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This study intends to address whether improving the vaginal microbiome can help couples increase chances of conceiving.
Disrupted vaginal microbiomes are associated with a number of poor reproductive outcomes, including infertility, miscarriage, premature rupture of membranes, preterm labor and delivery, delivery of a low birthweight baby, and maternal infections (chorioamnionitis, endometritis). A healthy vaginal microbiome is typically thought to be one that is dominated by one of several Lactobacillus species, such as L. crispatus, L. gasseri, or L. jensenii. Several studies have shown that non-lactobacilli-dominant biomes are associated with poor in vitro fertilization or intrauterine insemination outcomes. Fewer studies have examined fertility in the home setting, and none to date has asked whether improving the vaginal microbiome (VMB) could increase fertility. This study addresses both. By assessing the VMB before and after using a vaginal care system which supports a healthy VMB, we will be able to examine whether there are associations between VMB composition and infertility, and whether shifting the VMB toward a lactobacillus-dominant state is able to improve chances of conception.
In this study, women will either follow routine care (control) or routine care plus the vaginal care system and fertility lubricant (intervention) for 3 months or until becoming pregnant, whichever comes first. In addition to tracking conception rates during those 3 months, we will follow women for an additional year following completion of the 3-month timeframe. If any woman is pregnant at the one-year mark, her pregnancy will be followed until delivery (or early termination) to track delivery outcomes and adverse events.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control arm | No Intervention | Women follow routine care only, including prescribed medications and recommended techniques and supplements for attempting to become pregnant at home for up to three months. | |
| Flourish HEC + BioGenesis arm | Experimental | In addition to routine care followed by women in control arm, women in this arm also use the Flourish HEC (Hydroxyethylcellulose) vaginal care system and BioGenesis fertility lubricant for up to three months. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Flourish HEC and BioGenesis | Combination Product | Flourish HEC is a 3-component system, including: 1) Balance feminine wash, used daily; 2) BioNourish vaginal moisturizer, used daily before bed except if having intercourse; 3) BiopHresh homeopathic vaginal suppository with probiotics, used once every 3 days before bed except if having intercourse. BioNourish is a class II medical device with FDA 510k clearance, on the market for 2 years. BioGenesis is also a class II medical device with FDA 510k clearance, and is designated as a fertility lubricant, safe for sperm and embryos. |
| Measure | Description | Time Frame |
|---|---|---|
| Conception at home | Percentage of women becoming pregnant at home within the 3 month study. | 3 months |
| Change in vaginal microbiome | Vaginal microbiome composition tested by next-generation sequencing | Baseline to end of active study period, which is either at 3 months or upon confirmation of pregnancy, whichever occurs first. |
| Change in vaginal pH | Vaginal pH tested by vaginal fluid applied to pH test strip | Baseline to end of active study period, which is either at 3 months or upon confirmation of pregnancy, whichever occurs first. |
| Measure | Description | Time Frame |
|---|---|---|
| Conception within one year | Percentage of women becoming pregnant by any method within the 3 month study or within one year after ending the study. | 15 months |
| Rate of live birth | Percentage of women giving live birth within one year after ending the study; or if pregnant at one year, following to the end of her pregnancy. |
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Inclusion Criteria:
Women part of a cisgender couple aged 18 to 40 who are attempting to become pregnant and are attending a fertility clinic.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Aimee Eyvazzadeh, MD, MS, MBA | Dr. Aimee Eyvazzadeh, Inc. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Dr. Aimee Eyvazzadeh | San Ramon | California | 94583 | United States |
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| ID | Term |
|---|---|
| D007246 | Infertility |
| ID | Term |
|---|---|
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
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| ID | Term |
|---|---|
| D008660 | Metabolism |
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A longitudinal open label randomized controlled trial.
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| 24 months or fewer |
| Gestational age at delivery | Average gestational age of babies born within one year after ending the study; or if mothers are pregnant at one year, following to the end of her pregnancy. | 24 months or fewer |
| Birthweight at delivery | Average weight of babies born within one year after ending the study; or if mothers are pregnant at one year, following to the end of her pregnancy. | 24 months or fewer |
| Rates of pregnancy complications | Percentage of women experiencing complications (including preeclampsia, miscarriage/fetal loss/stillbirth, preterm/premature rupture of membranes, chorioamnionitis or endometritis, gestational diabetes, and any other adverse outcome) within one year after ending the study; or if mothers are pregnant at one year, following to the end of her pregnancy. | 24 months or fewer |