Many women and doctors still believe in the myth that lactobacilli in the vagina can cure various inflammatory processes of the vagina and improve its microbiome. Various preparations of lactobacilli, conventionally called probiotics, have become a fad, not a real treatment. This topic was considered at the 38th Annual Meeting of the European Society of Human Reproduction and Embryology.

The vaginal microbiome can affect conception rates as well as IVF. When there is a real inflammatory process, intercourse becomes impossible due to severe discomfort. The inflammatory reaction of the vagina can affect sperm motility.

Since lactobacilli are considered the main healthy vaginal bacteria they dominate in the second half of the cycle, when ovulation has already occured. Therefore, a lot of lactobacilli does not mean an enhancement of conception! If there are too many of them, inflammation of the vagina can occur, which we call cytolytic vaginitis.

At the ESHRE meeting, data from a new study was presented, which again failed to confirm the benefit of lactobacilli as a therapeutic agent. The microbiome of the vagina tries to «equalize», that is, to balance very quickly. In a third of women, improvement in the microbiome is observed in 1-3 months. When I counsel women with vaginal problems, I always explain to them that it takes several months to get back to normal condition even without treatment.

So, new data have shown that treatment with probiotics does not affect the condition of the vagina in any way and does not improve the level of effectiveness of IVF. Interestingly, vaginal conditions improved in 40% of women in the placebo group compared to 29% in the lactobacillus group, although the lactobacilli did not appear to be helpful. If there is a violation of the microbiome (and it is not a sexual infection), doctors suggest postponing IVF for 2-3 months, and it will recover on its own.