Is Your IBS Contributing to Your Fertility?

A standard question during my consults is around your bowel movements. How regular? Form? Ease? Any issues with bloating, uncomfortable gas, or abdominal pain? The digestive tract impacts what nutrients we absorb, it houses our microbiome, directly influences inflammation, and is our primary organ for the elimination of toxins. In my opinion, the health of the digestive tract is the center of health. New research shows it may also influence fertility.



The diagnosis of IBS requires abdominal pain/discomfort and two 2 more of the following:

  • A change in frequency of stool (i.e. more often or less often)
  • Feels better after passing a bowel movement
  • A change in the form of stool (constipation, diarrhea, or mixed)

Unfortunately, for many people, the diagnosis stops there. There is no further exploration as to the root cause of these symptoms. There is also often a lack of awareness of the consequences of IBS on other aspects of our health. This includes imbalances in your skin, influences on your mental health, increased risk of dementia, influences on your metabolism and weight, influences on your immune system, and others.

One more to add to that list may be the impact on fertility.


Fertility Microbiome

We know that the uterus has its very own microbiome (similar to the vagina, the skin, and other organ systems). We also know that imbalances in the uterine microbiome can directly impact fertility and pregnancy rates. 

A 2020 systematic review showed that imbalances in the uterine microbiome (aka endometritis) can be 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, treatment of chronic endometritis can lead to a complete normalization and restoration of reproductive function in women with imbalances. In other words, this may be a modifiable factor – something that can be screened for and treated.

Many fertility clinics are now testing your uterine microbiome. This test is called the EMMA and ALICE. It is performed prior to a frozen embryo transfer. The endometrium is biopsied and the microbiome is screened for two things: 

  1. Is there a bug that shouldn’t be there? This is known as endometritis.
  2. Are there low levels of the bugs that should be there? Ideally, we want >90% lactobacillus present.

Depending on the results, treatment may include eradicating bugs that shouldn’t be there, and/or replenishing any deficiencies.

IBS + Fertility – What’s the Link?

The microbiome is an important consideration when it comes to IBS. This can lead to symptoms including: 

  • Irregular bowel movements (constipation, loose stool, diarrhea)
  • Uncomfortable or excessive bloating and gas
  • Abdominal pain and discomfort
  • Heartburn or excessive belching

The research showing the link between gut health and fertility is growing. 

Some key points:

  • We know that certain bugs can increase the risk of a leaky gut – which allows for more things from our gut to pass into our blood, including bacteria and a toxin known as LPS. One study showed in women undergoing IVF, high LPS linked to increased oxidative stress in the follicular fluid and lower progesterone levels.
  • We know that many of the bugs that cause irregularities in the uterine microbiome, come from the gut. (Buzzaccarini, 2020)
  • H.pylori, a stomach bug, was shown to be significantly higher in fertility patients compared to controls. In females, one study suggested that CAgA-positive H.pylori may be linked to early pregnancy loss. In another study, male patients infected with H.pylori had lower sperm quality compared to uninfected controls.

The role of the gut microbiome and fertility is becoming more established. This is an area of research we’ll want to keep an eye on.