Vaginal Probiotics for Reproductive Health and Related Dysbiosis

Ana López-Moreno and Margarita Aguilera

This is a medline indexed article that was published in the Journal of Clinical Medicine on April 2, 2021. It is a systematic review and meta-analysis of the use of probiotics in reproductive microbiota changes, such as in bacterial vaginosis. The researchers wanted to investigate the efficacy of commonly used vaginal probiotics. Most of the studies selected for this systematic review focused on bacterial vaginosis and some of the others focused on vulvovaginal candidiasis or on pretreatment during in vitro fertilization. While many women have a variety of colonization patterns, the Lactobacillus genus remains dominant and is often a determinant of a healthy microbiome. There are controversial ideas regarding the role of the Lactobacillus genus and fertility. In particular bacterial vaginosis might be linked with preclinical pregnancy loss. Therefore probiotics remain an important adjunctive treatment in order to rectify the dysbiosis that patients with BV experience. In order to determine the efficacy of probiotics in dysbiosis the researchers screened for articles that fit the following criteria; 1) being published within the last fifteen years, specifying (2) the probiotic strain used, (3) the dose, and (4) the time/period of administration. They included 5 clinical trials for quantitative meta analysis and also included one systematic review. One study highlighted that Lactobacillus are the dominant colonizers in reproductive sites and defend these sites against other microorganisms. Others indicated that Lactobacillus probiotics lead to an increased amount of adhesions on epithelial cells, acid production, and a restoration of the normal microbiota. Overall there was a large variety of doses used, most ranged between 1 × 10^6 CFU/day to 3 × 10^10 CFU/day. The variety of fertility disorders treated with vaginal probiotics found was significantly low compared to oral administration of probiotics.