By Gabrielle Gleeson-Solomon, CEO of Tota
Scientific Review by Dr Nick Parkinson, PhD
Connecting the Dots Between Symptoms, Fertility and the Microbiome
Working out what's going on with your body can quickly turn you into the project manager of your own healthcare.
You're tracking symptoms, test results, appointments and doctor's notes. You might even have a spreadsheet for it. You're joining the dots yourself, repeating the same story to different doctors and hoping that someone will finally look at the whole picture, not just the symptom that falls in their specialty.
But our bodies don’t organise themselves into departments and specialities in the way that healthcare systems do. Especially when it comes to women’s health. So it’s no wonder it’s frustrating to women who are dealing with a healthcare system not designed for them.
In fact, the government’s Renewed Women's Health Strategy for England identifies “fragmented care” as a major challenge facing women today. When symptoms are viewed in isolation, important connections can be missed, making it harder to reach the right diagnosis and treatment.
And yet, one of the most important factors influencing many aspects of women's health is rarely part of the conversation, and that is the microbiome.
So what is your microbiome?
Before we dive in, let's talk about what a microbiome actually is.
A microbiome is the name scientists give to the community of bacteria, fungi and other tiny microorganisms that naturally live in a particular part of the body.
We have microbiomes all over our body, including in our gut, mouth, on our skin and elsewhere.You've probably heard plenty about the gut microbiome over the last few years, but the vaginal and urinary microbiomes haven't had quite the same attention. That's starting to change, with new research revealing just how important both are to women's health.
The vaginal microbiome is the community of microorganisms (bacteria, fungi and other microbes) that naturally live inside the vagina. Together, they help protect against infection and irritation while supporting a healthy vaginal environment.
The urinary microbiome (found in both men and women) is the community of microorganisms that naturally live within the urinary tract, including the bladder.
Our understanding of these microbiomes has changed dramatically over the last decade. In fact, it was only in 2012 that researchers from Loyola University Chicago demonstrated that the healthy bladder is not sterile. Before then, doctors believed that a healthy urinary tract contained no bacteria whatsoever.
To put that in perspective, in science terms, 2012 is basically yesterday. We're still in the early chapters of understanding what these communities are, let alone everything they're up to. But one thing is becoming increasingly clear: these microbial communities matter.
The more research that's done, the more evidence emerges showing the influence of the vaginal microbiome and urinary microbiome on everything from general wellbeing and infection risk to fertility and reproductive health.
Why the microbiome matters
One of the reasons the microbiome has become such an important area of research is that it may help explain something many women have experienced firsthand: ongoing symptoms despite being told everything looks normal.
Too many women are stuck in a loop of negative tests, antibiotics that don’t have any impact and doctors telling them they’re “normal”, “healthy”, that “there’s nothing wrong with you”. Yet symptoms persist, lives are impacted and it can take a serious toll on a person’s mental health.
The challenge is that the tests traditionally used to investigate urinary and vaginal symptoms don't always tell the full story.
The standard urine culture was designed decades ago to catch a handful of common bacteria, so plenty of others slip past it. Standard vaginal swabs look for a small number of specific pathogens. If the pathogen they're looking for isn't found, the result comes back as clear. No infection found.
But that doesn't necessarily mean nothing is wrong. They haven’t ruled everything out.
Traditional testing asks a very specific question: "Can we find this particular organism?”.
Tota’s third-generation non-targeted DNA sequencing tests read every species of bacteria and fungi present and how much is there. We tell you which organisms are present in your microbiome. Good and bad, big and small.
Sometimes our tests reveal an imbalance that can help you to understand your symptoms. Sometimes it doesn't. And that's useful too. Because setting aside the microbiome can be just as valuable as identifying a problem. It gives you more information, more confidence, greater symptom clarity and a clearer idea of where to look next.
Fertility and the microbiome
The connection between the microbiome and fertility is one of the most exciting areas of emerging research. Scientists are increasingly discovering that the vaginal microbiome may do far more than help protect against infection. We’re learning it may also play an important role in creating the conditions needed for conception and pregnancy.
A healthy microbiome does not guarantee pregnancy. But research is beginning to show that women with a vaginal microbiome dominated by beneficial Lactobacillus bacteria tend to have more favourable reproductive outcomes, including higher implantation and clinical pregnancy rates following IVF. Emerging evidence also suggests it may play a role in natural fertility.
The evidence is becoming increasingly difficult to ignore. A large review of 25 studies found that women with vaginal dysbiosis had lower clinical pregnancy rates and a higher risk of early pregnancy loss following IVF than women with healthier vaginal microbiomes.
Scientists are still working to understand exactly why this happens. One of the leading theories is that a healthy vaginal microbiome helps create a more supportive environment for embryo implantation by supporting immune balance and reducing inflammation during the earliest stages of pregnancy.
One group of researchers in the Netherlands has even built an IVF screening tool around this idea. Their research suggests that analysing the vaginal microbiome before treatment may help predict a woman's chances of becoming pregnant through IVF, highlighting the potential value of a fertility health check for women before treatment begins. In other words, the microbiome could provide valuable information before treatment even begins, helping to build a more complete picture of the factors that may influence IVF success.
In other words, the microbiome isn't just relevant when something feels wrong. It may also play an important role when everything is going right.
A clearer picture, wherever you are on your fertility journey
Whether you’re thinking about trying, already trying to conceive or preparing for fertility treatment, understanding your vaginal microbiome can add another valuable piece to your overall health picture..
Sources
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Department of Health and Social Care. The Renewed Women’s Health Strategy for England. London: Department of Health and Social Care; 2026. CP 1558. GOV.UK
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García-Velasco JA, Menabrito M, Catalán IB. What fertility specialists should know about the vaginal microbiome: a review. Reprod Biomed Online. 2017;35(1):103-112. PubMed: 28479120
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Whiteside SA, Razvi H, Dave S, et al. The microbiome of the urinary tract—a role beyond infection. Nat Rev Urol. 2015;12(2):81-90. PubMed: 25600098
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Balla B, Illés A, Tobiás B, et al. The role of the vaginal and endometrial microbiomes in infertility and their impact on pregnancy outcomes in light of recent literature. Int J Mol Sci. 2024;25(23):13227. PubMed: 39684937
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Sehring J, Beltsos A, Jeelani R. Human implantation: the complex interplay between endometrial receptivity, inflammation, and the microbiome. Placenta. 2022;117:179-186. PubMed: 34929458
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Koedooder R, Singer M, Schoenmakers S, et al. The vaginal microbiome as a predictor for outcome of in vitro fertilization with or without intracytoplasmic sperm injection: a prospective study. Hum Reprod. 2019;34(6):1042-1054. PubMed: 31119299
This article is for general information and does not replace medical advice. If you're experiencing new, severe, persistent or worsening symptoms, please speak to a GP or another qualified healthcare professional.
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