Effect of laparoscopic niche resection on vaginal microbiota and its relation to pregnancy rate
Bibliographic record
Abstract
Objective To study the impact of a laparoscopic niche resection on vaginal microbiota in relation to pregnancy rate. Methods A explorative prospective cohort study that included women with a large niche (residual myometrium ≤ 3 mm), actual wish to conceive who were scheduled for laparoscopic niche resection. Pre- and three months post-operatively, a vaginal swab was collected during the mid-luteal phase (cycle day 19 to 24). The microbiota composition was determined using 16S rDNA sequencing. Microbiota profiles were assigned to community state types (CST) based on the dominant bacterial species. Results In total, 55 women completed sequential sampling. In all women, laparoscopic niche resection significantly reduced niche volume, withmean paireddifference of 1766.6 mm 3 (95 % CI: 640.4 – 2892.8). CST-IV was the dominant type both pre- and post-operatively (38.2 % vs 36.4 %, respectively). In ten (18.2 %) women the dominant CST changed after surgery. Three (5.5 %) women experienced a favourable change linked to fertility, while two (3.6 %) had unfavourable change and five (9.1 %) showed neutral shift. Women with favourable change had a greater reduction in niche volume (median reduction 1067.4 mm 3 (p = 0.014)). Within a year, 23 (54.8 %) women became pregnant. The highest pregnancy rate (90.0 %, n = 9) was observed in women with post-operative CST-I, while the lowest rate (38.5 %, n = 5) was seen in those with CST-III. Conclusion Laparoscopic niche resection resulted in a more than 10-fold reduction in niche volume. However, no significant changes in vaginal microbiota were observed postoperatively. Notably, women who experienced the largest reduction in niche volume also demonstrated a favourable shift in their microbiome profile, which is associated with improved fertility.Postoperatively, the highest pregnancy rate (90 %) was observed in women with Lactobacillus crispatus-dominant microbiota (p = 0.78). These results provide valuable insights into the pathophysiology of uterine niches and suggest potential therapeutic approaches for women experiencing niche-related infertility, however lager studies are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".