Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease

Am J Obstet Gynecol. 2021 Mar;224(3):251-257. doi: 10.1016/j.ajog.2020.10.019. Epub 2020 Oct 19.


Bacterial vaginosis, pelvic inflammatory disease, and endometritis are infections of the genital tract that can lead to many adverse health outcomes, including infertility. Bacterial vaginosis is characterized by a lower prevalence of lactobacilli and a higher prevalence of anaerobic bacteria, including Gardnerella vaginalis, Megasphaera spp., and Atopobium vaginae. Endometritis and pelvic inflammatory disease are caused by the ascension of pathogenic bacteria to the uterus, although the mechanisms by which they do so are unclear. Bacterial vaginosis, chronic endometritis, and pelvic inflammatory disease have been linked to infertility in retrospective and prospective trials. Similarly, the causes of bacterial vaginosis and endometritis-related infertility are likely multifactorial and stem from inflammation, immune targeting of sperm antigens, the presence of bacterial toxins, and increased risk of sexually transmitted infections. Diagnosis and treatment of bacterial vaginosis, chronic endometritis, and pelvic inflammatory disease before attempting conception may be important components of preconceptional care for symptomatic women to improve outcomes of natural and assisted reproduction.

Keywords: bacterial vaginosis; endometritis; infertility; lactobacilli; pelvic inflammatory disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Endometritis / diagnosis
  • Endometritis / microbiology*
  • Endometritis / therapy
  • Female
  • Humans
  • Infertility, Female / diagnosis
  • Infertility, Female / microbiology*
  • Infertility, Female / therapy
  • Pelvic Inflammatory Disease / diagnosis
  • Pelvic Inflammatory Disease / microbiology*
  • Pelvic Inflammatory Disease / therapy
  • Vaginosis, Bacterial / complications*