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. 2025 Nov 15;124(5 Pt 2):1071-1081.
doi: 10.1016/j.fertnstert.2025.06.035. Epub 2025 Jun 28.

Fusobacterium nucleatum is not significantly present in eutopic endometrium from patients with minimal-mild and moderate-severe endometriosis

María Carmen Graciano-España  1 , Kurt Barnhart  2 , Marta Gonzalez-Monfort  1 , Marta Arenas-Barrero  3 , Richard S Legro  4 , Tracey R Thomas  2 , Margaret A Rush  2 , Felipe Vilella  3 , Manuel Fernández-Sánchez  5 , Carlos Simon  6 , Inmaculada Moreno  7
Affiliations

Fusobacterium nucleatum is not significantly present in eutopic endometrium from patients with minimal-mild and moderate-severe endometriosis

María Carmen Graciano-España et al. Fertil Steril. .

Abstract

Objective: To evaluate the presence of Fusobacterium spp. and Fusobacterium nucleatum in eutopic endometrial samples from women with endometriosis compared with controls, and assess their association with the disease.

Design: Retrospective case-control study.

Subjects: Ninety-two women (55 endometriosis cases and 37 controls) aged 18-44 years undergoing gynecologic endoscopy for endometriosis and/or benign conditions at University of Pennsylvania, Endomarker Study (PMID: 29524590).

Exposure: DNA extraction from eutopic endometrial samples using QIAamp DNA Microbiome and IndiSpin Pathogen Kits. Quantification of Fusobacterium spp. and F. nucleatum by quantitative PCR using genus- and species-specific primers.

Main outcome measure(s): Relative abundance of Fusobacterium spp. and F. nucleatum in cases vs. controls, analyzed using the ΔCt method.

Results: No significant difference in Fusobacterium spp. or F. nucleatum abundance was observed between cases and controls (P = .258 for genus-specific primers, P = .738 for species-specific primers). Subgroup analysis by disease severity (minimal-mild: n = 42; moderate-severe: n = 13) also showed no significant differences (Fusobacterium spp.: P = .1465; F. nucleatum: P = .2936).

Conclusion: Fusobacterium spp. is not differentially present in eutopic endometrium of women with endometriosis, regardless of disease severity according to revised American Society for Reproductive Medicine classification. This contrasts with prior findings in eutopic endometrium in patients with ovarian endometriosis, suggesting that Fusobacterium has limited diagnostic or prognostic value in endometriosis.

Keywords: Fusobacterium nucleatum; Fusobacterium spp.; endometriosis; eutopic endometrium; quantitative PCR.

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Conflict of interest statement

Declaration of Interests M.C.G-E. has nothing to disclose. K.B. has nothing to disclose. M.G-M. has nothing to disclose. M.A-B. has nothing to disclose. R.S.L. is a member of the Scientific Advisory Board of PCOS Challenge and serves on the Investment Subcommittee of the Endocrine Society, owns shares in Biodesix, and has received research grants from Guebert Pharmaceuticals and consulting fees from Monsanto (2024), Organon and Celmatix (2023), and Covis Pharma GmbH (2022). R.S.L. reports funding from UG3/UH3 HL162971 Early Intervention to Promote Cardiovascular Health of Mothers and Children in Northern Appalachia NIH, UL1 TR002014 Penn State Clinical and Translational Science Institute NIH, 1R01HD100630 AMH Signaling Pathways Variation in PCOS NIH, R01AT009484-A1 NIH Inositol Supplementation to Treat Polycystic Ovary Syndrome: A Double-Blind Dose Ranging RCT (INSUPP-PCOS), 4100089395 COVID 19: Maternal and Child Health Outcomes in Diverse Pennsylvania Communities Department of Health Pennsylvania, 1R43HD11427-01 A Metabolomics-Based Laboratory Developed Test to Improve Diagnostic Precision of Polycystic Ovary Syndrome NIH, R01 HD091350-04 The COMET-PCOS Trial: Comparing the effects of Oral Contraceptive Pills versus Metformin in the medical management of overweight/obese women with Polycystic Ovary Syndrome NIH/University of Pennsylvania, Therapeutic Effect of Sonographic Hysterosalpingography: Oil vs Water Based Media: The SHOW Pilot Trial Guerbet Pharmaceuticals; Honorary Professor, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China 2012-Present Member, Steering Committee. Eastern Siberia PCOS Epidemiology & Phenotype study, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation 2016-Present Member, International Advisory Panel, Developing, disseminating and implementing a core outcome set for infertility. Funded by the Royal Society of New Zealand Catalyst Fund and the University of Auckland, New Zealand; PCOS Challenge (patient support group) Member, Medical/Scientific Advisory Board, 2017-Present Endocrine Society: Member Investment Subcommittee, 2018-Present; Editorial Editor, Fertility and Sterility, 2020-2024, Associate Editor, Global Reproductive Health, 2017-2024; Owner of 200 shares of Biodesix (BDSX); NIH: ZHD1 DSR-K (LR) 1 Loan Repayment Program (Annually, 2008-Present). T.R.T. received support from May Health for travel to meeting. M.A.R. has nothing to disclose. F.V. has nothing to disclose. M.F-S. has received grants and/or speaker fees from Ferring, Merck, Organon, MSD, Gedeon Richter, Theramex, IBSA. C.S. reports patents Asherman Therapy SL and Igenomix SL no royalties received and is the president of Carlos Simon Foundation. I.M. has nothing to disclose.

References

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