{
  "abstract": "Infertility is a global health challenge, and impaired endometrial receptivity remains an important contributor to treatment failure. Endometrial dysbiosis, characterized by a low proportion of Lactobacillus in the endometrial microbiota, has been proposed as a potentially modifiable factor that may affect endometrial receptivity and fertility, and treatment with Lactobacillus-containing probiotics is emerging as a promising therapeutic approach. However, the optimal route of Lactobacillus supplementation remains unclear. We compared oral versus vaginal supplementation using the same Lactobacillus-containing formulation as an adjunct to standardized doxycycline/metronidazole therapy and continued oral lactoferrin in patients with baseline endometrial Lactobacillus <10%, based on paired microbiome profiling of endometrial samples (aspirated intrauterine fluid and endometrial tissue). In this single-center retrospective cohort study, thirty-two patients underwent paired endometrial microbiome testing before and after 30 days of supplementation (oral, n = 18; vaginal, n = 14). In the vaginal group, the median endometrial Lactobacillus proportion increased from 0.05% [0.00–0.20] to 99.15% [70.45–100.00] (p = 0.001), whereas in the oral group it increased from 0.00% [0.00–0.18] to 0.30% [0.03–66.33] (p = 0.005). The median change was greater with vaginal versus oral supplementation (+98.90% [70.45–99.80] vs + 0.25% [0.03–66.33], p < 0.001). Post-treatment Lactobacillus ≥80%, used as an exploratory marker of marked microbiota improvement, was observed in 9/14 patients (64%) in the vaginal group and 3/18 (17%) in the oral group (p = 0.010). Exploratory reproductive outcomes were limited by the small sample size and did not define a reliable clinical threshold. These findings suggest that, within this combined treatment regimen, vaginal Lactobacillus supplementation may provide a greater route-associated additional improvement in endometrial microbiota profiles than oral administration.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.",
    "Tsubaki Women's Clinic, Matsuyama, Ehime, Japan."
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Daiki Hiratsuka",
      "orcid": "0000-0001-7128-2859"
    },
    {
      "affs": [
        1
      ],
      "name": "Ayumi Iki"
    },
    {
      "affs": [
        0
      ],
      "name": "Mayu Kinoshita"
    },
    {
      "affs": [
        0
      ],
      "name": "Yumiko Doi"
    },
    {
      "affs": [
        0
      ],
      "name": "Okikaze Kato"
    },
    {
      "affs": [
        0
      ],
      "name": "Kotaro Oshima"
    },
    {
      "affs": [
        0
      ],
      "name": "Takehiro Hiraoka"
    },
    {
      "affs": [
        0
      ],
      "name": "Mitsunori Matsuo"
    },
    {
      "affs": [
        0
      ],
      "name": "Mari Ichinose"
    },
    {
      "affs": [
        0
      ],
      "name": "Tomoko Makabe"
    },
    {
      "affs": [
        0
      ],
      "name": "Gentaro Izumi"
    },
    {
      "affs": [
        0
      ],
      "name": "Miyuki Harada"
    },
    {
      "affs": [
        0
      ],
      "name": "Yasushi Hirota",
      "orcid": "0000-0003-0241-9780"
    },
    {
      "affs": [
        1
      ],
      "name": "Motowo Nabeta"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/86an5vmbtfft0.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0360619",
  "fulltext_url": "https://europepmc.org/articles/PMC13704797",
  "id": "86an5vmbtfft0",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0360619",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2404|Reproductive tract infections research"
    ],
    [
      "plos",
      "/Biology and life sciences/Genetics/Genomics/Microbial genomics/Microbiome"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbiome"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antibiotics"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Microbial genomics/Microbiome"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Probiotics"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Bacteria/Gut bacteria/Lactobacillus"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials/Antibiotics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Routes of administration"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Routes of administration/Oral administration"
    ],
    [
      "plos",
      "/Medicine and health sciences/Urology/Infertility"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Maternal health/Pregnancy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Pregnancy"
    ]
  ],
  "openalex": "W7223659577",
  "pdf_url": "https://europepmc.org/articles/PMC13704797?pdf=render",
  "pmcid": "PMC13704797",
  "pmid": "42932302",
  "published": "2026-10-26",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/86an5vmbtfft0.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:17Z",
      "native_id": "10.1371/journal.pone.0360619",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0360619"
    },
    {
      "first_seen": "2026-10-30T12:21:51Z",
      "native_id": "MED:42932302",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42932302"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
    },
    {
      "field": "medicine",
      "origin": "plos:pharmacology",
      "subfield": "pharmacology-toxicology"
    },
    {
      "field": "medicine",
      "origin": "plos:women's health",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Oral versus vaginal Lactobacillus supplementation for endometrial dysbiosis: A paired pre and post–endometrial microbiome study",
  "title_text": "Oral versus vaginal Lactobacillus supplementation for endometrial dysbiosis: A paired pre and post–endometrial microbiome study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:51Z",
  "url": "https://research.draconitic.com/paper/86an5vmbtfft0",
  "venue": "PLOS One",
  "versions": []
}