributes to the vaginal environment acidification (pH ≈3.0-4.6), suitable for Lactobacillus bacteria harboring, and enabling them to grow, multiply, and dominate the cervico-vaginal niche.
In addition, lactic acid is considered a healthy VMB marker, due to its mild-acid pH shift, which makes cervico-vaginal environment unsuitable for pathogenic colonization. Lactobacillus bacteria, through lactic acid production, are able to up-regulate the autophagy process through cyclic adenosine monophosphate (cAMP) inhibition, promoting pathogen bacteria clearing.
In order to kill other bacteria and to prevent vaginal colonization by pathogenic species, Lactobacillus crispatus synthesize hydrogen peroxide (H202) and bacteriocins proteins, contributing to maintaining a healthy genitourinary status.
