Reproductive Medicine Associates of New Jersey (RMANJ) Third-Year Fellow Dr. Shelby Neal has begun her study into the reproductive microbiome, which seeks to better understand the microorganisms that live inside the male and female reproductive tracts in an effort to increase fertility and In Vitro Fertilization (IVF) success.

The study, which is currently recruiting patients undergoing IVF in Basking Ridge, is an important step in gaining critical information about the reproductive microbiome and learning about its effect on fertility. While the microbiome of the GI tract has been well studied, less is known regarding the microbiome of the reproductive tract. The very existence of a microbiome in the upper reproductive tract is relatively new in the scientific community, as the upper reproductive tract was previously believed to be sterile.

Now that researchers know the uterus, cervix, and vagina – as well as the penis and urethra – are home to a collection of (mostly beneficial) microorganism cells that interact with the human body, they want to know whether a specific group of microorganisms leads to higher rates of fertility.

“We want to profile the microbiome of infertile couples undergoing IVF and follow their pregnancy outcomes to identify any factors which may be predictive of pregnancy outcomes,” said Dr. Neal, who is aiming to recruit 1,000 couples for the study. “Specifically, we wish to identify differences in the microbiome of patients who get pregnant versus those who don’t, as well as those who miscarry or have a pre-term birth.”

While IVF has come a long way, and the use of preimplantation genetic testing (RMANJ uses the NexCCS platform), allows doctors to choose an embryo with the highest chances of implanting, there are still important subject areas that are little understood by the field. One of them is the uterus, Dr. Neal said, and the more that is known about it, the higher the chances of success for patients with Recurrent Implantation Failure (RIF), for example.

“There is still a lot about the uterus we don’t know,” Dr. Neal said, “and we think the microbiome may play a role.”

“Depending on the outcomes of this study, future research would be needed to see if there was a way to modify the microbiome to optimize pregnancy outcomes.”

The study is open to existing RMANJ patients who are undergoing an IVF cycle. In most cases, recruitment takes place after patients have started medications but prior to egg retrieval. For enrolled female patients, clinical staff will collect urine on the day of retrieval, four swabs at retrieval while under anesthesia, two swabs at a monitoring visit during the Frozen Embryo Transfer (FET) cycle, two more swabs at the time of the FET, and several tubes of blood. Staff will also take a small sample from the partner sperm provided on the day of IVF, and the tip of the embryo transfer catheter after the FET is completed.