• A M Eskew, M J Stout, B S Bedrick, J K Riley, K R Omurtag, P T Jimenez, R R Odem, V S Ratts, S L Keller, E S Jungheim, and K M Wylie.
• Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, MO, USA.
• BJOG. 2020 Jan 1; 127 (2): 208-216.

ObjectiveThe objective of this study was to use high-throughput sequencing to describe the vaginal eukaryotic DNA virome in patients undergoing in vitro fertilisation (IVF) to examine associations between the vaginal virome, antibiotic exposure and IVF outcomes.DesignProspective exploratory study.SettingSingle academic fertility centre.PopulationSubfertile women age 18-43 years undergoing their first IVF cycle with a fresh embryo transfer.MethodsThe primary exposure was prophylactic azithromycin or no azithromycin before IVF. A mid-vaginal swab was obtained at the time of embryo transfer for virome analysis.Main Outcome MeasuresThe primary outcomes compared between exposure groups were characteristics of vaginal virome and clinical pregnancy rates. Secondary outcomes were virome associations with number of oocytes retrieved, number of blastocysts and implantation rate.ResultsTwenty-six women contributed a vaginal swab before embryo transfer. There were no significant differences in IVF outcomes between azithromycin groups. There was no association between viral diversity and clinical pregnancy overall. A higher diversity of herpesviruses and α-papillomaviruses was observed in samples from the azithromycin-treated group compared with the no azithromycin group (P = 0.04). In women that received azithromycin, viral diversity was higher in the group that did not achieve clinical pregnancy compared with those who did (P = 0.06).ConclusionsWe demonstrate that the vaginal eukaryotic virome in women undergoing IVF is associated with antibiotic exposure. Additionally, we demonstrate an inverse trend between viral diversity and pregnancy, with a higher number of viruses detected associated with failure to achieve clinical pregnancy in the azithromycin group.Tweetable AbstractHigher viral diversity is associated with prophylactic antibiotic exposure in subfertile women undergoing IVF.© 2019 Royal College of Obstetricians and Gynaecologists.

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