The Seminal Microbiome and its impact on Bacterial Vaginosis in females

Bacterial vaginosis is an infection which impacts a third of reproductive aged women. It can sometimes be completely symptomless, whilst in other women a grey and fishy smelling discharge may be present.

BV sets up an environment in the vagina where the protective strands of lactobacillus bacteria drop to below optimal, PH increases, and unwanted anaerobic bacteria including Gardnerella, Atopobium vaginae, prevotella bivia and others increase.

BV in women has been linked to unwanted fertility outcomes including miscarriage and setting up an inflammatory environment where implantation can be lower.

One of the issues with BV is the high recurrence rate, which is up to 50% within 6 months of antibiotic treatment. This can be due to a number of factors including biofilms, a lack of protective lactobacillus being reintroduced but also a very important consideration is the impact of the seminal microbiome in male partners and reinfection whilst having intercourse. PMID: 34470644

A recent RCT studied the impact of treating male partners as well as females diagnosed with BV and found that the treatment of both partners was so successful in reducing the recurrence rate that the study was stopped early. There was a 35% recurrence rate in the treated group compared to a 63% recurrence rate in the group where males were not treated. (PMID: 40043236)

We know that other infections including Ureaplasma can pass between couples and negatively impact IVF outcomes. Ureaplasma in particular can negatively impact the uterine environment and is linked to miscarriage, unsuccessful IVF and unexplained infertility. (PMID: 3044493)

The seminal microbiome in males consists of protective and in some cases unwanted bacteria which can impact fertility outcomes. When having intercourse there is a transfer of bacteria between partners, with couples sharing up to 56% of their predominant bacteria: whether healthy or dysbiotic (PMID: 34660337), leading to a cycle of reinfection.

Men who have tested positive for Gardnerella have been found to be more likely to have partners with recurrent BV.PMID: (34177961)

Even if bacteria is not passed between couples, intercourse can change the make-up of the female microbiome.

As with the female vaginal microbiome, in the seminal microbiome lactobacillus bacteria play a role in protecting and fertility, with increased levels of lactobacillus linked to higher clinical pregnancy after IVF whereas prevotella bivia linked to lower levels and also to a lower sperm concentration (PMID: 34660337)

This is important because so often the focus is on treating the female. If you have a vaginal microbiome test and you have tested positive for BV, or have BV associated bacteria and Ureaplasma you need to also look at interventions for your partner.

Male risk factors which can negatively impact seminal microbiome

-        Smoking

-        Use of vaginal products during intercourse

-        Autoimmunity

-        High fat and sugar diet – processed foods, an excess of meat, take away

-        STI such as HPV, UTI, chlamydia, gonorrhoea

-        Poor hygiene

-        Alcohol intake

-        Drug use

-        Antibiotic use

-        Prolonged abstinence

-        Excess heat exposure: sauna, laptop/computer on lap, tight fitting underwear

-        Presence of Mycoplasma and Ureaplasma

Improving the seminal microbiome:

-        Specific probiotic supplementation to improve levels of protective lactobacillus bacteria

-        Daily washing with a non-perfumed, chemical free body wash or water

-        Cut out alcohol, drugs and cigarettes

-        Get checked for STI’s

-        Omega 3 fats: oily fish, walnuts, chia, flax

-        Fermented foods: kimchi, sauerkraut

-        A high fibre diet – aim for 7 portions of veg daily

-        Avoid excess heat exposure: sauna, laptop/computer on lap, tight fitting underwear

-        Run a seminal microbiome test

My view is always test dont guess. We can take the steps to improve the seminal microbiome but by testing we can identify specific baceria that could be impacting you and a specific course of action. Sometimes this is via supplements, lifestyle and diet and sometimes I will refer on to a gynaecologist, urologist or your IVF clinic for antibiotics or other treatment.

There is no magic pill when it comes to supporting fertility outcomes. We are complex and what we need differs significantly from person to person.

If you are looking for support with your fertility, please do reach out via the contact form and we can discuss how best to support you. I do not ask clients to commit to packages of sessions, I find that what people need is so varied, as are timelines so I work in a tailored way to support you. This starts with an initial appointment, and we will build your timeline together from there.