{"id":415,"title":"Vaginal microbiome composition and medically assisted reproduction outcomes: a systematic review and network meta-analysis of 2289 women across three WHO regions","title_zh":"阴道微生物组组成与医学辅助生殖结局：一项涵盖三个WHO区域2289名女性的系统综述与网络荟萃分析","url":"https://pubmed.ncbi.nlm.nih.gov/42885155","doi":"10.1093/humupd/dmag033","pmid":"42885155","journal":"Hum Reprod Update","kind":"paper","lang":"en","published_at":"2026-10-15T00:00:00+00:00","fetched_at":"2026-11-08T03:44:12+00:00","authors":["Shabana H","Gudnadottir U","Hugerth LW","Rodriguez-Wallberg KA","Brusselaers N"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":8.0,"hits":["assisted reproduction","embryo transfer","icsi","iui","ivf"]},{"slug":"repro-microbiome","score":5.0,"hits":["lactobacillus","vaginal microbiome"]},{"slug":"early-pregnancy","score":2.0,"hits":["pregnancy outcome","pregnancy outcomes"]}],"topic_score":8.0,"preference_score":5.0,"preference_labels":["可转化到 ART 实验室的发现"],"llm_score":80.0,"final_score":89.0,"score_dims":{"novelty":78,"rigor":76,"impact":80,"relevance":88,"translation":65},"recommend_reason":"首次以网络荟萃分析细分阴道CST并比较其与辅助生殖妊娠结局的关联，挑战“乳酸杆菌优势普遍有益”的既有认知，对生殖道微生物组研究设计有直接指导意义；但活产数据稀少、观察性证据受限，结论尚不能直接用于临床。","keywords":["阴道微生物组","社区状态类型","网络荟萃分析","辅助生殖","妊娠结局","乳酸杆菌"],"selected":1,"story_id":400,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-top-journals","source_name":"PubMed · CNS/大子刊/四大医学刊（生殖相关）","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":"hru","journal_tier":"field-top","journal_if":14.8,"is_mock":false,"summary_zh":"该研究通过系统综述与网络荟萃分析（NMA），整合12项纵向研究、共2289名接受医学辅助生殖（IVF/ICSI/IUI）女性的直接与间接证据，比较不同阴道社区状态类型（CST）与妊娠结局的关联。以L. crispatus为参照，L. jensenii优势型（OR 0.42）和低乳酸杆菌群落（OR 0.59）与妊娠几率显著降低相关；L. gasseri与L. iners未见显著差异。研究提示“乳酸杆菌优势即有益”的假设需谨慎对待，但活产证据有限（仅5项研究、57例活产），且存在异质性与残余混杂，尚不足以支持临床开展CST分型。","summary":"BACKGROUND: The vaginal microbiome may influence the success of medically assisted reproduction (MAR), including IVF with or without ICSI, and IUI. However, findings across studies remain inconsistent, and previous meta-analyses have largely relied on binary microbiome classifications or pairwise comparisons. The relative associations between individual vaginal community state types (CSTs) and pregnancy outcomes therefore remain uncertain. OBJECTIVE AND RATIONALE: To compare the associations between individual CSTs and pregnancy following MAR by integrating direct and indirect evidence in a systematic review and network meta-analysis (NMA) and to determine whether specific CSTs were associated with lower odds of pregnancy. SEARCH METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched from database inception to 2 April 2026. Eligible longitudinal studies assessed vaginal microbiome composition using sequencing-based profiling before embryo transfer or IUI and reported pregnancy following MAR. Cross-sectional studies, studies without CST classification, or pregnancy outcome data, and studies based solely on post-treatment sampling were excluded. Two reviewers independently performed study selection and risk-of-bias assessment. Odds ratios (ORs) with 95% CIs were synthesized across CSTs using NMA. Twelve longitudinal studies including 2289 women met the inclusion criteria. The prospectively registered review was reported in accordance with PRISMA and the PRISMA extension for NMA. OUTCOMES: The NMA allowed integration of direct and indirect evidence across six CST categories. Compared with Lactobacillus (L.) crispatus, Lactobacillus jensenii-dominated CSTs (OR 0.42, 95% CI 0.19-0.92), and low-lactobacillus community CSTs (OR 0.59, 95% CI 0.38-0.91) were associated with significantly lower odds of pregnancy. No statistically significant differences were observed for other lactobacilli, including Lactobacillus gasseri and Lactobacillus iners, compared with L. crispatus. Tests found no evidence of overall or loop inconsistency in the primary network. Subgroup analyses showed broadly similar patterns but were limited by sparse data, imprecision, and local inconsistency in some subgroup networks. Interpretation was further limited by clinical and methodological heterogeneity, observational study designs, residual confounding, and sparse evidence for several CST comparisons. Live-birth evidence was particularly limited: only five studies reported a total of 57 live births. Transitivity could not be formally assessed because potential effect modifiers were not consistently reported for individual CSTs. WIDER IMPLICATIONS: The findings indicate that general assumption of Lactobacillus-dominated CSTs being beneficial to MAR-treatment effects should be regarded with caution, as these may differ in their associations with pregnancy, depending on the specific Lactobacillus dominance. However, the available evidence is insufficient to support clinical implementation of CST profiling. Larger, standardized prospective longitudinal studies with CST-specific reporting, adjusted estimates, repeated microbiome sampling, and live-birth outcomes are required to determine whether CST profiling has clinically useful prognostic value and whether microbiome-targeted interventions improve reproductive outcomes. REGISTRATION NUMBER: PROSPERO CRD420251066092.","interpretation_basis":null,"fulltext_status":"non_oa","interpretation":null,"fulltext":{"available":false,"status":"non_oa","reason":"Europe PMC 未收录免费全文（非 OA，或该来源不在 Europe PMC 全文范围内，如 bioRxiv 预印本）：isOpenAccess=False, inEPMC=False","pmcid":null,"license":null,"chars":0,"source":"Europe PMC","fetched_at":"2026-11-08T04:16:33+00:00"}}