Ep 189: Decoding the Vaginal Microbiome for Better Outcomes with Priyanka Jain

For many women, trying to get a clear answer to their health problems can be challenging, if not downright frustrating. But it doesn’t have to be this way. Joining us today is Priyanka Jain, co-founder and CEO of Evvy, a women's health technology company focused on closing the gender health gap by decoding the vaginal microbiome. In this conversation, Priyanka shares how her own experiences with unanswered symptoms led her to question the limits of traditional testing and explore overlooked areas of female biology. She explains the role of the vaginal microbiome in protecting reproductive health, how imbalances can contribute to inflammation and fertility challenges, and why many conditions are still misdiagnosed or missed entirely. They also discuss how Evvy’s at-home testing works, what makes it more comprehensive than standard approaches, and where it can support patients across the fertility journey, from early planning to IVF. Tune in for an informative and empowering conversation about an often-overlooked factor in women’s health! 

Transcript

SPEAKER_00 0:14

Everyone, we are Rina and Dara, and welcome to Fertility Ford. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.

SPEAKER_02 0:36

I'm really excited today to have Priyanka Jane on our podcast, who is the co-founder and CEO of EVI, a women's health technology company focused on closing the gender health gap by decoding the vaginal microbiome. Under her leadership, EVI provides at-home metagenomic testing to identify imbalances, aiming to move beyond traditional limited testing for better diagnostics. Bianca, I'm so happy to have you today.

SPEAKER_03 1:04

Thank you so much for having me. I'm so excited to be here.

SPEAKER_02 1:07

It's amazing. I was at my favorite or one of my favorite health conferences, IHS Integrative Health Symposium, a couple months back, and I was walking around looking at all the different booths, and I came across your company and learned a lot about it. And I'm so happy today for you to share with our listeners all about EV. So I'm I'm super curious of how you came up with the idea, how you got started with this company.

SPEAKER_03 1:38

Of course, yes. As I think probably most founders in women's health will say, it came from my own personal journey. And for me, it was very much feeling like I could just never get answers at the doctor's office. I mean, I think any woman who's listening to this probably has some version of this story at some point in their lives. But for me, it was I was in my late 20s and I was dealing with just an onslaught of mysterious health problems. And I went to doctor after doctor. I drew 20 tubes of blood. I did every test that anyone could, you know, tell me to do. And I get constantly we got the call of like, all of your results look perfect and nothing seems wrong. And maybe you're stressed, or maybe you're dehydrated, or maybe you don't sleep enough. And I was like, in what, you know, my background is actually in data science and machine learning, not in healthcare. And I was sitting in my data science job being like, wow, we can predict anything and it's the age of AI and machine learning. And then I was going to the doctor and constantly being told, we don't know, there's no data, there's no signal, whatever. And so I was incredibly frustrated, as I think so many patients are. And I started doing my own research, which is when I found out that women in the US were not in clinical research until 1993, and that to this day, women are diagnosed on average four years later than men across over 700 of the same diseases. And to me, that really screamed that we actually have a data problem, right? Like fundamentally, we have defined health and disease based on whatever predicts health and disease in middle-aged, mid-sized white men. And the female body is different down to the cellular level. There are so many signals that our bodies are trying to give us, telling us what's going well, where do we need help? But we just do a terrible job measuring and tracking those things because we just never studied women. And so I really wanted to focus on these overlooked biomarkers in the female body, right? Could we do a better job measuring and tracking these female specific signals? And could that actually help us improve outcomes in women's health? And so that was kind of the original impetus for EV. And obviously, we've now focused on the vaginal microbiome, which I'm sure I'll get to tell you more about.

SPEAKER_02 3:40

Wow. So it's great. See, finding a gap in healthcare and trying to fill that gap. It's it's very frustrating. I agree with you. The limited research or the research that has been done for so many years really focuses on white middle-aged men. Yes, we're more complicated, but that's not a reason that we, you know, not to study us.

SPEAKER_03 4:03

Totally. We should be able to find signal, right? There's so many signals and we should be able to better measure them and track them. And it's just crazy that we've like reduced female biology to the parts that overlap with male biology, right? And there's so much more to us. And could we be leveraging that additional amazing biology to actually have better health outcomes, right? I think there's so much opportunity there.

SPEAKER_02 4:24

Good for you. Like the idea of hearing that you're okay, that everything looks good. Good for you for saying, you know what, I'm not taking this answer. There's something else that I could look at.

SPEAKER_03 4:36

Totally. So it's I mean everyone's had that happen to them, I think.

SPEAKER_02 4:40

I think it's it's super common. Microbiome. Like I I love in school, in nutrition school, you learn a little bit about the gut, but even the gut microbiome has become a little bit more spoken about, definitely in the medical world, but even to the general population. But vaginal microbiome, let's talk about that.

SPEAKER_03 5:02

We're in the early innings, girl. No, I mean it's so interesting because most people have heard the term microbiome, right? Your gut, there's one in your mouth, there's one on your skin. But most of us are just totally unaware unless you're dealing with the problems that we solve for. A lot of people are unaware of the microbiome that exists in the vagina. And really, microbiome is just a fancy word for a community of microbes. So bacteria, fungi, viruses, you name it. And those microbes, we've actually co-evolved with the community in our vaginas to play this really important immune-like role for our entire reproductive system. And so what I found when I was at the beginning of starting EVI was that vaginal discomfort, meaning symptoms of odor, discharge, itching, bacterial vaginosis, yeast infections, recurrent UTIs, these are the leading reason women seek healthcare advice in America. And when we go to the doctor, we are more likely to be misdiagnosed than correctly diagnosed, and we are more likely not to get better than to get better. I mean, in my opinion, that's offensive and embarrassing for the healthcare system. And so understandably, we as patients end up online the same way I did. We're buying God only knows what wipe, wash, depository, is going to make your vagina smell like a flower because the healthcare system doesn't actually know what's going on and doesn't have the tools to actually understand it. And what was so interesting to me about the vaginal microbiome is like, okay, yes, when there are these pathogenic bacteria in the vagina, you often experience these symptoms and infections. But what the research shows time and time again, there are hundreds of studies on this now, is that when you have those pathogens in the vagina, you not only are getting these symptoms and infections, but you now also have infection and inflammation of the reproductive tract. And all of these studies are showing that inflammation and infection plays a critical role in fertility outcomes, whether it's idiopathic infertility, unexplained infertility, IVF failure, recurrent pregnancy loss, pregnancy outcomes, whether it's preterm birth or preeclampsia, but then goes down the line to cervical cancer progression and STI acquisition, endometriosis relapse and menopause symptoms. And I was like, oh my God, this is such an important set of information. And frankly, these markers in the vaginal microbiome are playing this incredibly important role in our overall health, and we're entirely ignoring it, right? Which blew my mind. And when I describe these pathogens in the vagina that create these symptoms, what's interesting is that 80% of the time that women have a completely disrupted vaginal microbiome, they have no symptoms, which means that actually a lot of women don't even know that this is happening. And it's not something that we're routinely checking or improving. And you're then leaving all of these women with these inflamed reproductive tracts that might be then affecting our health outcomes throughout our lives.

SPEAKER_02 7:46

Yeah, it's interesting. It's interesting to hear that a lot of times you actually don't get any outward signs, so to speak. And it's often when you go to the doctor for a checkup or you're going for something specific, that's when sometimes it may be uncovered, perhaps.

SPEAKER_03 8:03

Totally. Totally. And I mean, the other thing that I didn't explain is kind of how it works, which I think kind of relates back to all of this. So what's interesting is if you think about the gut microbiome, right? People talk about diversity, right? You want high diversity, you want lots of different things. What's interesting is that in the vagina, you actually want the opposite. You want dominance by a couple of species of specific bacteria. So there are certain species of lactobacilli, I'm sure you've heard of those, it's in certain probiotics or yogurt. There's vaginal specific strains of lactobacilli that play a really important role in reproductive health. And more specifically, they produce lactic acid, they produce hydrogen peroxide, and they take up space on the vaginal wall. And they basically make it so that when pathogens inevitably get into the vagina, I mean, it is literally an open gateway, when they get there, they can't survive. They can't thrive, it's too acidic, there's no space for them. And so when we say the vagina is a self-cleaning oven, it's really actually that the vaginal microbiome is keeping out those bad bacteria from moving up the tract, right? But God forbid you live your life, you have sex with someone new, you sit in your swimsuit for too long, you have a long period. All of those things can increase the vaginal pH and allow those pathogenic bacteria to start to replicate. And when that happens, that's when, you know, sometimes we go to the doctor with those symptoms. But also now you've lost that protective barrier for the rest of the reproductive tract. And that's what's then associated with all of these health outcomes across the lifespan.

SPEAKER_02 9:32

Oh, wow. So from one little thing, it can actually snowball into something a lot greater.

SPEAKER_03 9:38

Totally. And I think it's this is where it's like knowing what's going on. And frankly, like this is a very accessible sample. You don't have to draw your blood, you don't have to like prick, prot, you don't do anything. I mean, it's a swab of your vagina. I joke that it's easier than putting in a tampon. And there's so much valuable information right there of just like, what does your immune barrier for the reproductive tract look like? Is it intact? Is it not? And what's amazing about the vaginal microbiome to me, especially in the case of fertility, is that it's modifiable, right? Unlike so many things you can be told in the fertility journey that you can't change. Like, I can't change how old I am. I can't change, you know, a lot of the parts of the journey. I can change my vaginal microbiome, right? And Evi's actually really good at improving the vaginal microbiome. We published a lot of studies on that. So I think it's really exciting to be an accessible biomarker that patients can manage at home, that's affordable, and that also you can improve. And that that improvement is then associated with improved outcomes.

SPEAKER_02 10:37

So, yeah, let's talk about exactly this at home kit, how it works. It kind of sounds so it sounds easy. It's just a you said a swab.

SPEAKER_03 10:44

Yeah, it's incredibly easy. Patients can order it themselves at ev and it comes to your house. It's literally what it sounds like. It's like a little Q-tip swab of the vagina. You put it back in the tube, you mail it back to the lab. We do what's called shotgun metagenomic sequencing on the sample. It's a fancy way of saying that we sequence all the bacteria and fungi, the whole genome of everything in the sample. And it's the first time that you can actually get a comprehensive picture of everything going on. What's good, what's bad, how much of everything, what type of bad, what specific genes are present, how are those associated with different types of inflammation. And then we take all of that comprehensive molecular data and we put it in the context of you, right? So we'll say, okay, you have no symptoms, or you do have symptoms, or you're trying to conceive, or you're in perimenopause, or you're on this specific birth control. We'll combine all of that personalized data and we'll predict the specific treatments and ingredients that are most likely to help your vaginal microbiome get back to a state of health, dominated by that good bacteria. What do we need to treat? What biofilms do we need to break? How do we get the good lactobacilli in there? How do we feed them? We'll actually prescribe, we have the clinicians on our platform to prescribe custom compounded vaginal suppositories with exactly what the patient needs and send it to their journey. So we're able to enable patients to kind of manage the entire process at home. And for a lot of the patients who are on some version of a fertility journey, whether they're before getting to an IVF clinic or they're working with a fertility doctor, it's something that they don't have to go into the clinic for. It's something that doesn't require any more tricks and trotting and shots, but it's actually quite easy to manage. And again, it's a modifiable factor that we think is a really exciting opportunity to improve outcomes.

SPEAKER_02 12:31

So the kit comes, I'm assuming. So you said the kit with a combined with like a questionnaire and in-depth of how old you are, do you have any symptoms? Are you seeking fertility support and all of that combined with the results from that swab can kind of give you a better picture of where you are and how you, if need be, can improve your vaginal microbiome.

SPEAKER_03 12:55

Exactly. Exactly. And the the research in fertility is just so robust and it's so interesting, where there's study after study after study that has shown that being in that state of dominance by this healthy bacteria, low levels of the pathogenic bacteria, low levels of inflammation, all of that being highly associated with positive outcomes in, again, natural fertility as well as IVF. And so I think it's one of those things where if you're not there, it's totally fine because we know how to get you there, right? And if you are there, amazing. Now you know that this is actually really supporting you in your fertility journey. And so we're really excited to be able to bring that research and make it kind of clinically accessible to patients. And then we're also building on the research with a lot of our partners at RMA and otherwise. And we're really excited to kind of bring some of this novelty to patients.

SPEAKER_02 13:45

Yeah, I would love to hear if you're able to share with us the research that you have been doing and perhaps the research that you are going to be ongoing with RMA.

unknown 13:55

Yeah.

SPEAKER_03 13:57

We're so excited to have such a great partnership with the team. And I mean, just to give everyone a little bit of a sense of the company. So we have the test product, we have the care offering. And today we work with over 100,000 patients across the country, and we work with over 2,000 doctors who use us for vaginal health as well as fertility. And we've been looking, so we've now built by miles the world's largest data set that's ever existed on the vaginal microbiome. 96% of our patients have consented to research, which means that we can finally actually use that data to find these patterns and understand what's related to infertility and are there specific genes and enzymes and markers and really get to the answers that, frankly, we just haven't funded that research historically in this country. So we're very excited to kind of be pushing that forward. And in addition to the retrospective data, we are also running prospective studies. And so we, well, I'm trying to remember, we did an abstract with RMA last year at ASRM, which is the big American Society of Reproductive Medicine conference. And I think in that one, we were looking retrospectively at patients who reported infertility, and we found very specific signatures that were uniquely different in that cohort versus patients who didn't have infertility, which was very interesting and kind of builds on the existing published research in that space. And the prospective study that we've been so grateful to have such amazing guidance from the RMA team in the design and execution of the study, we're doing a study where we are taking EV tests very explicitly during IVF cycles to see if within the IBF journey, we can pinpoint specific markers in the vaginal microbiome that predict implantation success and failure in an IBF cycle. And so we actually now have the data from the first 170 patients in that study. And we're incredibly excited about what the data is showing us in terms of very clear signatures in the vaginal microbiome that are highly predictive of outcomes. And what's exciting is that those same markers are ones that we know how to modulate in our care programs already. And so we're really excited to put all of that together. We're finishing and rolling into that study now, and then we're hoping to publish it later this year so that we can actually get this new algorithm that we're training out to patients to help improve outcomes as fast as we can.

SPEAKER_02 16:15

That's wild. It's so interesting to see, you know, I've been in RV for 15 years, and we have is we've always been, I think, at the forefront of research, but to see just the evolution and, you know, even things, this was not even on my mind. The idea, it's interesting. I learned for many years about the gut microbiome and you know, the brain microbiome and the vaginal, but just and then also the interconnection. I think that's something that I'm curious to see vaginal health and mental health.

SPEAKER_03 16:43

Yeah.

SPEAKER_02 16:43

And the interplay between the two.

SPEAKER_03 16:46

Totally. I mean, we haven't done our own study on that, although we do collect some data. One of the things that I know is that the most commonly reported other diagnosis, right? So we ask about PCOS and endometriosis and autoimmune disease and cancer history and infertility and you name it. The most common answer, unfortunately, for our patients who have recurrent vaginal infections is anxiety and depression. And that matches, unfortunately, the published literature that shows that patients with recurrent yeast infections have like double the rate of mental health issues compared to people who don't. And so I think, as my co-founder always says, vaginal health is mental health. I think that it affects if you're, and I think very similar to fertility, right? If you're dealing with these challenges, it's not just physical, right? It's emotional, it's relational. And so I think what we have seen is that the importance of taking care of patients mentally is equally as important as actually changing their vaginal microbiome.

SPEAKER_02 17:44

Yeah, it goes hand in hand for sure. But it's great that you said because I think when I'm speaking with my patients, when they think of the microbiome and they think of all, you know, the organisms, the microbes in their body, they often think of like the yucky not good and not recognizing that we need. There's a lot of goodies out there. But it's fascinating because you know, when I was doing research myself, I did see certain microbes like the lactopacilli strains repeatedly coming up, and then maybe one or two other ones that were there. But it's interesting. Now it makes sense that now that you're saying we do not want the diversity. So when I speak about gut health and having a diverse amount of fruits and vegetables and grains and proteins, your gut likes that diversity. It's fascinating to hear that your vaginal microbiome actually does not want the diversity.

SPEAKER_03 18:30

100%. You want it to be dominated. You want those bacteria to be your protective shields. They can handle a little bit of, you know, here and there and whatever, but you do not want those guys taking over because that's when you start to have that infection, inflammation, symptoms, you need it. And one other thing I wanted to say on the mental health thing that I think is so important is I think that so much of where this all comes back to is also just the stigma and the taboos and the shame around these topics, right? And I think that's why I'm so glad you are doing these podcasts where you are talking about these things, you know, out in the world, because the reality is these are the leading reason women go to the doctor, right? These are incredibly, incredibly prevalent conditions, but people feel so alone in them. And unfortunately, like so many patients feel incredibly dismissed at the doctor's office, right? You're fine, your result is normal. We don't know. Oh, it's it doesn't really matter, just take this antibiotic. And I think that feeling of dismissal over and over again can be so harmful to your own mental health. And so I think the compounding nature of stigmatized and taboo topics that are often dismissed then lead to so many women struggling with these problems alone. And I hope that platforms like yours and platforms like ours really together are trying to break down both of those pieces.

SPEAKER_02 19:44

Amen to that. Yeah, it's interesting. I'm happy you mentioned PCOS because I was thinking that could be another, you know, I I work with a lot of PCOS patients. And I think testing for that population group, I think can be really great. I'm curious to see like when is the best time to test? Is it like when people are at first trying to conceive? Is it when they're struggling? Is it when they get that diagnosis of like unexplained infertility or or maybe all of the above?

SPEAKER_03 20:11

Yeah. I mean, what we see is that there's kind of four distinct patient profiles we see on the fertility side. The first is what I would say is like planning to conceive, right? My friends who are starting to take prenatal vitamins and are doing their blood work and making sure things are okay. I mean, it's such an easy thing to check to see like, oh, is this something I need to improve? Is this something that could stand in my way? And we definitely see a subset of our patients kind of in that early planning phase. Then we see patients who are struggling, right? Whether that's three months, six months. I mean, you know as well as I do. A lot of people just hate that feeling of being out of control, not knowing what's going on. It hasn't been 12 months yet. They don't know what doctor to go to. And we see a lot of patients coming to us then saying, you know, is there any testing that I didn't do that maybe actually could be pointing to why this feels harder than I thought it should be? And a lot of times we'll partner with amazing dietitians and acupuncturists and naturopaths, the places that those patients tend to end up to kind of make sure that we are a part of that overall journey. The third and fourth patients are often with the IVF clinics, right? So some patients, before they even do their first transfer, they want to make sure their highest likelihood of success. And we'll see them testing before they schedule the appointment or right after their egg retrieval to make sure that they're in an optimal condition before a transfer. And some patients will see after their first transfer fails and they're looking for what might be a reason for that, we'll see them coming back to us then. And so I would say those are kind of the four most common places in the journey that we see patients engage with EVI. But we're really excited that, you know, we often can support them before they have a doctor when they're at home and they're just thinking about it and we can educate them. We have amazing health coaches that can explain the vaginal microbiome, talk to them about its role in their health. But then we're also able to work with so Many amazing doctors and practitioners to be a part of kind of their broader care journey.

SPEAKER_02 22:05

I think that's great. Yeah, I for me the idea of being proactive, but of course it starts with people knowing that it's out there. Yeah, I think it should be, you know, you go to your OBGYN, you know, before you start trying to conceive, and that should be like a discussion. I think it it should be part of, you know, normal practice. But the fact that it can be helpful throughout is great for our audience to hear that there's not necessarily one specific time that is best, it can help throughout.

SPEAKER_03 22:35

Totally. I completely agree.

SPEAKER_02 22:37

And the fact that you could even, so you said you often uh Sonic will recommend a repeat to see if the changes that you recommended from your company after this changes to see if it's made a difference. Yeah.

SPEAKER_03 22:47

Yeah. Because look, some patients it takes longer. Some patients it happens really fast. And some, like, look, everyone's different. And I would never tell anyone how to do their journey. Some patients really want to know that they're in an optimal place before they do a transfer, right? Maybe you only have one embryo, or maybe, you know, you just don't want to spend the money to do it again. I think we often will see those patients doing a retest before they do a transfer. But other patients, you know, they just take the test, they don't even get the results. They do the transfer. And if it doesn't work, they're like, okay, now let me go back and look if that could have been a contributing factor. And so I think all of those decisions are always best made by the patient who's in that body and making those decisions and in partnership with their clinician. And we're just there to support and plug in in whatever way makes the most sense.

SPEAKER_02 23:32

I think you've created something phenomenal. Like I'm really impressed. I wish I knew about you when I was going through my fertility struggles, just to get some more insight. It's again amazing to see the evolution of things being created, of the research that's out there and the research that you're doing. It's I really can't wait to see where the company continues to go and how it evolves and changes over time. And I'm really like, I would love to have you back on to hear some of the research, like the future research that you conduct.

SPEAKER_03 24:01

Well, when we publish our study in a in a few short months here, I would love to come on and tell everyone about it because the results are incredibly exciting. And I think just a really amazing new tool for us to have. I think that like at the end of the day, I am two things. I am a data nerd and I'm a patient, right? And I believe that patients should have access to tools and best in class technology. I mean, nothing drives me more crazy than just the dearth of good technology and women's health and the dearth of good data and research, right? And so I really hope that by bringing better technology to this problem, we can finally gather the data that finally allows us to understand the female bodies so that we don't have to hear unexplained everywhere we go.

SPEAKER_02 24:39

Oh man, I think that's great. How do our listeners find you, your company? What's the best way for them to get to see your product?

SPEAKER_03 24:50

Yeah. So we're online at evie.com, it's just ebvy.com. We are on Instagram at Evi and we are on TikTok at EviBio. And I will shamelessly plug our TikTok. It is so amazing, so hilarious. I think we get 200 million views a year across all of our content. It's a phenomenal place to just be a woman and laugh about all the things that we should have learned, that we don't understand, that we want to understand. It's such a great community and so much amazing educational content, but also just humor about what it's like to have a female body in 2026.

SPEAKER_02 25:24

You made my day because I am newish to TikTok, but your Instagram account, I think, is phenomenal too. I see I love the research. There's humor, there's videos, but good to know TikTok's even more fun. That's amazing. Well, we're so happy to have you, Priyanka, on our podcast and to share with our listeners the great work that you're doing. And how we always end our podcast is with words of gratitude. So what are you grateful for today?

SPEAKER_03 25:51

Wow. Honestly, this conversation makes me so grateful for all of the incredible fertility doctors that sit with their patients through some of the hardest, most emotional times in our lives. I mean, we see those patients all day, every day. And I feel so grateful they're in the hands of these incredibly competent superhero providers who are doing their absolute best to make patients and families' dreams come true. And I've truly loved getting to know the fertility doctor community, how curious they are, how much they want to see the data, they want to innovate. And I think it's such a unique field of medicine, right? Where everyone is so aligned towards the goal of improving outcomes in a way that I don't think is, I think there's a lot of kind of run-of-the-mill status quo elsewhere in medicine. And I think in fertility medicine, you really see a push towards let's do better. And I think that's really driven by the amazing doctors.

SPEAKER_02 26:43

Yeah. Again, the evolution is pretty wild. I'm gonna piggyback on that. I'm grateful that we can normalize vaginal health. I think, you know, back in my mother's day, my grandmother's day, it was such a taboo topic. And A, now we're much more informed. And B, we can also have the humor with it too. Like it doesn't need to be something shameful. And it is part of our body, and it's something that we need to continue to learn about. And you guys are doing great work in this field. So I'm very happy that we had you on and can't wait to see what's to come.

SPEAKER_03 27:19

Yeah, no, I so appreciate you having me. Thank you so much again, and for the amazing work that you are doing with this platform. Thanks. Appreciate it.

SPEAKER_01 27:27

Thank you so much for listening today. And always remember, practice gratitude, give a little love to someone else and yourself, and remember, you are not alone. Find us on Instagram at fertility underscore forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more fertility forward.