What ​is ​the vaginal microbiome and how that can impact fertility?

Well this is very new research. Over the last probably 10,15 years, interest in the microbiome, in the gut microbiome, has really been growing massively and its impact on health and the realization that different organs of the body have their own microbiomes. The idea that the uterus was always sterile, has now been… I mean, I don’t think anybody knows for sure but we can be fairly sure that there’s a huge amount of diverse bacteria that lives in the endometrium, in the cervix and in the vagina and they’re generally the same but some different ones prefer the cervix and apparently some different ones prefer the vagina and so on and so forth. They sort of fall into three groups – You’ve got your lactobacilli so, lactobacilli is very important for all our microbiomes. These are our lactic acid producing bacteria, these are our good bacteria – what we call our good bacteria really? They interact with cells, they seem to be able to send messages in between cells, they have a very very complex role and the more we have of them and the more diverse they are, the more different families of these lactobacillus we have, the better everything is. Then we’ve got our commensal bacteria – this is in the vagina, really I’m talking about the vaginal microbiome here, we’ve got our commensal bacteria, these are the bacteria that live in the vagina, They’re normal inhabitants of the vagina but if they get a bit too uppity, then they’ll start to cause problems and this will usually be because there’s not enough of the good lactobacilli to defend the area basically from the commensals, from starting to take over and then we’ve got our pathogenic bacteria – pathobionts they’re known as and they are not supposed to be in the vagina and they’re the ones the commensals can cause problems. So gardnerella is a normal inhabitant of the human vaginal flora but we know that if gardnerella gets a bit of a handle in, it can cause all sorts of problems. Definitely, I would say for sure, there’s lots of research on the effect of gardnerella also known as bacterial vaginosis on implantation, on sperm quality so, this little bacteria that it’s part of the flora and fauna, if it can get a hold, it can start causing trouble. The pathobionts tend to come from the bowel, they’re known as enteric bacteria, they just jump ship basically. They go awol from the back passage into that space between the urethra, the back, the anus and the vagina, it is minuscule and they just find their way. So E.coli, enterococcus faecalis, streptococcus (strep b) – they shouldn’t be living in the vagina and if they get a hold in the vagina, they can really cause inflammation breakdown of the mucous membrane of the vagina.They start kind of crowding out the good healthy lactobacilli. It’s been very interesting. I do a lot of vaginal microbiome testing for my own clients but also for the partners of male fertility doctors, andrologists and urologists because they can’t identify, they know something’s wrong, something’s up with the sperm, there’s white blood cells in the in the semen but they can’t identify the bacteria so, I just do the testing for the partners – I don’t see them as clients, I just do the testing and interpret the results and sometimes we can really come up with: “my god there’s this privateella”. Provotella is a bacterial vaginosis bacteria you can’t check for it in men and interestingly enough it doesn’t come up in the EMMA, ALICE test either but it’s a nasty commensal and it can really cause problems. So doing vaginal microbiome testing is very very useful. Certainly for people if they’ve got a bit of a history of certainly UTIs, frequent UTIs (urinary tract infection) and when you’re having a baby or trying to conceive, you’re trying to have lot of sex and you kind of like get to the stage where you’re just dreading it because you just know that you’re going to get a UTI and you say “oh i’m supposed to lie here, I was with my legs up and for 10 minutes and actually if I do that I’m going to have a UTI”. Well, this it’s really really really good for testing this. Obviously gardnerella, odd smells, I’ve just come out with it straight and say to my clients do you ever notice a bit of an unusual unpleasant smell after sex? Particularly and quite often they say “well yeah. I just thought that was kind of like normal” and sometimes it’s not and so it’s quite good to just have a look. Then apart from the not so good bacteria, we’ve also got our good bacteria and actually we know now that is very important for implantation as well as for protection and defense. One of them is called lactobacillus crispatus, which is a good bacteria that’s very important for reproductive health – it seems to play a big role in implantation. So as well as looking for bad bacteria, we can look at the families of good bacteria and the very good thing we can do now is we can treat very bespokely these so, you can buy probiotics that contain lactobacillus crispatus. I tend to get people if they’ve got no crispatus and if they’ve got high gardnerella or something like that, to use these probiotics topically as well, intravaginally as well, as to swallow them to try and push this healthy bacteria that will try and it will get rid of the pathogenic bacteria. Sometimes you do need antibiotics for sure, absolutely but if you don’t treat with the right probiotics and the right diet that encourages the growth of the good bacteria, the infection will just come back. It’s just the way it is – antibiotics will decimate all your good bacteria, your defenses are then down and the​y are​ opportunistic, they will just come back in so, you can’t just take antibiotics without doing the probiotic therapy as well and the diet and all the lifestyle and kind of different things. I mean, there’s all sorts of things, for example, smoking has quite a detrimental effect on the vaginal microbiome. Interestingly enough. If you eat fruit and vegetables regularly, that’s the food for the microbiome so you can take your probiotics until the cows come home but if you don’t feed them, they’re just going to die, they’re not going to multiply or flourish whereas they love your good bacteria. Good bacteria love broccoli, they love onions, actually their favorite food is the onion family: onions, garlic, leeks, chives -they love that. They love broccoli stalks, they love blueberries – all the berries are very favorite food. So, if you can eat a wide variety of fruit, vegetables, don’t use intimate hygiene products and of course, if you’ve got gardnerella, you’ll know when you’ve got a sort of unusual smell, that you know isn’t right. You’re quite likely to be whooshing yourself with all of these intimate hygiene products which just oh they’re going to make things 10 times worse. G-strings whoever invented the bloody G-string for god’s sake! big M,S, big cotton knickers – you don’t want the G-string – how wonderful a bridge all the way to everywhere(!) So there are the lifestyle things and I think, it really does work actually, it does work it really.