ENDOMETRIUM MICROBIOMA – DEFINITION
The uterus is the part of the female reproductive system that will host the fetus. The inner side of the uterus is called the endometrium. For many years there was a perception that there are no micro-organisms reside in the endometrium. Recent data, however, have shown that micro-organisms exist in the endometrium as well as in the intestine, vagina with a possible implication in normal functions.
WHAT KIND OF MICROBIA CAN BE FOUND IN THE ENDOMETRIUM?
Normally in the endometrium only lactobacilli are found, which have a protective role. In some cases, aerobic and anaerobic bacteria or atypical bacteria such as mycoplasma, ureaplasma and chlamydia can be found in the endometrium. The presence of these microorganisms can cause chronic infection (endometritis). Infections affect the normal function of the endometrium and prevent the implantation of the fetus, thus causing infertility.
HOW IS THE ENDOMETRIUM MICROBIOME TESTED?
Recently, testing endometrial microbiome has become a routine in the investigation of female fertility. The test is done by
- the Hidden-C ® test
- an endometrial biopsy, which is a painless medical act performed by the gynecologist on a specific day of the cycle. The test shows if there are pathogenic microorganisms and the gynecologist will determine the correct treatment for the desired outcome.
IN WHICH CASES SHOULD WE HAVE AN ENDOMETRIAL TEST?
Endometrial tests are recommended in case of:
- unexplained infertility
- implantation failure after assisted reproduction
- repeated miscarriages
- history of recurrent infections by mycoplasma, ureaplasma or chlamydia
Detection of microorganisms in menstrual blood specimens by molecular techniques
For many years doctors are interested in the microbiological milieu of the vagina, however microorganisms exist in other parts of the female reproductive track, such as the uterine cavity or even the fallopian tubes. Given the influence that the microorganisms have in virtually all tissues and organs, it is not surprising that the changes in the microbiome could be responsible for changes in the gamete function that will cause problems in reproduction and could be responsible for previously unexplained failure in assisted reproduction techniques.
Chlamydia are well known for their effect on fertility in women. Many reports have established their association with problems in the fallopian tubes. Apart from Chlamydia, the female reproductive track is also vulnerable to infections from other microorganisms. Mycoplasmas and Ureaplasmas in particular have been associated with miscarriages. Given the effects on the couple’s fertility, the presence of microorganisms should be investigated and treated in both spouses.
Detection of microorganisms in the vagina or the cervix is common because of the easy way that the sample can be collected. On the contrary detection of microorganisms in the uterus, which was not possible for many years, started only the past few years with the use of the HIDDEN -C® test. The HIDDEN -C® test is based on the detection of microorganisms in menstrual blood or tissue (endometrial apoptotic tissue) and allows the detection of chlamydial infection, or other infections, even when they are limited (hidden) in the upper parts of the female genital tract, something that is not always possible with the classic detection methods. The method used is Real Time PCR and offers exceptional sensitivity and specificity compared with conventional methods for detecting microorganisms.
This is a test with significant advantages, such as the tissue content of the upper genital canal, the easy sample collection at home, without a medical visit, the excellent preservation of the material and the exceptional sensitivity and specificity that real time PCR provide, which make it a popular test. The test is widely used as a screening method both for prevention reasons by young women and for infertility testing by couples.
The specific test or “HIDDEN-C® Test” is protected by an international patent and is performed exclusively by authorized laboratories.