0:01

Hi, I'm Rachel Sherriff

0:01

and welcome to the fertility

0:04

suite podcast. Our aim is to

0:04

educate and empower couples who

0:08

are struggling with all aspects

0:08

of fertility. By giving you the

0:11

information to make informed

0:11

decisions along the way. We've

0:15

had a little rebrand since

0:15

series one we were formerly the

0:17

fertility method podcast. But in

0:17

this second series, rest

0:20

assured, we still have the same

0:20

high standard of fertility

0:23

experts coming to share their

0:23

knowledge and support you. So if

0:27

you are struggling with

0:27

fertility, miscarriage or you

0:30

just want to arm yourself with

0:30

the facts, then this podcast is

0:33

for you. Hi, everybody, and welcome back

0:35

to another episode of the

0:38

facility suite podcast and

0:38

joining us this week we have the

0:41

amazing gold new sculpture Ozzy

0:41

and gold Nish is a molecular

0:45

biologist. And she's also the

0:45

founder of screen me. And this

0:49

week, we're going to be talking

0:49

all about the vaginal microbiome

0:53

I'm sure it's something that

0:53

lots of you listening have heard

0:55

about. So go Nish would you like

0:55

to introduce yourself a little

0:58

bit further to our listeners and

0:58

just tell everyone a little bit

1:00

more about yourself? Cause Thank you for having me.

1:02

And for the for the kind

1:05

introduction. Yes, my name is

1:05

golden age. I am a molecular

1:09

biologist. I'm Cambridge

1:09

graduates. And I'm also a doctor

1:14

in genetics. And I thought I

1:14

would be an academic, which I

1:19

did my PhD in genetics. And but

1:19

it took me I think till 2019

1:25

before I decided that I'm more

1:25

needed elsewhere, then in

1:32

academia, and it was my own kind

1:32

of health journey in the system.

1:36

I had record, you know, painful

1:36

periods from the age of 12. It

1:39

was very disruptive to my life,

1:39

my degree, my you know, career

1:45

got very little help through the

1:45

medical system. And then I

1:51

started having other symptoms

1:51

like anxiety, like issue

1:56

sleeping, heart palpitations,

1:56

you know, they started doing all

1:59

sorts of tests to see if

1:59

something's wrong with my heart.

2:02

Things they use sometimes doing

2:02

people who are 50 or 60, I was

2:05

having done in my 20s and then

2:05

infections, you know, symptoms

2:10

of infections, at least, where I

2:10

would think I would have UTIs.

2:15

And I would be tested and there

2:15

would be nothing there. Or they

2:18

would say there was nothing

2:18

there. And I would either be

2:21

told to just write it out and

2:21

drink more water or I will be

2:24

put on antibiotics. And it was

2:24

until she doesn't maintain

2:29

that's you know, life gotten

2:29

life has gotten quite rough when

2:34

I got a diagnosis of

2:34

endometriosis, but no help or

2:39

support. And I realised that

2:39

actually, it's not just me who's

2:44

feeling the way I'm feeling. In

2:44

around 50% of women who

2:49

experienced symptoms are either

2:49

dismissed or misdiagnosed. And

2:55

especially with gynaecological

2:55

issues, around 50% of women who

2:59

express gynaecological concerns

2:59

are either dismissed or

3:04

misdiagnosed. And for me, that

3:04

was a big wake up call that we

3:09

need to we need to change the

3:09

way things were. I had myself

3:12

tested using NGS, you know, just

3:12

a swab of myself and I had, I

3:18

had genetically to genetically

3:18

tested the bacteria to see

3:22

what's there. And I found a lot

3:22

of answers. And I thought, why,

3:29

why wasn't this done previously?

3:29

Why didn't anyone do this? Why

3:33

was I stopped and cultured,

3:33

which is what they used to do.

3:36

They used to culture, the swab

3:36

just look for specific bacteria,

3:40

and nothing would grow, or

3:40

nothing would be found. That's

3:43

because the methods that were

3:43

being used, were ancient, not

3:47

sensitive enough, not good

3:47

enough to give me answers. And

3:51

so we, you know, we started

3:51

screen me with my amazing co

3:55

founder, and very good friend,

3:55

Dr. Rakesh Kruszewski. In order

4:00

to make better scientific tools

4:00

like gold standard techniques

4:06

available to people, you know,

4:06

starting with a woman in order

4:14

to advance in a give give people

4:14

the information and insight that

4:19

they deserve in order to take

4:19

charge of their lives. This may

4:23

help prevent disease, it may

4:23

help diagnose disease, but it

4:28

will certainly help women feel

4:28

more in charge of their lives

4:33

and have more awareness and so

4:33

and so and so that's where

4:36

screen me started. And here we

4:36

are offering vaginal and seminar

4:40

screening to people all across

4:40

their life's life stages.

4:45

I think there's so many women

4:45

listening to this golden age who

4:49

will resonate with what you've

4:49

just said in terms of symptoms

4:53

and being misdiagnosed or just

4:53

told to put up and shut up and I

4:58

think it's really, really be

4:58

reassuring to know that the

5:02

founder of a company such as

5:02

yours, is actually doing this

5:05

from their own personal

5:05

experience, that you have that

5:08

level of empathy and that level

5:08

of understanding that the effect

5:11

this has on women's lives. You

5:11

know, we're going to talk today

5:15

about the impact of the vaginal

5:15

microbiome on fertility. But

5:18

it's not just about fertility,

5:18

it's about your day to day

5:23

living and the interruption that

5:23

causes and we're told that it's

5:26

just normal, and we should just

5:26

get on with things. It's so

5:29

reassuring to hear you say that.

5:29

And like I said, I'm sure a lot

5:32

of our listeners will will

5:32

resonate with that for sure. So,

5:36

obviously, you've talked about

5:36

swabbing, and how you kind of

5:39

got to understand what was going

5:39

on with your vaginal microbiome.

5:42

But I just want to rewind a

5:42

little bit and talk about for

5:45

people listening who might have

5:45

no idea what it is like,

5:48

actually, what is the vaginal

5:48

microbiome? And why is it

5:51

important that we are looking

5:51

into the health of our

5:54

microbiome? Yeah, really, they think the vagina is this

5:56

mysterious word that no one

6:00

really likes to say, or is

6:00

scared to say, let alone the

6:05

vaginal microbiome you know. So,

6:05

you know, the vagina is always

6:10

thought to be just this hole

6:10

that we either shove things into

6:14

or out of, which is, you know,

6:14

not true. The vagina is an

6:19

organ, a very important organ,

6:19

which is involved, obviously, in

6:25

the physiological act of birth,

6:25

and pregnancy in getting

6:29

pregnant conception, but it's,

6:29

you know, the vagina itself

6:33

plays a big role in a woman's

6:33

health and life, it's like the

6:37

door to your house. And it

6:37

controls a lot of our immune

6:42

system, you know, it's there to

6:42

fend off what is not meant to

6:46

enter. And, and to and to also

6:46

tell our immune system, you

6:52

know, we need to attack or no,

6:52

we, we need to, we need to calm

6:56

down. So the vaginal microbiome

6:56

is an ecosystem that lives in

7:02

the vagina, and plays a huge

7:02

role in regulating it a woman's

7:08

immune system, and protecting

7:08

everything that's in the pelvis,

7:12

like pelvic floor in a way,

7:12

especially the reproductive

7:15

system. So it's, it's, it's made

7:15

up of bacteria, made up of yeast

7:22

viruses, as well. So micro

7:22

organisms that interact with

7:27

our, our cells, our human cells

7:27

and body in order to protect us

7:34

and reduce risk of disease. Well, if they when you talk

7:37

about like, first line of

7:42

defence, I thought that's interesting as well, because something I often say to

7:44

patients is like, the only thing

7:46

between the vagina in the uterus

7:46

is a cervix, and that can be

7:49

open, right? So it really is

7:49

kind of defending your

7:53

reproductive organs. So if

7:53

things aren't right in the

7:55

vaginal microbiome, it can lead

7:55

to further problems. Absolutely.

7:59

So like I said, like the like

7:59

the door to the house, the

8:03

cervix is there as a physical

8:03

barrier, but like it's not a

8:07

closed barrier. So things do

8:07

travel up through the cervix

8:10

into the uterus further than

8:10

that, and if we get unwanted

8:16

visitors, so unwanted

8:16

microorganisms or an imbalance

8:20

in the microbiome, other than

8:20

these unwanted disease causing

8:26

agents crawling up going up

8:26

through into the uterus, their

8:30

presence itself, actually

8:30

initiate so elicits an immune

8:35

response. So you know, that the

8:35

body will say, Oh, this, you

8:39

know, this is we're in trouble.

8:39

These things shouldn't be here,

8:42

we must fight. And so that

8:42

causes higher inflammation in in

8:48

the woman's body and the

8:48

reproductive tract, and that

8:50

inflammation itself can then be

8:50

counterproductive for our

8:54

fertility. So not only is there

8:54

the microbiome trying to prevent

9:00

infections, which directly

9:00

affect fertility, but also, the

9:05

microbiome modulates the immune

9:05

system, which itself can affect

9:10

fertility. So it's a two way

9:10

thing. Now, the microbiome, the

9:14

vaginal microbiome, a healthy

9:14

vaginal microbiome, in a woman

9:18

of reproductive age, is expected

9:18

to be protective. And what that

9:24

means that, unlike the gut

9:24

microbiome, where everyone talks

9:28

about improving diversity, you

9:28

know, we want diverse, lush

9:33

amount of bacteria in the

9:33

vagina. We don't want a diverse

9:37

microbiome, we actually want a

9:37

protective one that's dominated

9:42

by acid producing bacteria

9:42

called Lactobacillus. And that

9:47

environment is then acidic, is

9:47

actually quite hostile to

9:52

everything else, and prevents

9:52

the growth and invasion of micro

9:56

organisms that are not friendly

9:56

that we don't that will cause

10:00

issues. Now, if a woman loses

10:00

that dominance of lactobacillus,

10:05

which happens very often 80% of

10:05

women at some point in their

10:09

life, do you lose that dominance

10:09

due to different reasons like

10:13

your hormonal balance, your

10:13

diet, food, your lifestyle,

10:19

hygiene practices, and your sex

10:19

life, your immune system as

10:23

well, and different sorts of

10:23

diseases and medication. All of

10:26

this affects your vaginal

10:26

microbiome. So at some point,

10:28

every woman experiences an

10:28

imbalance in that vaginal

10:32

microbiome, which means they

10:32

lose that protective

10:35

environment. And so when you

10:35

lose that protective

10:38

environment, you're at higher

10:38

risk of infections, which are

10:43

asymptomatic a lot of the time

10:43

of fertility issues,

10:49

miscarriage, preterm birth, but

10:49

also things like HPV contraction

10:56

and chronic HPV infection, which

10:56

then leads to increased risk of

11:00

cancer. So it's really important

11:00

that that balance, that

11:04

dominance of lactobacillus is

11:04

really important. And it does,

11:09

it does affect our fertility

11:09

very much.

11:13

So it's not just about the

11:13

inflammation, it's about the

11:16

immune system, as well as you've

11:16

got, like, all of these things,

11:20

all of these ways that the

11:20

vaginal microbiome is working to

11:24

improve fertility and make us

11:24

fertile. And then you've got

11:27

these other things that can come

11:27

from having a dysbiosis Exactly.

11:31

So you know, the the vaginal

11:31

microbiome is trying to stop

11:35

disease causing bacteria from

11:35

overgrowing. But at the same

11:39

time, those protective

11:39

lactobacillus bacteria actually

11:44

tell the immune system to calm

11:44

down and reduce inflammation.

11:49

So if we've got people

11:49

listening, who have perhaps

11:52

struck, they're struggling to

11:52

get pregnant, or they've had

11:54

recurrent miscarriage, or

11:54

they've had repeated,

11:57

unsuccessful IVF, and they're

11:57

listening, and they're thinking,

12:00

no one's ever mentioned this to

12:00

me before, like, because you

12:04

said that a lot of these

12:04

infections can be asymptomatic

12:07

or even if there's not infection, we could be looking at immune system issues or

12:09

inflammation. So how would

12:12

someone know what signs might

12:12

their body be giving off that

12:16

something is not quite right?

12:16

And that they might want to

12:19

consider having vaginal

12:19

microbiome testing?

12:22

Yeah. So you know, I think in an

12:22

ideal world, I would say every

12:27

woman of reproductive age, every

12:27

woman who is sexually active,

12:31

should be having a vaginal

12:31

microbiome test to check that

12:35

they are having a dominance

12:35

protective vaginal microbiome,

12:39

and they should be doing this

12:39

once a year or twice every six

12:43

months, if something is up, so

12:43

that would be ideal. In a

12:49

preventative way measure, let's

12:49

see, yeah. However, in terms of

12:53

signs to look out for, I think,

12:53

if you have a history of

12:58

symptoms, so if you have a

12:58

history of noticing that your

13:02

vagina is sometimes off, it

13:02

doesn't have to be very obvious

13:05

symptoms were that are on the

13:05

internet or everyone. But as I

13:08

think every woman knows what's

13:08

normal for them. And so any

13:12

deviation from what you think is

13:12

normal for you, is a sign that

13:16

there is some instability going

13:16

on. So definitely listen to

13:20

anything that is not normal for

13:20

you as as a person and have that

13:25

checked. pain with sex is

13:25

definitely another sign any sort

13:30

of dryness as well. Obviously

13:30

infections or recurring

13:34

infections is another one as

13:34

well. If you're struggling with

13:38

fertility, so miscarriage,

13:38

unexplained infertility and

13:43

recurring miscarriage is one you

13:43

know, I often find when if I

13:47

hate this, that a woman has to

13:47

have multiple miscarriages for

13:50

it to be thought to be a

13:50

problem. I think with especially

13:55

early stage miscarriage, I think

13:55

looking at infections or

13:59

overgrowth is really important.

13:59

And I would definitely consider

14:03

that as well. So, really, I

14:03

think it should be routine, part

14:09

of part of a woman's in the same

14:09

way we did blood tests, to look

14:12

at minimum levels, we should be

14:12

looking at the vagina to make

14:16

sure that our vagina is

14:16

protecting us.

14:19

Absolutely. I couldn't agree

14:19

more. And that's something that

14:21

obviously in our clinic, we're

14:21

always encouraging. Certainly,

14:23

if patients come to us with a

14:23

history of any of those things,

14:26

you know, repeated unsuccessful

14:26

IVF or recurrent miscarriage, we

14:30

would be looking at the vaginal

14:30

microbiome as often now, sort of

14:34

one of our first line tests

14:34

really because of the reasons

14:37

you've just explained. I think

14:37

it would be really good for

14:39

listeners to talk about then why

14:39

these things aren't tested and

14:43

the differences between what you

14:43

might be offered on the NHS and

14:48

the options privately because so

14:48

many of the clients who come to

14:52

us will say, Well, why is no one

14:52

mentioned this to me before I've

14:55

been to my doctor, my doctor

14:55

knows I've had unsuccessful IVF

14:58

you know, the NHS So IVF clinic,

14:58

I'm not talking about this, like

15:02

wherever we are with differences

15:02

between accessing this sort of

15:06

care. Yeah. Okay, so I think

15:07

classically, historically, in

15:12

the NHS men, you know, the way

15:12

that the vagina was tested was

15:16

not to look at vaginal health,

15:16

it was to look for infections.

15:20

And there's, you know, we need

15:20

clinically there is a difference

15:24

when men talk. So, historically,

15:24

and in the textbooks, when we

15:27

talk about the vagina, no one

15:27

really is talking about actual

15:31

health of the vagina more so is

15:31

there an overgrowth of a

15:36

specific bacteria. And so they

15:36

will test that by swabbing, and

15:42

trying to grow those bacteria in

15:42

a little dish in a lab. Now,

15:48

there is an issue with that,

15:48

because it's really hard to grow

15:50

bacteria. In addition, a lab,

15:50

not all bacteria, like growing

15:54

in additional lab, it's hard to

15:54

have the right environment, the

15:58

right media, the right to get

15:58

bacteria to grow. So some

16:01

bacteria don't grow at all, even

16:01

if some bacteria do, there needs

16:05

to be a significant loads of

16:05

them to allow that growth. And

16:08

so the culture method, which has

16:08

been used historically, to look

16:13

for certain infections, is not

16:13

the most accurate or the most

16:17

sensitive, which has led to many

16:17

false negatives, or lack of

16:22

answers. So that's, and that's

16:22

something that's still being

16:26

used in in the in the medical

16:26

system, it's quite a fast method

16:30

is so cheap method. So it

16:30

doesn't cost much, and it with

16:36

some infections that Austro it,

16:36

you can't deny that then after

16:40

the culture method, there came

16:40

the PCR method, not everyone

16:43

knows PCR because of COVID. You

16:43

know, everyone's done those

16:46

tests. And what PCR does is it's

16:46

more sensitive than culture

16:50

method is definitely a better

16:50

method, it's more molecular

16:53

level. And what you do is you

16:53

take a swab, and you take,

16:59

again, DNA from from the

16:59

bacteria. And in this case, you

17:04

choose a panel of bacteria, you

17:04

choose around 20 to 25, usually

17:08

at the best, and you screen for

17:08

those with the presence of those

17:13

bacteria, and quantify them

17:13

based on a predefined threshold.

17:20

And so this method is much

17:20

better, it's a lot more

17:24

accurate, a lot more sensitive.

17:24

But its accuracy and sensitivity

17:30

is still different for different

17:30

groups of bacteria. So it's it's

17:35

slightly more expensive, but

17:35

it's a fast, again, relatively

17:40

affordable method of looking for

17:40

specific infections. Again,

17:45

you're looking for the presence

17:45

and the amount of specific

17:49

bacteria. And it's great if you

17:49

know what you're looking for.

17:53

You know, I want to know, if I

17:53

still have ureaplasma PCR is

17:57

great to look at that if it's

17:57

there, you know or not, if I

18:00

want to know if I have Jordan

18:00

and vaginalis. Again, PCR is a

18:04

great way of looking at that.

18:04

However, it does not test that

18:08

microbiome, that protective

18:08

environment is the microbiome

18:14

dominant in lactobacillus PCR

18:14

cannot test for that because it

18:18

does not test the entire

18:18

environment. And it cannot know

18:23

how much of each bacteria is

18:23

present relative to the other.

18:27

And this is why when you're

18:27

looking at the actual

18:30

microbiome, and you move away

18:30

from infections, and you say,

18:33

actually, I want to be looking

18:33

at this environment as a whole,

18:36

a bigger picture. In in the

18:36

literature, we use what's called

18:42

16 s sequencing or next

18:42

generation sequencing. So that's

18:45

gold standard when looking at

18:45

microbiome research. And what

18:49

this means is, instead of taking

18:49

bacterial DNA, and then

18:54

screening for 20, bacteria, we

18:54

take bacterial DNA, and we run

18:58

it through a sequencing machine,

18:58

just like you do in human DNA to

19:03

see what your DNA is made of. We

19:03

do it with bacterial DNA, and we

19:06

run it through a sequencing

19:06

machine. And through this, we

19:09

can actually screen for

19:09

everything that's present. So

19:13

all bacteria that's present, and

19:13

we can know how much of each

19:17

bacterial species is present

19:17

relative to the other. So this

19:21

allows us to know exactly what's

19:21

there. And how much of the

19:25

vaginal space or microbiome is

19:25

taken by each of these species.

19:30

Do we have 95% and above have

19:30

lactobacillus to protect this

19:35

woman from infections from other

19:35

diseases from fertility

19:38

complications? And this is the

19:38

only way that we can actually

19:41

tell if a woman needs to improve

19:41

their vaginal health, are they

19:45

at increased risk or not?

19:49

So the NHS will only look at a

19:49

very, very basic culture. Yes,

19:54

they're not they're not doing

19:54

the PCR or the or the next.

19:57

In some cases, they do do PCR So

19:57

culture is the first stop. The

20:04

next stage when someone is

20:04

really struggling, or has severe

20:07

symptoms, recurring symptoms,

20:07

they get referred to a

20:11

specialist at that point PCR is

20:11

are done to look at certain

20:15

bacteria, like your plasma, like

20:15

like other certain STDs, etc. So

20:22

it is it's PCRs are turned to

20:22

and in certain circumstances in

20:27

the NHS privately they're done

20:27

quite often and private practice

20:32

when looking for infections. But

20:32

NGS is something that is

20:37

relatively new. That is not, you

20:37

know, the interpretation and

20:41

understanding of an NGS data set

20:41

is not really done in medical

20:46

school yet. And so it's

20:46

something that's not made it yet

20:48

into the clinical setting. Okay.

20:51

I think, again, that's really

20:51

important for people listening

20:53

to understand that if you are

20:53

falling into this category of

20:56

you know, unexplained infertility recurrent miscarriage, or, you know,

20:58

unexplained, unsuccessful IVF.

21:04

That actually, it's really,

21:04

really important that you think

21:08

outside the box a little bit and

21:08

maybe go okay, well, you know, I

21:11

might have exhausted the NHS

21:11

options in terms of the basic

21:14

level testing do I need to look

21:14

into using some private testing,

21:18

and just being aware that although you might have been told or you've been swapped in,

21:20

everything's fine, actually,

21:23

that gives us very limited

21:23

information. And there could be

21:25

a lot more going on. Going back

21:25

words, again, a little bit to

21:31

talk about how this really

21:31

impacts fertility and loss and

21:34

IVF. I just wanted to touch on

21:34

something you mentioned about

21:38

how this can affect free time

21:38

preterm birth. We know from the

21:43

study that Tommy said that

21:43

having low levels of

21:46

lactobacillus links to increased

21:46

first trimester miscarriage, but

21:50

how can the health of the

21:50

vaginal microbiome in terms of

21:54

inflammation or infection have

21:54

an impact on perhaps maybe

21:57

second trimester baby loss or

21:57

preterm birth.

22:01

So we need so much research to

22:01

so much more to understand this

22:07

black box of the vagina, and the

22:07

impact of that on various things

22:12

including fertility, miscarriage

22:12

and preterm birth. So there's a

22:16

lot to be done. Now, in terms of

22:16

preterm birth, there is

22:21

correlation showing that

22:21

presence of certain infections,

22:27

it can cause early, you know,

22:27

early rupture of the SAC, the

22:32

opening of the cervix and

22:32

preterm birth. And that's about

22:36

all we know, I mean, we know

22:36

that certain bacteria cause the

22:41

production of lytic enzymes,

22:41

which are, which cause the, you

22:47

know, the embryo, which cause

22:47

this kind of miscarriage, they

22:51

cause the loss of the pregnancy,

22:51

we also know that certain

22:54

infections actually increase

22:54

prostaglandin production, which

22:59

increases contractions, and can

22:59

also lead to loss as well. But

23:04

we know very little in terms of

23:04

exactly how or when, or what

23:10

leads to these events happening.

23:10

There. You know, it's more we

23:14

know, correlations, sometimes

23:14

very close, close to causation.

23:19

But in terms of mechanisms that

23:19

lead to this very little is not

23:24

as crazy given that this happens

23:24

to women frequently. Absolutely.

23:29

Not just that. We're also in an

23:29

area where we even you know,

23:33

strep B, for example, has been

23:33

something of a of a debate. You

23:37

know, it's been taught to be

23:37

involved in increasing risk of

23:42

preterm birth, and

23:42

complications. For years. Now,

23:46

there is debate of whether, you

23:46

know, they're not, you know,

23:50

they're kind of thinking of not

23:50

testing for it. So they're not

23:53

testing for it in the NHS

23:53

anymore, unless there's a high

23:55

risk. And I just think it's

23:55

crazy that we are making these

24:00

decisions clinically, without

24:00

having enough data to actually

24:07

justify them. I think if, if a

24:07

woman has had loss, and they

24:12

have an unhealthy vaginal

24:12

microbiome, that should be taken

24:15

seriously, irrespective of

24:15

whether the data has a black and

24:20

white proof of whether this is a

24:20

causative or not. We're talking

24:25

about human suffering and loss.

24:25

And I don't think that's

24:30

something we should be taking

24:30

risks with or playing games.

24:37

Yeah, I agree. I agree. I think yeah,

24:38

like, I always have to use the

24:41

no stone unturned approach when

24:41

help trying to help clients, but

24:45

I think it's trying to get that

24:45

message across can be difficult

24:49

sometimes, to other health

24:49

professionals. You know, you

24:51

don't ever want to put someone in a position where they're going to potentially have

24:53

another loss, but yet women are

24:55

frequently told, I'll just try

24:55

again. You know, it's just bad

24:58

luck and that is just so

24:58

negative. Challenge is not

25:00

terrifying. I mean, if you speak to any

25:01

woman who's had a loss, you

25:05

know, even though wanting a baby

25:05

is in this all you want, really,

25:11

the moment you're told you're

25:11

pregnant, you're also afraid

25:15

you're more afraid than

25:15

anything. And being in that

25:18

position is awful. And then, you

25:18

know, even in then carrying IVF,

25:23

we've had many women who've had,

25:23

for example, a strep B

25:26

infection, very low levels,

25:26

which hasn't been picked up,

25:29

which was picked up in NGS and

25:29

who did not, were not offered

25:34

treatment, because it wasn't

25:34

coming up on on a vulture. And

25:38

but then, you know, towards

25:38

birth, they were put on

25:41

antibiotics, both them and the

25:41

baby to prevent a strep B from

25:45

causing systemic infection or

25:45

against the baby, we can do

25:49

better than that we should be we

25:49

should be picking these things

25:52

up before pregnancy or early

25:52

pregnancy and have plans in

25:56

place have the issue is that

25:56

medical system is very much

26:01

diagnose and treat. And if you

26:01

cannot treat, then they don't

26:04

really want to diagnose because

26:04

they don't know what to do with

26:07

it. And I think this is a

26:07

problem. A lot of the times the

26:10

vaginal microbiome we can't fix

26:10

immediately, there is no

26:13

overnight treatment. And that's

26:13

why it scares a lot of

26:17

practitioners and clinicians,

26:17

when it comes to dealing with

26:20

it. It takes time, right? It takes

26:20

time, we're going to come on and

26:23

talk talk about what can be done

26:23

about this. Because I think

26:27

again, it's an important message

26:27

to get across to women is that

26:29

you know, this is able to be

26:29

treated. This is something we

26:33

can rectify. I just wanted to

26:33

very quickly touch on IVF. So

26:38

when we're talking about

26:38

fertility and miscarriage, I

26:40

think for people listening, they

26:40

may be thinking, Oh, well, I'm

26:43

having IVF. So maybe I don't

26:43

fall into that category. How is

26:47

this important for patients who

26:47

might be considering IVF? Or

26:50

starting IVF? imminently? Yeah, actually really, really

26:52

important. You know, what's,

26:55

again, going back is to remember

26:55

that the vaginal microbiome is

26:58

like a regulator of the

26:58

reproductive system, it is a

27:02

part it's a key player in

27:02

regulating our reproductive

27:05

system, including the uterus.

27:05

Now, the amount of inflammation

27:10

in the uterus, the presence of

27:10

bacteria in the uterus affects

27:14

implantation of an embryo. We

27:14

know that. And even going beyond

27:20

that, we know that the bacteria

27:20

present the vagina goes into the

27:24

uterus, but also the ovaries,

27:24

and chronic infections, scarring

27:28

can can affect all of this. Now,

27:28

studies done recently looking at

27:33

IVF have shown that having a

27:33

healthy microbiome, or a

27:39

balanced microbiome, where you

27:39

have a dominance of

27:42

lactobacillus can actually

27:42

increase your chances of

27:46

successful embryo transfer by

27:46

seven times. That's a huge

27:51

amount. You know, there's a lot

27:51

more that needs to be done in

27:55

terms of understanding what this

27:55

all means. But what we know is,

28:00

you know, what makes sense, and

28:00

this is my opinion, purely, is,

28:03

of course, it's logic, you know,

28:03

we know that having an imbalance

28:07

or low protective bacteria

28:07

shifts immune the immune system

28:11

and the reproductive system, you

28:11

know, reproductive track, and

28:14

that is bound to have a role and

28:14

in everything. So when you're

28:20

going through an IVF cycle,

28:20

you're spending so much

28:23

physically, emotionally,

28:23

financially. And I think that

28:30

everyone deserves to be given

28:30

the best chance they can have.

28:34

I've had an IVF cycle. And so I

28:34

understand. And I didn't

28:39

actually, even though I spoke

28:39

about it previously, I didn't

28:42

fully understand it until I went

28:42

through it myself. And you can

28:48

only understand it, once you've

28:48

been through it, how important

28:51

it is for you, that you have the

28:51

best chances of this working,

28:55

because you really don't want to

28:55

undergo another cycle. So

28:59

really, I think it's important

28:59

to make sure that you've covered

29:03

your bases. But it's very hard

29:03

to say this, because obviously

29:06

there is a world of stuff out

29:06

there that's thrown at you, and

29:11

tests and things that you can

29:11

do. So I think that, you know,

29:15

it's really important to have a

29:15

good coach, or a good

29:18

practitioner who can really

29:18

identify what you need as a

29:21

person as an individual, and

29:21

what can be covered. But but you

29:25

know, the vaginal microbiome and

29:25

the seminal microbiome, I think

29:31

are both in my opinion, one of

29:31

those things like a blood test.

29:36

That should be and if there is a

29:36

address prior to an embryo

29:40

transfer. Yeah, absolutely. Having had IVF

29:41

myself, you know, I'm completely

29:44

on the same page as you with

29:44

that. And yeah, or something.

29:47

Again, I often say in clinic is

29:47

everyone should only ever have

29:51

to have one cycle of IVF in a

29:51

dream world, right? You don't

29:53

want to be having repeated

29:53

cycles. And if spending the

29:57

money on a vaginal microbiome

29:57

test I'm looking at sperm health

30:01

in advance can enable that to

30:01

happen, then why would you not

30:06

spend the, you know, in

30:06

comparison, smaller amounts of

30:09

money on getting this testing

30:09

done first before you invest

30:12

fully in an IVF cycle, and

30:12

you're right is overwhelming.

30:16

That's why we're here doing this

30:16

right to get the information out

30:18

there and to try and make it

30:18

slightly less overwhelming for

30:20

people. But it is it's so much

30:20

to go through. And if there's

30:23

anything you can do to improve

30:23

your chance of success, that

30:26

stat actually really surprised

30:26

me seven times, like seven times

30:30

more likely like to have a

30:30

successful IVF cycle. If you you

30:34

know, it's a no brainer. We know

30:34

even clinically, when I speak to

30:38

doctors who sometimes have an

30:38

issue with addressing vaginal

30:41

microbiome, you, you know, I

30:41

think it's a matter of

30:44

vocabulary. We we've been using

30:44

antibiotics in couples trying to

30:50

conceive for years, sometimes

30:50

when it was, you know, when it's

30:53

there's no other option when you

30:53

don't know what's going on

30:56

unexplained. They would just put

30:56

couples on antibiotics. And then

31:01

they try. Why are they doing

31:01

that? What are we addressing in

31:04

that in that circumstance, that

31:04

we're addressing the presence of

31:09

bacteria in the vaginal in the

31:09

reproductive system. And so

31:13

we've known that there is a role

31:13

for decades, we've treated it,

31:19

we've just haven't come around

31:19

to understanding it and

31:22

screening it until now. Or if not verbalised it properly

31:24

and that people people didn't

31:27

explain what they were doing. So

31:27

let's talk about what we can do

31:30

about this, then like you've

31:30

touched on antibiotics, like if

31:33

you've had a vaginal microbiome

31:33

test done, and it comes back

31:36

that you've got, you know, some

31:36

path of violence and bacteria is

31:39

there that you don't want there,

31:39

you might have low levels of

31:41

lactobacillus, like, what is the

31:41

treatment plan? And what should

31:44

people expect to invest from a

31:44

time perspective and a, you

31:48

know, a medication supplement

31:48

perspective? What are we looking

31:50

at? So, the first thing to

31:51

understand is, there is no easy

31:55

fix off off the spouse B, just

31:55

because there's something that

31:59

hasn't been researched as much.

31:59

We haven't put enough resources

32:03

into it. We don't have all the

32:03

answers. Yeah. So for, you know,

32:08

my opinion, the first step is to

32:08

get, you know, get an

32:11

understanding of what is going

32:11

on, is there an imbalance? What

32:13

bacteria are causing the issue?

32:13

And then we're talking about how

32:17

do we fix it? And yes, like you

32:17

said, the, you know, the first

32:21

option and the, you know, the

32:21

clinically the first thing

32:23

that's touched upon is

32:23

antibiotics. And this is usually

32:26

used if there is an overgrowth

32:26

of specific bacteria that need

32:30

to be knocked back. Now, if

32:30

you're not in a rush to fix or

32:34

address this issue, a lot of the

32:34

time, it can be done through a

32:38

combination of antibiotics with

32:38

some holistic steps in order to

32:43

turn the antibiotics will kill

32:43

things. And that's when they

32:47

that's when they work at their

32:47

best. Sometimes they don't even

32:50

do that. But they will kill

32:50

everything. Right? So we're

32:53

kicking things back. Once we do

32:53

that, what do we want, we want

32:57

to reestablish a healthy

32:57

microbiome. And so that's the

33:00

step that takes time. It takes

33:00

work. And it takes working with,

33:08

usually at the moments, your

33:08

options after a woman who are

33:11

trained in intimate health

33:11

practitioner practitioners who

33:15

are actually spending their life

33:15

trying to help women in this

33:18

field, and is working with them

33:18

with the use of various things

33:23

like anti microbials, like

33:23

herbal pessaries, like

33:27

probiotics, in order to flip

33:27

this microbiome from a non

33:33

protective microbiome to a

33:33

protective microbiome. And this

33:37

will be different for each

33:37

woman, there is no protocol that

33:41

will just be used and put in

33:41

action for you know, for

33:45

everyone. And if anyone tells

33:45

you there's like, one one for

33:48

you know, one way and this is

33:48

what's done for this is a lie,

33:53

has to be case by case because

33:53

your hormonal balance your

33:58

immune system, your medications,

33:58

your history will all affect in

34:03

identification of the root cause

34:03

of the dysbiosis or the

34:07

imbalance. And so that has to be

34:07

addressed in creating a balanced

34:11

microbiome. So there will be

34:11

antibiotics involved. There will

34:14

be probiotics involved. There

34:14

will be various supplements or,

34:19

or herbal kinds of interventions

34:19

involved. Does it work? Yes, it

34:27

does. We've seen it. We've seen

34:27

women who've tested and have had

34:31

severe dysbiosis with very low

34:31

levels of lactobacillus who have

34:35

turned things around, you know,

34:35

within six to eight months of

34:40

actually being committed,

34:40

dedicated working alongside a

34:43

practitioner. So it does require

34:43

commitment. It does require

34:49

work. However, if you don't have

34:49

time, and I understand that with

34:53

a lot of us were going through

34:53

IVF cycles, etc. The most

34:57

important thing is identifying

34:57

it and kicking it back, I would

35:00

say to antibiotics, antibiotics

35:00

prior to an embryo transfer, if

35:06

you don't have time, you know,

35:06

getting it kicked back is better

35:10

than than doing nothing about it. And let let some just touch on

35:13

that then. So, because this is

35:17

really important, I will often

35:17

have patients in clinic say to

35:20

me, Well, I took antibiotics

35:20

last month for a throat

35:22

infection, it will be fine. Can

35:22

we talk about how important it

35:25

is that antibiotics are targeted

35:25

to specific bacterias? And this

35:30

understanding that certain

35:30

bacterias are resistant to

35:32

certain antibiotics? Of course. So there is loads of different

35:34

antibiotics out there. So many

35:39

different times. The reason

35:39

there are so many different

35:42

antibiotics out there is because

35:42

not all bacteria respond to the

35:47

same antibiotic. Otherwise, we

35:47

would only have one, we wouldn't

35:50

need any of the other ones. So

35:50

the understanding that actually

35:53

no, you know, different

35:53

antibiotics work on different

35:57

types of bacteria is really

35:57

important. And that's why blind

36:01

treatment is not great, which is

36:01

what we've been doing forever,

36:05

you know, some you know, some

36:05

women have an infection of, for

36:08

example, at a podium, which is a

36:08

bacteria that's not tested for

36:12

actually, usually through

36:12

culture, it doesn't grow on

36:15

culture, and it's not as a

36:15

foreign PCR. A lot of us don't,

36:18

haven't even heard of it. And

36:18

when that's, you know, when

36:22

you're treated with the usual BV

36:22

medic in antibiotics, that

36:27

doesn't treat as a problem. And

36:27

so women are left with this

36:31

infection. So it's really

36:31

important to not think that the

36:36

same way taking supplements

36:36

blindly doesn't help. You know,

36:39

taking antibiotics blindly

36:39

doesn't mean that you've treated

36:42

the issue, test, understand what

36:42

you're treating before you treat

36:46

it, and then treat. And then you

36:46

know, at least you've done what

36:51

you can from from that

36:51

perspective. However, again,

36:54

this is when you don't have

36:54

time, I think when you do have

36:57

time, definitely worth working

36:57

on it improving the conditions

37:03

prior to going in for another

37:03

round.

37:07

And we're talking like three to

37:07

six months in advance. Right?

37:09

Yeah, I would say so. Yeah. I

37:09

think, Phil, again, lots of

37:14

people listening like this, the

37:14

message is that it's really

37:17

important that if you're going

37:17

to do this testing, you do it

37:20

properly. And then you have

37:20

someone interpret the results,

37:24

who understands the

37:24

complexities. That, you know,

37:27

it's a blanket approach is not

37:27

quite right. And then it does

37:30

need like you said

37:30

individualised one to one

37:33

approach where people are

37:33

looking at your unique test

37:36

results and looking at the picture as a whole and not singling things out? Definitely.

37:38

What do you offer as a company

37:42

then to support people? So if I

37:42

was a patient and I had listened

37:45

to this podcast, and I was in a

37:45

situation might have, you know,

37:48

problems with fertility or a

37:48

current loss of unsuccessful

37:51

IVF? Like, how would I approach

37:51

you and what what can you offer

37:55

me to help? So we, you know, we offer

37:57

directly to patients, testing of

38:03

the vaginal and the seminal

38:03

microbiome, which are at home

38:07

kits that you do, and you send

38:07

samples through the post samples

38:10

are stable, you don't need to

38:10

worry about them, they can, you

38:13

know, they can be posted at any

38:13

any, any day in the week through

38:16

the post office. We screened

38:16

them. Now, the limitation with

38:21

this type of screening, which is

38:21

very comprehensive and accurate.

38:25

The limitation is the time it

38:25

takes because there's a genetic

38:28

testing, it takes slightly

38:28

longer for results to come

38:30

through between like three to

38:30

five weeks for results to come

38:34

through. So that is that is a

38:34

downfall of using NGS. But

38:38

unfortunately, that's not

38:38

something that we can control,

38:41

or change. Once we have results

38:41

in, you receive your results,

38:45

but also a consultation with an

38:45

intimate health practitioner,

38:49

and who also you know, deals

38:49

with fertility. And in that

38:55

consultation, you you will go

38:55

through your results so that you

38:59

understand what it means in your

38:59

context with your needs in mind.

39:04

And you'll have a plan of action

39:04

as to what am I meant to do

39:07

next. And this way, you have

39:07

your results. You have an

39:12

understanding you're educated,

39:12

and in your needs and your body.

39:17

And you get you're given access

39:17

to the people who can help you

39:21

that you're able to advise

39:21

people who can prescribe

39:24

antibiotics for example? Yes, absolutely. So you are put

39:26

in touch and so your

39:28

consultation was an intimate

39:28

health practitioner, who can

39:31

carry on seeing you

39:31

independently. If you need

39:34

someone else you can request you

39:34

know, if you want to see a

39:37

special kind of specialist, you

39:37

can request a view we can

39:40

recommend or refer to

39:40

specialists in the field. And if

39:45

antibiotics are needed, and you

39:45

cannot request them through your

39:49

GP. We can refer you to private

39:49

pharmacists who can prescribe

39:53

those brilliant because another common

39:54

question that comes up is well,

39:57

what's the point in testing

39:57

because my GP won't give me the

39:59

answer. 68. So it's a lot of the

39:59

the issues around women's health

40:03

that actually accessing the care

40:03

that you need, right? It's like,

40:07

this is the most common thing

40:07

that comes up in our clinic all

40:09

the time, how do I get this? How

40:09

do I get that? Why is everything

40:11

such a fight, so to be able to

40:11

come to a company that does the

40:16

testing, and then signpost you

40:16

to the people that can help you.

40:20

If like, everything in one

40:20

place, it's perfect.

40:24

Because really, the testing

40:24

isn't of value, if you then

40:28

don't know what to do with it.

40:28

And this is the problem we have

40:30

with so many testing companies

40:30

that are popping up is that

40:35

people are just being given

40:35

results with nothing and no

40:40

direction or understanding of

40:40

what to do with it. And so this

40:44

is a problem. And that's because

40:44

a lot of companies don't want to

40:47

take that risk or that cost. And

40:47

I think that if we come together

40:51

as a community, we don't we can

40:51

reduce risks and reduce costs,

40:56

and get people the help they

40:56

need. Instead of focusing on our

40:59

profits and our margins. You

40:59

know, we should be focusing on

41:04

how can we make things better

41:04

for women? How can we make

41:08

things more accessible? And I

41:08

think the only way we can do

41:11

that is to come together as a

41:11

community and try to address

41:16

identify what's lacking, and

41:16

then try to address it.

41:20

I think that's a great, final

41:20

finishing point gourmet. Like

41:24

you've kind of rounded that up

41:24

really well like how do people

41:27

find you? What's your website, you can find us on of course, on

41:30

our website, screen me.co.uk You

41:34

follow us on Instagram screen

41:34

meet on Skype or screen me woman

41:38

there is an underscore that just

41:38

screen me woman, we've changed

41:40

that now. So excuse me, woman,

41:40

you can message direct message

41:44

us on Instagram, we're very

41:44

responsive. Or you can email us

41:48

at support at screen me.co.uk.

41:48

And if you need to talk to me,

41:52

you can just address that as

41:52

Google News and it will get

41:54

forwarded to me. Amazing.

41:57

I'm going to put all of that

41:57

information in the podcast

41:59

episode information. So for

41:59

anyone listening, if you scroll

42:03

down, you'll find that

42:03

information where you can

42:05

contact garnish. That has been

42:05

so enlightening. Thank you for

42:09

coming on. Thank you for having me.

42:12

I'm sure you've definitely

42:12

helped lots of our listeners.

42:14

And like Ganesh said, If anyone

42:14

has any questions, feel free to

42:17

email her or you can email us at

42:17

the fertility suite and we will

42:20

happily forward on the questions and I think it's worth it's really

42:23

worth thanking you guys. I think

42:29

yourself Rachel and so many

42:29

other other people who are

42:34

working in your field, as you

42:34

know as women and men who are

42:38

supporting people going through

42:38

their fertility journey, as

42:42

practitioners nutritionist,

42:42

herbalist, acupuncturist, I

42:47

think, in the fertility

42:47

community, I really don't think

42:51

we could do things, the way

42:51

we're doing them. Now, it's such

42:56

a better way of going about this

42:56

whole journey, I wouldn't have

43:01

been able to go through it as

43:01

well as I did if I didn't have

43:06

the support of my practitioners,

43:06

even though I'm a scientist,

43:10

even though I'm in the field, so

43:10

I think you know, whoever is

43:14

listening out there. Find

43:14

someone who can help you and

43:19

support you through this. We can

43:19

get you the information you

43:22

need. It will make a whole lot

43:22

of difference. Even as many we

43:26

wouldn't be able to do it

43:26

without practitioners like

43:28

yourself. Yeah, absolutely. That's the reason I

43:29

set up our online like one to

43:33

one service like we have a like

43:33

a facility and Miscavige

43:36

assessment service where we just

43:36

basically hold people's hand

43:40

through the process for that

43:40

reason and signpost, people to

43:43

companies like yourself, I think

43:43

it's really critical. It takes a

43:46

village right, you really need

43:46

it. You really need a village to

43:49

help you. It does. It does. So

43:49

thank you, thank you for all you

43:52

do. Thank you garnish. It was lovely

43:52

to have you on and I will speak

43:55

to you very soon. Take care