Laparoscopic and bacteriologic evidence of bacterial vaginosis in unexplained infertility

Abstract

Background: Aim of current study was to estimate the prevalence of Bacterial Vaginosis (BV) among women with Unexplained Infertility (UI) and to describe laparoscopic appearances in positive cases. Methods: Design: Prospective randomized comparative diagnostic trial. Setting: Tertiary care referral facility and University hospital. Patients: One hundred and fifty women divided into UI study group A (120 cases) and a control group B (30 cases). Intervention(s): Vaginal and endouterine swabs form two subgroups of the UI group (60 cases each) and vaginal swabs from control group (30 cases). All swabs were tested using Amsel's criteria then cultured. Thereafter, UI group (60 cases) was subjected to diagnostic laparoscopy. Main outcome measure(s): the prevalence of BV among women with UI and laparoscopic findings among positive cases. Results: In the study group, the number of positive cases of BV confirmed by culture was 51 cases (42.5%) while it was diagnosed in three cases (10%) in group B (P = 0.0001). In group A, BV was diagnosed in 24 and 27 infertile cases with periods of infertility less than and more than 3 years respectively and in 39 patients (32.5%) with recurrent vaginitis without statistically significant difference. There was an insignificant difference in diagnosis of BV whether the site of sample was the posterior fornix of the vagina or the endometrial cavity. Positive laparoscopic findings were reported in 77 patients (64.2%). The most common laparoscopic abnormalities were hyperemic uterus and chronic salpingitis. Conclusions: BV is frequently implicated in female infertility and it is probably an underestimated cause of UI. There is no extra benefit from using culture instead of Amsel's criteria for the diagnosis of BV. No difference in the site of sample taking in diagnosis of BV from posterior vaginal fornix or endometrial cavity. Laparoscopy is very beneficial in explaining the effect of BV on the upper genital tract. Keywords: Bacterial vaginosis (BV), Laparoscopy, Unexplained infertility