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There are plenty of ways to improve your chances of success if you’re trying to conceive, but one you may not have thought of relates to your vaginal health: the vaginal microbiome. Understanding more about the good and bad bacteria in your vagina, along with how to improve that balance, can make a difference when it comes to your fertility.
What is the vaginal microbiome?
The vaginal microbiome is a complex community of tiny microorganisms, that naturally live in the vagina. You might hear it called the vaginal microbiota or vaginal flora. This ecosystem is important for reproductive health and overall well-being, and imbalances in the vaginal microbiome can result in conditions like yeast infections, bacterial vaginosis (BV), and other vaginal infections. Imbalances in the vaginal microbiome can also be linked to issues like infertility, complications during pregnancy, sexually transmitted infections (STIs), and even certain types of cancer.
How is the vaginal microbiome different from the gut microbiome?
Your vaginal microbiome and gut microbiome are both made up of bacteria, but they serve different purposes. The gut microbiome plays a key role in digestion, metabolism, and immune function, while the vaginal microbiome helps protect against urogenital infections and plays a major role in your reproductive health. Even though they’re separate, the two are connected through something called the gut-vagina axis—meaning an imbalance in the gut (due to factors like antibiotics, diet, or stress) can also impact vaginal health. Keeping your gut microbiome in check may be one way to help support a balanced vaginal microbiome, too.
Can probiotics help improve vaginal health?
Probiotics are live microorganisms, primarily bacteria, commonly found in fermented foods (like yogurt, kefir, and kimchi) and supplements. Often referred to as "good bacteria," probiotics help maintain or restore balance in the body's microbiome—in some cases, even the vaginal microbiome.
Probiotics, especially those containing Lactobacillus species, may help restore the natural balance of vaginal flora after it has been disrupted by factors like antibiotics, hormonal changes, or infections.
That said, the science on probiotics and the vaginal microbiome is still emerging, and when it comes to vaginal health, there's no one-size-fits-all solution. Everyone's vaginal microbiome is different, which means that what works for one person might not be the best choice for another. It can be a bit frustrating to invest in probiotics without being sure if they’ll do the trick for you, but finding the right fit for your body is key.
How does the vaginal microbiome work?
The vaginal microbiome is made up of various bacteria, fungi, and viruses, but the stars of the show are the Lactobacillus bacteria. Often referred to as "good" or "protective" bacteria, they play several vital roles in keeping your microbiome balanced:
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They produce lactic acid to maintain a healthy vaginal pH (about 3.8 to 4.5), which acts as a shield against pathogens
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They take up space on the vaginal walls, making it tougher for harmful bacteria to settle in
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They produce bacteriocins, natural antibiotics that keep disruptive bacteria at bay
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They help reduce inflammation in the reproductive tract
When the levels of those beneficial Lactobacillus bacteria dip, it can lead to an overgrowth of harmful bacteria, creating a situation called vaginal dysbiosis, or an imbalance in the vaginal microbiome.
Bacterial vaginosis (BV) is the most prevalent form of vaginal dysbiosis, affecting nearly 30% of people with vaginas each year. Some common symptoms include an increase in vaginal discharge that may look watery or greyish and has a noticeable fishy odor, especially after sexual activity.
How does the vaginal microbiome affect fertility?
While the connection between the microbiome and fertility is still being explored, researchers have uncovered some important insights. Studies suggest that a healthy vaginal microbiome, dominated by Lactobacillus bacteria, is linked to better fertility outcomes. One well-established link is between bacterial vaginosis and fertility issues. BV increases the risk of STIs, which in turn raises the likelihood of pelvic inflammatory disease (PID), a condition that can lead to infertility. For those who are sexually active, routine STI testing is essential to protect fertility.
The microbiome can also impact the immune system. Vaginal dysbiosis, such as BV or infections, can trigger a local immune response that may interfere with conception. Emerging research also indicates that certain bacteria could affect sperm motility, adding another layer to this complex relationship.
Vaginal health and spontaneous conception
Some evidence connects a balanced vaginal microbiome with improved chances of spontaneous conception (when you’re trying to conceive without the support of medication or a clinic). A 2022 study examined the vaginal microbiome of 89 females and tracked how long it took them to conceive. Within a year, 59.6% of the participants became pregnant. The researchers found higher levels of Lactobacillus bacteria in those who conceived, while Gardnerella (the bacteria most commonly linked to BV) was more prevalent in those who did not.
Vaginal health and fertility treatments
The relationship between the vaginal microbiome and reproductive treatments like IVF has also been studied: a meta-analysis of 17 studies involving 3,543 patients found that vaginal dysbiosis in IVF patients was associated with lower clinical pregnancy rates and a higher likelihood of early pregnancy loss.
How does vaginal microbiome testing work?
Vaginal microbiome tests involve collecting a sample from the vagina, which is then analyzed to identify the types and quantities of bacteria present. The testing process typically looks like this:
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Sample collection: This involves using a cotton swab to collect a sample of vaginal fluid. It can be done at a healthcare provider's office, or from the comfort of your own home using an Evvy Vaginal Health Test.
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Lab analysis: Once the sample is collected, it gets sent to a lab where scientists use advanced DNA sequencing technologies to discover and measure the different types of bacteria and fungi present.
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Results: The results will give you an insightful overview of your vaginal microbiome, showing the balance between helpful and potentially harmful bacteria.
Evvy’s at-home test screens for over 700 types of bacteria found in the vaginal microbiome with just one swab, and uses metagenomics, a state-of-the-art technology that sequences the whole genome of all microbes present. That means you don’t have to order several tests to get a good picture of what’s up down there—just one.
