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Infertility from Various Angles

Nov 11th, 2013 Research

I’ve decided to dig deeper into infertility for one of my class papers.  It is paper number three in a series of short essays on the mechanisms that lead to different health outcomes.  The previous two focused on disparities in cesarean and how stress doesn’t affect breastfeeding. The essays are limited to three pages in APA format, which gives just about enough space to describe the situation before you need to start your concluding paragraph–no messing around with flowery words here. The limitations mean you focus on a very small piece of the puzzle.

For my infertility paper, I am focusing on the smallest piece — the microbial ecosystem that inhabits the genital tract.  While the known details are interesting, it is the unknowns that are fascinating.  For example, women with BV have a higher preterm birth rate and early pregnancy loss rate and are less likely to achieve conception with assistive reproductive technologies.  Unfortunately, we can’t really say why…yet. And as interesting as the mid-vaginal microbes are, there apparently exists a controversy over whether or not the uterus is a sterile environment.

Me, I’m very clearly on the non-sterile side of the debate.  The cervical os opens monthly, and we know it is possible for pathogenic bacteria such as chlamydia and gonorrhea to ascend all the way up to the tubes.  Why would we assume the good microbes would not also make the trip? This view is also supported by the evidence that babies who are born via cesarean after the bag of waters has broken appear to have the same microbial gut colonization as babies born vaginally — current evidence suggests only babies who do not have time in the uterus without the protection of the amniotic sac have a different gut colonization. Based on this, I’m proposing that better understanding of uterine microbial ecosystems can help explain some of the 10% of infertility cases that are currently labeled as “unknown reasons.”

Excuse me now,  I need to do a bit more research so I can make recommendations of possible collection techniques to obtain uterine microbe samples (without too much human DNA) for 16S rRNA sequencing and  can finish this paper.

 

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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