The reproductive microbiome is something to consider in cases of unexplained infertility, recurrent IVF failures, and repeated early pregnancy loss. In fact, it's something I'm considering in all my fertility cases.

A systematic review explored the role of the uterine microbiome and embryo implantation. Defined as chronic endometritis, “CE”, is a persistent inflammatory condition of the endometrial lining, and its pathogenesis is largely thought to be due to an imbalance of the endometrial microbiome. Several studies have found CE to be cured with antibiotic cycles, further supporting the role of the microbiome in its etiology.

CE cannot be identified by ultrasound and is often overlooked. The current gold standard for diagnosing is through an endometrial biopsy.

How does the endometrial microbiome impact fertility?

This review outlines the potential interaction between CE and fertility.

“Several studies have found that CE is highly prevalent among women suffering from unexplained infertility (from 40.7 to 55.7%), recurrent IVF failures (from 13.95 to 57.55%), and repeated early pregnancy loss (from 42.9 to 56%). Importantly, adequate therapy of CE can lead to a complete normalization of endometrial histology and to the restoration of the reproductive function in women with CE.”

How can I help?

One of the major takeaways from this systematic review was that the predominant types of bugs found in CE were coming from the intestinal flora – Enterococcus faecalis, Escherichia coli and Streptococcus. Additionally, lipopolysaccharide, an endotoxin for gram-negative bacteria and known indicator for leaky gut, may be a trigger and mediator of chronic endometritis.

Several studies have found this to be a curable condition with the rebalance of the microbiome.

I believe our gut health and microbiome is a foundational pieces of health, healing, and prevention. I’ve seen pretty incredible shifts in clinical pictures with microbiome assessment and treatment.

The first step is a proper assessment. A comprehensive stool analysis may be a great step to assessing your microbiome composition and identifying the presence of problematic bacteria.

Additionally, supporting a healthy gut microbiome through lifestyle and nutrition, consistently, can be impacted. In fact, research shows that positive changes in the gut microbiome can be observed in as little as 24 hours. Given that the most common bug causing endometritis comes from the gut, we want to ensure we're supporting a healthy gut microbiome and preventing leaky gut.

Daily habits to nurture your microbiome

Get enough fiber intake: Fiber is an excellent prebiotic and can be transformed by your gut microbiota into SCFA (small chain fatty acids). SCFA is essential for supporting a healthy gut lining, reducing leaky gut, and lowering inflammation.
Eat fermented foods. Fermented foods such as sourdough, kimchi, and sauerkraut are also great prebiotics and probiotics.
Get a diversity of plant foods in the diet. Diversity is key. Our gut microbiome consists of trillions of bugs. They all eat different things and those foods get transformed into many different types of beneficial postbiotics (or health-promoting compounds, like SCFAs). If we eat the same meals day in and day out, we miss out on the full range of postbiotics. In fact, one study showed that the best diversity for optimal microbiome is 30 different plant foods a week!
Eat mindfully, slowly, and chew thoroughly. This is really important for signaling your brain that it's time to eat. Your brain then powers up your digestive tract and promotes the release of stomach acid and digestive enzymes. The stomach acid can help kill off bacteria that don't belong, such as Streptococcus. We need good healthy digestive juices for a healthy gut microbiome.
Give your digestive system a break. Limit grazing between meals to allow for proper gut motility and digestion. Talk to your doctor about what this looks like for you.

In Health,

Dr. Ashley Damm, ND

Naturopathic Doctor - Women's Health & Fertility in Vancouver, BC

References:

Buzzaccarini, G., Vitagliano, A., Andrisani, A. et al. Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review. J Assist Reprod Genet 37, 2897–2911 (2020). https://doi.org/10.1007/s10815-020-01955-8