The vaginal microbiome is an internal ecosystem, colonised by mixed communities of billions of bacteria. A healthy vaginal microbiome is crucial for fertility and conception. A lot of interest has been placed on the gut microbiome lately, we are all very aware of the far reaching implications of poor gut health especially in regard to the immune system and function, but what about our vaginal microbiome? And can it help or hinder fertility?
Why am I so interested in looking into the vaginal microbiome health with my patients? Studies have demonstrated that women whose vaginal microbiome is dominated by lactobacillus have a higher success rate for pregnancy and live births. If we can create an optimum pregnancy friendly environment for conception, there could be a potential to improve fertility outcomes.
What’s a healthy vaginal microbiome?
A healthy vaginal microbiome is dominated by lactobacillus (L. iners, L. crispatus, L. gasseri and L. jensenii). Lactobacillus species produce lactic acid which makes the vagina more acidic. The Ideal vaginal PH is around 3.8-4.5 (with the exception of ovulation when it increases to match the sperm), this more acidic environment protects the vaginal from pathogens and opportunistic bacteria. with the exception of ovulation when it increases to match the sperm.
The composition of the vaginal microbiome can be impacted by hormones, douching, lifestyle factors, sexual practices, diet and vaginal washing.
What’s an unhealthy vaginal microbiome?
Vaginal microbiome dysbiosis is characterised by a lack of lactobacillus dominance and an increase in microbial diversity. A lack of lactobacillus creates a more alkaline environment, which creates potential for opportunistic bacteria/ fungi/ pathogens to proliferate and may lead to elevated vaginal inflammatory markers. Some pathogens can lead to the formation of biofilms which can be resistant and tricky to break down.
There is a growing body of evidence that an unhealthy vaginal microbiome significantly increases the risk of sexual health complications such as infertility, pre term birth, miscarriage, pelvic inflammatory disease and greater risk of STI’s such as chlamydia and HIV. A disordered microbiome doesn’t always present with the more obvious presentations such as bacterial vaginosis and thrush, fertility difficulties may warrant vaginal microbiome which can be used to inform treatment plans.
How can I improve my vaginal microbiome?
Avoid douching
Sterilise sex toys/ menstruation cups
Avoid soaps in the vulvo-vagina area
If using lubricants, choose one which is closer to the PH of the vagina (around 4)
Reduce processed foods and foods with a high sugar content
Refrain from smoking and drinking alcohol
Consume a balanced and varied diet, including prebiotic fibre and fermented foods (kimchi, kefir, sauerkraut, miso, yoghurt)
Consider specific probiotics targeting the vaginal microbiome
After a course of antibiotics, consider probiotics.
Address hormone imbalances, HRT has shown to improve lactobacillus count in post menopausal women and reduce the incidence of UTI
Consider having your microbiome tested with a health professional, you then have a starting point.
In my practice, when indicated, I use Vaginal EcologiXTM vaginal microbiome testing, an advanced PCR technology.
I'm Fertility Support trained Acupuncturist. We're trained to think out of the box, question a little more and dig a little deeper.
Resources
Cicinelli E, Matteo M, Tinelli R, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014; 21(5): 640-647.
Schoenmakers, S, Laven, J. The vaginal microbiome as a tool to predict IVF success, Curr Opin Obstet. 2020; 32(3): 169-178
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