SPEAKER_00 0:01

Welcome back to the Fertility Suite Podcast Series 3, where we're bringing the Fertility Experts to you so you can make the most informed, educated choices about your fertility. Hello everybody, and welcome back to another episode of the Fertility Suite Podcast. And joining me today, I have someone that I know very well and I love. Her name is Jess, and Jess is an intimate health specialist. And Jess is going to be talking to us today all about the vaginal microbiome and its impact on fertility and just giving you some really practical, helpful information about how the microbiome does impact fertility, but more importantly, how you can support that yourself at home. So, Jess, welcome. Thanks so much. Nice to be here. Yeah, thanks for coming. Do you want to just sort of give people a little intro, tell people a little bit about yourself, your background, and then we'll get stuck in?

SPEAKER_01 0:51

Yes, Bab, thanks. So I'm a nutritional therapist by trade. I've been practicing for about eight, nine years now. And about four or five years ago, I really wanted to specialise in women's intimate health. So anything to do with the vaginal microbiome and the bladder microbiome is kind of where I've been supporting clients. And I've worked for now two companies in vaginal microbiome testing. So I've kind of gone quite in depth around how a healthy microbiome and how an imbalanced microbiome can affect women at different stages of their life. And it's very relevant when it comes to fertility. And you know, I'll go into more detail in a bit.

SPEAKER_00 1:35

Amazing. Thanks, Jess. You've definitely got a wealth of knowledge, which is why I love working with you. So do you want to just start by telling us a little bit more about actually what is the vaginal microbiome? Because I think for someone who has never heard of it, it you know it can sound a bit daunting. So just explain to us a little bit more about what actually that term means.

SPEAKER_01 1:54

That's fine. So at a basic level, a microbiome, you might have heard this referred to when it comes to the gut. The gut microbiome is a little bit more well known and gets kind of more research and column inches at the moment. And so a microbiome environment is a place in or on the body that contains a very unique set of species. So these can include bacteria, viruses, and yeasts. And so we have the gut microbiome, as I say, which is quite well known. We have other areas such as a microbiome in the mouth, we have one on the skin, but we also have one in the vagina. And specifically in the vagina, this can either be kind of health promoting when it's in a healthy state, and I'll talk about what that means in a sec, but it can also be detrimental to health. And specifically in the vaginal area, it can be detrimental to anything kind of eurogyney, so anything affecting the whole gynecological area, but also impacting the bladder as well. So when we're looking at a vaginal microbiome, we're looking to find a dominance of a bacteria called lactobacillus. So very much unlike the gut, where we want to see variety and diversity, a healthy vaginal microbiome is actually very much dominated by a bacteria called lactobacillus that produce lactic acid and hydrogen peroxide and keep the area at a healthy acidic pH. And the reason they do this and why this is so fundamental is by doing this, they keep opportunistic microbes. So they may be kind of nasty bacteria and also nasty yeasts at bay. And it's these kind of nasty opportunistic microbes that can have an impact on fertility outcomes if a woman has these at significant levels in the environment.

SPEAKER_00 4:04

Amazing. Yeah, that makes sense. So the lactobacillus are like the good guys and they're keeping out the bad guys essentially.

SPEAKER_01 4:11

Absolutely. It's actually quite a simple concept in this area. It's a lot simpler than the gut. So you just we just want to see when we're looking at reports a really high amount of this acid produced in lactobacillus because this is very protective and keeping out the bad guys, like you say.

SPEAKER_00 4:30

So, how would someone perhaps know, if someone's listening and thinking, oh, I haven't got a clue about my vaginal microbiome, like what's going on down there? How would someone maybe know that there is an imbalance? Like what would the first potential signs be that something's not quite right?

SPEAKER_01 4:46

Yeah, that's so I suppose some of the conditions that you might be familiar with that indicate there's an imbalance are things like bacterial vaginosis, also known as BV, and possibly an increase of candida, which is vaginal thrush. So they're kind of the most common conditions. There's also another condition where we get an increase of aerobic microbes, which I'll talk about. They can be quite associated with poorer fertility outcomes, but also urinary tract infections. So BV is actually one of those things that it's actually asymptomatic in a in about 50% of women. So some of these imbalances, annoyingly, are sometimes asymptomatic. So that that is one thing we can discuss around testing, because it's a woman doesn't always have symptoms. But some of the obvious symptoms to look for, and it's whether you have these now or whether you've had these in the past, I would think are quite relevant to this area, are things like an unusual discharge. So more gushy, that's linked to BV, or cottage cheese-like, as we know is linked to vaginal thrush, an unusual odour. And when I say unusual, you know, it's it's it's good to get to know what's normal for you. You know, we all have a bit of discharge, and you know, there is a distinct smell, but it's when that smell changes, and a lot of the time with BV, the smell becomes a bit more fishy or ammonia-like. So that's just something to look out for. The other symptoms are things like discomfort, pain, itching, burning, anything like that around the vaginal tissue, but also around the fulval area as well. Um, and then a big red flag that the vaginal microbiome is also potentially imbalanced is getting urine routract infections and particularly recurrent urine routract infections. So it's not always kind of black and white, but because the vaginal microbiome is so close to the urethra, which is where urine comes from, and it can be quite closely linked to the bladder microbiome as well. So any of those kind of symptoms, urinary tract infections, you know, discharge, odor, pain, discomfort, is an indication that something isn't quite right down there. And one of the one of the big areas I would recommend looking into is what's going on at a microbial level.

SPEAKER_00 7:25

That's interesting, isn't it? Because I guess from the the urinary tract thing wouldn't be an obvious connection for a lot of people. But when you think about it like that and explain it like that, like physically, they are very close together. So it makes sense that bacteria could be translocated between the two.

SPEAKER_01 7:41

Yeah, absolutely. And it's us women have a very short urethra compared to men. This is why in women urinary tract infections are so much more common. And you know, they are common, lots of different ages in women. And some people can go through a you know a nasty cycle of quite of a few because they tend to have quite a high recurrency rate. And annoyingly, you know, they are triggered by things like sex, dehydration. You know, lots of people report having them if they go on holiday or have a slight change in routine, you know, doing lots of exercise. The other, the other thing, and we'll come on to it, is there's lots of other other factors that can impact the vaginal microbiome. So really anything that impacts that can sometimes trigger you know UTI problems. But definitely something to consider if you're suffering from UTIs, you know, and given they're so unpleasant.

SPEAKER_00 8:38

Yeah, gotcha, absolutely. You know, nobody wants a UTI. And actually, a lot of women are sort of told, oh, here, just take antibiotics and we can't really work out why it keeps coming back. So maybe this is, you know, well, I know it's giving us some answers towards potential causes for UTIs for sure. So it's good to know that that's a sign to look out for. So if somebody did have these like signs and symptoms going on, and they're thinking, I know my vagina, I know something's not quite right, or and we'll talk more about the impact on fertility shortly, but or they're about to have fertility treatment, or they're struggling to conceive and they want to find out more, what is the process for finding out this information? How do they go about this?

SPEAKER_01 9:22

So there are tests on the market, and we at Pelvic Relief sell a test. Now, the beauty of these tests is that they can be done at home. So, you know, you order a test kit, you can take the swab at home. It's actually a um quite a low vaginal swab, so it is actually safe in pregnancy as well. So it's you know it's a very safe test to do on yourself. We ask you to swab for a few seconds, put it back in a kind of test tube thing, and then this is sent off to our lab to analyse how much and what bacteria, yeasts, and also molecutes, which is urea plasma and mycoplasma, which is kind of a growing area in fertility. So we very much have a look at what microbes are present and also in what quantities, and then myself or the a practitioner that you're working with can give you, can interpret these results and tell you whether you need to take any action. And sometimes that may be that you know looks different for different people. Sometimes it's medical, sometimes it's supplements, sometimes it's some lifestyle tips, or whether it's healthy and you know, you've got the green light to progress, which is also great to know because it can be very reassuring. So the test is the test we sell is£199. So in comparison, you know, to costly IVF treatments, you know, it is a uh useful practical test to do, I would say, to rule out any, you know, obstacles or barriers to having you know successful outcomes in pregnancy.

SPEAKER_00 11:05

Yeah, absolutely. I think anyone who's run any sort of um fertility testing will uh agree with me when I say anything you can run yourself from home that's easy and simple to do is always welcome, especially if it gives you some more answers. So am I right in thinking then that the so the environment you are going to find some bacteria that like it's not it's never going to be like a perfect environment, like it's meant to have a little bit of variation, but what you want to see is predominantly good bacteria and minimal nasty bacteria.

SPEAKER_01 11:39

Definitely, and you know, we've never seen a sterile environment, so there's always something there. Women have different loads of bacteria, you know, but depending on things like age, but we are really looking for dominance, and actually in our tests, we calculate that at about over about 90% of the whole microbiome. We're looking for whether lactobacillus is taking up that much space. And then, yes, that you we will get some low-lying other microbes often kind of kicking around, and in most cases that's okay, but it's when we see very little lactobacillus or you know, 40%, 50%, and then a lot of the other microbes, and we categorize these into anaerobic ones, which are BV related, and then aerobic ones, which for me are the ones that cause UTIs, but they're also the very inflammatory ones when it comes to fertility. So just to chuck out a few names, things like E. coli and pterococcus ficalis, some of the Streptococcus species, you know, these at very, very low lying amounts may be okay, but at higher levels can be very inflammatory. And this inflammation interferes with, you know, the proper functioning of the vagina, really, and then also with embryo development, placental development, implantation, and various things like that.

SPEAKER_00 13:12

So let's go on and talk about that then. So let's talk a bit more in-depth about actually how some of these bacteria as you've mentioned, or even just not having enough good bacteria, enough of those lactobacillus, how does that actually impact fertility? And like in what way is that potentially causing an issue? And we're not saying that if you you know haven't got a perfect vagina that you're not going to be able to conceive, but there are definite links to having these bacterias and fertility, right?

SPEAKER_01 13:40

Yes, and what you've just said is really, really important. I would say this is an area where there's lots of shades of grey, and it's just my my goal with anyone who's wanting to conceive is making it as optimal as possible. So it doesn't mean that if you've got a certain bacteria at this level, you know, then it's black and white, you're not going to get pregnant. It absolutely doesn't work like that. It's very much just making this environment as supportive as it can be. And it's supportive of conception, but also carrying to full term. Because uh just to interject, you know, some of the associations we're seeing in the literature with very imbalanced vaginal microbiomes are with poorer conception rates, increased miscarriage, preterm birth, and also um infections of the newborn. So it's not just about conception, having a healthy vaginal microbiome, it's very much looking at the whole journey and making sure that at every point, you know, you're supported. So back to answering your question of how do these microbes impact the area, and really the bottom line is they cause inflammation. So opportunistic microbes cause inflammation not only in the vagina but also in the cervix, and these microbes tend to ascend, so they kind of travel upwards, and we also have a kind of mini microbiome in the endometrium, too, and you know, these environments are interlinked, so an imbalanced microvaginal microbiome may well mean you know, higher up is a little bit imbalanced as well, and from an inflammatory perspective, you know, these bacteria are causing a bit of a immune, a local immune response, which involves increased things like prostagland and cytokines, which none of this is conducive in the tissues to for sperm to travel upwards, to be healthy when they get to the egg, and then also for implantation. So I would just see it as kind of every other aspect in our body. Inflammation is never really a good thing. And specifically with BV, actually, we see the discharge that comes with BV, which is often gushy, grey. This has been found to be very unfavourable on sperm function. So, you know, just having BV can mean that the sperm doesn't travel, you know, as well as it should do. And then also the inflammation around the cervix, but also, you know, if you do get pregnant, the amniotic sac can cause it to be slightly weaker, slightly more dysfunctional. Hence, you know, the vaginal microbiome can be associated with pre-birth and miscarriage as well. So really, there the underlying thing to associate with this is inflammation, and we want to make sure that this whole environment is in a balanced, you know, non-inflammatory state for conception and for the whole journey afterwards as well.

SPEAKER_00 17:03

You explained that so well because it's not an easy area to explain, and it can be really complex, but I feel like you gave a really simple and relevant explanation. So thank you. Yeah. And that it all makes sense when you explain it like that as well. And you know, you touched on the links with the endometrium, and for some people listening, they might have already had more complex sort of testing done. But often in our clinic, certainly I know in yours as well, like the vaginal microbiome is a really good place to start when you are struggling with fertility. And if you've got any of those signs or symptoms, you know, or definitely if you've got those signs and symptoms, like you said, it's a simple test you can run at home. And so it makes sense. And are there links to IVF outcomes as well? I guess when you've just talked about it like that, there's surely there must be.

SPEAKER_01 17:49

Yes, and I can always actually post a few, you know, at the end of this podcast if you want. There's, and again, it's to do with the inflammatory impact these species are having in the endometrium. So, yes, there are studies with poorer outcomes in IVF with a imbalanced diotic vaginal microbiome state. And actually, it's very much to do with the inflammation that's being caused in the endometrium. So I'll link to a study where we can show that there's poorer outcomes in increased implantation failure rates and increased chance of miscarriage if you do fall pregnant initially. So, yes, and it's it's definitely something that is, you know, it's such a good check before going down the route of IVF because, you know, in some cases it might be the you know, a really significant part of the puzzle and it might support getting pregnant naturally, or it's just going to improve outcomes of IVF for you. And again, I very much see it as it's one piece of the puzzle. There are so many other factors, and you know, Rachel cover this covers these on her podcasts um brilliantly. You know, the immune system, your thyroid, your hormones. This is just one other area that we would definitely recommend looking into, making sure it's optimal. If it's not, then you know, people like us can guide you through options to make it optimal to at the end of the day improve chances.

SPEAKER_00 19:25

And when you look at the cost versus the cost of what people are spending on IVF, you know, it doesn't even, it's not even comparable, is it? So it makes perfect sense to think about just sort of ticking this off the list. Certainly if you've got symptoms, but even if you've got no symptoms, like you said, about 50% of women may have something going on and not know anything about it. You touched on urea plasma, and that is a word that a lot of people, first of all, might not understand what it is, but might have heard of it, and there's been a lot of sort of chat around it in the fertility world lately. Can you just explain a bit more about urea plasma and how that affects fertility?

SPEAKER_01 19:57

Yes, that's fine. I mean, I still think it's an area that needs a lot more research. So I would say this is kind of what we know as of today. I'm hoping in 10 years' time we'll know more. But urea plasma comes under this heading of molecutes, as does mycoplasma. So there's different types as well. You've got things like urea plasma parvum, urea plasma uroliticum. But basically, what these are are they are bacteria without a cell wall, and they're the kind of the tiniest bacteria we'll get in the body. And in some studies, they have been shown to negatively impact fertility outcomes in both men and women, actually. So this is one of those things it's sexually transmitted, but it's not a sexually transmitted infection. So, you know, men and women share microbes when they have unprotected sex. This has been shown in uh if it's present in semen to have some poorer outcomes around the quality of that sperm and then the quality of the egg made. Again, I can point you to that study. And then in some cases, it's been found to have a negative impact. But to be really honest, there's also some studies that show that it doesn't have an impact. So it's it's it's one of those ones that if we if I see it at a very, very low level, it might be worth then checking if your partner's carrying it as well. But it very much depends on where that person is in their journey. You know, it's relatively common. Most GPs wouldn't treat it, but if that person has been trying for many, many years and has optimized all other areas of health, then it's something to consider treating. And because it's sexually transmitted, I always have the conversation around treating the man and the woman. Um so, yes, this probably needs a podcast on its own. Um but uh with every person I see, you know, we really have to consider their. Their personal circumstances, you know, how long have they been trying? What other things are going on? And I always very much take into account those with my recommendations. So again, it is not back to that kind of black and white. It's easy to give you a treatment plan. It's it's very much bespoke for that woman, what's coming out of the results, where they are in their journey, even things as well, like how old they are, other kind of external factors that may be impacting it. It's a really kind of holistic approach that we need to take in these situations.

SPEAKER_00 22:37

The fertility is so complex, right? And I think this is a really important conversation to have is that when we're talking about fertility and tests and someone's overall picture, like you have to look at people on an individual basis or look at the couple as an individual couple. You can't, there's no black and white really with fertility, is there? There's lots of grey areas, and those grey areas can sometimes be dependent on all of those factors you've just mentioned. You know, someone who's been trying for three years, we would look at very differently to someone who has perhaps only been trying for a short amount of time. You have to look at all the factors involved. So yeah, I think that's so important when it comes to fertility. So when you are talking about like treatment plans and say, say someone's come to you, they've had some test results, and the environment is considered not optimal, and they are maybe about to go under IVF in a couple of months' time, like what would sorts of things would you be looking at to recommend? I know again it's very tailored, but just give us an idea of the sorts of treatment plans that people would be thinking about.

SPEAKER_01 23:43

That's fine. So there's a variety of things. If there's a really obvious case of BV, you know, no good bacteria and really high gardenerella, some of the other BV microbes, we would often give the option to treat that with antibiotics medically, because we appreciate people, you know, the time is of the essence often. So antibiotics come into some of these treatment plans, not that regularly, but they it definitely can be an option to very drastically reduce the load of opportunistic microbes. I'll come onto this in more detail, but it's so, so important to then put the good bacteria back, so the lactobacillus. And there's various ways we can do that, but the main way is with probiotics containing these lactobacillus species that are found native to a healthy vagina. And these are on the market as oral capsules. There's a few kind of vaginal ones, but I would recommend them more for short-term use. So antibiotics is one way of reducing these opportunistic microbes. There are some other ways as well. So I sometimes give dietary advice, some supplement advice. Garlic specifically has been found to be quite an effective ingredient that reduces BB microbes, but I often give it, you know, as part of a multifaceted plan. Often it's not just one thing that's gonna rebalance, it's a mix of lifestyle, diet, supplements, and possibly some medical interventions. Even in older ladies, so not older in terms of age, but you know, in women perhaps uh in their early 40s who are possibly going slightly towards perimenopause, even things like vaginal estrogen can be excellent to increase lactobacillus levels because oestrogen is quite a driver of supporting lactobacillus levels. So, yes, that's kind of the uh the basics, but it's it's so individual. And uh a few other things to be just wary of is that antibiotic use can really deplete the lactobacillus levels in the vagina. So just being wary of them. If people are taking them, then how do we support them? Some of the kind of lifestyle habits like douching is not recommended, the vagina is self-cleaning, making sure you're not allowing the area to get kind of really hot and sweaty. I say this alongside the trend of women kind of living in lycra these days. You know, there are some kind of lifestyle things like that that may be specific to a woman and just supportive of the microbiome by cutting some of these things out, like you know, regular hot tub use may not be helpful. It's all quite individual. Occasionally, as well, the there might be microbes coming from the partner. So sometimes checking the partner if we find a high load of BV or a high load of aerobic microbes in the woman may be relevant to check the partner because that's it's possibly kind of a reservoir of microbes that are coming, you know, every time that couple has unprotected sex. So that would be a conversation with a practitioner. But there are those tests on the market now as well, test men. But again, like Rachel says, it's you know, there might be some tests that you start with, see how things go. This is just another kind of area to look at.

SPEAKER_00 27:24

So I think one of the things that people listening might be thinking is, you know, what can I actually do at home to help support this, or even actually have these bacteria got there in the first place? And how can I fix that, or how can I stop that reoccurring? You know, I think naturally, whenever you have something come up on a test result and you treat it, it's a normal worry that that might revert back to its original state. Like, what sorts of practices should, as women, should we be sort of encouraging at home that can help stop these bacteria from becoming overgrown or cause the imbalance?

SPEAKER_01 28:00

So, kind of the opposite of what I said in terms of letting the area kind of air and making sure you're wearing kind of loose clothing, natural fibres like cotton or bamboo underwear are much better than wearing, you know, polyester and also thongs aren't great. That really you know can encourage translocation between anus and vagina, which we don't really want to encourage. Diet does come into it. So if you've heard of probiotic foods, things like keffia, live yogurt, kimchi, kombucha is a great swap from alcohol. These foods will have live bacteria in them. A lot of them have lactobacillus. You can actually go onto the Yo Valley website and have a look at the kind of bacteria they put in their yogurts, for example. So nurturing your gut microbiome can will only have a positive impact on the other microbiomes in the body. The lactobacillus bacteria are found in these foods, but we can talk in a minute about the probiotics with lactobacillus in are also really beneficial, particularly if you've had antibiotics. So I would always be trying to replenish if you've had that, and possibly if it's in a plant to help you rebalance the microbiome. Looking after your immune health is important. So there are actually some studies that show lower levels of vitamin D can be associated with, I think it's a slight increase in B V or a slight imbalance of my the microbiome there, because at the end of the day, it's the immune system that's really trying to kind of ward off these opportunistic microbes. Smoking has been linked to poorer vaginal microbiome, so that's absolutely one thing to avoid. And even just having very erratic blood sugar levels won't be helpful. So yeast and some of these opportunistic bacteria will kind of have more of a party in environments where there's high sugar. So trying to eat a diet where you've got a nice mix of protein and complex carbohydrates and fat, having set meal times, but avoiding sugary snacks all day long will definitely have an impact as well on this area.

SPEAKER_00 30:21

Loads of helpful tips there. Thank you. So when someone's looking at taking a probiotic, like the markets are wash with like probiotics, how do you know what to look for? What would be some relevant things that you would want to look for when you're trying to choose a probiotic? I get asked this all the time, by the way, like about supplements generally, but probiotics in particular, because there's so many out there.

SPEAKER_01 30:45

Yeah, there is. And so probiotics at the basic level are live bacteria. And for the vaginal microbiome, the key thing you want to be looking for are the lactobacillus strains. However, having said that, there are ones that are more relevant than others. Mainly because A, they have been found in the vaginal microbiome. So, you know, you get a lot of different members of the family, but only some of them really are found native to the vaginal microbiome. And then secondly, only some have been studied to be taken orally and reach the vagina alive. So, you know, the way they get that is they go through the gut and they translocate. Now we sell a product that has four strains of lactobacillus in, and these have all been found to be kind of the most common strains found in women with healthy vaginal microbiomes. So these include things like Lactobacillus crispatus, lactobacillus gaseri, lactobacillus gensinae, and lactobacillus ramnosis. So, you know, all these names are probably like what on earth, you know, are these? But these are kind of the the labels given to these types of bacteria. And we have evidence from the company we manufacture them with that these have been found to reach the vagina alive. And then the main role they have when they get there is to acidify it. That's really kind of the mechanism that is absolutely key from these probiotics. Um, and I said, as I said at the start, it's about this acidification is a way to keep the opportunistic microbes at bay. To be really honest, you know, taking one or a week's worth isn't going to often be enough to have an impact with these types of products. I would be recommending people take at least three months.

SPEAKER_00 32:44

Um that makes sense, I think.

SPEAKER_01 32:47

Yeah, and I have to say they they are quite useful. Ours are safe to be taken during pregnancy as well. They're quite useful if women are going through IVF, as I said, had taking antibiotics, because they can help to you know reduce your risk of tipping into an unbalanced state as well. Particularly, I say during IVF, because there's some medications involved, and your hormones can change, so the microbiome can change. So they can be quite useful at different points. And especially if we find imbalance there, then they are always part of my plan, really.

SPEAKER_00 33:25

Yeah, absolutely. And that's really important to mention, actually, because something I'm starting to see, and probably you are as well, is with clients when they're coming through the door who are who are undergoing IVF, is that there might be like a precautionary sort of five-day dose of antibiotics given at some point just before they start STEMs or during STEMs, which I think is kind of, you know, from a consultant's perspective, they're thinking, let's just address any bacteria, but then no one's replenishing the good lactobacillus. So certainly if you're having repeated cycles and you're taking, you know, a five-day course of antibiotics every so often, and naturally, obviously, having IVF, your estrogen levels go up periodically. There's so many things there that could lead to like a dysbiotic environment, right?

SPEAKER_01 34:10

Yes, no, absolutely. And it's it's worth mentioning that the dbiotic environment can impact the guts and the vagina. So our probiotics can be taken alongside probiotics that support the gut as well. And I know it probably feels a bit overkill at the time, but for a few months, supporting the gut if you've had the antibiotics with a kind of gut-based probiotic like Simprove, you know, there's very specific ones on the market, but also supporting the vaginal canal, really, with these lactobacillus ones is important.

SPEAKER_00 34:45

Yeah, because I think, and again, just from personal experience, having looked on the shelf, probiotics, like it can be really confusing. So it's really good to know that actually for the vagina, you do need those lactobacillus. And even if you're taking like a day-to-day probiotic lights improved, like just to mention one, you know, that isn't necessarily supporting your vaginal microbiome in the best way possible.

SPEAKER_01 35:07

It might be being amazing for your gut, but it's not necessarily supporting the vaginal health, which is no, it it probably will have a positive benefit, but it's not as the specific strains that we want to see there. Brilliant.

SPEAKER_00 35:22

Thank you. That's been like really interesting, and I hope that for anyone listening who wanted to learn more about the microbiome or maybe is struggling with fertility and has perhaps had some signs and symptoms of something vaginally, that we've joined a few dots up and given you some practical tools and advice. So, Jess, if someone wants to run a vaginal microbiome test, how do they go about finding you guys?

SPEAKER_01 35:48

So, our website is wwwpelvicrelief.co.uk and there's a header that says vaginal microbiome test at the top, which you can kind of easily find and go in there. Members of the public can purchase it independently. And at the moment, we're offering support around interpretation of the results. But a lot of our clients come through practitioners like Rachel, other nutritionists, acupuncturists, some medical people. And in that case, they may then have a call with their practitioner to go through the results. It kind of depends on who's who's looking after you. But we can absolutely give guidance around the results, give immediate next steps, and point you in the direction of referrals or medical support if needed. And our tests, so you can buy the test online for£199. It'll be delivered in a few days. You can do the test in your house, as I said, and it's actually worth mentioning that there is a favorable time of doing the test. You definitely want to avoid your bleed, so no period blood. And doing it around ovulation is often best time given that's such an important window for fertility. So I would kind of wait until that time to do the test so that we see what the environment is around the time that you're trying to conceive. Then you send it off in the post, you scan a little QR code in the box to just tell us that that's your test and that's how we link it to you. And we ask you a few questions as well. In our test box, we include a pH stick. So alongside the results of kind of all the different microbes, we also take the vaginal pH into account, and this very much correlates often with what we see. So if it's healthy, we see this to be quite acidic, and if it's alkaline, we see it to be much more imbalance. And this is actually a great way of tracking it over as you maybe take some interventions and try to make the environment better. You can actually track it with a pH test, which we sell separately as well. So then the results come back a maximum about three weeks. We're trying to get this down, and then it is up to you who you who you want to review this with. But I can absolutely review these um at the moment with people, if particularly when it's imbalanced and you know, you want to know what to do next.

SPEAKER_00 38:19

Yeah, absolutely, because that's the key part, right? Like anyone can run a test. But as I always say, like, there's only any point running a test if it changes what you do and you've got someone to help you with that next step. So yeah, it's really good that you guys do the call afterwards for anyone that just wants to purchase a test independently. I think that's key. So yeah, brilliant. Thank you, Jess. That has been wonderful and hopefully really helpful for a lot of our listeners. And it would be great if you could send over those studies. And I will pop for anyone listening, I'll pop them in the episode notes so you'll be able to go and have a look at the information that Jess is talking about, along with the contact details for Pelic Belief as well.

SPEAKER_01 38:58

Thank you for having me, Rachel. Thanks for coming, Jess. I'll speak to you soon.