Introduction
The microbiota of the female genital tract and its role in health and
disease has extensively been studied. The vaginal microbiome has been
well described both in healthy reproductive-age women (1), and
postmenopausal women (2). Various community state types (CST) exist
within the vaginal microbiome, and while most states are dominated by
lactobacilli, other diverse, non-lactobacilli-based microbiome profiles
have been described, sometimes associated with the presence of bacterial
vaginosis (BV) (1,3,4).
Together with the well-characterized lower genital tract microbiome, the
presence of bacteria in the upper reproductive tract including the
uterine cavity, the placenta, and fallopian tubes, has been more
frequently investigated in recent years (5). Studies examining the
presence of bacteria in the fallopian tubes found a diverse microbial
environment, albeit in very low quantities (6–8). A study examining the
ovarian microbiome found significant differences between cancer patients
and healthy controls (9). As these sites are accessible only via a
surgical procedure, there is an obvious obstacle in studying and
establishing a healthy microbial fingerprint, if one exists
Hydrosalpinx denotes a blocked edematous fallopian tube that is filled
with fluid. Tubal blockage and
tubal infertility
usually result from previous pelvic infection such as pelvic
inflammatory disease (PID), but damage to the fallopian tube from
previous surgery, endometriosis or adhesions can also result in
hydrosalpinx (10,11). The association of hydrosalpinx with decreased
pregnancy and implantation rates in in vitro fertilization (IVF)
cycles has been widely reported, and value for surgical treatments for
tubal disease prior to IVF has been previously established (12).
Microbiome studies examining infertility found different endometrial and
vaginal bacterial compositions associated with implantation and
pregnancy rates (13) as well as different lactobacilli-dominated vaginal
compositions, associated with pregnancy rates in women with unexplained
infertility (14). A recent meta-analysis also pointed to the association
between BV, a marker of vaginal dysbiosis, with tubal factor infertility
(15). BV has also been shown to be associated with increased risk for
sexually transmitted infections (16) pelvic inflammatory disease (17),
and preterm labor (18). However, the association between the vaginal and
fallopian tube microbiomes and their relation to hydrosalpinx has yet to
be elucidated.
In this study, we aim to describe the vaginal microbiome of women
undergoing salpingectomy for hydrosalpinx and compare it with those
undergoing salpingectomy for various other indications. Furthermore, we
analyze the microbiome of the resected fallopian tubes and its
association with hydrosalpinx.