Trying to conceive.. have you considered your intimate health?

In my opinion, unexplained infertility means testing unfortunately has not yet found a reason why a couple are unable to conceive. 

If microbiome testing hasn’t yet hit your radar, and you are trying to conceive (TTC) or about to embark on IVF, read below to understand more about this potentially significant piece of the puzzle. 

Recent evidence suggests the health of the female and male genital microbiomes may play an important role for some couples in the struggle to conceive and carry a baby to full term. 

Firstly, what is the vaginal and seminal microbiome? 

The human body is colonised by a multitude of microorganisms collectively referred to as the human microbiota. Microorganisms include bacteria, viruses, fungi and parasites. 

In females, one of the main microbiota sites - the vaginal microbiome - hosts over 200 bacterial species.  In males, seminal fluid contains a bacterial composition.  During unprotected sex, microorganisms are shared between partners.  

Microbiomes are often quite dynamic, particularly in the woman’s case, and can be influenced by age, ethnicity, sex, changes in hormone levels, genital infections and personal hygiene. 

For women, the vagina should be slightly acidic; it is self cleaning and produces a protective mucus layer.  And importantly, the vaginal microbial mix should be dominated by the species lactobacillus.  For men, lactobacillus strains are also found to be very protective of sperm quality. ⁽¹⁾

What are the implications of imbalance in these areas? 

If lactobacillus bacteria are compromised in any way, their numbers can reduce, allowing pathogenic strains to colonise and grow; this is what an imbalanced microbiome may look like and it affects both women and men. 

Implications for women

This transition can be temporary or long lasting, and it can present with symptoms in some, but not in others; for example, bacterial vaginosis, the most common cause of imbalance, presents without symptoms in 50% of women it affects⁽³⁾. 

Pathogenic conditions include things like STDs e.g. chlamydia, gonorrhoea, bacterial vaginosis (BV), ureaplasma, mycoplasma and recurrent, chronic states of candida / thrush.   

Unfortunately, in women, this imbalance can sometimes impact conception and pregnancy: 

• pathogens such as mycoplasma, ureaplasma, trichomoniasis, chlamydia, and gonorrhoea have been linked to difficulties conceiving ^{(2, 10, 11)} 
• vaginal imbalance can carry pregnancy complications including pre-term labour ⁽⁴⁾, premature
  rupture of membranes ⁽⁵⁾ and may contribute to second trimester miscarriage. 
• bacterial vaginosis can increase one’s risk of pelvic inflammatory disease which can lead to fertility issues, ectopic pregnancy and endometritis ^(6).
• vaginal imbalance has been linked to lower success rates in IVF ^(7,8).
• candida infections have been commonly linked with complications in pregnancy such as low birth weight and premature delivery. ⁽⁹⁾
  

Overall, the vaginal microbiomes of women with healthy, full term pregnancies have been shown to have a stable lactobacilli community ^(13). 

Implications for men

In men, pathogens can also impact fertility; Ureaplasma, E. faecalis, Mycoplasma and Prevotella negatively impact semen parameters, whereas Lactobacillli appear to protect sperm quality ^(12). 

What do symptoms include? 

For a woman, symptoms of imbalance include itching, soreness, abnormal fishy smelling discharge, possibly grey / green coloured, painful sex, burning and possibly regular / history of UTIs.  

But, many women may have a degree of imbalance and not have any symptoms. 

What can I do about it? 

If you have been struggling to conceive and want to explore other possible causes, or are embarking on IVF and want to optimise your outcomes, it may be wise for both yourself and your partner to test your intimate microbiomes. 

A test can either inform specific interventions to restore balance, or it can put your mind at ease that this area is healthy for you to continue your fertility journey.

Specific interventions can include dietary changes, supplements, medications and specific lifestyle changes. Ideally, it is best to re-balance the microbiome before pregnancy, as its health is important for carrying full term too. 

Given couples trying to conceive will be having unprotected sex, its important to consider both the health of the male and female given microbes can be passing between the two.  You can always start with the vaginal microbiome test, and depending on results, take a semen microbiome test afterwards if needed. 

How much does it cost? ‍

There are a few tests on the market and they range from £90 - £230. I interpret the results based on your individual case, and make personal recommendations to ensure your microbiome is optimised along with your wider health.

My prices start from £150 for an initial consultation lasting 90 minutes, including interpretation of test results and a plan of action. 

Interested? 

Book in for a 20 minute chat where you can ask me any questions about your next steps, and I can chat further about how we may work together. 

References

1. _{https://pubmed.ncbi.nlm.nih.gov/32794312/} 
2. _{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193130/} 
3. _{https://academic.oup.com/humrep/article/28/7/1809/611205}
4. _{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345902/} 
5. _{https://link.springer.com/article/10.1007/s43032-022-01153-0}
6. _{https://www.ajog.org/article/S0002-9378(20)31193-5/fulltext}
7. _{https://www.frontiersin.org/articles/10.3389/fmed.2020.00217/full} 
8. _{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823330/}
9. _{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908259/}
10. _{https://pubmed.ncbi.nlm.nih.gov/11478453/} 
11. _{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569030/} 
12. _{https://pubmed.ncbi.nlm.nih.gov/32794312/}
13. _{https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0098514}