ROLE OF VAGINAL PROBIOTICS IN ASSISTED-REPRODUCTIVE TECHNOLOGY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To investigate the effect of intravaginal probiotics on assisted reproductive technology success Design: Systematic review and meta-analysis Materials and Methods: A comprehensive literature search was conducted on Pubmed and Embase up to January 01, 2024 to identify studies that assessed the success of assisted reproductive technology after intravaginal probiotic administration. Studies were included if they reported either a positive pregnancy test or β hCG. Random effects meta-analysis was performed using Mantel Haenszel odds ratios with 95% confidence intervals. Statistical heterogeneity was assessed using the I2 value. Results: In total, 367 studies were screened, and four randomized controlled trial studies, including 690 patients, met inclusion criteria. Only one study analyzed the secondary outcomes related to live birth and miscarriage rates. Intravaginal probiotic administration was not found to be associated with a significant chemical pregnancy (β hCG) rates (OR 1.07, 95% CI 0.80-1.43) or with clinical pregnancy rates defined by ultrasound findings (OR 1.20, 95% CI 0.90-1.60), although it was found to be associated with lower rates of miscarriage in one study (OR 0.45, 95% CI 0.23–0.87). Conclusions: Pooled analysis of the included trials failed to demonstrate a significant improvement in chemical or clinical pregnancy rates after administration of intravaginal probiotics. Further investigation is warranted before vaginal probiotics should be recommended to individuals with recurrent pregnancy loss.