The vaginal microbiome and how can it influence fertility outcomes.
As a fertility acupuncturist specialising in complex fertility cases, I see significant value in testing the vaginal microbiome. Recent research has highlighted a correlation between an imbalanced vaginal microbiome and less favorable fertility and pregnancy outcomes.
What is the vaginal microbiome
The vaginal microbiome is a diverse community of bacteria, fungi, and other microbes, this complex ecosystem plays a crucial role in maintaining vaginal health. Lactobacillus species, in particular, contribute to creating an acidic environment, which helps prevent the overgrowth of harmful bacteria. The balance of these microorganisms is essential for supporting the overall health of the reproductive system.
Changes in the vaginal microbiome can influence fertility, pregnancy outcomes, and susceptibility to infections. Understanding and monitoring the composition of the vaginal microbiome through testing provide valuable insights into reproductive health and can aid in identifying potential issues or imbalances.
The research
Tommys
Tommy's miscarriage charity fund pioneering research to understand why some pregnancies do not go to full term. They recently conducted research examining the vaginal microbiome in cases of chromosomally normal pregnancy losses. The study revealed that the composition of the vaginal microbiome could impact pregnancy outcomes by influencing the immune system's response to bacterial presence.
This research identifies a potentially correctable cause of miscarriage by identifying underlying bacteria present in the vaginal microbiome and proposing treatment strategies such as vaginal hygiene, antibiotic and probiotic interventions.
The vaginal microbiome and IVF outcome
The vaginal microbiome has also been considered a possible influence of IVF outcome. Recent studies have demonstrated Imbalances in the vaginal microbiome such as dysbiosis, bacterial vaginosis, or the lack of specific Lactobacilli species could potentially result in implantation failure.
The absence of Lactobacillus Crispatus, or lower levels present in the vaginal Microbiome sample were found to be less likely to have a successful embryo implantation. Further highlighting the importance of a vaginal Microbiome screening.
Lower levels of Lactobacillus crispatus in the vaginal microbiome and higher levels of pathogenic bacterium such as prevotella have been linked to Preterm birth
Research into the seminal microbiome has also shown Lactobacillus also to be associated with improvements in semen parameters. However, it’s important to note that in a 2024 study, men with abnormal motility were shown to have a semen microbiome rich in Lactobacillus iners.
Growing research has demonstrated that there was an increased prevalence of ureaplasma infertile men, which has been shown to negatively effect concentration and morphology. In addition to this finding, the presence of provetella and Enterococcus faecalis were also found to negatively impact semen quality.
E. faecalis and Provetella can be transmitted between male and female sexual partners. In my clinical experience, both are frequently detected in vaginal microbiome testing among individuals with unexplained infertility.
What are the signs of a disordered vaginal microbiome?
The most common signs of a disordered microbiome are
- Unusual vaginal discharge
- Vaginal itching and irritation
- Redness and swelling
- Painful urination
- Pain during intercourse
- Vaginal odor
- Recurring infections
- Burning sensation
- General discomfort
- Fertility issues
How is it tested
The vaginal microbiome test that I use is a simple home swab, which is then posted off to the lab to assess for inflammation markers, the presence of lactobacillus species (which is mostly correlated to a more favourable environment) and also various pathobiants, fungi and opportunistic bacteria which can be associated with a less favourable environment.
I find the vaginal microbiome testing to be more accessible, affordable and to pose less risk than the EMMA and ALICE testing which assesses the presence of bacteria in the uterine cavity. There is a high probability that the presence of identified bacteria in the vagina is likely (but not guaranteed) to be present in the endometrium as it’s not a sterile environment, it shares a biological pathway such as when sperm travels, or in menstruation.
Interestingly, leading consultants such as Jonathan Ramsey have been known to utilise the vaginal microbiome testing as a surrogate for the seminal microbiome, as many bacteria and will be shared amongst the couple and could have the potential to influence sperm health.
Dr Yau thum, a leading reproductive immunologist also recognises the value of the microbiome testing and would often treat a couple based on the findings of these tests.
What can you do to improve your vaginal microbiome?
Before anything else, I highly recommend getting tested, especially if you're trying to conceive, undergoing planned IVF, or experiencing symptoms like thrush, BV, or vaginitis. Testing helps determine whether lactobacillus is present and dominant, and if there are any unwanted bacteria that require treatment.
Taking care of your vaginal microbiome is essential for overall health and well-being. While diet and lifestyle play a crucial role, sometimes pathogens or opportunistic bacteria may require antibiotic treatment, which could involve both partners.
To naturally support your microbiome, it's important to avoid over-washing the vagina. Avoid soap, as the vagina is efficient in self-cleaning, just use plain water. Additionally, ensure sex toys and menstrual cups are properly sterilised, and opt for underwear made of natural fibers to promote a healthy environment. Wearing G string like underwear could possibly translocate bacteria from the rectum to the vagina and has the potential to negatively impact the microbiome
In terms of diet, focus on consuming a balanced diet rich in dietary fiber, fresh vegetables, and fermented foods like kimchi, sauerkraut, miso, kefir, yogurt, and kombucha. Diets high in sugar can negatively impact the vaginal microbiome and can be associated with dysbiosis. Consider supplementing with probiotics that are clinically researched to benefit the vaginal microbiome. Smoking can also negatively impact the vaginal microbiome as well as fertility in general.
Remember, small changes in lifestyle and diet can have a significant impact on maintaining a healthy vaginal microbiome.
As Fertility Support Trained practitioners, we work in an integrated way. We have a commitment to keep up to date with emerging research, testing and facilities to better support and guide our clients. I believe that the disheartening label of ‘unexplained infertility’ placed on many often means ‘undiagnosed’ and the cause can often be identified given appropriate testing. By identifying imbalances, we can apply appropriate treatment and have the potential to optimise fertility outcomes. Vaginal microbiome testing is just one of the valuable tools in our tool kit.
I'm @fertilitysupport trained Acupuncturist. We're trained to think out of the box, question a little more and dig a little deeper.
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