Anirban Das

Infertility is on rising leading to the number of increasing assisted reproductive technology treatments. Despite the advances, we have in assisted reproductive technology approximately still 8% to 12% of the individuals worldwide are willing to conceive but are unable to do so.  Fertility depends a lot on the receptive state of the endometrium and hormonal adaptation as well as the immune system and the molecular mechanisms underlying infertility are often unknown and this leads to a long diagnostic part and many parts ineffective therapies.  So today the challenges facing scientists are to recognize the hidden cause of infertility and to improve the efficiency and the efficacy of IVF techniques.

Local and systemic immunity or metabolic events are greatly influenced by the microbiota and therefore the microbiota has been recently considered as a topic of interest for fertility.  Let us define what microbes are and what microbiotas are.  Microbiota is referred to all the microorganisms in an environment including bacteria, archaea, and viruses, fungi, etc., whereas microbiome refers to the collection of genomes of the microbiota.

Gut bacteria can break food compounds, it is resistant to pathogens, protects injury against the epithelium. It modulates the bone mass index, promotes fat storage, promotes angiogenesis. It also develops training of the immune system, biosynthesis of amino acids, vitamins, and metabolism of therapeutics. It has been found that gut bacterial dysbiosis is linked with heart disease, Parkinson’s disease, autoimmunity, cancer, diabetes, and now is infertility.

There is published work about gut microbiota related to infertility especially with PCOS and endometriosis but not with an endometrium that is the recurrent implantation failure.  It shows that the high-fat low-fiber diet leading to obesity affects the gut microbiota.  The gut-brain axis by secretion of various mediators like serotonin, ghrelin which have, an effect on appetite regulation, energy, homeostasis, psychological wellbeing, and LH secretion. The gut microbiota dysbiosis diversity, affects the gut permeability with metabolic endotoxemia, activation of the immune system, hyperinsulinemia, hyperandrogenism, and PCOS. So this dysbiosis activates the immune system.  This immune system activation will interfere with insulin receptor functioning causing hyperinsulinemia and therefore this theory is also known as DOGMA, dysbiosis of the gut microbiota.  Common factors being obesity, high fat low-fiber diet.

A few other questions to be answered include:

• Why is it important?
• Can such a gut bacteria test be done for infertility?
• Can we find out about the Prevotella, Bacteroides on a simple test or it has to be NGS?

For detailed answers to these and other questions you might have on Gut bacteria: A new frontier in infertility treatment, enroll for live lectures by Dr. Nayana Patel (MD, FICOG), here, https://docmode.org/gut-bacteria-a-new-frontier-in-infertility-treatment-dr-nayana-patel/