BV and fertility

[fairgame84]

Just been told I have bacterial vaginosis. I have no symptoms at all, I had swabs taken in preparation for HSG which obviously can't go ahead now.
Could this be the cause of us being infertile?
DH has low sperm count but only 9.5 million so not the worst ever.

I had swabs done in February of this year and a cervical biopsy in April and there was no mention of bv then so this must be recent in the past 6 months or so.

I'm clinging onto a bit of hope that after antibiotics I might get a bfp, or am I being stupid?

This seems to have been my biggest issue, 2 years of ttc and 3 IVF transfers have been unsuccessful. I had a biopsy of my endometrium that showed I have 0.00% lactobacillus (good bacteria), there needs to be over 90% for the best outcomes.

This study https://doi.org/10.1016/j.ajog.2016.09.075 separated women with more than 90% lactobacillus vs those with less than 90% lactobacillus, the outcomes were statistically significant:
Implantation 60.7% vs 23.1%
Pregnancy 70.6% vs 33.3%
Ongoing pregnancy 58.8% vs 13.3%
Live birth 58.8% vs 6.7%

I took a week of co-amoxiclav followed by vaginal probiotics. After this I had an unsuccessful transfer so we did the biopsy again, I still had 0.00% lactobacillus. The first tome I had a mix of dysbiotic bacteria, the treatment got rid of everything except the gardnerella. So I have really gone at it this time, 7 days of vaginal clindamycin and 12 days of oral metronidazole, alternating daily between a vaginally probiotic and clotrimazole, followed by 7 days of balance activ and vaginal probiotics twice a day, I am in a FET cycle right now and continuing with the probiotics twice a day and balance activ once every 3 days, while monitoring my vaginal pH.

Some people are prone to bacterial vaginosis. The vagina is supposed to be acidic. Semen, menstrual fluid, water and soap all increase the pH, once it is higher dysbiotic bacteria such as gardnerella flourish and lactobacillus diminishes.

Treatment should have a three pronged attack,

1. Get rid of the bad bacteria with antibiotics
2. Restore the pH to acidic, you can do this with Balance activ
3. Replenish the good bacteria, you do this with vagina probiotics in the UK the most popular one is canesflor, I also use gynolact which I think comes from Germany and Flora femme which is from the USA.

You need the balance activ, because you need an acidic environment for the good bacteria to adhere to the vagina walls, it is lactobacillus that produces that acidic environment under normal circumstances, so while you are replenishing it you need to artificially create that environment with the balance activ.

Now the biggest issue is going to be recurrence, it is very common for bacterial vaginosis to recur even within a few weeks of treatment. You may notice after having unprotected sex that the pH is higher and there is a smell to the discharge. You can keep an eye on the pH with pH sticks you can get them from Amazon ( https://www.amazon.co.uk/dp/B07WNQJGJP/ref=cmswwrcppapiglttfabcVQD5V005P460V26B2TSK??encoding=UTF8&psc=1 ) I've decided I won't be trying to conceive naturally anymore and just sticking to the IVF transfers, this will give me the best chance of normal microflora.

Vaginal microflora influences the uterine microflora hence why it's important. If you want to see how your microflora is after the treatment you can either do the ERA EMMA ALICE (this involves doing a medicated mock FET and having a biopsy) or you can send off a sample of menstrual fluid to http://fertilysis.com

I've attached a helpful treatment protocol that someone shared with me.

Thankyou so much.
Clinic are starting me on metronidazole, I'm collecting the prescription tomorrow. I'll get some balance activ as well.

I can't figure out where this has come from. The things I've done differently since my last swabs are taking the 2 types of conceive plus vitamins and using preseed gel so whether one of those has upset my vagina, I don't know.
I'm going to stick to normal conception vitamins which I already decided since the fancy ones are a waste of money.
I might ditch the preseed and stick to conceive plus lube which we already used before.
Having said that, I switched menstrual cups a few months back and noticed a really weird smell when using the new one. It only happens during AF when I've used the cup so I'm back on tampons this month and so far I haven't noticed the weird smell.

I asked the nurse if I should wait until AF has finished before starting the antibiotics but she wasn't sure, what would your advice be?

You can take the antibiotics at any time, I finished mine before my period. But be aware that menstrual fluid can increase the pH, so I waited for my bleed to stop and then used balance activ for 7 days (you shouldn't use it when on your period). You must also use a vaginal probiotic daily, at least for 10 days after the antibiotics, you can get canesflor from Amazon.

You can take oral probiotics to help as well, you will want ones with the strains that have the most evidence of improving gynae microflora, they are lactobacillus rhamnosus, gr-1 and lactobacillus reuteri, rc-14. I take femodophilus and optibac probiotic for women, both have these strains in.

Are you sure the swabs were MC+S I only had to have a chlamydia swab before starting my treatment. Do you know what the results were, usually they grade it with how much lactobacillius is present alongside the dysbiotic bacteria.

I'm not sure about the menstrual cup, it should be ok as long as you're not washing it in soap and not putting it in covered in water. I don't use tampons now as the fibers might cause issues. I just use period pants which I get from sainsburys.

The swabs were mc+s and chlamydia. They test for everything prior to the hsg.
I don't know what the lactobacillus level is, I'll ask when I speak to clinic again.

Were the past ones MC+S though? Either way BV can just come on, it's very common. I honestly was beyond shocked when I got my biopsy results, I eat so many probiotics in my diet. In my case I had a IUD in the past and it's likely that caused the issues which got so bad I needed antibiotics to give lactobacillus a change.

Yes the past ones were mc+s as well.
I'm just praying this goes as fast as it has appeared.
Thankyou for your advice, I really appreciate it.
I will keep you updated.

Hi
I constantly have BV it clears-ish every month then soon as I’ve had a period it’s back (periods can set it off) no antibiotics or vaginal treatment has work, just something il have to live with
Luckily I didn’t have it when doing ivf it just appeared after giving birth :-( hell to live with as I do have symptoms
Good luck

I'm hoping this is a one off. I'm on metronidazole and today I'm starting on balance activ and canesflor if they have any at Boots.
I think I might have caused this myself. I read that somebody got pregnant buy putting a mooncup in after sex so I tried it and left it in overnight. The smell the next morning was grim but seemed to go after a few days but then comes back when AF comes. Before that everything was fine and all my swabs were fine. I've had a few swabs over the past year because I was getting recurrent thrush and post coital bleeding which has all been sorted now and none of those swabs showed BV.

Could I please ask if you can take the balance activ and vaginal pessaries together or did you leave a gap?

I took the oral antibiotics and used the balance activ at the same time. I didn't use canesflor in the end, I took optibac instead.

@marzmaz I've used them together for 7 days, then carried on with the course of vaginal probiotics