Bacterial Vaginosis and Fertility: Why Your Vaginal Microbiome Matters
- Rachael Robinson
- 1 day ago
- 5 min read
Table of Contents
Quick Summary
• Bacterial vaginosis is a common vaginal microbiome imbalance that may affect fertility, implantation, and early pregnancy.
• Many women have no symptoms, so testing the vaginal microbiome can be important when trying to conceive.
• Treating both partners and supporting healthy lactobacillus levels may reduce recurrence and improve reproductive health.
Introduction
When we talk about fertility, we often focus on hormones, egg quality, or ovulation. However, the vaginal microbiome also plays an important role. In recent weeks I have seen several clients with disrupted vaginal microbiomes caused by bacterial vaginosis. This common condition can quietly influence fertility and early pregnancy outcomes. Understanding how bacterial vaginosis affects reproductive health can help you take proactive steps before conception.
What is Bacterial Vaginosis?
Bacterial vaginosis is a common vaginal infection caused by an imbalance in the vaginal microbiome. The vaginal microbiome is made up of many types of bacteria. In a healthy environment, protective bacteria called lactobacillus dominate.
Lactobacillus helps maintain an acidic environment in the vagina. This acidity protects against harmful bacteria and infections. When lactobacillus levels drop, other bacteria can grow more easily. In bacterial vaginosis, anaerobic bacteria increase while protective lactobacillus levels decrease. This shift disrupts the natural balance of the vaginal microbiome. As a result, the vaginal environment becomes less protective and more inflammatory.
How Bacterial Vaginosis Can Affect Fertility
The vaginal microbiome plays an important role in reproductive health. When bacterial vaginosis is present, inflammation can increase within the vaginal environment. Inflammation may affect sperm survival and movement. Sperm need to travel through the vagina and cervix to reach the egg. If the environment is hostile, fewer sperm may successfully make that journey. In addition, bacterial vaginosis has been linked with higher rates of pelvic infections. These infections can affect the uterus and fallopian tubes, which may impact fertility over time.
Research also suggests that bacterial vaginosis may affect implantation. A disrupted vaginal microbiome may influence the uterine environment. This can make it harder for an embryo to implant successfully. If left untreated, bacterial vaginosis has also been associated with complications in early pregnancy. For women trying to conceive, optimising the vaginal microbiome is therefore an important but often overlooked step.
Bacterial Vaginosis is Often Symptomless
One of the biggest challenges with bacterial vaginosis is that many women have no symptoms. Some women notice a grey discharge with a fishy smell. However, this is not always present. In fact, many cases are only detected when testing the vaginal microbiome. This means that some women may have bacterial vaginosis for months or even years without realising it. If you are trying to conceive, identifying these hidden imbalances can be very helpful. Testing allows us to understand which bacteria are present. It also helps guide targeted treatment and support.
Why Recurrence Rates Have Been So High
Historically, bacterial vaginosis has been difficult to treat long term. For many years, treatment focused only on the woman. Unfortunately, recurrence rates were very high. Many women experienced repeated infections despite treatment. However, new research has started to change our understanding.
In 2025, a randomised controlled trial examined recurrence rates in heterosexual couples. Researchers compared outcomes when only the female partner was treated versus when both partners received treatment. The results were significant. When only the female partner was treated, the recurrence rate was 63 percent. However, when both partners were treated, recurrence dropped to 35 percent. This finding has important clinical implications. It suggests that bacterial vaginosis may sometimes involve bacterial exchange between partners. Therefore, if you have a history of recurrent bacterial vaginosis, partner support or treatment may be worth exploring.
Supporting a Healthy Vaginal Microbiome
There are several steps that can help support a healthier vaginal microbiome and reduce the risk of bacterial vaginosis.
Support Lactobacillus Levels
Healthy lactobacillus bacteria help maintain the protective acidity of the vagina. Supporting these bacteria can be helpful if you are prone to bacterial vaginosis. For example, targeted probiotic supplementation may support lactobacillus levels. Some probiotics can be taken orally, while others are used vaginally. In addition, probiotic rich foods may help support overall microbial balance.
Choose Low Tox Period Products
Conventional period products may contain plastics, fragrances, or chemicals that can irritate sensitive tissues. Choosing organic and plastic free period products may help support vaginal health. This simple change can reduce irritation and support the natural microbiome. I often recommend Daye and Flo.
Use Unscented Body Wash
Scented washes and intimate hygiene products can disrupt the natural vaginal environment. For this reason, it is best to choose gentle and unscented body washes. The vagina is self cleaning and does not require harsh products.
Wear Breathable Underwear
Cotton underwear helps maintain airflow and reduce moisture. In contrast, synthetic fabrics may trap heat and moisture. This environment can encourage unwanted bacterial growth. Choosing breathable fabrics can therefore support vaginal balance.
Change Out of Sweaty Clothing
Remaining in sweaty activewear for long periods can also disrupt the vaginal environment. After exercise, it is helpful to change into dry clothing as soon as possible. This reduces excess moisture and supports a healthier microbial balance.
Consider Biofilm Disruptors
Some bacteria associated with bacterial vaginosis can form protective biofilms. These biofilms make bacteria harder to eliminate. If testing confirms BV associated bacteria, a biofilm disruptor may be helpful before treatment. This approach can help improve the effectiveness of treatment.
Why Testing Your Vaginal Microbiome Matters
Testing the vaginal microbiome can provide valuable insights when trying to conceive. Rather than guessing, testing allows us to see exactly which bacteria are present. This helps guide targeted and personalised support. For example, we can identify whether lactobacillus levels are low or whether BV associated bacteria are present. Testing also helps monitor progress after treatment. This ensures the microbiome has returned to a healthier balance. For women planning pregnancy, this step can help optimise the reproductive environment before conception.
Conclusion
The vaginal microbiome is an important but often overlooked part of fertility. Bacterial vaginosis can quietly disrupt this delicate balance. It may influence sperm survival, implantation, and early pregnancy health.
Because bacterial vaginosis is often symptomless, many women do not realise it is present. Testing the vaginal microbiome can therefore be a powerful tool when preparing for pregnancy. With the right testing and targeted support, it is possible to restore balance and create a more supportive environment for conception.
Next Steps
Testing for bacterial vaginosis and associated bacteria before conception can be a valuable step in optimising fertility. If you would like to better understand your vaginal microbiome and how it may affect your fertility, feel free to get in touch. You can reach out via the contact form or explore my IVF nutrition resources to receive tailored, evidence based support through every stage of treatment. You can also join my newsletter for evidence based guidance and gentle emotional support.
Arrange a 1:1 session [via the contact form and we can work on a plan that supports you, whatever your situation and whatever you have been through.
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