臨床婦人科産科78巻11号

2024年11月発行

今月の臨床 生殖医療の最新潮流とその一歩先

最新潮流 : 卵巣予備能から着床まで 【子宮内膜の評価と着床】

EMMA検査・ALICE検査

著者： 岩見菜々子¹

所属機関： ¹神谷レディースクリニック

ページ範囲：P.1016 - P.1021

文献概要

●子宮内膜細菌叢は細菌の絶対数の少ない環境ではあるが，技術の発展に伴い，次世代シークエンサーによる細菌の16SリボソームRNA配列決定を利用し，子宮内細菌叢の解析が可能になった．

●子宮内膜細菌叢は受精卵の着床や妊娠維持に関与している可能性が報告されている．

●子宮内膜細菌叢にGardnerellaやStreptococcusなどの病原菌が多数存在するdysbiosisな状態を抗菌薬により治療することは，妊娠成立までの時間を短縮する可能性がある．

参考文献

1）Turnbaugh PJ, et al : The human microbiome project. Nature 449 : 804-810, 2007

2）NIH HMP Working Group；Peterson J, et al : The NIH human microbiome project. Genome Res 19 : 2317-2323, 2009

3）Mitchell CM, et al : Colonization of the upper genital tract by vaginal bacterial species in non-pregnant women. Am J Obstet Gynecol 212 : 611.e1-611.e9, 2015

4）Mlodzik N, et al : Endometrial microbiota-do they mean more than we have expected? Ginekol Pol 91 : 45-48, 2020

5）Toson B, et al : The endometrial microbiome and its impact on human conception. Int J Mol Sci 23 : 485, 2022

6）Dahdouh EM, et al : Comprehensive chromosome screening improves embryo selection : a meta-analysis. Fertil. Steril 104 : 1503-1512, 2015

7）Benner M, et al : How uterine microbiota might be responsible for a receptive, fertile endometrium. Hum Reprod Update 24 : 393-415, 2018

8）Franasiak JM, et al : Endometrial microbiome at the time of embryo transfer : next-generation sequencing of the 16S ribosomal subunit. J Assist Reprod Genet 33 : 129-136, 2016

9）Moreno I, et al : The diagnosis of chronic endometritis in infertile asymptomatic women : a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol 218 : 602.e1-602.e16, 2018

10）Ravel J, et al : Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A 108（Suppl 1） : 4680-4687, 2011

11）Moreno I, et al : Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol 215 : 684-703, 2016

12）Moreno I, et al : Endometrial microbiota composition is associated with reproductive outcome in infertile patients. Microbiome 10 : 1-17, 2022

13）Cela V, et al : Endometrial dysbiosis is related to inflammatory factors in women with repeated implantation failure : a pilot study. J Clin Med 11 : 2481, 2022

14）Moreno I, et al : Relevance of assessing the uterine microbiota in infertility. Fertil Steril 110 : 337-343, 2018

15）Kitaya K, et al : Endometritis : new time, new concepts. Fertil Steril 110 : 344-350, 2018

16）Wu F, et al : Improvement of vaginal probiotics Lactobacillus crispatus on intrauterine adhesion in mice model and in clinical practice. BMC Microbiol 23 : 78, 2023

17）Yoshida T, et al : Lactobacillus crispatus promotes invasion of the HTR-8/SVneo trophoblast cell line. Placenta 111, 76-81, 2021

18）Iwami N, et al : Therapeutic intervention based on gene sequencing analysis of microbial 16S ribosomal RNA of the intrauterine microbiome improves pregnancy outcomes in IVF patients : a prospective cohort study. J Assist Reprod Genet 40：125-135, 2023

19）岩見菜々子，他 : 一般不妊治療における子宮内細菌叢（Endometrial Microbiome Metagenomic Analysis : EMMA/Analysis of Infectious Chronic Endometritis : ALICE）の有用性．日受精着床会誌40：252-260，2023