Fertility, IVF and the microbiome - Part 2

Fertility is a wide-reaching topic, and each facet is just as important - and interesting - as the other. Whether you’re looking to find out about how to address issues regarding conceiving, the microbiome and its relation to improved fertility or IVF, this four-part series can assist. Furthermore, the ethical and moral issues surrounding genetic ‘editing’ are significant talking points.

Mr Stuart Lavery, consultant gynaecologist and specialist in reproductive medicine and surgery, goes into further detail about conceiving in the second part of his fertility series, looking specifically at diet, supplements and the role of microbiome, highlighting the exciting prospect that it may improve women’s chances of conception.  

How does the microbiome play a part in fertility?

The microbiome is such an important part of medicine, but we're understanding how the original work was done in miscarriage. In women who have abnormal microbiomes, they are more prone to pre-term labour and miscarriage. There are trials already underway using probiotics, which try and keep that microbiome stabilised. What we're looking at now is saying, ‘Well, could sub fertility be the earliest part of that spectrum?’

We have ongoing studies at Imperial, where we're looking studying the microbiome both within the vagina and within the womb, and trying to identify women with particular microbiomes, whether they are more at risk. Ultimately, can we manipulate the microbiome to get a healthier microbiome to try and improve outcomes?

Are you seeing any results linked to any particular strain of bacteria?

There are about five different dominant population groups, and in each woman there will be thousands and thousands of different bacteria, but they tend to be dominant with lactobacillus species. It's the manipulation with probiotics that we're looking at to see if it can improve outcome, reduce miscarriage or improve chances of conception.

It's at a very early stage, but it’s very exciting. Many in the field think this is probably one of the most exciting areas of medical research at the moment, and it will impact various different spheres of medicine.

Is there any truth in zinc for men, and for example, eating oysters?

I think eating oysters is fabulous and I think they make you feel better. If you look at what, in terms of what the evidence out there is, it's probably more in favour of supplementation on the male side than it is on the female.

One of the reasons is that eggs are with us from the day that we're born, whereas we're making new sperm every minute of the day. The male system is much more sensitive to what's going on in the environment, and it can be that you can influence the quality and the quantity of the sperm through external factors such as diet, probably much more so than with eggs.

With men, we do see them responding to things like antioxidants, zinc, selenium and vitamin E. There's some new work coming through with carnitine and supplementation. All of these things are exciting and they probably do have a meaningful impact.

What about sperm damage? For example, by having laptops on your lap, or phones in your pocket. Is there evidence to show that that can have an adverse effect?

It’s difficult to know. There is some research about being close to electrical sources in terms of radiation, but there is just too little at the moment for us to really understand whether it has a significant impact.

There does seem to be evidence showing how sperm counts all over the world are reducing. That hasn't actually turned out to really impact fertility issues yet, because you can imagine that if you drop from 120 million sperm to 80 million sperm, that's still plenty to achieve a pregnancy. However, there is something going on with male sperm counts and we see it in clinics all over the world. And we've seen a reduction going on for probably nearly 30 years.

Is this the same rate everywhere, or in different countries?

It does seem to be different, and this may be a diet-related issue. We just don't know. There's lots of research to try and look into this. I think everybody accepts that the finding is real, but our understanding of why it is still unclear.

What happens if all of the tests are positive but you’re still having issues with conceiving?

About 40 per cent of the couples that we see, will do all these tests and all of them will be fine. For these couples, it can be very difficult emotionally to deal with, because if you tell somebody, ‘Look, you've got blocked fallopian tubes’, it's terrible news, but you can deal with it and then decide, ‘what can I do about it?’ Or if you say to the man, ‘Look, the sperm is not fabulous in terms of its’ quality, again, it's not good news. But you can do something. You can make a plan.

It's terribly difficult for couples to accept when you tell them everything's fine. When we are in situations where the fertility remains unexplained, there are really two different scenarios. Number one; there's nothing wrong. You just need a little bit more time, a little bit more patience and things will happen. Or number two; there is something going on, but it's much more subtle and the tests we do at these initial stages aren’t sophisticated enough to give us an answer.

If the couple are 23 years old and they've been trying for 12 months, it's much more likely there's nothing wrong. You might encourage them to say, you know, ‘maybe give it a few more months.’ Equally, if the couple are 35 and they've been trying for five years, that's not bad luck. That's something else is going on. Then, it may be appropriate to consider some form of intervention to speed things up.

If you'd like to find out more about further fertility interventions such as IVF and egg freezing, take a look at part three of Mr Lavery's fertility series.     

Arrange an appointment with Mr Lavery to address any of your fertility and conception concerns, via his Top Doctors profile.