Is Evvy Worth It on Your Fertility Journey? Here’s What We Think
Is Evvy Worth It on Your Fertility Journey? Here’s What We Think
Why the microbiome matters for fertility
When most people hear “microbiome,” they think about gut health. But there’s another microbiome that doesn’t get nearly enough attention on the fertility journey — the vaginal and uterine microbiome. These are communities of microorganisms living in two very distinct but connected environments, and the balance of bacteria within them can have a real impact on your ability to conceive.
The dominant organism we want to see is Lactobacillus — the same good bacteria you’ve likely heard of in probiotics. A healthy vaginal and uterine environment is one where Lactobacillus thrives. What we don’t want to see is an overgrowth of organisms like ureaplasma, mycoplasma, gardnerella, strep, staph, or enterobacteria. These are the six most commonly flagged microorganisms in fertility microbiome testing, and three of them — ureaplasma, mycoplasma, and gardnerella — have research specifically linking them to reduced fertility potential.
Here’s the stat that stopped me in my tracks: a 2020 study looking at over 21.7 million women found that approximately 29% had bacterial vaginosis (BV) — an overgrowth of harmful bacteria in the vaginal canal. Of those women, 84% had no symptoms whatsoever. No odor, no unusual discharge, no discomfort. They had no idea.
BV — you might have it and not know
Bacterial vaginosis is essentially what happens when harmful bacteria outnumber the good. The vaginal canal has an optimal pH range of 3.8 to 4.2 — a slightly acidic environment where Lactobacillus flourishes. When bacteria shift that pH higher toward a more basic environment, good bacteria can’t do their job, and the balance tips.
Most of us learned about BV in health class as something that comes with obvious signs — a distinctive odor, unusual discharge, irritation. But the research tells a very different story. The vast majority of women with BV have none of those classic symptoms. If you have a history of BV, or especially recurrent BV, this is something that needs to be addressed before any fertility treatment begins. And even if you’ve never been diagnosed, it may still be worth ruling out.
Gold standard testing vs. accessible options
The gold standard for assessing the microbiome in a fertility context is always going to be uterine data. A vaginal swab alone can’t tell us what’s happening inside the uterus — and while the two environments are connected, they don’t always match. We’ve seen clients with a healthy vaginal microbiome who had a disrupted uterine environment, and vice versa.
For uterine data, the two best options are a clinic-run biopsy with the EMMA/ALICE test, which breaks down exactly which microbes are present in the uterine lining, or the full female microbiome panel through Fertilysis — an at-home option that uses a menstrual blood sample and vaginal swabs to give you both vaginal and uterine data. The catch with Fertilysis is that it ships to and from Greece, so turnaround can take four to six weeks depending on where you’re located.
These options aren’t always accessible — whether due to cost, clinic resistance, or timing. That’s where Evvy comes in.
Why we recommend Evvy
Code: FCM10Evvy is a vaginal microbiome test you can do at home, and after reviewing results with clients for years, then meeting with Evvy’s team and formalising a partnership, we feel genuinely confident recommending them. They’re doing important work in a space that has been largely ignored, and it shows.
Their reports are thorough — going beyond a simple pass or fail to break down specific bacterial and fungal strains in the vaginal microbiome. The depth of their reporting has improved considerably over time, and one of the standout features is that Evvy can connect you with treatment directly. That matters enormously, because one of the biggest barriers women face after self-directed testing is getting their doctor to act on results they didn’t order. Evvy removes that barrier.
At around $100–150, it’s significantly more accessible than a clinic biopsy, easy to retest, and results come back faster than international shipping allows. For the right person at the right stage of their journey, it’s an excellent place to start.
Who should use Evvy
- →Newer to trying and want to be proactive — Evvy is a great first step. Getting a baseline picture of your vaginal microbiome early can save a lot of time down the road.
- →You have a history of BV — Run this now. A recurring microbiome issue needs to be addressed before anything else.
- →Unexplained infertility or heading into IVF — Evvy is still worth doing, but we’d also encourage pushing for uterine data. Spending a few hundred dollars to identify a microbiome issue upfront is a very worthwhile investment before committing to a full IVF cycle.
We’ve partnered with Evvy because we believe in what they’re building. Use code FCM10 at checkout for a discount on your test kit. And if you want a full fertility plan built around your unique biology, book a free Clarity Call — let’s figure out what your body actually needs.
Book a clarity callKoumans, E.H., Sternberg, M., Bruce, C., McQuillan, G., Kendrick, J., Sutton, M., & Markowitz, L.E. (2007). The prevalence of bacterial vaginosis in the United States, 2001–2004; associations with symptoms, sexual behaviors, and reproductive health. Sexually Transmitted Diseases, 34(11), 864–869. https://doi.org/10.1097/OLQ.0b013e318074e565
There’s a 50% Chance Male Fertility Is Keeping You From Getting Pregnant
Half of all infertility cases involve a male factor. Yet sperm testing is still the last thing most couples are told to do — and the numbers being called “normal” are far from it.
- Male factor is involved in 50–70% of infertility cases — yet sperm testing is still routinely the last step, not the first.
- The WHO’s lower limit for “normal” sperm concentration is 15 million/mL — the 5th percentile. At that level, estimated per-cycle pregnancy odds are around 5%.
- Optimal sperm concentration sits at the 50th percentile of men who successfully conceived: approximately 60–73 million/mL.
- Below 30 million/mL, pregnancy probability drops off sharply. Above 50 million/mL it plateaus near the natural per-cycle ceiling of 20–25%.
- Sperm concentration is not fixed. A targeted, data-driven approach can produce significant improvement — often within 3–6 months.
When a couple struggles to conceive, the instinct — in clinical settings and at home — is to start with her. Her cycle, her hormones, her ovulation. This is understandable. It is also costing couples months, and sometimes years, they do not need to lose.
The data is unambiguous: male factor is involved in somewhere between 50 and 70% of infertility cases. Not as a rare secondary concern — as a primary driver, half the time. Yet semen analysis is still treated as the test you run after everything else has been checked, if it gets run at all.
What the statistics actually show
Infertility is clinically defined as 12 consecutive months of trying to conceive without a pregnancy. When researchers break down the causes, the picture looks like this:
This does not change based on prior pregnancies. Sperm quality and concentration shift over time, affected by age, health, stress, illness, and lifestyle. A previous successful conception — in this relationship or a past one — is not a current result. Testing still matters.
Why “normal” doesn’t mean what it sounds like
The reference range most clinics use comes from WHO guidelines. Under those guidelines, a sperm concentration of 15 million per millilitre is considered normal. A man who hits that number is typically told everything looks fine.
What that framing leaves out: 15 million/mL is the 5th percentile. It was derived from a dataset of men who did achieve pregnancy with their partners within 12 months — but the threshold was drawn at the very bottom of that group. Ninety-five percent of those men had better numbers. The threshold was not placed where success is likely. It was placed at the floor of the range where it has occasionally been shown to work.
At 15 million/mL, the estimated per-cycle probability of conception is approximately 5%. That is the number being rubber-stamped as acceptable in clinical semen analysis reporting.
The 50th percentile of that same dataset — the midpoint of men who successfully conceived — sits around 73 million per millilitre. A practical target for optimisation is above 60 million/mL. That gap, between what clears the bar and what actually reflects fertility potential, is not a minor technical distinction. It is where most couples who are told “nothing is wrong” are quietly losing time.
Where the real drop-off happens
Pregnancy probability by sperm concentration is not a linear curve. The steepest decline happens below 30 million/mL — which is still well above the WHO minimum threshold that triggers no clinical concern.
Above 50 million/mL, per-cycle pregnancy probability plateaus near 20–25% — a ceiling that reflects biological limits, not sperm count. Getting from 60 million to 100 million makes little practical difference. Getting from 15 million to 60 million makes a significant one.
Subfertility vs. infertility — and why the gap matters
One reason male factor gets missed is that clinical concern is triggered by infertility thresholds, not subfertility. If a result clears 15 million/mL, it does not prompt a referral or a follow-up conversation. But a man at 25 million/mL is not in the same position as one at 70 million/mL — and treating those results as equivalent is how couples end up in a prolonged stretch of “keep trying” that didn’t need to last as long as it did.
Subfertility — results that are technically within range but far from optimal — is common and, in many cases, improvable. The research base for male fertility nutrition, lifestyle, and supplementation is more robust than most people realise, partly because sperm concentration is a measurable, repeatable endpoint that is straightforward to study. Randomised controlled trials exist. The evidence base is there. But it cannot be applied well without knowing what the actual numbers are.
Getting tested — and reading the results correctly
A clinical semen analysis — where the sample is produced and analysed on-site at a lab — remains the most reliable method. At-home testing has improved; one option used in fertility-focused clinical programmes is Fellow, which runs morphology and returns actual numerical data rather than a simplified pass/fail result. If at-home results come back low or irregular, confirming with a clinical sample before building any treatment plan is the sensible next step.
When results come back, the question is not just whether concentration clears 15 million/mL. It is where concentration sits relative to the 50th-percentile target. Below 60 million/mL, there is room for improvement. Below 30 million/mL, understanding why — structural, hormonal, or lifestyle-related — should come before any intervention is started.
Testing is the beginning of a plan, not the end of a conversation.
The Sperm Count Blueprint
A focused resource for anyone whose sperm concentration is below optimal — or who doesn’t yet know where it stands. Covers how to interpret your numbers, the most common reasons concentration is low, and how to build a targeted plan based on what the research actually supports.
Get the Blueprint → Includes the Full Male Lab GuideReferences
- World Health Organization. (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). WHO Press. https://www.who.int/publications/i/item/9789240030787 — Source for sperm concentration reference ranges, including the 5th percentile lower threshold of 15 million/mL used in clinical semen analysis reporting.