The Vaginal Microbiome & Fertility with Golnoush Golshirazi

Golnoush Golshirazi, molecular biologist and founder of Screen Me joined me to discuss the vaginal microbiome and its importance for fertility & loss. Golnoush also discusses how her own experiences have shaped the community she has built and fuelled her research in this area. ScreenMe offers vaginal microbiome and seminal microbiome testing, paired with education, support and care to help people improve their intimate health. 

We covered: 

What is the vaginal microbiome? 
Why is it important to test your intimate health
How does this relate to fertility & Loss
How the vaginal miocrbiome can affect IVF success
What can be done if you have an imbalance & treatment plans

Transcript

Unknown: 0:01

Hi, I'm Rachel Sherriff and welcome to the fertility suite podcast. Our aim is to educate and empower couples who are struggling with all aspects of fertility. By giving you the information to make informed decisions along the way. We've had a little rebrand since series one we were formerly the fertility method podcast. But in this second series, rest assured, we still have the same high standard of fertility experts coming to share their knowledge and support you. So if you are struggling with fertility, miscarriage or you just want to arm yourself with the facts, then this podcast is for you. Hi, everybody, and welcome back to another episode of the facility suite podcast and joining us this week we have the amazing gold new sculpture Ozzy and gold Nish is a molecular biologist. And she's also the founder of screen me. And this week, we're going to be talking all about the vaginal microbiome I'm sure it's something that lots of you listening have heard about. So go Nish would you like to introduce yourself a little bit further to our listeners and just tell everyone a little bit more about yourself? Cause Thank you for having me. And for the for the kind introduction. Yes, my name is golden age. I am a molecular biologist. I'm Cambridge graduates. And I'm also a doctor in genetics. And I thought I would be an academic, which I did my PhD in genetics. And but it took me I think till 2019 before I decided that I'm more needed elsewhere, then in academia, and it was my own kind of health journey in the system. I had record, you know, painful periods from the age of 12. It was very disruptive to my life, my degree, my you know, career got very little help through the medical system. And then I started having other symptoms like anxiety, like issue sleeping, heart palpitations, you know, they started doing all sorts of tests to see if something's wrong with my heart. Things they use sometimes doing people who are 50 or 60, I was having done in my 20s and then infections, you know, symptoms of infections, at least, where I would think I would have UTIs. And I would be tested and there would be nothing there. Or they would say there was nothing there. And I would either be told to just write it out and drink more water or I will be put on antibiotics. And it was until she doesn't maintain that's you know, life gotten life has gotten quite rough when I got a diagnosis of endometriosis, but no help or support. And I realised that actually, it's not just me who's feeling the way I'm feeling. In around 50% of women who experienced symptoms are either dismissed or misdiagnosed. And especially with gynaecological issues, around 50% of women who express gynaecological concerns are either dismissed or misdiagnosed. And for me, that was a big wake up call that we need to we need to change the way things were. I had myself tested using NGS, you know, just a swab of myself and I had, I had genetically to genetically tested the bacteria to see what's there. And I found a lot of answers. And I thought, why, why wasn't this done previously? Why didn't anyone do this? Why was I stopped and cultured, which is what they used to do. They used to culture, the swab just look for specific bacteria, and nothing would grow, or nothing would be found. That's because the methods that were being used, were ancient, not sensitive enough, not good enough to give me answers. And so we, you know, we started screen me with my amazing co founder, and very good friend, Dr. Rakesh Kruszewski. In order to make better scientific tools like gold standard techniques available to people, you know, starting with a woman in order to advance in a give give people the information and insight that they deserve in order to take charge of their lives. This may help prevent disease, it may help diagnose disease, but it will certainly help women feel more in charge of their lives and have more awareness and so and so and so that's where screen me started. And here we are offering vaginal and seminar screening to people all across their life's life stages. I think there's so many women listening to this golden age who will resonate with what you've just said in terms of symptoms and being misdiagnosed or just told to put up and shut up and I think it's really, really be reassuring to know that the founder of a company such as yours, is actually doing this from their own personal experience, that you have that level of empathy and that level of understanding that the effect this has on women's lives. You know, we're going to talk today about the impact of the vaginal microbiome on fertility. But it's not just about fertility, it's about your day to day living and the interruption that causes and we're told that it's just normal, and we should just get on with things. It's so reassuring to hear you say that. And like I said, I'm sure a lot of our listeners will will resonate with that for sure. So, obviously, you've talked about swabbing, and how you kind of got to understand what was going on with your vaginal microbiome. But I just want to rewind a little bit and talk about for people listening who might have no idea what it is like, actually, what is the vaginal microbiome? And why is it important that we are looking into the health of our microbiome? Yeah, really, they think the vagina is this mysterious word that no one really likes to say, or is scared to say, let alone the vaginal microbiome you know. So, you know, the vagina is always thought to be just this hole that we either shove things into or out of, which is, you know, not true. The vagina is an organ, a very important organ, which is involved, obviously, in the physiological act of birth, and pregnancy in getting pregnant conception, but it's, you know, the vagina itself plays a big role in a woman's health and life, it's like the door to your house. And it controls a lot of our immune system, you know, it's there to fend off what is not meant to enter. And, and to and to also tell our immune system, you know, we need to attack or no, we, we need to, we need to calm down. So the vaginal microbiome is an ecosystem that lives in the vagina, and plays a huge role in regulating it a woman's immune system, and protecting everything that's in the pelvis, like pelvic floor in a way, especially the reproductive system. So it's, it's, it's made up of bacteria, made up of yeast viruses, as well. So micro organisms that interact with our, our cells, our human cells and body in order to protect us and reduce risk of disease. Well, if they when you talk about like, first line of defence, I thought that's interesting as well, because something I often say to patients is like, the only thing between the vagina in the uterus is a cervix, and that can be open, right? So it really is kind of defending your reproductive organs. So if things aren't right in the vaginal microbiome, it can lead to further problems. Absolutely. So like I said, like the like the door to the house, the cervix is there as a physical barrier, but like it's not a closed barrier. So things do travel up through the cervix into the uterus further than that, and if we get unwanted visitors, so unwanted microorganisms or an imbalance in the microbiome, other than these unwanted disease causing agents crawling up going up through into the uterus, their presence itself, actually initiate so elicits an immune response. So you know, that the body will say, Oh, this, you know, this is we're in trouble. These things shouldn't be here, we must fight. And so that causes higher inflammation in in the woman's body and the reproductive tract, and that inflammation itself can then be counterproductive for our fertility. So not only is there the microbiome trying to prevent infections, which directly affect fertility, but also, the microbiome modulates the immune system, which itself can affect fertility. So it's a two way thing. Now, the microbiome, the vaginal microbiome, a healthy vaginal microbiome, in a woman of reproductive age, is expected to be protective. And what that means that, unlike the gut microbiome, where everyone talks about improving diversity, you know, we want diverse, lush amount of bacteria in the vagina. We don't want a diverse microbiome, we actually want a protective one that's dominated by acid producing bacteria called Lactobacillus. And that environment is then acidic, is actually quite hostile to everything else, and prevents the growth and invasion of micro organisms that are not friendly that we don't that will cause issues. Now, if a woman loses that dominance of lactobacillus, which happens very often 80% of women at some point in their life, do you lose that dominance due to different reasons like your hormonal balance, your diet, food, your lifestyle, hygiene practices, and your sex life, your immune system as well, and different sorts of diseases and medication. All of this affects your vaginal microbiome. So at some point, every woman experiences an imbalance in that vaginal microbiome, which means they lose that protective environment. And so when you lose that protective environment, you're at higher risk of infections, which are asymptomatic a lot of the time of fertility issues, miscarriage, preterm birth, but also things like HPV contraction and chronic HPV infection, which then leads to increased risk of cancer. So it's really important that that balance, that dominance of lactobacillus is really important. And it does, it does affect our fertility very much. So it's not just about the inflammation, it's about the immune system, as well as you've got, like, all of these things, all of these ways that the vaginal microbiome is working to improve fertility and make us fertile. And then you've got these other things that can come from having a dysbiosis Exactly. So you know, the the vaginal microbiome is trying to stop disease causing bacteria from overgrowing. But at the same time, those protective lactobacillus bacteria actually tell the immune system to calm down and reduce inflammation. So if we've got people listening, who have perhaps struck, they're struggling to get pregnant, or they've had recurrent miscarriage, or they've had repeated, unsuccessful IVF, and they're listening, and they're thinking, no one's ever mentioned this to me before, like, because you said that a lot of these infections can be asymptomatic or even if there's not infection, we could be looking at immune system issues or inflammation. So how would someone know what signs might their body be giving off that something is not quite right? And that they might want to consider having vaginal microbiome testing? Yeah. So you know, I think in an ideal world, I would say every woman of reproductive age, every woman who is sexually active, should be having a vaginal microbiome test to check that they are having a dominance protective vaginal microbiome, and they should be doing this once a year or twice every six months, if something is up, so that would be ideal. In a preventative way measure, let's see, yeah. However, in terms of signs to look out for, I think, if you have a history of symptoms, so if you have a history of noticing that your vagina is sometimes off, it doesn't have to be very obvious symptoms were that are on the internet or everyone. But as I think every woman knows what's normal for them. And so any deviation from what you think is normal for you, is a sign that there is some instability going on. So definitely listen to anything that is not normal for you as as a person and have that checked. pain with sex is definitely another sign any sort of dryness as well. Obviously infections or recurring infections is another one as well. If you're struggling with fertility, so miscarriage, unexplained infertility and recurring miscarriage is one you know, I often find when if I hate this, that a woman has to have multiple miscarriages for it to be thought to be a problem. I think with especially early stage miscarriage, I think looking at infections or overgrowth is really important. And I would definitely consider that as well. So, really, I think it should be routine, part of part of a woman's in the same way we did blood tests, to look at minimum levels, we should be looking at the vagina to make sure that our vagina is protecting us. Absolutely. I couldn't agree more. And that's something that obviously in our clinic, we're always encouraging. Certainly, if patients come to us with a history of any of those things, you know, repeated unsuccessful IVF or recurrent miscarriage, we would be looking at the vaginal microbiome as often now, sort of one of our first line tests really because of the reasons you've just explained. I think it would be really good for listeners to talk about then why these things aren't tested and the differences between what you might be offered on the NHS and the options privately because so many of the clients who come to us will say, Well, why is no one mentioned this to me before I've been to my doctor, my doctor knows I've had unsuccessful IVF you know, the NHS So IVF clinic, I'm not talking about this, like wherever we are with differences between accessing this sort of care. Yeah. Okay, so I think classically, historically, in the NHS men, you know, the way that the vagina was tested was not to look at vaginal health, it was to look for infections. And there's, you know, we need clinically there is a difference when men talk. So, historically, and in the textbooks, when we talk about the vagina, no one really is talking about actual health of the vagina more so is there an overgrowth of a specific bacteria. And so they will test that by swabbing, and trying to grow those bacteria in a little dish in a lab. Now, there is an issue with that, because it's really hard to grow bacteria. In addition, a lab, not all bacteria, like growing in additional lab, it's hard to have the right environment, the right media, the right to get bacteria to grow. So some bacteria don't grow at all, even if some bacteria do, there needs to be a significant loads of them to allow that growth. And so the culture method, which has been used historically, to look for certain infections, is not the most accurate or the most sensitive, which has led to many false negatives, or lack of answers. So that's, and that's something that's still being used in in the in the medical system, it's quite a fast method is so cheap method. So it doesn't cost much, and it with some infections that Austro it, you can't deny that then after the culture method, there came the PCR method, not everyone knows PCR because of COVID. You know, everyone's done those tests. And what PCR does is it's more sensitive than culture method is definitely a better method, it's more molecular level. And what you do is you take a swab, and you take, again, DNA from from the bacteria. And in this case, you choose a panel of bacteria, you choose around 20 to 25, usually at the best, and you screen for those with the presence of those bacteria, and quantify them based on a predefined threshold. And so this method is much better, it's a lot more accurate, a lot more sensitive. But its accuracy and sensitivity is still different for different groups of bacteria. So it's it's slightly more expensive, but it's a fast, again, relatively affordable method of looking for specific infections. Again, you're looking for the presence and the amount of specific bacteria. And it's great if you know what you're looking for. You know, I want to know, if I still have ureaplasma PCR is great to look at that if it's there, you know or not, if I want to know if I have Jordan and vaginalis. Again, PCR is a great way of looking at that. However, it does not test that microbiome, that protective environment is the microbiome dominant in lactobacillus PCR cannot test for that because it does not test the entire environment. And it cannot know how much of each bacteria is present relative to the other. And this is why when you're looking at the actual microbiome, and you move away from infections, and you say, actually, I want to be looking at this environment as a whole, a bigger picture. In in the literature, we use what's called 16 s sequencing or next generation sequencing. So that's gold standard when looking at microbiome research. And what this means is, instead of taking bacterial DNA, and then screening for 20, bacteria, we take bacterial DNA, and we run it through a sequencing machine, just like you do in human DNA to see what your DNA is made of. We do it with bacterial DNA, and we run it through a sequencing machine. And through this, we can actually screen for everything that's present. So all bacteria that's present, and we can know how much of each bacterial species is present relative to the other. So this allows us to know exactly what's there. And how much of the vaginal space or microbiome is taken by each of these species. Do we have 95% and above have lactobacillus to protect this woman from infections from other diseases from fertility complications? And this is the only way that we can actually tell if a woman needs to improve their vaginal health, are they at increased risk or not? So the NHS will only look at a very, very basic culture. Yes, they're not they're not doing the PCR or the or the next. In some cases, they do do PCR So culture is the first stop. The next stage when someone is really struggling, or has severe symptoms, recurring symptoms, they get referred to a specialist at that point PCR is are done to look at certain bacteria, like your plasma, like like other certain STDs, etc. So it is it's PCRs are turned to and in certain circumstances in the NHS privately they're done quite often and private practice when looking for infections. But NGS is something that is relatively new. That is not, you know, the interpretation and understanding of an NGS data set is not really done in medical school yet. And so it's something that's not made it yet into the clinical setting. Okay. I think, again, that's really important for people listening to understand that if you are falling into this category of you know, unexplained infertility recurrent miscarriage, or, you know, unexplained, unsuccessful IVF. That actually, it's really, really important that you think outside the box a little bit and maybe go okay, well, you know, I might have exhausted the NHS options in terms of the basic level testing do I need to look into using some private testing, and just being aware that although you might have been told or you've been swapped in, everything's fine, actually, that gives us very limited information. And there could be a lot more going on. Going back words, again, a little bit to talk about how this really impacts fertility and loss and IVF. I just wanted to touch on something you mentioned about how this can affect free time preterm birth. We know from the study that Tommy said that having low levels of lactobacillus links to increased first trimester miscarriage, but how can the health of the vaginal microbiome in terms of inflammation or infection have an impact on perhaps maybe second trimester baby loss or preterm birth. So we need so much research to so much more to understand this black box of the vagina, and the impact of that on various things including fertility, miscarriage and preterm birth. So there's a lot to be done. Now, in terms of preterm birth, there is correlation showing that presence of certain infections, it can cause early, you know, early rupture of the SAC, the opening of the cervix and preterm birth. And that's about all we know, I mean, we know that certain bacteria cause the production of lytic enzymes, which are, which cause the, you know, the embryo, which cause this kind of miscarriage, they cause the loss of the pregnancy, we also know that certain infections actually increase prostaglandin production, which increases contractions, and can also lead to loss as well. But we know very little in terms of exactly how or when, or what leads to these events happening. There. You know, it's more we know, correlations, sometimes very close, close to causation. But in terms of mechanisms that lead to this very little is not as crazy given that this happens to women frequently. Absolutely. Not just that. We're also in an area where we even you know, strep B, for example, has been something of a of a debate. You know, it's been taught to be involved in increasing risk of preterm birth, and complications. For years. Now, there is debate of whether, you know, they're not, you know, they're kind of thinking of not testing for it. So they're not testing for it in the NHS anymore, unless there's a high risk. And I just think it's crazy that we are making these decisions clinically, without having enough data to actually justify them. I think if, if a woman has had loss, and they have an unhealthy vaginal microbiome, that should be taken seriously, irrespective of whether the data has a black and white proof of whether this is a causative or not. We're talking about human suffering and loss. And I don't think that's something we should be taking risks with or playing games. Yeah, I agree. I agree. I think yeah, like, I always have to use the no stone unturned approach when help trying to help clients, but I think it's trying to get that message across can be difficult sometimes, to other health professionals. You know, you don't ever want to put someone in a position where they're going to potentially have another loss, but yet women are frequently told, I'll just try again. You know, it's just bad luck and that is just so negative. Challenge is not terrifying. I mean, if you speak to any woman who's had a loss, you know, even though wanting a baby is in this all you want, really, the moment you're told you're pregnant, you're also afraid you're more afraid than anything. And being in that position is awful. And then, you know, even in then carrying IVF, we've had many women who've had, for example, a strep B infection, very low levels, which hasn't been picked up, which was picked up in NGS and who did not, were not offered treatment, because it wasn't coming up on on a vulture. And but then, you know, towards birth, they were put on antibiotics, both them and the baby to prevent a strep B from causing systemic infection or against the baby, we can do better than that we should be we should be picking these things up before pregnancy or early pregnancy and have plans in place have the issue is that medical system is very much diagnose and treat. And if you cannot treat, then they don't really want to diagnose because they don't know what to do with it. And I think this is a problem. A lot of the times the vaginal microbiome we can't fix immediately, there is no overnight treatment. And that's why it scares a lot of practitioners and clinicians, when it comes to dealing with it. It takes time, right? It takes time, we're going to come on and talk talk about what can be done about this. Because I think again, it's an important message to get across to women is that you know, this is able to be treated. This is something we can rectify. I just wanted to very quickly touch on IVF. So when we're talking about fertility and miscarriage, I think for people listening, they may be thinking, Oh, well, I'm having IVF. So maybe I don't fall into that category. How is this important for patients who might be considering IVF? Or starting IVF? imminently? Yeah, actually really, really important. You know, what's, again, going back is to remember that the vaginal microbiome is like a regulator of the reproductive system, it is a part it's a key player in regulating our reproductive system, including the uterus. Now, the amount of inflammation in the uterus, the presence of bacteria in the uterus affects implantation of an embryo. We know that. And even going beyond that, we know that the bacteria present the vagina goes into the uterus, but also the ovaries, and chronic infections, scarring can can affect all of this. Now, studies done recently looking at IVF have shown that having a healthy microbiome, or a balanced microbiome, where you have a dominance of lactobacillus can actually increase your chances of successful embryo transfer by seven times. That's a huge amount. You know, there's a lot more that needs to be done in terms of understanding what this all means. But what we know is, you know, what makes sense, and this is my opinion, purely, is, of course, it's logic, you know, we know that having an imbalance or low protective bacteria shifts immune the immune system and the reproductive system, you know, reproductive track, and that is bound to have a role and in everything. So when you're going through an IVF cycle, you're spending so much physically, emotionally, financially. And I think that everyone deserves to be given the best chance they can have. I've had an IVF cycle. And so I understand. And I didn't actually, even though I spoke about it previously, I didn't fully understand it until I went through it myself. And you can only understand it, once you've been through it, how important it is for you, that you have the best chances of this working, because you really don't want to undergo another cycle. So really, I think it's important to make sure that you've covered your bases. But it's very hard to say this, because obviously there is a world of stuff out there that's thrown at you, and tests and things that you can do. So I think that, you know, it's really important to have a good coach, or a good practitioner who can really identify what you need as a person as an individual, and what can be covered. But but you know, the vaginal microbiome and the seminal microbiome, I think are both in my opinion, one of those things like a blood test. That should be and if there is a address prior to an embryo transfer. Yeah, absolutely. Having had IVF myself, you know, I'm completely on the same page as you with that. And yeah, or something. Again, I often say in clinic is everyone should only ever have to have one cycle of IVF in a dream world, right? You don't want to be having repeated cycles. And if spending the money on a vaginal microbiome test I'm looking at sperm health in advance can enable that to happen, then why would you not spend the, you know, in comparison, smaller amounts of money on getting this testing done first before you invest fully in an IVF cycle, and you're right is overwhelming. That's why we're here doing this right to get the information out there and to try and make it slightly less overwhelming for people. But it is it's so much to go through. And if there's anything you can do to improve your chance of success, that stat actually really surprised me seven times, like seven times more likely like to have a successful IVF cycle. If you you know, it's a no brainer. We know even clinically, when I speak to doctors who sometimes have an issue with addressing vaginal microbiome, you, you know, I think it's a matter of vocabulary. We we've been using antibiotics in couples trying to conceive for years, sometimes when it was, you know, when it's there's no other option when you don't know what's going on unexplained. They would just put couples on antibiotics. And then they try. Why are they doing that? What are we addressing in that in that circumstance, that we're addressing the presence of bacteria in the vaginal in the reproductive system. And so we've known that there is a role for decades, we've treated it, we've just haven't come around to understanding it and screening it until now. Or if not verbalised it properly and that people people didn't explain what they were doing. So let's talk about what we can do about this, then like you've touched on antibiotics, like if you've had a vaginal microbiome test done, and it comes back that you've got, you know, some path of violence and bacteria is there that you don't want there, you might have low levels of lactobacillus, like, what is the treatment plan? And what should people expect to invest from a time perspective and a, you know, a medication supplement perspective? What are we looking at? So, the first thing to understand is, there is no easy fix off off the spouse B, just because there's something that hasn't been researched as much. We haven't put enough resources into it. We don't have all the answers. Yeah. So for, you know, my opinion, the first step is to get, you know, get an understanding of what is going on, is there an imbalance? What bacteria are causing the issue? And then we're talking about how do we fix it? And yes, like you said, the, you know, the first option and the, you know, the clinically the first thing that's touched upon is antibiotics. And this is usually used if there is an overgrowth of specific bacteria that need to be knocked back. Now, if you're not in a rush to fix or address this issue, a lot of the time, it can be done through a combination of antibiotics with some holistic steps in order to turn the antibiotics will kill things. And that's when they that's when they work at their best. Sometimes they don't even do that. But they will kill everything. Right? So we're kicking things back. Once we do that, what do we want, we want to reestablish a healthy microbiome. And so that's the step that takes time. It takes work. And it takes working with, usually at the moments, your options after a woman who are trained in intimate health practitioner practitioners who are actually spending their life trying to help women in this field, and is working with them with the use of various things like anti microbials, like herbal pessaries, like probiotics, in order to flip this microbiome from a non protective microbiome to a protective microbiome. And this will be different for each woman, there is no protocol that will just be used and put in action for you know, for everyone. And if anyone tells you there's like, one one for you know, one way and this is what's done for this is a lie, has to be case by case because your hormonal balance your immune system, your medications, your history will all affect in identification of the root cause of the dysbiosis or the imbalance. And so that has to be addressed in creating a balanced microbiome. So there will be antibiotics involved. There will be probiotics involved. There will be various supplements or, or herbal kinds of interventions involved. Does it work? Yes, it does. We've seen it. We've seen women who've tested and have had severe dysbiosis with very low levels of lactobacillus who have turned things around, you know, within six to eight months of actually being committed, dedicated working alongside a practitioner. So it does require commitment. It does require work. However, if you don't have time, and I understand that with a lot of us were going through IVF cycles, etc. The most important thing is identifying it and kicking it back, I would say to antibiotics, antibiotics prior to an embryo transfer, if you don't have time, you know, getting it kicked back is better than than doing nothing about it. And let let some just touch on that then. So, because this is really important, I will often have patients in clinic say to me, Well, I took antibiotics last month for a throat infection, it will be fine. Can we talk about how important it is that antibiotics are targeted to specific bacterias? And this understanding that certain bacterias are resistant to certain antibiotics? Of course. So there is loads of different antibiotics out there. So many different times. The reason there are so many different antibiotics out there is because not all bacteria respond to the same antibiotic. Otherwise, we would only have one, we wouldn't need any of the other ones. So the understanding that actually no, you know, different antibiotics work on different types of bacteria is really important. And that's why blind treatment is not great, which is what we've been doing forever, you know, some you know, some women have an infection of, for example, at a podium, which is a bacteria that's not tested for actually, usually through culture, it doesn't grow on culture, and it's not as a foreign PCR. A lot of us don't, haven't even heard of it. And when that's, you know, when you're treated with the usual BV medic in antibiotics, that doesn't treat as a problem. And so women are left with this infection. So it's really important to not think that the same way taking supplements blindly doesn't help. You know, taking antibiotics blindly doesn't mean that you've treated the issue, test, understand what you're treating before you treat it, and then treat. And then you know, at least you've done what you can from from that perspective. However, again, this is when you don't have time, I think when you do have time, definitely worth working on it improving the conditions prior to going in for another round. And we're talking like three to six months in advance. Right? Yeah, I would say so. Yeah. I think, Phil, again, lots of people listening like this, the message is that it's really important that if you're going to do this testing, you do it properly. And then you have someone interpret the results, who understands the complexities. That, you know, it's a blanket approach is not quite right. And then it does need like you said individualised one to one approach where people are looking at your unique test results and looking at the picture as a whole and not singling things out? Definitely. What do you offer as a company then to support people? So if I was a patient and I had listened to this podcast, and I was in a situation might have, you know, problems with fertility or a current loss of unsuccessful IVF? Like, how would I approach you and what what can you offer me to help? So we, you know, we offer directly to patients, testing of the vaginal and the seminal microbiome, which are at home kits that you do, and you send samples through the post samples are stable, you don't need to worry about them, they can, you know, they can be posted at any any, any day in the week through the post office. We screened them. Now, the limitation with this type of screening, which is very comprehensive and accurate. The limitation is the time it takes because there's a genetic testing, it takes slightly longer for results to come through between like three to five weeks for results to come through. So that is that is a downfall of using NGS. But unfortunately, that's not something that we can control, or change. Once we have results in, you receive your results, but also a consultation with an intimate health practitioner, and who also you know, deals with fertility. And in that consultation, you you will go through your results so that you understand what it means in your context with your needs in mind. And you'll have a plan of action as to what am I meant to do next. And this way, you have your results. You have an understanding you're educated, and in your needs and your body. And you get you're given access to the people who can help you that you're able to advise people who can prescribe antibiotics for example? Yes, absolutely. So you are put in touch and so your consultation was an intimate health practitioner, who can carry on seeing you independently. If you need someone else you can request you know, if you want to see a special kind of specialist, you can request a view we can recommend or refer to specialists in the field. And if antibiotics are needed, and you cannot request them through your GP. We can refer you to private pharmacists who can prescribe those brilliant because another common question that comes up is well, what's the point in testing because my GP won't give me the answer. 68. So it's a lot of the the issues around women's health that actually accessing the care that you need, right? It's like, this is the most common thing that comes up in our clinic all the time, how do I get this? How do I get that? Why is everything such a fight, so to be able to come to a company that does the testing, and then signpost you to the people that can help you. If like, everything in one place, it's perfect. Because really, the testing isn't of value, if you then don't know what to do with it. And this is the problem we have with so many testing companies that are popping up is that people are just being given results with nothing and no direction or understanding of what to do with it. And so this is a problem. And that's because a lot of companies don't want to take that risk or that cost. And I think that if we come together as a community, we don't we can reduce risks and reduce costs, and get people the help they need. Instead of focusing on our profits and our margins. You know, we should be focusing on how can we make things better for women? How can we make things more accessible? And I think the only way we can do that is to come together as a community and try to address identify what's lacking, and then try to address it. I think that's a great, final finishing point gourmet. Like you've kind of rounded that up really well like how do people find you? What's your website, you can find us on of course, on our website, screen me.co.uk You follow us on Instagram screen meet on Skype or screen me woman there is an underscore that just screen me woman, we've changed that now. So excuse me, woman, you can message direct message us on Instagram, we're very responsive. Or you can email us at support at screen me.co.uk. And if you need to talk to me, you can just address that as Google News and it will get forwarded to me. Amazing. I'm going to put all of that information in the podcast episode information. So for anyone listening, if you scroll down, you'll find that information where you can contact garnish. That has been so enlightening. Thank you for coming on. Thank you for having me. I'm sure you've definitely helped lots of our listeners. And like Ganesh said, If anyone has any questions, feel free to email her or you can email us at the fertility suite and we will happily forward on the questions and I think it's worth it's really worth thanking you guys. I think yourself Rachel and so many other other people who are working in your field, as you know as women and men who are supporting people going through their fertility journey, as practitioners nutritionist, herbalist, acupuncturist, I think, in the fertility community, I really don't think we could do things, the way we're doing them. Now, it's such a better way of going about this whole journey, I wouldn't have been able to go through it as well as I did if I didn't have the support of my practitioners, even though I'm a scientist, even though I'm in the field, so I think you know, whoever is listening out there. Find someone who can help you and support you through this. We can get you the information you need. It will make a whole lot of difference. Even as many we wouldn't be able to do it without practitioners like yourself. Yeah, absolutely. That's the reason I set up our online like one to one service like we have a like a facility and Miscavige assessment service where we just basically hold people's hand through the process for that reason and signpost, people to companies like yourself, I think it's really critical. It takes a village right, you really need it. You really need a village to help you. It does. It does. So thank you, thank you for all you do. Thank you garnish. It was lovely to have you on and I will speak to you very soon. Take care