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If you are struggling with unexplained infertility, of all the tests I work with, the one most likely to help explain why things are not working out is a vaginal microbiome test.
Yes, I know the GP you talked to said they are a waste of money. If they agree to test at all, they will recommend a culture - but that depends on microbes reaching the lab alive and growing well on the culture medium. A good vaginal microbiome test uses PCR or NGS technology which looks for DNA signatures of microbes and is so much more thorough and detailed.
Yes, I appreciate you may have no symptoms, but if you've had thrush or a UTI in the past, you may still have some remnants of those microbes present - and it's worth pointing out that around 30% of people with BV won't notice any symptoms (but that BV is likely to impact their fertility).
Yes, I know the clinic you are working with said there is no need to think about this kind of test until after you have had an unsuccessful IVF cycle (or two or three unsuccessful IVF cycles).
Yes, I know that your clinic is much more likely to upsell you into an EMMA/ALICE rather than run a relatively cheap vaginal microbiome test. (Why would you want to run an EMMA/ALICE unless you had already checked the vaginal microbiome first anyway ?? The risk of moving infection on and up is significant).
In my clinical experience, a good vaginal microbiome test is the goose that lays the golden eggs. Vaginal microbiome tests are the biggest game-changing tests that I have come across in the past 5yrs.
There are a range of tests now available, the tests that I rate and use frequently are these:
ScreenMe Vaginal Microbiome and Yeasts test (and they have a semen microbiome test too)
Invivo Healthcare's Vaginal Ecologix
MicroGenDX's WomensKey (they have a MensKey test for him too)
If you're going to pay the money for a vaginal microbiome test, don't cut corners. You can run some of the vaginal microbiome tests on your own - but I wouldn't advise that. I'd recommend working with a holistic fertility expert who understands which test would be most appropriate and help you to understand the results (not all tests are the same - some are far too simple, some more thorough than others). Often we need to find someone to prescribe antibiotics, and that isn't easy if your GP gaslights you and tells you they won't prescribe!
And yes, most of the tests we work with are in not cheap - they sit in the £200-£330 price bracket. But they are relatively inexpensive considering how useful they are.
A year of Pregnacare will set you back around £180, and do pretty much nothing to help you with unexplained infertility.
An EMMA/ALICE (a uterine biopsy procedure that checks for infection and inflammation in the uterus) is north of £1000, narrower in scope, and in my opinion not a good idea unless you know the vaginal microbiome is clear and still suspect microbiome issues are involved because the procedure invites infection to move on and up into the uterus. They give antibiotics after the EMMA/ALICE to help minimise this ).
An IVF cycle would set you back around £4000-£6000 - and I so often find vaginal microbiome issues in clients who come to me after unsuccessful IVF so I would really recommend exploring this as part of your IVF prep.
And just to make it clear - I'm not saying that you can fix unexplained infertility with this one test. There is often more work to do with sorting out cycle symptoms, sleep, digestion etc - but all systems will become more responsive to change once a hidden infection has been cleared, and clearing an infection will make conception and pregnancy less precarious.
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