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Microbiota refers to the totality of all micro-organisms that colonise the human body, while microbiome refers to their collected genetic information. Different parts of the body, such as the oral cavity, the gastrointestinal tract or even the vagina and uterine cavity, show a characteristic composition of the micro-organisms residing there.

The microbial colonisation of the vagina contributes about 9 % to the total microbiome of the body. Only 1 % of the resident micro-organisms can be detected by conventional smear or culture methods. However, modern molecular biological methods make it possible to detect all resident germs and also their quantity ratio. Currently, five main types of the vaginal microbiome can be distinguished, each consisting of a combination of numerous different bacterial species.

Initial studies suggest that significant deviations of the vaginal microbiome from the main known types may reduce the chances of implantation of a pregnancy or increase the risk of premature birth and miscarriage. However, it must be emphasised that findings on the influence of the vaginal microbiome on pregnancy outcomes are very recent and preliminary. Examination of the vaginal microbiome may nevertheless be useful under certain circumstances in the case of implantation failure after IVF/ICSI or repeated miscarriages in order to recognise individual deviations and, if necessary, to initiate a targeted therapy. Taking the swabs to examine the vaginal microbiome is similar to a cancer screening smear and is not a difficult procedure. Analysis of the vaginal microbiome is currently not covered by statutory health insurance.

The timely structural transformation of the uterine lining, which begins after ovulation under the influence of the corpus luteum hormone, is crucial for the implantation of an embryo.

During a gynaecological examination, a sample of the uterine mucosa is taken without anaesthesia using a small catheter (called a pipelle). The endometrial biopsy is preferably performed in the middle luteal phase, i.e. at the time when an embryo would implant. Fine tissue examinations are carried out to determine whether the endometrium is normal or changed (e.g. inflammation, polyps or hyperplasia) and, in addition, whether the structure of the endometrium corresponds to the cycle phase, i.e. whether it has changed properly.

In some cases, it is useful to examine the density of different immune cells (e.g. CD3, CD56 and CD138 cells) in the endometrial biopsy. An increase in CD138 cells, for example, is an indication of chronic inflammation of the endometrium and should be treated with antibiotics. The data on the proliferation of other immune cells (e.g. CD56 cells) and their influence on the onset and course of pregnancy is not yet clear. Depending on the extent and type of immune cell proliferation, supplementary drug treatment may be useful. This is especially true for patients with implantation failure or repeated miscarriages.

In individual cases, e.g. where there is a relevant history or massively changed values of the immune cells in the endometrial biopsy, it may be useful to also examine the relative distribution of the lymphocytes as a subgroup of the white blood cells in the blood (lymphocyte typing).

The possible benefits of administering micronutrients and dietary supplements in infertility are still relatively unexplored. Micronutrient is an umbrella term for a variety of different substances that are essential in the cell for the course of numerous enzyme reactions. These include various water- and fat-soluble vitamins, minerals, trace elements, amino acids and fatty acids, etc. Individual studies indicate a possible positive effect on pregnancy rates in vivo and in vitro by taking folic acid, vitamin C, vitamin D, iodide and omega-3 fatty acids (DHA). Myo-inositol, as an additive therapy, could also improve the chances of pregnancy, especially in patients with PCOS and metabolic syndrome.

An analysis of the blood levels of various micronutrients can identify nutritional deficiencies and help to compensate for them. The German Society for Nutrition recommends a regular intake of 400 µg folic acid, 20 µg vitamin D (equivalent to 880 IU), 200mg DHA and 100-150 mg iodide, accompanied by a healthy diet, for those who wish to have children and are in early pregnancy.