Let me start out speaking about the microbiota which consists of bacteria that live in different areas of our body. We will focus on the special bacteria that lives in the female reproductive area and in the semen.
Microbiome and Fertility in Men
For males, studies have shown that “altered sperm cells affect motility, hyperviscosity, oligoasthenoteratozoospermia, and/or sperm DNA fragmentation.” And “several factors, including the geographical location, diet, age, hygiene practices, circumcision, age at sexual debut and sexual activities, are able to influence the semen microbiota composition” (D’Argenio, 2021). For men, attending to lifestyle can positively affect sperm. I find it interesting in males that research shows that Lactobacillus-predominant semen has been associated to improved semen parameters while other pathogens like Ureaplasma urealyticum, Enterococcus faecalis, Mycoplasma hominis and Prevotella negatively impact semen quality (D’Argenio, 2021). However, I don’t see that these are tested in men.
In another study for males, a six-week supplementation with Lactobacillus and Bifidobacterium in asthenozoospermic (the reduced sperm motility in a man’s semen sample) has shown its efficacy by increasing sperm motility and reducing the rate of sperm DNA fragmentation (Valcarce D.G 2017). In addition, a study showed that male patients that were given a six-month daily treatment of Lactobacillus paracasei, arabinogalactan, fructo-oligosaccharides, and l-glutamine had a positive effect on sperm count and motility (Maretti C. 2017).
Microbiome and Fertility in Women
For women, the Human Microbiome Project has assessed that the vaginal microbiota accounts for about 9% of the whole human microbiota. (Human Microbiome Project Consortium, 2012) But there are also special bacteria that inhabit the fallopian tubes, uterus and ovaries. The reduction of Lactobacilli and an increased bacterial diversity, are associated with pregnancy complications, including preterm birth; and studies have shown that the endometrium hosts its own microbiota whose alterations may impact both fertility and pregnancy outcomes [Di Simone, 2020). In addition, in some research, alterations of both vaginal and endometrial microbiota have been found to be negatively correlated to IVF pregnancy rates. (Selman, 2007) Of course more research needs to be done. While the vaginal microbiota is well described, the uterine microbiota is still underexplored.
Gut Health + Fertility
In my experience, the microbiome of men and women are never tested. However, it is possible that restoring gut health might be a good start to restoring the microbiome everywhere. Start with a stool sample to assess the combination of beneficial and harmful bacteria. In the case of overgrowth of bad bacteria, we are able to give pre and probiotics to help restore good bacteria and in some cases we will have to kill off the bad bacteria once the good bacteria is reestablished. One way to look at this is to ask yourself if you have any of the following symptoms: bloating, gas, constipation, diarrhea, frequent bladder infections, and/or frequent bacterial vaginosis. In a 2021 study the researchers said that one should test the seminovaginal microbiota to properly assess the couple’s fertility status. Another study showed that treating both partners when the woman gets frequent bacterial infections helps reduce the disease recurrence. These forms of probiotics have been shown to positively restore the reproductive mycobiome in women who have recurrent bacterial vaginosis. Probiotics, such as L. reuteri RC-14, L. fermentum, L. gasseri, L. rhamnosus, L. acidophilus, L. crispatus, L. casei, and L. salivarius, and these can be inserted directly into the vagina as well as taken orally. (D’Argenio, 2021).
What can women do to have a healthy microbiome?
This is a complicated question because there are so many factors that affect the microbiome. But a good place to start is with the gut. One study showed that treating both partners when the woman gets frequent bacterial infections helps reduce the disease recurrence. Probiotics can be inserted directly into the vagina as well as taken orally. And don’t forget to eat fermented foods. Again, we also need to assess the gut because if a woman also has small intestine bacterial overgrowth ( SIBO) she might only be able to start with bifidus and acidophilus as well as spore probiotics.
Another compelling fact is that if the vaginal microbiota has a reduction in Lactobacilli and an increased bacterial diversity, this is associated with pregnancy complications, including preterm birth. The endometrium hosts its own microbiota whose alterations may impact both fertility and pregnancy outcomes ( Di Simone, 2020). A prospective study carried out on 300 women of reproductive age waiting for an IVF procedure validated the predictive value of vaginal microbiome assessment on IVF outcome, suggesting the introduction of this kind of evaluation in diagnostic algorithms (Koedooder R, 2018).
What does all this mean?
First, assess your stool if you are having issues. Next, if you have frequent bacterial vaginosis, make sure that you treat your partner as well. It’s important to keep the vaginal pH acidic (except when you are ovulating) and this can be changed from frequent antibiotic use, using the wrong lubrication, altered hormones and age-related factors as well as elevated BMI (Body Mass Index). Make sure your diet is also free from sugar, alcohol and that you have some healthy fermented food like fermented veggies.
There are so many differences in microbiota that vary from racial, genetic, geographic, and social factors as well as from environmental factors, such as hygiene habits, sexual exposure, change of sexual partners, and use and type contraceptives. And we can’t forget that other factors such as stress have an impact on our whole system.
In Chinese Medicine we ask a lot of questions about the whole person including vaginal discharge, smell and pain. We also look at the tongue to assess if the person has a lot of dampness in their body. We can see this if there is a thick greasy coating on the tongue. Sometimes this coating is yellow and sometimes it is white. We then treat to clear out dampness in the body if we find it and with that it is possible that we are treating the microbiome! What creates dampness in the body? It is often created by a person who has a poor diet and lifestyle. This may be a person that eats greasy foods and consumes sugar as well as has a poor digestion.
The microbiome, though widely different in individuals, is a new frontier in medicine. Although it is the micro system of the macro, it is a way to look at the body’s health. If you are having frequent yeast infections, bacteria infections, urinary tract infections, or digestive problems, make sure to get help from a natural doctor.
Dr. Denise Wiesner, DACM, L.Ac, founder of the Natural Healing and Acupuncture Clinic in West Los Angeles, is an internationally recognized Traditional Chinese Medicine practitioner, specializing in the Whole Systems Chinese medicine approach to women’s health, sexuality, and fertility. Since 1994, Wiesner has treated and helped women manage challenges from menstrual disorders and menopause to infertility and pregnancy. Using a combination of acupuncture, diet and lifestyle counseling, nutritional supplements, and Chinese herbs, Wiesner has helped thousands of couples navigate the tricky, and often stressful, journey toward fertility, without losing their loving connection. She is author of the book, “Conceiving With Love,” and has a BS in Kinesiology and a doctorate in Traditional Chinese Medicine.