Tiny Case Study: Supporting the Vaginal Microbiome to Build a Family


Get deep insights into your vaginal microbiome with our mess free, at home test. Learn more
Get deep insights into your vaginal microbiome with our mess free, at home test. Learn more

Video: Tiny Health's Medical Director, Dr. Taylor Soderborg, MD, PhD, shares Christine's story and insights into the vaginal microbiome during pregnancy

The process of in vitro fertilization (IVF) is a journey of hope and anticipation, but also uncertainty. The excitement of taking the first steps towards parenthood are often met with the months of monitoring, injections, and procedures. The whole process is physically and emotionally taxing, yet a testament to the deep love that builds a family.

Christine, a microbiologist, and her husband, Ben* were eager to be parents in their late 30s, but had a difficult time getting pregnant. They didn’t shy away from the amazing scientific advances that help so many couples conceive. 

The process of IVF took its toll on Christine’s body, and she noticed a shift in her vaginal health. She looked to Tiny Health’s Vaginal Health Test for answers, and uncovered imbalances in her microbiome associated with higher risks for preterm labor. 

Trying to conceive or support a healthy pregnancy? This Tiny Case Study is for you. Read on to learn how Tiny Health empowered Christine with microbiome insights and an action plan to take control of her vaginal health.

*Note: We’ve changed all of the names in this real life Tiny Health success story to protect the family’s privacy.

The stressful journey of IVF 

In vitro fertilization, or IVF, is the process of retrieving eggs from an ovary, combining the eggs with sperm in a lab, and transferring the fertilized egg, or embryo, into the uterus. Or as Mayo Clinic so simply defines it, “a series of complex procedures that can lead to a pregnancy.” These days, IVF is a common treatment for infertility, with over 8 million children born worldwide. Over 2.5 million cycles of IVF are performed every year, resulting in over 500,000 deliveries [1].

But don’t let the simple description fool you. Christine can attest that the IVF process is intense. First, she and Ben had fertility and overall health testing and examinations. Then Christine had to take hormones and medications for several months. 

“You have to pierce your stomach with needles many days—if you’re scared of that, it’s hard! The first time I did it I almost fainted. But you do get used to it, and it gets easier,” she recalls. Some of the medications left her stomach burning or feeling itchy.

The next step was the egg retrieval procedure, followed by genetic testing of the embryos prior to transfer. Christine then took an endometrial receptivity test to help them time the transfer for the greatest chance at success. The downside is that this test requires that you take the same medications needed for the transfer. For Christine, this included hormones, an antibiotic, a glucocorticoid, and a week of vaginal suppositories.

“It’s a stressful journey,” Christine shares. “It’s hard to see how your body reacts to everything you’re putting into it.” 

As time went on, Christine wasn’t feeling well. She was feeling bloated, her digestion was slowing, and she started experiencing reactions to certain foods. She also noticed a change in her vaginal smell and had vaginal irritation. While these vaginal symptoms are common with hormonal changes from IVF or pregnancy, Christine felt a little concerned.

Christine decided to take a break from her IVF protocol. “I thought, I can’t continue doing this right now. I want to take care of myself, too.” After a couple of months off and taking some local yoga classes, Christine was back to feeling more like herself. But before starting back up again, she decided to take an at-home Vaginal Health Test from Tiny Health.

Her surprising vaginal health test results

Tiny Health case study - Christine's vaginal health report sowed very low levels of Lactobacillus, a protective microbe.
Lactobacillus are key bacteria when it comes to vaginal health. A vaginal microbiome dominated by Lactobacillus species is more resilient against infections.

When Christine received her Tiny Health report, she was definitely surprised. Her sample was extremely low in Lactobacillus, which typically dominate the vaginal microbiome. These friendly bacteria help to protect the vaginal terrain and keep infection at bay. In other words, low levels of Lactobacillus can make the vaginal microbiome more likely to harbor harmful microbes [2].

Instead, Christine’s report showed her vaginal microbiome was high in Prevotella bivia. This pro-inflammatory species plays a role in the development of bacterial vaginosis (BV), a condition marked by bacterial overgrowth, odor, and vaginal itching [3, 4]. It’s even associated with preterm birth [5, 6]. 

“I was feeling fine when I took my first test. When I saw the results, I thought, ‘Wow, how can I not have any Lactobacillus down there yet I’ve always felt fine, and never had symptoms of an infection?’” Christine recalls.

The biggest concern was knowing that her vaginal community state type was similar to those associated with infertility and increased risk of preterm birth [7-9]. With her first IVF embryo transfer around the corner and hopes for a successful pregnancy, Christine looked to her Tiny Health action plan for next steps.

Shifting the vaginal microbiome to support pregnancy

Christine’s action plan recommended a specific Lactobacillus probiotic containing two strains known to help shift the vaginal community. She started on the recommended probiotic two weeks before her IVF transfer. Christine and Ben were overjoyed when they learned that their first IVF transfer was a success: they were pregnant! 

Determined to have a healthy pregnancy, Christine cut out inflammatory foods and foods high in refined sugar. She continued on her probiotic for the recommended two months and felt that it was working. 

At 21 weeks pregnant, Christine’s gut and vaginal health were feeling okay. So she retested her vaginal microbiome to see if her supplement and lifestyle changes were making a difference. And she was so relieved to receive her results.

Tiny Health vaginal health report - microbiome breakdown showing two test results side by side
Christine's second test showed she had successfully shifted her vaginal microbiome.

Christine’s second test showed she had successfully shifted her vaginal community to one dominated by Lactobacillus gasseri. This type has a protective, lower pH than other types and is associated with lower risk for preterm delivery during pregnancy [10-12].

After such a long journey to become a mother, the gift of her healthy pregnancy is not lost on Christine. “As a scientist, knowing the biology of all of this… it’s like magic.” Now she is awaiting the day when her baby girl arrives. “I’m so excited to meet her,” she says. “There’s going to be a lot of emotion. I’m also so excited to see my husband become a dad.”

A vaginal test with an empowering experience

Highlights from a Tiny Health vaginal health report case study - from a vaginal microbiome dominated by unfriendly microbes to a community with an abundance of protective microbes to support a healthy pregnancy

Christine’s story shows how understanding your vaginal microbiome can help you take action. If your vaginal health report shows a disrupted community, you’re one step closer to taking proactive measures to support your vaginal or pregnancy health. You may also identify the root cause of any symptoms you might have. 

When asked if she had anything else to add, Christine’s reply was simple:

“Knowledge is power. This test helps.”

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[1] B. C. Fauser, “Towards the global coverage of a unified registry of IVF outcomes,” Reprod Biomed Online, vol. 38, no. 2, pp. 133–137, Feb. 2019, doi: 10.1016/j.rbmo.2018.12.001.

[2] D. B. DiGiulio et al., “Temporal and spatial variation of the human microbiota during pregnancy,” Proceedings of the National Academy of Sciences, vol. 112, no. 35, pp. 11060–11065, Sep. 2015, doi: 10.1073/pnas.1502875112.

[3] C. A. Muzny et al., “Identification of Key Bacteria Involved in the Induction of Incident Bacterial Vaginosis: A Prospective Study,” J Infect Dis, vol. 218, no. 6, pp. 966–978, Aug. 2018, doi: 10.1093/infdis/jiy243.

[4] D. N. Fredricks et al., “Molecular identification of bacteria associated with bacterial vaginosis,” N Engl J Med, vol. 353, no. 18, pp. 1899–1911, Nov. 2005, doi: 10.1056/NEJMoa043802.

[5] R. G. Brown et al., “Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes,” Transl Res, vol. 207, pp. 30–43, May 2019, doi: 10.1016/j.trsl.2018.12.005.

[6] A. C. Freitas et al., “Increased richness and diversity of the vaginal microbiota and spontaneous preterm birth,” Microbiome, vol. 6, no. 1, p. 117, Jun. 2018, doi: 10.1186/s40168-018-0502-8.

[7] M. Fu et al., “Alterations in Vaginal Microbiota and Associated Metabolome in Women with Recurrent Implantation Failure,” mBio, vol. 11, no. 3, pp. e03242-19, Jun. 2020, doi: 10.1128/mBio.03242-19.

[8] R. G. Brown et al., “Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes,” Transl Res, vol. 207, pp. 30–43, May 2019, doi: 10.1016/j.trsl.2018.12.005.

[9] J. M. Fettweis et al., “The vaginal microbiome and preterm birth,” Nat Med, vol. 25, no. 6, Art. no. 6, Jun. 2019, doi: 10.1038/s41591-019-0450-2.

[10 ] J. Ravel et al., “Vaginal microbiome of reproductive-age women,” Proc Natl Acad Sci U S A, vol. 108 Suppl 1, no. Suppl 1, pp. 4680–4687, Mar. 2011, doi: 10.1073/pnas.1002611107.

[11] M. T. France et al., “VALENCIA: a nearest centroid classification method for vaginal microbial communities based on composition,” Microbiome, vol. 8, no. 1, p. 166, Nov. 2020, doi: 10.1186/s40168-020-00934-6.

[12] L. M. Kindinger et al., “The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk,” Microbiome, vol. 5, no. 1, p. 6, Jan. 2017, doi: 10.1186/s40168-016-0223-9.