Bacterial vaginosis and fertility

Bacterial vaginosis is the most common disease of the genital organs in women of childbearing age. It is characterized by a transition from a healthy vaginal microbiome dominated by acid-forming bacteria (healthy bacteria such as lactobacilli) to a vaginal microbiome dominated by unhealthy bacteria. The most noticeable and often most bothersome symptom of bacterial vaginosis is a strong fishy smell from the vagina, but some women with bacterial vaginosis also have an increased amount of gray discharge.

Bacterial vaginosis can be a vicious cycle of triggers, which means it can be very difficult to break the cycle of bacterial vaginosis imbalance. Women with bacterial vaginosis have lower levels of amylase in the vagina, an enzyme that breaks down large carbohydrates into smaller carbohydrates called glycogen, which are eaten by healthy bacteria. Without this preferred food source, good lactobacilli cannot grow and thrive. Women with bacterial vaginosis also have lower levels of antimicrobial peptides that can fight invading bacteria. In a healthy vagina, the cells of the vaginal mucosa normally produce antimicrobial peptides.

Can sperm and eggs survive bacterial vaginosis?

Bacterial vaginosis is three times more common in infertile women than in women of childbearing age. Bacterial vaginosis and other infections in general can reduce fertility in several ways:

increasing inflammation and immune system activity, making a toxic environment for reproduction.
causing damage to sperm and vaginal cells.
interfering with the production of healthy cervical mucus during ovulation.
blocking the Fallopian Tubes through scar tissue damage from infections, so that sperm and egg can’t meet.

Can bacterial vaginosis affect my pregnancy?

Bacterial vaginosis is associated with a two-fold increase in the risk of preclinical pregnancy loss, sometimes called biochemical pregnancy, after in vitro fertilization. Women with bacterial vaginosis during pregnancy may be at increased risk of miscarriage, preterm labor and complications in the low birth weight newborn, and postpartum infections.

Can my vaginal microbiome affect my baby?

Research has shown that a naturally born baby has a very similar microbiome to that of the mother. The influence of microbes on the fetus can begin even in the womb through microbes from the placenta, amniotic fluid and cord blood. Breastfeeding after birth can also transfer the microbiome from mother to baby, but the greatest transmission of microbes occurs during the baby's journey through the vaginal canal. Your baby's lifelong health and immune system is affected by your vaginal microbiome during childbirth, so it's wise to keep your vaginal ecosystem healthy during pregnancy.

How does bacterial vaginosis develop?

Approximately 90% of women diagnosed with bacterial vaginosis develop after persistent loss of lactic acid-producing bacteria in the vagina. Lactic acid-producing bacteria help a healthy vagina maintain an acidic vaginal pH. This pH around 4.5 keeps the bacteria that cause bacterial vaginosis away. The acidic pH also promotes normal shedding or sloughing of cells in the vaginal mucosa, which in turn releases glycogen to feed beneficial bacteria.

If you can restore the conditions in your vaginal ecosystem that allow healthy bacteria to thrive, you can break the vicious cycle of bacterial vaginosis. However, if the population of harmful bacteria continues to grow, there will not be enough glycogen to feed healthy lactobacilli. Bacterial vaginosis bacteria then form a high pH biofilm that coats and protects these harmful bacteria, making it difficult for lactobacilli to return to healthy levels.

Treatment - Do's and Don'ts

Antibiotics such as metronidazole, clindamycin, and tinidazole are often prescribed to kill some of the bacteria that cause symptoms of bacterial vaginosis. But it is well known that antibiotics kill good bacteria as well as infection-causing bacteria, which can have disastrous long-term effects on vaginal health.

Since the health of the vagina is linked to the presence of good bacteria, antibiotics should only be used when absolutely necessary. Destroying the good bacteria along with the bad bacteria can lead to vaginal imbalance and recurring cases of bacterial vaginosis. Studies have shown that more than 50% of women treated for bacterial vaginosis relapse within 12 months. Bacterial vaginosis most often recurs after a course of antibiotics.

Since there are no easy answers when it comes to treating bacterial vaginosis, the best thing to do is simply to help our vagina heal itself by putting the good bacteria back in charge. Options to try instead of antibiotics might include a vaginal probiotic with healthy doses of micronutrients needed for a healthy vaginal ecosystem (such as iron, zinc, and manganese). Also consider using a vaginal gel containing lactic acid to make the vaginal pH more acidic.

How can I prevent bacterial vaginosis?

Healthy bacteria are the best defense against bacterial vaginosis, so anything you do to encourage the growth of lactobacilli bacteria will be a positive step forward in your fight against bacterial vaginosis. First of all, don't take a shower. Douching flushes out all the good bacteria along with the bad ones, and many douches contain harsh chemicals. When looking for vaginal care products to eliminate odor, maintain pH, or lubricate for intimacy, look for products without glycerin (glycerine), coating oils, or parabens. It is also important to choose foods that are isotonic to the vaginal cells, which means that the concentration of salts/ions in the product is the same as in the tissues of the vagina. Many lubricants and cooling gels have a salt concentration 4 times higher than vaginal discharge. High salt levels draw water out of cells and have been shown to permanently damage vaginal mucosal cells and lactobacilli. Never use household oils such as coconut oil in your vagina. Coconut oil can contain toxic peroxides and inflammatory chemicals due to exposure to light and storage at room temperature and can coat the vagina preventing the vagina from self-cleansing.

A few more comments about pH: Remember that a healthy vaginal pH is acidic, with a pH level of 4.5. When choosing products for odor control or lubrication, be sure to choose products with a pH of at least 4 or above about 5.5. The only exception is that when you are trying to conceive, it is best to use a pH 7 lubricant during your fertile period so as not to damage the sperm.

How does bacterial vaginosis affect the overall health of my vagina?

Bacterial vaginosis:

-can cause scarring of the Fallopian tubes and associated fertilization failure.

-keeps the vagina’s immune system into a persistent, raised state of response.

-causes chronic inflammation. Women with bacterial vaginosis have an increase in vaginal chemicals associated with inflammation, called interleukins.

-compromises the white blood cells that fight infection, making women with bacterial vaginosis more prone to other vaginal infections. Studies show bacterial vaginosis is associated with increased rates of human papillomavirus and HIV infection.

Good vaginal health is also good for fertility.

Bacterial vaginosis is not easy to fight, and it has a particularly big impact, not only when trying to conceive, as it can damage sperm and eggs, but also during pregnancy. By choosing vaginal care products that support the growth of healthy bacteria (or at least don't harm healthy bacteria), you can keep the vaginal ecosystem in proper balance and prevent key bacterial vaginoses.