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Benefits of oral administration of Probiotics

An optimal Lactobacillus concentration in the endometrial microbiota is essential as a predictive parameter of the outcome of IVF or IVF-ICSI treatments, since a ≥90% predominance of Lactobacillus is correlated with a higher live birth rate.

Whereas, the non-predominance of this genus has a direct correlation with abortion. Therefore, it is important to maintain optimal concentrations of Lactobacillus in the reproductive system.

Another important point to keep in mind is to be able to maintain a favorable microbiological environment to avoid infections. In this sense, Lactobacillus also play an important role, since there are studies in which after an administration of Lactobacillus the healthy vaginal microbiota has been restored in up to 82% of women with previous vaginal dysbiosis.

Lactobacillus-containing probiotics play a beneficial role in women’s reproductive health.

They have the fundamental and desirable probiotic properties required to maintain a healthy vaginal environment, including high hydrophobicity and self-regulation, as well as adherence to epithelial cells and acid production.

The oral route is the most natural and effective

There are more and more research studies proving the beneficial effects of oral probiotic supplementation7, as well as the ability of orally administered Lactobacillus to colonize the vagina, exerting a positive modulating effect on vaginal health.8,9

Furthermore, at this time, there is unequivocal evidence of direct beneficial effects on clinical outcomes in reproductive health: modulation of vaginosis, PCOS, mastitis, etc.

Likewise, Lactobacillus administered orally are effective in restoring and maintaining a normal / healthy urogenital microbiota.

This oral administration has to be done at the standard dose required to pass through the intestine and reach the vagina where it can displace pathogens: 109-1010 CFU / day.

To exert the expected clinical effect on reproductive microbial dysbiosis, Lactobacillus administered orally must be transferred to the final site of colonization.

This transmission is carried out by physical transfer or by ascending route (probiotics colonize the intestine, are eliminated through the rectum and ascend through the vagina), by hematogenous route and by means of lymph node transfer.12

Oral administration of Lactobacillus has certain advantages over vaginal administration:

When they are administered orally, we obtain an intestinal action, a systemic action and a local action on the reproductive system13, thus achieving beneficial effects on the intestinal, vaginal and endometrial microbiota.

Effects in the intestine that can report systemic effects:

The gastrointestinal microbiota plays an important role in regulating the physiological hormonal axis. So much so, that when there is a dysbiosis in the intestine we have as a result a decrease in the circulation of estrogens. Therefore, we can presume that the oral administration of probiotics could improve this aspect.

Oral probiotics improve the intestinal barrier with which they can improve the absorption of other components such as ingredients with activity in the reproductive process and improvement of the quality of the oocytes.

In addition, the oral route prevents pathogens from ascending to the vagina from the perineum and rectum and is much less invasive with the microbiota already established in the endometrium.

Reduces the rate of bacterial vaginosis recurrences compared to vaginal administration.

With oral administration, better rates of follow-up are achieved in the treatment because it is a more comfortable route of administration than the vaginal route.

Oral probiotics: the treatment of choice

Oral probiotics are characterized by having both a systemic and local action, therefore, we will have a sustained effect over time, both vaginal and intestinal.

On the contrary, probiotics administered locally only exert an effect in the vaginal cavity and is a more aggressive route for microorganisms that are already established.

We can comparatively conclude that despite the fact that vaginal administration allows a direct colonization action to restore the altered vaginal microbiota, in many studies, it is argued that the oral administration of probiotics is much more effective against bacterial vaginosis and less aggressive for the microbiota. established, and in short, it is the natural colonization route.

When can we start treatment with Lactobacillus?

Lactobacillus should be started from at least the beginning of ovarian stimulation.

Due to the beneficial effect that probiotics have in the prevention of abortions and premature births associated with alterations of the vaginal microbiome, and the correlation between the endometrial microbiota not dominated by Lactobacillus with implantation failure and pregnancy loss2–4, it is recommended to continue with treatment during pregnancy.

Referencias:

Moreno, I. et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am. J. Obstet. Gynecol. 215, 684–703 (2016). 2. Ravel, J. et al. Vaginal microbiome of reproductive-age women. Proc. Natl. Acad. Sci. 108, 4680–4687 (2011). 3. Romero, R. et al. The vaginal microbiota of pregnant women who subsequently have spontaneous preterm labor and delivery and those with a normal delivery at term. Microbiome 2, 18 (2014). 4. Romero, R., Chaiworapongsa, T., Kuivaniemi, H. & Tromp, G. Bacterial vaginosis, the inflammatory response and the risk of preterm birth: a role for genetic epidemiology in the prevention of preterm birth. Am. J. Obstet. Gynecol. 190, 1509–1519 (2004). 5. Falcinelli, S. et al. Dietary lipid content reorganizes gut microbiota and probiotic L. rhamnosus attenuates obesity and enhances catabolic hormonal milieu in zebrafish. Sci. Rep. 7, 5512 (2017). 6. Melgaço, A. C. C. et al. Potential of Maintaining a Healthy Vaginal Environment by Two Lactobacillus Strains Isolated from Cocoa Fermentation. BioMed Res. Int. 2018, 1–14 (2018). 7. de Goffau, M. C. et al. Recognizing the reagent microbiome. Nat. Microbiol. 3, 851–853 (2018). 8. Falagas, M. E., Betsi, G. I. & Athanasiou, S. Probiotics for the treatment of women with bacterial vaginosis. Clin. Microbiol. Infect. 13, 657–664 (2007). 9. Bohbot, J. M. & Cardot, J. M. Vaginal Impact of the Oral Administration of Total Freeze-Dried Culture of LCR 35 in Healthy Women. Infect. Dis. Obstet. Gynecol. 2012, 1–4 (2012). 10. Yang, S. et al. Is There a Role for Probiotics in the Prevention of Preterm Birth? Front. Immunol. 6, (2015). 11. Dhanasekar, K. R., Shilpa, B., Gomathy, N. & Kundavi, S. Prenatal Probiotics: The Way Forward in Prevention of Preterm Birth. J. Clin. Gynecol. Obstet. 8, 63–69 (2019). 12. Albillos, A., de Gottardi, A. & Rescigno, M. The gut-liver axis in liver disease: Pathophysiological basis for therapy. J. Hepatol. 72, 558–577 (2020). 13. Floch, M. H., Ringel, Y. & Walker, W. A. The microbiota in gastrointestinal pathophysiology implications for human health, prebiotics, probiotics, and dysbiosis. (2017). 14. López-Moreno, A. & Aguilera, M. Probiotics Dietary Supplementation for Modulating Endocrine and Fertility Microbiota Dysbiosis. Nutrients 12, 757 (2020). 15. Jang, S.-E. et al. Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus La-14 Attenuate Gardnerella vaginalis-Infected Bacterial Vaginosis in Mice. Nutrients 9, 531 (2017).
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