Candida G lab rata Chorioamnionitis Following In Vitro Fertilization and Embryo Transfer

EDITORIAL COMMENT: We accepted this case for publication not only because it provides, for the first time, convincing evidence that Candida glabrata can cause chorioamnionitis and premature rupture of the membranes, but for the suggestion that infection in the upper vagina and/or cervix should be considered in women having in vitro fertilization and embryo transfers (IVF‐ET). The authors suggest swab and culture to exclude infection before IVF‐ET. Since this technique could cause ascending infection an alternative would be to set up a culture from the cannula used to introduce the embryo(s) into the uterus, and commence appropriate antibiotic therapy if the culture was positive. Although previously not reported these cases illustrate that systemic treatment of Candida glabrata is indicated in women with a positive culture who have had IVF‐ET or have developed premature rupture of the membranes. In retrospect, the management in Case 1 was indeed conservative. As the authors indicate Candida glabrata is extremely resistant to all antifungal agents so the value of treatment of patients such as those reported here remains to be established. Summary: Candida glabrata is a yeast which is considered to be a commensal of the vagina with limited pathogenicity in die immunocompetent host. We report 2 cases of severe chorioamnionitis occurring in pregnancies achieved by in vitro fertilization techniques which resulted in preterm delivery and pregnancy loss. Candida glabrata as the causative agent was probably introduced into the uterus by the cannula at the time of embryo transfer. It is recommended mat appropriate investigation of the microbial flora of the cervix be undertaken and treatment instituted prior to embryo transfer in order to prevent this complication.