A chat with nutritionist Rebecca from Probio7 about the role of the microbiome in fertility

I am going to be talking to Rebecca Traylen from Probio7 about the microbiome and its importance in health. It is becoming increasingly important to fertility and general health.  

Often people ask what the microbiome has to do with fertility, and it has a huge role to play. The gut microbiome is the most researched out of all the organs. One of the questions I ask on the questionnaire is do you have any digestive problems: diarrhea, constipation on IBS and many women say they do. 

When you think about making eggs and sperm and going through IVF, the food you eat is absorbed into your intestines and it makes up your hormones to be able to produce eggs and sperm. So if you have poor absorption then it is going to have an impact. 

We hear a lot about the gut microbiome but not so much about the vaginal microbiome. It is like an eco-system full of bacteria and viruses that colonise our skin, intestines, gut, and microbiome. 

Rebecca: when people think about the gut microbiome they just think about their digestion and think they don’t have anything wrong with their digestive system so they're fine, but it is much more than that. The gut microbiome isn’t just bacteria found in our intestines, it goes all the way from our mouth, so we have an oral microbiome all the way down our esophagus, intestines and to our anus. Also on our skin, lungs, and vagina, we have more of these microorganisms than human cells in our body, they are so important. 

Zita: one of the things that worries women is that they’re called viruses and bacteria. But they are friendly bacteria and if they go out of balance that is when you get issues like cystitis, IBS etc. 

R: we used to think all bacteria was bad but actually we should have a balance of bad and good bacteria and it's important to keep this ecosystem balance. It will happen that you pick up bad bacteria but it's about making sure that when you have a good balance of good bacteria your body is able to fight it off and stop the colonisation of the bad. We want to know how to pick up this good bacteria from our environment and food. 

In terms of nurturing your bacteria what foods would you recommend?

R: food is a great way to start as your gut bacteria will come in contact with everything you eat. One of the biggest things to think about is fibre, as it is so important. Fibre is a type of carbohydrate that we’re unable to digest so it reaches our large intestines largely undigested, and it acts as a food source for our friendly bacteria. So, the friendly bacteria digest this fibre, which helps them grow and thrive in our guts and produces some good compounds known as short chain fatty acids. These short chain fatty acids have a role throughout our whole body, they move past just our gut health, they interact with our lungs and skin.  

Where do you get fibre from and how much do you need to look after your body's microbiome?

R: fibre is found in plant-based food so things like fruit, vegetables, wholegrain carbs, nuts, and seeds. So, you need 30g a day and most people get around 15g so we could all increase our fibre intake. 

How do you know what 30g of fibre is? 

R: it's hard to know and I never recommend anyone to weigh out what they’re eating, it’s not a healthy relationship to have with food. So, I recommend people to count their plant points during the week and aim to get 30 different types of plant points, a variety of different types of plant-based food rich in fibre. If we hit 30 different plant points in the week then it’s likely you will be getting your 30g of fibre. 

Z: What if you’re like me and some weeks are good and some bad, sometimes I simply get a packet of fibre and pour it over my porridge, is that okay? 

R: Generally, I say try to snack on fruits and veg or nuts, they’re an excellent source of fibre and fats. You can definitely get some fibre supplements, or something to pour over your cereal. Psyllium Husk is a great source of fibre that you can sprinkle on your cereal. 

Z: it's not just for your microbiome is it, it gets rid of extra oestrogen, it is great for women in their reproductive years to have.  

What depletes the gut microbiome? 

R: the gut microbiome can be disturbed in a few different ways. We’ve touched on diet, if you are having a poor diet and getting a lack of fibre or processed foods. Medication too, antibiotics are a big one. They can be an essential part of medicine, but they target the pathogenic bacteria but they're not selective, so they also kill off the good bacteria. Stress is a massive one and studies have shown that it can negatively affect the gut and kill the good bacteria. It’s something that people often overlook. Especially when you're thinking of something like fertility, if you're having fertility issues its a huge factor for stress. Plenty of exercise is beneficial, I suggest 20 mins a day. It's really important to get that diverse microbiome coming from so many different sources. Don’t feel overwhelmed by it, try to take on a bit of everything. There is no point in focusing on just one because if your diet is perfect, but you're stressed then this will negatively impact your gut. Try and think about all these different areas. 

Z: for many women trying for a baby, when their period comes, they will crave more carbs, so it's difficult. Your point about stress is great, doing yoga and being able to breath is important because the gut has 90% of our immune cells and produces serotonin which is the feel-good hormone.  

R: 90% of serotonin is made in our gut which stresses how important it is. Foods that we eat convert tryptophan into serotonin, things like turkey and nuts. Our gut microbiome is helping to digest all this. Try to do breathing exercises and go for walks. 

Z: gut microbiome and the vaginal microbiome is becoming increasingly important. Studies have shown that lactobacillus is beneficial for implantation or any issues like endometriosis, cystitis, and recurrent miscarriage.

How do you balance the vaginal microbiome and what different strains are needed? 

R: It's such an exciting area of research and the number of papers that have come out in the last few years have really emphasis the importance of the vaginal microbiome to fertility. The vaginal microbiome is very different to our guts, our gut is a rich and diverse ecosystem with loads of bacteria in there doing lots of different things, but our vaginal microbiome is much less diverse, it is very dominant in lactobacillus which produce lactic acid which makes the PH is our vagina very acidic and this is so important as it deters pathogenic bacteria. So, this is why when we have an unbalanced microbiome and a less dominant lactobacillus in our vagina this is when we start getting pathogens in and colonising causing UTIs etc so its important we’re balancing the vaginal microbiome. There are hygienic practices we can do, making sure when we go to the toilet, we are wiping front to back so were not transferring fecal bacteria to our vagina, as our fecal matter comes from our gut which is a very different environment. Not using wash products that will affect the PH of our vagina. All the things I mentioned before, diet, stress, exercise, don’t just affect our gut, but our vagina as well. Something to think about with fertility is whether you have just finished a course of antibiotics because that will be affecting your microbiome as well. 

Z: the lactobacillus is important to prepare the endometrium and the endometrium is rich in nutrients which are so important for implantation. 

R: the studies at the moment are looking at the dominance of lactobacillus particularly in IVF outcomes and showing that over 90% of the vagina's microbiome needs to be lactobacillus. It's shown to have a more favourable outcome in IVF, pregnancy, and the rates of miscarriage. There has been some interesting research into how different ethnicities have different vaginal microbiomes, this changes the rates of miscarriage among women as well. The research will highlight more and more how important these findings are. 

I am 6 weeks pregnant and can't eat anything healthy at the moment. Is there anything I can do to keep my vaginal microbiome healthy; I am really worried about miscarriage? 

Z: I can understand this because when you're first pregnant after IVF it does freak you out and women are always amazed that they have been so healthy while getting pregnant and once they're pregnant they crave carbs, chips and sandwiches etc. 

You can take a probiotic for pregnancy, what would the dominant strain in a probiotic be for pregnancy? 

R: I'd definitely recommend taking a probiotic during pregnancy. There has been a lot of research to show that it reduces the risk of adverse outcomes and reduces the risk of eczema in the infant. When looking for a probiotic during pregnancy you want to look at one that’s been researched on pregnant women, as when you get pregnant your gut microbiome changes especially in the second and third trimester. The species of bacteria completely changes and it's amazing how our bodies adapt to this. All these changes help support the growth of our baby and the natural weight gain. The Zita West Pregnakalm powered by Probio7 has been researched on women who are pregnant. It's easy to say to have a healthy diet, but your body is going through so much. 

Z: when having carbs and sugar and fulfilling your cravings it will effect the microbiome. 

R: like I said earlier it's not just diet, think about stress and whether you're getting out so much. That way if your diet isn't 100% healthy all the other things will help. 

How do you choose the right probiotic? 

R: It's amazing that there are so many probiotic options buts it's so overwhelming. Some think that the more bacteria the better but that’s not necessarily true it's about getting the specific strain for the specific condition or symptom that you're targeting, so when you are choosing a probiotic you should be looking at the strain of the bacteria and the research on that bacteria. 

Check out this blog for more info. 

Z: what you're saying is it's not the quantity but the strain.

Do I need a different probiotic for the gut and the vagina? 

R: Yes, they're very different environments. When finding a probiotic for your gut microbiome you'll get a more diverse range of bacteria, it might have bifidobacterial in it. Whereas when finding one for your vaginal microbiome the lactobacillus is important, and you want to be sure that research shows that it is able to reach where you need it to. 

Can you test for vaginal and gut microbiome?  

Z: you can test for the vaginal microbiome. What frustrates me is that you can do a test, and no one knows how to treat it.  

It’s the same when people have a sperm DNA fragmentation test looking at the oxidative stress and damage to the sperm. They do the test then ask what they need to take, and the medical community is divided about the amount of vitamins to take etc. Whereas in this situation it's clear cut which strains work for the vagina, pregnancy, and the gut. I have mixed feedings about testing as every test has a result that can put women into a panic so sometimes just taking the right probiotic is the best way. 

R: Yes, there are tests you can do which have been amazing for research but sometimes it can tell you results and it's just another source of stress. But there are probiotics you can take without doing a test. I wouldn’t recommend a test for your gut microbiome as there is still so much, we don’t know and it’s so diverse, even a set of twins don’t have the same microbiome. It's a lot more beneficial to just look at the research. 

Z: for every test you do it's expensive and then you have to repeat the test to see improvement. 

Can you overdose on probiotics? 

R: Probiotics are completely safe and there are no studies that suggest you can overdose, they are a natural part of our digestive system and microbiome. Just a word of warning you are taking too many probiotics you may experience increased flatulence and bloating. The more bacteria you have will be digesting this fibre and a byproduct of that is gas production.  

I have Crohn's disease and I go to the toilet 8-10 times a day; would a probiotic benefit me? 

R: Yes, there is research looking at Crohn's and probiotics, it's just important that you're finding the right probiotic for you condition and if you're under medical provision discuss this with your GP as well. At probio7 I run free 1:1 consultations where I can advise you on specific probiotics and what would be suitable. 

Many women are on steroids while going through IVF, can you take a probiotic with steroids? 

R: yes, probiotics are generally safe alongside medication but it's always worth making your GP or practitioner aware of your supplements.  

What about probiotic drinks in supermarkets? 

R: I think they're beneficial but again if you are trying to target something specific like fertility and pregnancy the shakes might be too generic, perhaps better for daily maintenance rather than specific. 

Can you influence the vaginal microbiome if you have endometriosis? 

R: yes, there has been research that you can influence it with probiotics and dietary interventions. Making sure that if you have underlying health conditions updating your GP and I always suggest to people who are starting a new probiotic to keep a food and symptom diary. Your gut microbiome is so unique and one thing that works for your friend isn't necessarily going to work for you. 

Z: for so long during the pandemic no one was getting coughs or colds as we weren't having contact but now it is so important to keep your immune system up with vitamin d and probiotics. 

What about the man? Can a probiotic improve sperm? 

R: here is amazing research on this. We used to think there wasn't bacteria in sperm but there is, and it plays an important role in things like inflammation in the sperm which is important in DNA. There are probiotics specifically for men and fertility.  

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