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Recent studies implicate the endometrial microbiome in implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This clinically oriented narrative review summarizes female reproductive tract microbiota and evidence on endometrial microbiome testing and management in infertility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Findings (Results)<\/jats:title>\n                    <jats:p>\n                      Vaginal dysbiosis is linked to adverse reproductive outcomes and provides a reference for interpreting upper\u2010tract findings. Endometrial microbial signals are detectable by sequencing, but interpretation is challenged by the low\u2010biomass environment and vulnerability to carry\u2010over, kitome effects, and contamination. Across ART studies, a\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      \u2010enriched endometrial profile is more often associated with favorable pregnancy\u2010related outcomes, whereas non\u2013\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      \u2010dominant patterns are more frequently reported in implantation failure, although effect sizes and statistical significance vary across cohorts and depend on sampling validity and cutoff definitions. Limited nonrandomized intervention studies suggest that testing\u2010guided targeted management (typically antibiotics with or without vaginal\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      \u2010containing probiotics) may benefit selected patients, but protocols are heterogeneous and results remain inconsistent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evidence is rapidly evolving, yet observational designs and methodological variability limit causal inference. Future progress will require standardized sampling and contamination controls, outcome\u2010anchored threshold validation, and pragmatic real\u2010world evaluations of protocolized test\u2010and\u2010treat pathways using clinically meaningful endpoints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/rmb2.70040","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T05:19:53Z","timestamp":1773379193000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Endometrial Microbiome and Implantation: From Basic Knowledge to Clinical Medicine"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-2859","authenticated-orcid":false,"given":"Daiki","family":"Hiratsuka","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsunori","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Hirota","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoac051"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.4788"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2013.08.011"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmz033"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2022.100162"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/gmit.gmit_64_23"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16185"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2023.02.014"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature18848"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.02387"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.09.075"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12634"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-92906-9"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25010622"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2024.104192"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmy012"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-020-00875-0"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-022-00974-4"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2024-333378"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms7010014"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/cmi.12308"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.02.009"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-312729"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2012.04.016"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00014-14"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12032"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01228-07"},{"issue":"1","key":"e_1_2_10_29_1","first-page":"87","article-title":"Modulating the Intestinal Microbiota: Therapeutic Opportunities in Liver Disease","volume":"8","author":"Philips C. 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