Do probiotic interventions improve female unexplained infertility? A critical commentary

Abstract

Disruption of the women's gut and cervicovaginal microbiota has been associated with multiple gynaecologic diseases such as endometriosis, polycystic ovary syndrome (PCOS), noncyclic pelvic pain, and infertility. Female infertility affects 12.6% of women worldwide; its aetiology is complex and multifactorial and can be underpinned by uterine pathologies, systemic diseases, and age. In addition, a new perspective has emerged on the role of the gut and vaginal microbiomes in reproductive health. Research shows that the administration of precisely selected probiotics, often in combination with prior antibiotic treatment, may facilitate the restoration of symbiotic microbiota to increase successful conception and assisted reproductive technology outcomes. However, full research clarity is currently hampered by a lack of consistency and harmonisation in clinical studies: various lactobacilli and bifidobacteria species have been delivered through both the oral and vaginal routes, in different dosages, for different treatments’ durations. This commentary explores the intricate relationship between the microbiota in the cervicovaginal and gut of women, exploring their potential contribution to infertility. It highlights ongoing research on the use of probiotic formulation in improving pregnancy outcomes, critically examining the divergent findings in these studies, which complicate a conclusive assessment of the efficacy of these interventions