The stability of lower genital tract (LGT) microbiota correlates with reproductive system function and in vitro fertilization and frozen embryo transfer outcomes in women with polycystic ovarian syndrome

Abstract

We previously found that the lower genital tract (LGT) microbiota of polycystic ovarian syndrome (PCOS) women has altered when compared to healthy reproductive-aged women, however whether this alternation will have an impact on the reproductive system function and outcomes of PCOS patients have not yet been identified. Between 2018 and 2021, we totally enrolled 191 reproductive-aged women in three independent case-control studies. Firstly, we analyzed the correlation between LGT flora and clinical indexes of 97 women (containing 47 PCOS patients and 50 control reproductive-aged women), canonical correspondence analysis (CCA) showed that LH/FSH ratio was the most relevant factor that was related to the dominant genera in women with PCOS (r2=0.233, p=0.001), and menstrual cycle frequency was also strongly related to the LGT organisms (r2=0.116, p=0.005). Next, through analysis of 72 PCOS patients who were underwent IVF-FET therapy, the FET outcome in PNB group(PCOS with relative abundance of Lactobacillus ≥50%, n=57) was significant better than PDB group(PCOS patients with relative abundance of Lactobacillus<50%, n=15). Further, we randomly selected nine reproductive-aged PCOS patients (approximately half of them had altered LGT microbiota: Lactobacillus spp. ≤50%, n=5) and simultaneously collected both LGT swabs and cervical epithelial cells from them. By synchronization analysis of RNA sequencing of the cervical epithelial cells and 16S rRNA sequencing of the microbes, we found that the gene expression profiles of the cells significantly differed between the PDB (PCOS patients with relative abundance of Lactobacillus<50%, n=4) and PNB (PCOS with relative abundance of Lactobacillus ≥50%, n=5) groups.