Objectif. - Evaluer l'efficacite de notre prise en charge des infections cervicovaginales des couples inclus en assistance medicale a la procreation (AMP).Patients et methodes. - Durant l'annee 2000, un prelevement cervico-vaginal et une spermoculture ont ete realises dans le mois precedant la ponction ovocytaire chez 951 couples. Un traitement antibiotique adapte a l'antibiogramme a ete prescrit en cas d'infection.Resultats. - Pour 733 patientes le prelevement cervicovaginal ne revelait pas d'infection (77,1 %), 222 ont concu (30,29 % grossesse/transfert). Une infection a ete retrouvee au niveau cervicovaginal et traitee dans 218 cas pour lesquels un taux de grossesse comparable a ete observe (30,27 %). Le taux d'implantation embryonnaire est neanmoins significativement abaisse en cas d'infection du prelevement : 14,6 vs 19,3 % (p < 0,02). Cinq types de germe ont ete mis en evidence au niveau vaginal : Candida albicans (69 cas), Ureaplasma urealyticum (49 cas), Gardnerella vaginalis (43 cas), Streptococcus B ou D (24 cas) et Escherichia coli (22 cas). Une infection conjointe du prelevement et du sperme par le meme germe a ete mise en evidence pour 77 couples pour lesquels le taux de grossesse clinique etait de 19,5 vs 36,2 % lorsque seul le prelevement cervico-vaginal revelait une infection (p < 0,01) avec un taux de fausse couche spontanee du premier trimestre de 46,7 vs 17,6 % (p < 0,01).Discussion et conclusion. - La presence d'une infection au niveau cervicovaginal, meme traitee, semble affecter l'implantation embryonnaire. L'infection concomitante du conjoint exacerbe cet effet deletere. Le report de la tentative parait alors la solution la plus respectueuse des interets du couple infertile.
Objective. - To evaluate the efficiency of our treatment of vaginal infection for couples included in an IVF program.Patients and methods. - Microbiologic screening of vaginal flora and semen has been performed one month prior to in vitro fertilization for 951 couples in 2000. Antibiotic treatment was prescribed in case of positive culture.Results. - Positive microbial growths were observed from endocervical and vaginal cultures in 218 women (22.9%). The clinical pregnancy rate was 30.29% in the group of patients without growth and 30.27% in the group with positive microbial growth. The implantation rate was significantly diminished in case of bacterial growth: 14.6 compared to 19.3% (P <0.02) for sterile endocervical culture. Five main bacterial species were found at the cervical level: Candida albicans (69 cases), Ureaplasma urealyticum (49 cases), Gardnerella vaginalis (43 cases), Streptococcus B or D (24 cases) and Escherichia coli (22 cases). Positive cultures from both vagina and semen were observed for 77 couples whose clinical pregnancy rate was 19.5 vs 36.2% in case of vaginal infection alone (P <0.01) with a spontaneous miscarriage rate of 46.7 compared to 17.6% (P <0.01).Discussion and conclusion. - Endocervical microorganisms, even treated with adapted antibiotics, may affect embryonic implantation. Positive culture from both female and male partner may enhance this negative effect. In this case, the best strategy would be to cancel the IVF treatment.