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Bacterial Vaginosis and Fertility: Exploring the hidden obstacles to conception

Nutritionist Magdalena Marvell explores the scientific world behind infertility and the challenges faced by women trying to conceive.

Although bacterial vaginosis (BV) is a common infection, it is not often recognised as a potential factor in infertility. BV is usually associated with noticeable symptoms, such as unusual discharge or odour, but it can also affect fertility in more subtle and complex ways. BV occurs when there’s an imbalance in vaginal bacteria, where harmful bacteria outnumber beneficial lactobacilli, disrupting the vagina’s natural environment1.

The vaginal microbiota makes up 10% of the total human microbiome. This imbalance can pose unique challenges for women trying to conceive, impacting fertility in ways that may not be immediately apparent2.

Magdalena Marvell is a Nutritional Practitioner and Founder of the Persea Clinic which helps support clients who want to optimise their health in areas such as gut health, hormonal balance, skin conditions, weight management, family nutrition. To find out more about her work please visit www.persea.clinic.

What is Bacterial Vaginosis?
BV occurs when the balance of bacteria in the vagina shifts, decreasing lactobacilli and allowing harmful bacteria like Gardnerella vaginalis to proliferate1/3. This imbalance can lead to inflammation and changes in the vaginal environment, which may hinder fertility2/4. Gardnerella vaginalis may also be associated with endometriosis and can produce toxins that may affect the vaginal lining.

How BV Affects Fertility
While BV itself is not classified as a sexually transmitted infection (STI), research has shown that it can indirectly affect fertility by increasing the risk of pelvic infections, damaging sperm and egg function, and interfering with embryo implantation5/6.

Women with BV have a higher risk of developing pelvic inflammatory disease (PID), a serious infection that can spread to the uterus, fallopian tubes, and ovaries. PID often leads to scarring and blockages in the fallopian tubes, which can prevent the egg and sperm from meeting, reducing the chances of fertilisation. In severe cases, PID can result in complete tubal obstruction, requiring medical intervention, such as in vitro fertilisation (IVF), to conceive7.

BV alters cervical mucus, which normally helps support sperm survival and movement. BV-associated changes in pH and an increase in inflammatory substances can create a hostile environment for sperm, reducing their motility and lifespan in the reproductive tract. This can hinder sperm from reaching the egg, significantly lowering the chances of fertilisation6/8.

Research suggests that probiotic strains such as L. rhamnosus GR-1 and L. reuteri RC-14 can stimulate the production of lactic acid and hydrogen peroxide, which lower vaginal pH and create a more hostile environment for pathogens and infections.

A balanced vaginal microbiome is essential for a healthy uterine environment. BV can affect the endometrial lining, which is critical for embryo implantation. Inflammation and bacterial toxins associated with BV may make the endometrium less receptive to an embryo, reducing the likelihood of successful implantation and increasing the risk of early pregnancy loss5/9. Probiotics such as L. rhamnosus GR-1 and L. reuteri RC-14 may help support cytokine production, which can reduce inflammation in the vaginal epithelium.

Increased risk of pregnancy complications
Although this doesn’t directly affect conception, BV has been linked to a higher risk of pregnancy complications, including preterm birth and low birth weight2/10. Women with untreated BV during pregnancy are more likely to experience these complications, which can affect future fertility and overall reproductive health3.

BV is known to recur frequently, even after treatment. For women trying to conceive, recurring infections increase the risk of chronic inflammation and may weaken the vaginal and uterine environment over time9. Recurrent BV episodes also elevate the risk of PID, tubal scarring, and endometrial changes, which can progressively impact fertility8.

Diagnosis and treatment of BV to support fertility
BV is usually diagnosed through a pelvic exam, pH testing, and microscopic analysis of vaginal discharge. If you’re experiencing symptoms or have a history of BV and are trying to conceive, seeking a diagnosis is essential1.

BV is typically treated with antibiotics, such as metronidazole or clindamycin, which can help rebalance the vaginal microbiome by reducing harmful bacteria. However, antibiotics can sometimes lead to recurrence, so using probiotics, particularly L. rhamnosus GR-1 and L. reuteri RC-14, may help support a healthy vaginal flora and reduce recurrence10/11.

These probiotics have been shown to enhance the effectiveness of antibiotics and can be taken within two hours of antibiotic doses.

For those planning to conceive, taking preventive steps can help manage BV’s impact:
• Practice Good Vaginal Hygiene: Avoid douching, as it disrupts the vaginal flora and can encourage bacterial imbalances12.
• Use Probiotics: Research shows that probiotics containing lactobacilli strains, especially L. rhamnosus GR-1 and L. reuteri RC-14, can support a balanced vaginal microbiome, potentially lowering the risk of BV recurrence11/12.
• Regular Health Check-Ups: Routine gynaecological exams and BV testing, especially if you experience symptoms, can help catch and manage infections before they impact fertility5.
• Dietary Adjustments: A diet high in fibre and low in sugar may help support a balanced microbiome by limiting the sugars that harmful bacteria thrive on6.

References

  1. link.springer.com/article/10.1007/s11908-014-0425-2
  2. sciencedirect.com/science/article/pii/S0891552020300119
  3. sciencedirect.com/science/article/pii/S1473309917303149
  4. academic.oup.com/aje/article/159/4/313/102456
  5. jci.org/articles/view/60205
  6. obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2010.02752.x
  7. journals.lww.com/greenjournal/Abstract/2005/07000/Bacterial_Vaginosis_and_Risk_of_Pelvic_Inflammatory.11.aspx
  8. annualreviews.org/doi/abs/10.1146/annurev.micro.092611.152238
  9. academic.oup.com/jid/article/214/suppl_1/S14/2583440
  10. amjmed.com/article/0002-9343(83)90261-5/fulltext
  11. jogc.com/article/S1701-2163(16)30223-5/fulltext
  12. link.springer.com/article/10.1007/s00253-019-09853-2
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