When we talk about fertility, the conversation usually centres around hormones, ovulation, egg quality, sperm health and timing.
But there’s another piece of the fertility picture that deserves attention: the vaginal microbiome.
Your vagina is home to its own community of microorganisms, and research is continuing to explore how changes within this environment may be connected to reproductive health and fertility.
First, what is the vaginal microbiome?
The vaginal microbiome is the community of microorganisms that naturally live within the vagina.
In many healthy vaginal environments, Lactobacillus species are dominant. These bacteria help produce lactic acid and support the naturally acidic vaginal environment that helps protect against the overgrowth of potentially problematic microorganisms.
When this balance shifts, the vaginal environment can become less Lactobacillus-dominant and contain greater numbers of anaerobic bacteria.
One common example of this is bacterial vaginosis (BV).
What is bacterial vaginosis?
BV occurs when there is a disruption to the normal balance of vaginal bacteria.
Rather than being dominated by protective Lactobacillus species, BV is associated with a lower prevalence of lactobacilli and increased levels of anaerobic bacteria, including species such as Gardnerella vaginalis, Megasphaera and Atopobium vaginae.
Some women experience obvious symptoms, including:
changes in vaginal discharge
a noticeable or “fishy” odour
irritation or discomfort
But BV can also occur without obvious symptoms, which is part of what makes vaginal microbiome health so interesting from a fertility perspective.
So, what does BV have to do with fertility?
A review published in the American Journal of Obstetrics and Gynecology examined the relationship between bacterial vaginosis, endometritis, pelvic inflammatory disease and infertility.
The authors found that BV, chronic endometritis and pelvic inflammatory disease have all been associated with infertility in previous research.
Importantly, this does not mean that having BV means you will experience infertility.
Instead, researchers believe the relationship is likely to be multifactorial.
Several possible mechanisms have been proposed, including changes in inflammation and immune activity, bacterial toxins and an increased susceptibility to sexually transmitted infections.
There is also the possibility of bacteria ascending from the lower reproductive tract towards the uterus.
The vaginal microbiome isn't isolated
This is one of the reasons we don't look at vaginal symptoms as though they're happening in isolation.
The vagina, cervix and uterus are part of the same reproductive tract.
When certain pathogenic bacteria ascend towards the uterus, they may contribute to conditions such as endometritis, which is inflammation of the uterine lining, or pelvic inflammatory disease (PID).
Both chronic endometritis and PID have been associated with infertility.
Researchers are still working to understand exactly how these microbial changes influence fertility, and association does not automatically mean causation. But the emerging research reinforces why persistent or recurrent vaginal symptoms deserve proper investigation.
What does this mean if you're trying to conceive?
It doesn't mean you need to panic about every change in discharge or immediately assume your vaginal microbiome is affecting your fertility.
It does mean that vaginal health deserves a place in the preconception conversation.
If you're experiencing recurrent BV, unusual discharge or odour, persistent irritation, pelvic discomfort or repeated vaginal infections, simply treating the symptoms over and over may not give you the full picture.
The review's authors suggest that diagnosing and treating BV, chronic endometritis and PID before conception may be an important part of preconception care for symptomatic women.
At Floura, this is where we like to get curious.
Why are symptoms recurring?
What does the vaginal environment actually look like?
Are there other factors contributing to the picture?
And if you're trying to conceive, is there anything here worth addressing as part of your broader preconception care?
The takeaway
Your vaginal microbiome is about more than discharge, odour or irritation.
It's part of your reproductive environment.
Research increasingly supports an association between disruptions such as bacterial vaginosis and broader reproductive conditions, including endometritis, pelvic inflammatory disease and infertility.
That doesn't mean BV equals infertility. Far from it.
But if you're trying to conceive and experiencing persistent or recurrent vaginal symptoms, they're worth paying attention to rather than simply putting up with them.
Your vaginal health is reproductive health.
If you're experiencing recurrent vaginal symptoms or preparing for pregnancy and want to better understand your vaginal health, book an appointment with the Floura team.
This article is for educational purposes only and is not intended to replace individual medical advice, diagnosis or treatment.
Research
Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology. 2021;224(3):251–257. doi:10.1016/j.ajog.2020.10.019.