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O papel do microbioma uterino na fertilidade feminina
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Durante muito tempo, o útero foi considerado um ambiente estéril. Atualmente sabe-se que existe uma comunidade diversa de microrganismos residentes na cavidade uterina. Ao contrário do microbioma vaginal, altamente estudado e caracterizado, o microbioma uterino está apenas recentemente a suscitar interesse na comunidade científica. É considerado que este microbioma tenha um papel importante na manutenção da homeostasia uterina, e que tenha influência na atividade inflamatória e imune das células do útero. Desta forma, alterações do microbioma uterino poderão influenciar negativamente o ambiente uterino, levando a condições patológicas, como endometrite crónica, que poderão afetar os processos fisiológicos da reprodução, como a implantação e a manutenção da gravidez. Adicionalmente, a disbiose uterina poderá estar relacionada com piores resultados nos tratamentos de procriação medicamente assistida. Dado estimar-se que 1 em cada 6 pessoas adultas sofra de infertilidade ao longo da vida, torna-se premente otimizar as soluções que a medicina pode oferecer. Entender a composição do microbioma uterino pode abrir novos caminhos na compreensão dos mecanismos de infertilidade, e permitir novas abordagens terapêuticas a esta condição. Este trabalho tem como objetivo rever a composição do microbioma uterino e as suas relações com o útero, assim como entender de que forma a disbiose uterina pode influenciar a fertilidade feminina e os resultados dos tratamentos de procriação medicamente assistida. Pretende-se, também, perceber se existem benefícios terapêuticos da utilização de antibióticos e probióticos em casos de disbiose uterina.
For a long time, the uterus was considered a sterile environment. It is now known that there is a diverse community of microorganisms residing in the uterine cavity. Unlike the vaginal microbiome, which has been highly studied and characterized, the uterine microbiome has only recently been of interest to the scientific community. It is thought that this microbiome plays an important role in maintaining uterine homeostasis and influences the inflammatory and immune activity of uterine cells. Thus, alterations in the uterine microbiome could negatively influence the uterine environment, leading to pathological conditions such as chronic endometritis, which could affect the physiological processes of reproduction, such as implantation and the maintenance of pregnancy. In addition, uterine dysbiosis may be related to poorer outcomes in assisted reproduction treatments. Given that it is estimated that 1 in 6 adults suffer from infertility throughout their lives, there is an urgent need to optimize the solutions medicine can offer. Understanding the composition of the uterine microbiome could open up new ways of understanding the mechanisms of infertility and allow for new therapeutic approaches to this condition. The aim of this study is to review the composition of the uterine microbiome and its relationship with the uterus, as well as to understand how uterine dysbiosis can influence female fertility and the results of assisted reproduction treatments. The aim is also to understand whether there are therapeutic benefits to using antibiotics and probiotics in cases of uterine dysbiosis.
For a long time, the uterus was considered a sterile environment. It is now known that there is a diverse community of microorganisms residing in the uterine cavity. Unlike the vaginal microbiome, which has been highly studied and characterized, the uterine microbiome has only recently been of interest to the scientific community. It is thought that this microbiome plays an important role in maintaining uterine homeostasis and influences the inflammatory and immune activity of uterine cells. Thus, alterations in the uterine microbiome could negatively influence the uterine environment, leading to pathological conditions such as chronic endometritis, which could affect the physiological processes of reproduction, such as implantation and the maintenance of pregnancy. In addition, uterine dysbiosis may be related to poorer outcomes in assisted reproduction treatments. Given that it is estimated that 1 in 6 adults suffer from infertility throughout their lives, there is an urgent need to optimize the solutions medicine can offer. Understanding the composition of the uterine microbiome could open up new ways of understanding the mechanisms of infertility and allow for new therapeutic approaches to this condition. The aim of this study is to review the composition of the uterine microbiome and its relationship with the uterus, as well as to understand how uterine dysbiosis can influence female fertility and the results of assisted reproduction treatments. The aim is also to understand whether there are therapeutic benefits to using antibiotics and probiotics in cases of uterine dysbiosis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Microbioma uterino Endometrite crónica Infertilidade Procriação medicamente assistida Probióticos Ginecologia Obstetrícia