The Effect of Intrauterine Candida Colonization on Pregnancy Outcome Following Intra-cytoplasmic Sperm Injection (ICSI)

Abstract

Background: Infertility is caused by numerous anatomical and hormonal factors; however, the role of ascending colonization from vaginal microbiota in infertility is not properly addressed. C.albicans, the most common yeast retrieved from vagina is associated with 61.53% cases of infertility while C.species is associated with 38.46%1. Intrauterine Candida colonization and its effect on ICSI are still under study and need to be explored further. Objective: This work aims is to detect the effect of Candida colonization of the uterus in patients undergoing ICSI cycle and clinical pregnancy rate. Methodology: Menstrual blood flow sample at day two induction cycles is subjected to culture and identification of growing organisms. Growth and identification was correlated to Success of ICSI. Predetermined criteria were set up for selection of patients. Results: 69.2% of females with positive growth had failed the ICSI trial with p value 0.04, while 94.4% of patients with no culture growth had successful ICSI with p value 0.0001. Samples with growth of mixed Candida species with bacterial isolates either gram positive and /or gram negative showed 100% failed trials. Samples showed pure growth of Candida albicans or Candida spp. had positive ICSI with p value <0.001. Conclusion: Pure Candida colonization does not seem to affect ICSI outcome; in contrary, mixed Candida with gram positive and/or negative colonization affect pregnancy rate negatively. This could be due to microbial interactions and increasing the ability of Candida to turn into the pathogenic state when mixed with other microorganisms. Screening of females and administration of antifungals and/or antibiotics before ICSI is recommended.