Do probiotics really improve vaginal health?

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A new study casts doubt on the ability of probiotics to improve vaginal health. Image credit: Liliia Lysenko/Getty Images.
  • Vaginal health, including vaginal flora, is essential for well-being and fertility.
  • The success rate of fertility treatments, such as IVF, can be affected by many factors, including the composition of the vaginal microbiome before treatment.
  • Recent findings suggest that probiotics given vaginally for 10 days before fertility treatment may not improve unfavorable vaginal microbiomes.

The importance of probiotics and maintaining “good” bacteria in the body is essential in many areas of health. Microorganisms that inhabit the vagina can impact pregnancy and other health issues.

However, improving the vaginal microbiome might not be as simple as taking probiotics. Experts shared the results of recent studies at the 38th annual meeting of the European Society of Human Reproduction and Embryology (ESHRE).

They found that treatment with vaginal probiotic capsules in women with unfavorable vaginal microbiomes did not improve vaginal flora any more than a placebo.

The National Institute of Environmental Health Sciences Note that “[t]he microbiome is the collection of all microbes, such as bacteria, fungi, viruses and their genes, that naturally live on our bodies and inside us.

Human microbiomes play a crucial role in many areas of health. The vaginal microbiome refers to all the microorganisms present in the vagina. The composition of the vaginal microbiome may have an impact on the risk of gynecological cancers.

It can also impact the risk of sexually transmitted infections. Finally, it can also affect conception and pregnancy. The microorganism Lactobacillus generally contributes to healthy vaginal microbiota and helps protect the body.

Doctors need to consider vaginal health and how to improve it, including for those seeking infertility treatment like in vitro fertilization (IVF).

A healthy vaginal microbiota can increase the chances of a healthy pregnancy. However, the best way to improve vaginal microbiomes might be more complicated than just using vaginal probiotics.

The study in question was a randomized, double-blind, placebo-controlled study, which allows for high objectivity and helps eliminate the risk of bias. The researchers included 74 participants. The participants had all been referred for IVF and had unfavorable vaginal microbiomes.

The researchers divided the participants into two groups: one received a placebo and the other received vaginal probiotic capsules that contained Lactobacillus. The researchers reassessed the participants’ vaginal microbiomes after they finished their treatment and after they had their next menstrual cycle.

The study authors found no significant difference between the control and intervention groups. However, more than a third (34.2%) of all participants saw improvements in the quality of the vaginal microbiome over 1-3 months, whether they received a probiotic or a placebo.

Yasser Diab, consultant gynecologist and obstetrician at Cadogan Clinic, who was not involved in this study, noted Medical News Today this “[t]there was no significant difference between the two groups – the lactobacilli group [and the] placebo group.

“The intervention did not include all strains of lactobacilli implicated in influencing fertility outcomes. More detailed studies are needed to establish therapeutic strategies to improve fertility treatment outcomes from interventions involving on the vaginal microbiome,” he pointed out.

Study author Dr Ida Enberg Jepson said she and her colleagues were surprised by the results and that specific probiotic treatments may not be as effective as they had hoped.

She explained for DTM:

“The study indicates that the ‘probiotic rush’ should be tempered with caution. We found that the use of a specific probiotic containing Lactobacillus rhamnosus and Lactobacillus gasseri did not improve an unfavorable (asymptomatic) vaginal microbiota in infertile women.

When sharing the results of the study, its authors noted a few limitations. First, the vaginal probiotic capsules did not contain all strains of Lactobacilli that can influence fertility outcomes. They also noted that their broad categorization of low, medium, and high vaginal microbiome profiles may have masked subtle changes.

The study does not deny the importance of vaginal health. However, this raises questions about how best to approach vaginal health, especially when working towards optimal vaginal microbiomes prior to infertility treatments.

Dr. Jepson further noted a few areas for potential additional research:

“Suggestions for new research could be to explore different strains of lactobacilli or to investigate vaginal microbiota transplantation in women with normal vaginal microbiota. In addition, it would be interesting to study whether it is possible to obtain a higher pregnancy rate if we postpone IVF treatment in patients with an unfavorable vaginal microbiota until spontaneous improvement is observed at over the next 1 to 3 months, as this study suggests.

The results may further influence future recommendations before IVF. Dr. Jepson explained that “[w]We found spontaneous improvement in patients with an unfavorable, mostly low-profile, vaginal microbiota over 1-3 months. This suggests that one idea for patients with an unfavorable vaginal microbiota might be to postpone IVF treatment until spontaneous improvement.