I have a really cool topic that we’re going to talk about today. It’s all about the microbiome, and I have an expert in the microbiome, of course. I have Hana Janebdar here to talk to us all the way from London. She is the co-founder and CEO of Juno Bio.
Hana Janebdar: Thank you. Hello. So happy to be here.
Dr. Aimee: It’s awesome to talk to you. This is something that I describe as the new frontier. You would think we’ve had vaginas for a really long time, so why should it be the new frontier. I’m really happy that you’re joining us to talk about it.
Before we get into the topic, I just want to share with our listeners a little bit more about you. You have a bachelor of science in biology from the Imperial College of London and a master’s in science in biochemical engineering. You researched microbiomes and you discovered that there was an opportunity to close the gender health gap and advance vaginal microbiome research. You have this company called Juno Bio and you’ve recently launched your vaginal microbiome test. It’s the first at-home comprehensive screen that allows women to receive insight into their full vaginal microbiome profile and what it means for their wellness.
Welcome, again. The big question: could your fertility issue be explained by an abnormal microbiome? Before we even get into that, Hana, what is a microbiome? Please explain.
Hana Janebdar: It’s a good place to start because I think a lot of people won’t even have a clue what the word means.
Microbiome just really means community of microbes. Microbes are bacteria and yeast and viruses. A lot of people won’t know that actually 56% of all the cells that make up who we are are microbial cells, they’re not human cells. These microbes have a huge impact on our health and our wellness. They exist in our mouths, in our guts, in our skin, and in our reproductive tract and vaginas.
If you have heard of microbiomes, you might have heard of them in the context of the gut. You will know that they help you metabolize your food. You might have taken probiotics. But the microbes that live in the vagina are super important in women’s health and fertility, it turns out.
So, they’re communities of microbes, they live in and on us, and for the most part they’re really important for our health and wellness, they behave and work with us.
Dr. Aimee: I’m really fascinated to hear what led you to research the microbiome. I have my own history, my mom had miscarriages, so I was super interested in solving that problem for society as much as I can. What led you to be interested in researching microbiomes?
Hana Janebdar: It’s a funny one. Actually, my background is in biochemical engineering. That means creating bioreactors and processes on scale, so the production of microbial goods, etcetera. But one of the really fascinating problems is how do you scale up personalized microbial solutions.
My first immediate question was why do you need personalized microbial solutions, why on Earth would you need this. So, I learned about microbiomes and the fact that you have these microbes in your body and that in order to really change them you have to do it at a tailored level for every single person.
That’s how I fell into microbiomes. Then I started working on a whole host of different ones. Back five or six years ago, we had this huge explosion of both research and commercialization in things like the gut microbiome, the skin, the soil, etcetera, but no one was working on the vaginal microbiome, which was crazy to me because it was the most causative of the conditions that it’s associated with and it’s implicated in over 30 women’s health conditions that affect billions of women worldwide.
For me, it was really just an absolute shock that we’re in the 21st Century, that we have this technology, that it’s being used for every other aspect of microbiomes that you can imagine, but a complete empty open space when it comes to women’s health. It’s ridiculous, quite frankly.
Dr. Aimee: It is. I’m particularly interested in how it can impact fertility. Can you speak on that for us?
Hana Janebdar: The research is ongoing and it’s relatively new. As you say, it’s like the next frontier of women’s health and infertility. The research really falls into two buckets when it comes to fertility.
One body of research looks at the vaginal microbiome in the context of IVF success rates. There are studies that show that women that have dysbiotic vaginal microbiomes – those are vaginal microbiomes that are disrupted, it might be disrupted and cause bacterial vaginosis, which is a condition that can be symptomatic or asymptomatic. When it’s symptomatic, you have things like foul odor, discharge, discomfort, inflammation, etcetera. One of these studies, for instance, showed that women that have these dysbiotic or disrupted vaginal microbiomes fail their IVF route 91% of the time, so there is a huge potential impact that it’s having on something as big as IVF. As you well know, it’s emotional, financial, physical, it’s everything, and you want to optimize it as much as you can.
Join Dr. Aimee for The IVF ClassThe second category of research that’s happening is more specifically in infertility. Infertility can happen for a number of reasons, as you well know, and your audience probably knows as well. There are multiple factors that go into it, but the vaginal microbiome is thought to have an impact on things like pelvic inflammatory disease, and therefore also tubal factor infertility. This means that it can have a role in causing damage, essentially, to the reproductive organs and causing infertility as well.
We know for a fact that things like STIs, like chlamydia or gonorrhea, untreated can lead to tubal factor infertility. But there is a growing body of research that is saying that the other microbes can also increase your risk of this and also potentially be causative of it as well. So, at the minute, those are the two areas that we know about when it comes to fertility.
Dr. Aimee: I couldn’t agree with you more. I feel like when a patient is told she has a blocked tube she all of a sudden shames herself into thinking that she’s contracted some sexually transmitted infection from her partner because of some Google search that she did. I’m like, no. It could be so many other different bacteria that could be causing this. It could also be something else, like endometriosis. Please, for those of you who are listening, if you have a blocked tube, don’t shame yourself into thinking that it’s some STI. It could just be from another type of bacteria.
Right? Is that what you’re trying to say?
Hana Janebdar: Yes. There is a growing body of research that is thinking that yes, there are other types of bacteria that could be causative elements here for sure.
I think it’s so hard in this world not to shame ourselves, because we’re constantly shamed and it’s constantly ingrained in ourselves. But microbes are part of us and it’s a taboo topic even without talking about STIs and talking about yeast infections, etcetera. I think the more that we can move towards being open and knowing that the stigma should be removed, and we’re all here to remove it, the better we’ll all be for it.
When we started, we ran a study called the Juno Study. It was a huge study, one of the biggest of its kind IRB approved. Over 1,000 women from all over the US took part and built one of the richest repositories of vaginal microbiomes. This is like what microbes can even really exist in the vagina and what it mean for women’s health. That informed the first product that we have, which is a Juno Wellness Test for the vaginal microbiome. It’s a test based on next generation sequencing.
It’s a big term, but essentially what it boils down to is that we can give you the full bacterial and yeast profile in your vaginal swab. If you go online and order a kit, you get something in the mail. It’s a really simple swab, much like the COVID tests that we’ve been doing, but instead of putting it in your nose, you put it in your vagina for 20 seconds. Then you send it back to us, we process it, and you get a full breakdown of what the bacteria that live in your vagina is and what the yeast that live in your vagina is, what it means for you in your specific context, and what your best next steps can look like.
Dr. Aimee: How do you know what you did to treat it has worked? What do you recommend based on the research that you’ve done?
Hana Janebdar: Depending on where you are… Some women will get a test and their vaginal microbiome looks amazing, nothing to be done, all good and dandy. Sometimes though, it is very clear you should really follow up with your doctor to get a confirmatory diagnostic, get treatment, etcetera. That treatment can sometimes be antibiotics.
Sometimes it’s more things that you can do to support your general wellness. There are things that you can do in terms of better practices. A lot of women when they do have recurrent infections or when it’s not happy down there, if you’d like, they will go and, unfortunately, use things like douching products, and you absolutely shouldn’t. There are things that you can do in terms of avoiding that.
Also, you can use probiotics and prebiotics that are more tailored to you and your unique context to support your general wellness. So, it is very dependent on your context what your solution will look like.
Dr. Aimee: Right. I tell people your vagina is like a self cleaning oven, you do not need to douche.
Hana Janebdar: Right. I was going to say your vagina is absolutely a self cleaning oven, but when it goes awry, then it’s very much not a self cleaning oven and what you really do need is dedicated clinicians and tests that can help you get back on track. I think that’s where there’s a huge gap, where communities like ours really go for things like Juno.
Dr. Aimee: Maybe there is a warning alert on your oven that says Need Juno, must come help, bring in the maintenance crew to get everything perfect. I love it.
Where can people find your test?
Hana Janebdar: You can find us at Juno.bio. You can order your test directly from us. There’s no faff, there’s no whatever. You go straight to our website and you can order it and get it in the mail in a couple of days.
Dr. Aimee: Excellent. Is there anything you want to tell our audience about the microbiome and the vagina for them to remember so that they remember this interview today?
Hana Janebdar: I would say number one, your vaginal microbiome is important. For the most part, it’s protective. Sometimes it misbehaves, but we’re here for you when it does.
Dr. Aimee: I love that quote. I think we’ll make that into a t-shirt. I see little Juno Bio baseball caps.
Hana Janebdar: Can I please have one of those t-shirts? I’d wear it all the time.
Dr. Aimee: I’ll send it to you. I think your test would go well with my Egg Whisperer pants. I don’t know if you’ve seen them, they have a crotchless opening. You should look that up, EggWhispererPants.com.
For those of you who are interested in Hana’s test, it’s Juno.bio. I have my patients doing it. I’m getting their results back, and I’m finding the results to be extremely helpful. I hope that if you’re interested that you do the same as well.
For those of you who don’t know, I have the TUSHY method, the five tests that you need to do to understand your fertility; tubes, uterus, sperm, hormones, and your genetics. Hana, I think I’m going to add your vaginal microbiome test to that list as well. Do you agree?
Hana Janebdar: Absolutely.
Dr. Aimee: Awesome. Wait. One more question. What about men?
Hana Janebdar: Men should get their microbiomes tested. There is no test right now for them, but I hope in a year or two we will have something for men, too.
Dr. Aimee: Awesome. Looking forward to it. Thank you, Hana, for joining us today. We really appreciate your time.
Hana Janebdar: Amazing. Thank you for having me.
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