Can BV Affect Fertility? What the Evidence Actually Shows About Conceiving

If you have BV and are worried about your fertility, take a breath. BV does not mean you are infertile, and it does not damage your eggs or stop you from ovulating. Most people with BV can still get pregnant.

The fertility concern is more indirect. BV is associated with a higher risk of other infections, including chlamydia and gonorrhea, and those infections can lead to pelvic inflammatory disease (PID). PID can scar the fallopian tubes, which can make it harder to get pregnant.

So yes, can BV affect fertility? It can be part of the picture, especially if it is linked with PID or another untreated infection. But BV by itself is not considered a direct cause of infertility.

TL;DR: Key takeaways

• BV does not damage your eggs, lower your ovarian reserve, or stop ovulation.
• The fertility concern is mainly about complications such as PID and other infections that can damage the fallopian tubes.
• Research has found a stronger association between BV or vaginal dysbiosis and early pregnancy loss than with difficulty getting pregnant.
• No guideline recommends screening or treating BV without symptoms just to improve fertility.
• If you have symptoms, treat them rather than leaving them untreated.
• Fever with pelvic pain, or one-sided pain with a missed period, needs urgent medical attention.

Worried about BV symptoms affecting your fertility, or dealing with recurrent BV? Try August AI's free symptom checker to evaluate your symptoms in under 2 minutes, or book a $39 online BV treatment visit with August AI. A US-licensed clinician can review your symptoms and prescribe when appropriate, with same-day pharmacy pickup across all 50 states. The visit does not guarantee a prescription. For fertility-specific concerns, an OB/GYN or fertility specialist can offer more comprehensive evaluation. Severe pelvic pain, fever, fainting, or possible pregnancy complications need in-person care.

Can BV affect fertility? Usually not directly

Having BV does not mean your ovaries stop working.

BV does not destroy eggs, reduce ovarian reserve, or prevent ovulation. It also does not mean you will have trouble getting pregnant the next time you have sex.

The concern comes from what can happen alongside BV. 

BV is associated with an increased risk of acquiring infections such as chlamydia, gonorrhea, and HIV. Some untreated infections can move upward from the vagina and cervix into the uterus and fallopian tubes. If that leads to PID, the inflammation can cause scarring in the tubes.

That scarring is where fertility can become a problem. A completely blocked fallopian tube can prevent sperm and egg from meeting. Partial blockage can also increase the risk of an ectopic pregnancy.

So the important distinction is:

BV itself is not the same thing as tubal infertility.

The concern is untreated infection and the complications that can follow.

CDC describes BV as the most common vaginal condition in US women aged 15 to 44 and notes that BV is not classified as an STI. The CDC STI Treatment Guidelines also note that BV is associated with a higher risk of acquiring several STIs.

PID is the fertility problem you do not want to miss

Pelvic inflammatory disease is an infection of the female reproductive organs. It can involve the uterus, fallopian tubes, and ovaries.

The reason PID matters for fertility is the damage it can leave behind.

Inflammation can cause scar tissue around or inside the fallopian tubes. You may not feel that damage happening. Someone can recover from the infection and only discover the effect later when they have trouble conceiving or develop an ectopic pregnancy.

CDC specifically notes that untreated BV can lead to PID and that PID can make it difficult to have children.

BV is also associated with complications following some gynecologic procedures. The CDC guidelines discuss associations with procedures such as IUD insertion, hysteroscopy, and D&C.

There is another important point here: BV is not the only thing that can lead to PID. Chlamydia and gonorrhea are major causes of PID and can damage the tubes even if BV was never present.

That is why recurrent BV, pelvic pain, or STI exposure deserves proper evaluation rather than repeated self-treatment.

What does the research say about BV and infertility?

The evidence is more complicated than a simple "BV causes infertility" headline.

A 2024 case-control study in BMC Infectious Diseases found BV in 61.5% of women with tubal factor infertility compared with 30.6% of controls. The study reported an adjusted odds ratio of 3.77.

That sounds significant, but it does not prove that BV caused the infertility. The study was observational, and women with tubal infertility may also have had other factors that increase both BV and fertility problems, including previous infections or PID. A study like this can show an association. It cannot establish that BV itself damaged the fallopian tubes.

The same caution applies to studies looking at vaginal bacteria and fertility treatment.

A 2021 systematic review and meta-analysis of vaginal dysbiosis and IVF outcomes included 17 studies involving 3,543 patients. It did not find a statistically significant difference in clinical pregnancy or live birth rates. The researchers rated the overall certainty of the evidence as very low.

So if you have BV, you do not need to assume that it has already affected your ability to conceive.

BV can change the vaginal environment, but that does not mean you cannot get pregnant

BV changes the normal balance of bacteria in the vagina. Lactobacilli become less dominant, other bacteria increase, and vaginal pH can rise.

That has led researchers to ask whether the change could affect sperm movement or survival.

It is a reasonable biological question, but it is not the same as proving that BV causes infertility.

Your ovaries still release eggs. You can still ovulate. Sperm can still travel through the reproductive tract. Many people with BV become pregnant without fertility treatment.

So if you have BV and are trying to conceive, there is no reason to assume that you have lost your fertility.

If you have been trying for a while without getting pregnant, that is when a proper fertility evaluation becomes more useful. BV is only one possible factor, and often not the most important one.

Depending on your age and history, your clinician may look at things such as PCOS, irregular menstrual cycles, ovulation, fallopian tube health, and your partner's sperm count.

The stronger concern is pregnancy loss, not getting pregnant

There is some evidence linking BV and other forms of vaginal dysbiosis with early pregnancy loss.

The same 2021 meta-analysis found an association between abnormal vaginal microbiota and early pregnancy loss, with a relative risk of 1.71.

That does not mean that having BV will cause a miscarriage.

It means that, across the studies included in the analysis, pregnancy loss was more common among people with certain vaginal microbiota patterns.

BV has also been associated with pregnancy complications such as premature rupture of membranes, preterm birth, intra-amniotic infection, and postpartum endometritis. The CDC pregnancy guidance reflects these associations.

But there is an important difference between identifying a risk and proving that treating every person without symptoms will prevent that risk.

Routine screening for BV during pregnancy is not recommended for the purpose of preventing preterm birth in people without symptoms who are not at increased risk. The USPSTF gives this a Grade D recommendation. For people at increased risk of preterm delivery, the evidence is still considered insufficient.

That is why a positive test does not automatically mean "you need antibiotics now."

Should I treat BV before trying to get pregnant?

If you have symptomatic BV, yes, treatment makes sense.

The reason is not that treating BV gives you a fertility boost. It is because symptomatic BV should be treated and because you want to address an infection that may be associated with other reproductive health problems.

CDC first-line BV regimens include:

• Metronidazole 500 mg by mouth twice daily for seven days
• Metronidazole 0.75% vaginal gel once daily for five days
• Clindamycin 2% vaginal cream at bedtime for seven days

Your clinician can choose the treatment based on your symptoms, medical history, allergies, pregnancy status, and previous treatment.

There is also no guideline that says you have to wait a certain number of days after finishing BV antibiotics before trying to conceive.

Once you have completed the treatment and your symptoms have resolved, there is generally no fertility-related reason to delay trying.

If you keep getting BV, though, tell your clinician. Recurrent BV may need a different treatment approach rather than repeated short courses whenever symptoms return.

What if I am already trying to conceive?

You do not need to stop trying simply because you have had BV.

If you have symptoms, get them assessed and treated. If you are taking antibiotics, tell your clinician that you are trying to conceive so they can choose an appropriate medication.

Do not use leftover antibiotics from a previous BV episode. The symptoms could be from something else, and the medication you used last time may not be the right choice this time.

There is also no reason to use boric acid or vaginal washes to "balance" your vagina before sex. They can irritate the vagina and are not substitutes for appropriate BV treatment.

If you are already pregnant or think you might be pregnant, tell the clinician before starting any treatment.

Can BV come back while you are trying to conceive?

Yes. Recurrence is frustratingly common.

BV can return even after successful treatment, so getting another episode does not necessarily mean your first treatment failed.

If symptoms return, get checked rather than assuming you need the exact same antibiotic again. A recurring fishy odor or discharge can be BV, but recurrent symptoms can also point to another infection or a different vaginal problem.

And if you have pelvic pain, fever, or pain during sex along with recurrent symptoms, do not keep treating it as simple BV. Those symptoms deserve an evaluation for PID and other infections.

When should BV become part of a fertility workup?

If you have been trying to get pregnant without success, BV can be mentioned to your clinician, but it should not become the only explanation.

A fertility evaluation is generally recommended after 12 months of regular unprotected sex if you are under 35, or after six months if you are 35 or older. Your clinician may recommend an earlier evaluation if you have a history that raises concern, such as PID, tubal surgery, endometriosis, or irregular periods.

A fertility workup can look at:

• Whether you are ovulating
• Your menstrual cycle
• Ovarian reserve when appropriate
• The condition of your fallopian tubes
• The uterus
• Your partner's sperm
• Previous STIs or PID

If your tubes are blocked or damaged, that is much more relevant to fertility than a current episode of BV.

When BV symptoms need same-day care

Most BV symptoms are not an emergency. A strong odor or unusual discharge can usually wait for a routine medical visit.

Some symptoms are different.

Go to an emergency room or seek urgent medical attention now if:

• You have fever or chills with severe pelvic or lower abdominal pain.
• You have one-sided pelvic pain after a missed period, especially with bleeding, dizziness, or fainting. This can be a sign of an ectopic pregnancy.
• You have heavy or unusual vaginal bleeding.
• You feel faint, severely weak, or seriously unwell.

Book a visit within the next week if:

• Your BV symptoms do not improve after treatment.
• The odor or discharge keeps coming back.
• Sex has become painful.
• You have been trying to conceive for 12 months without pregnancy, or six months if you are 35 or older.
• You have a history of PID, chlamydia, gonorrhea, or tubal problems.

Talk to a clinician before treating yourself if:

• You might already be pregnant.
• You are about to start IUI or IVF.
• You have had PID or a previous ectopic pregnancy.
• You are thinking about using boric acid or another vaginal product while trying to conceive.

If you are not sure how urgent your symptoms are, the free August AI Symptom Checker can help you decide what to do next.

For straightforward BV symptoms, August's $39 online urgent care can connect you with a US-licensed clinician who can review your symptoms and determine whether treatment is appropriate. If there is concern for PID, an ectopic pregnancy, or another problem that needs an exam or testing, you will need in-person care.

The bottom line

Can BV affect fertility? It can be part of the story, but BV itself does not mean you are infertile.

BV does not damage your eggs, stop ovulation, or automatically prevent pregnancy. The bigger concern is untreated infection, particularly if BV occurs alongside an STI that leads to PID and fallopian tube damage.

There is also some evidence linking BV or vaginal dysbiosis with early pregnancy loss, but that does not mean a BV diagnosis will cause a miscarriage or make it harder for you to get pregnant.

If you have symptoms, get them treated. If BV keeps coming back, or you have pelvic pain, painful sex, a history of PID, or trouble conceiving, that is when it is worth looking beyond BV and checking for other causes.

Having BV is not the same thing as having a fertility problem.