Role of Bacterial Vaginosis in Female Infertility: Chronic Endometritis and Pelvic Inflammatory Disease

Abstract

Bacterial Vaginosis (BV) is the most prevalent vaginal dysbiosis among women of reproductive age and is increasingly recognized as a contributor to adverse reproductive outcomes, including infertility. Characterized by depletion of protective Lactobacillus species and overgrowth of anaerobic bacteria, BV disrupts vaginal homeostasis and facilitates ascension of pathogenic organisms into the upper genital tract. Chronic Endometritis (CE) and Pelvic Inflammatory Disease (PID), frequently associated with BV- related microbiota, represent key pathological intermediates linking vaginal dysbiosis to impaired fertility. This review synthesizes current evidence on the relationships between BV, CE, PID, and infertility, emphasizing microbiological, inflammatory, and immunological mechanisms. Diagnostic approaches, treatment strategies, and implications for natural conception and assisted reproductive technologies are discussed. Early identification and management of BV and related upper genital tract infections may represent a critical component of preconception care to optimize fertility outcomes.