Rescripted_Dear Infertility_S5_Ep10_Priyanka Jain: Audio automatically transcribed by Sonix

Rescripted_Dear Infertility_S5_Ep10_Priyanka Jain: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hogdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to Dear (In)fertility. This season, join me along with a variety of women's health experts as we explore holistic approaches to our reproductive, hormonal, sexual, mental, and overall health and wellness. From the practice of cycle syncing to the importance of pelvic floor therapy, we'll address some of the many questions women have about their bodies and share practical tips for improving your day-to-day life. Now, let's dive in and work towards ending the shame and stigma surrounding women's bodies once and for all, from first period to last period.

Kristyn Hogdon:
Hi, everyone, and welcome back to Dear Infertility. I'm your host, Kristyn, and I'm here today with Priyanka Jain. Hi, Priyanka!

Priyanka Jain:
Hello! Thank you so much for having me.

Kristyn Hogdon:
Of course, Priyanka Jain is the co-founder and CEO of Evvy, a company dedicated to closing the gender health gap by discovering and leveraging overlooked biomarkers in the female body, starting with the vaginal microbiome. And first and foremost, I just have to say that's like the most badass description of a company ever. But I've been a big fan of yours for a while, and everything you guys do on social, if you don't follow Evvy on TikTok, Amelia is amazing.

Priyanka Jain:
I would agree with that. And the feeling is very much ..., I'm very excited about this. Finally, you get to do an official collaboration.

Kristyn Hogdon:
Exactly what is the gender health gap? Because I've been a participant for the past two years in Evvy's ..., and like, how did you come to do this work, and what are you trying to solve for?

Priyanka Jain:
Yeah, big question. I, as I think so many women have experienced, I feel like I've been in and out of the doctor's office for a lot of my life trying to understand what's causing a certain symptom or why I feel a certain way. And more often than not, I feel like I've been met with a huge lack of data and information. A lot of very well-meaning doctors who just don't have the tools to help me understand what's going on, right? think I was told, maybe you should drink more water, or maybe you should sleep more, or it sounds like you're stressed, and I'm sure you've experienced this too, way more than I was ever told. Oh, let's look at this specific data, and how is this tracking over time? And as I think so many women do, I started doing my own research. I was like, okay, there have to be better answers out there that I can get my hands on. And as I started to do some of my own research, that was when I found out that women were not in clinical research in the US until '19. And that was the moment in which I was like, Wow, okay, first of all, I'm not crazy. That's nice to know, my whole life makes sense now. But then also, I was like, Wow, this is not only depressing, but also a really interesting opportunity from a data standpoint to actually think about what are all of those overlooked signals, right? Every, essentially all of the ways that we decide if somebody is healthy or sick are based on whatever was most predictive of health indices in middle-aged, mid-sized white men. And we've essentially like assumed women are small men, and we're like, great healthcare is going to work for you, and I think, as you and I probably know, that's not actually true. And so I became really interested in this idea that what if we could start tracking and measuring these unique female signals, right? These signals that our bodies are trying to tell us. I'm doing really well, or I really need help here. What if we could actually measure those, give women access to that information on their own bodies, and then start to use that data to actually inform ways that we can better predict risk of disease, diagnose disease, or treat disease as it uniquely manifests in women? So that was the beginning of the journey, and obviously, as we, our first focus on the vaginal microbiome.

Kristyn Hogdon:
Yes, I want to dig into that as well. So, I don't know, sometimes vaginal health just feels like the last thing, like we need to worry about as women. But thanks to Evvy, I've been enlightened in so many ways about like, how important it is. So can you go into why women should care about their vaginal health?

Priyanka Jain:
Completely. For many women, we have no choice but to care about our vaginal health, because actually vaginal discomfort is the leading reason that women seek healthcare advice in the US. So for so many of us only think about our vaginal health once it starts to cause problems for us, when we start to experience symptoms and discomfort, which if you are somebody who experiences that, you are very much so not alone. Bacterial vaginosis is the most common infection of the vaginal microbiome, and it affects 1 in 3 women at any given moment.

Kristyn Hogdon:
So just, I did not realize it's that prevalent.

Priyanka Jain:
It's extremely prevalent, right? And the most common symptoms are things like odor and discharge, and these things that I think, part of the reason that we don't realize how prevalent they are, people don't know the names of these conditions is because they've been obviously so stigmatized. And so what we're obviously hoping to do is shed a light on these conditions that are driving so many women to the doctor's office. And unfortunately, when we go to the doctor's office, the research shows that we're more likely to be misdiagnosed than correctly diagnosed for vaginal discomfort, and we are more likely not to get better than we are to get better in terms of the infections just coming back. So this is a massive problem for so many people. But on top of that, beyond the fact that the vaginal microbiome is the cause of all of these different infections and symptoms. Also, there's so much research showing that your vaginal microbiome plays a large role in your broader health outcomes. And maybe I'll just spend one minute explaining what the vaginal microbiome is, which would then, I think, help everyone understand why it's so important. But basically, I'm sure we're all familiar with the concept of a microbiome, right? Community of bacteria, fungi, etc., that live on or in some part of your body. Most people have probably heard of the gut microbiome or the oral microbiome. It turns out that we also have one in our vaginas. And what's interesting is if you think about the vagina structurally, right? It's essentially this kind of open gateway between the outside world, which is full of every type of microbe and pathogen, and then on the other side of our reproductive organs. And it turns out that we've actually co-evolved with this community of microbes that do more than just hang out on the vaginal wall. When you have a healthy or protective, sounds like maybe I'm skipping a little bit, it sounds like you had a lot of protective bacteria present. The reason that those bacteria are protective is because they're actually producing lactic acid, hydrogen peroxide, and they're taking up space on the vaginal wall. And what that's doing is that it's keeping the vaginal environment at a very low PH so that if and when bacteria from the outside world get into the vagina, they just cannot survive or thrive. It's too acidic, there's no space for them, and essentially, your vaginal microbiome is keeping them out of your system. But when, I always joke, God forbid, we have sex with someone new, we have too long of a period that bacteria gets in there, the PH starts to rise. And what is that? Those pathogens start to displace that healthy bacteria. That's when we start to experience discharge, itchiness, burning discomfort. But also, what's happened is that we've lost that barrier, right? So now we no longer have something protecting our reproductive system from the outside world. And ... is then much higher rates of things like IVF failure, preterm birth, cervical cancer progression, STI acquisition. But of course, in our understanding and care for the vaginal microbiome today, we aren't thinking about how important it is to rebuild that protective bacteria so that not only you don't have to have these symptoms, but you can also then rebuild that barrier that protects your system from everything else. Does that make sense?

Kristyn Hogdon:
Absolutely. And it's so interesting because I actually took the Evvy at-home vaginal health test recently because I've had five failed transfers in the past two years and just wanted to check another box, roll it out. And I just, because, why do you think it is that doctors don't really make that connection?

Priyanka Jain:
I think we started this conversation with the gender health gap, and I'll go right back there. I think that there's, I don't think that doctors are doing anything intentional or intentionally malicious, right? Like I think that we have not had the tools for them to use this information. We haven't had the studies to show how to use this information. And I think that is very much the gap that we are trying to close that is saying, okay, we are going to give every woman, and person with a vagina, information on their own bodies to help them understand what's going on, how is it contributing to their symptoms and health outcomes, and on the back end, we're finally going to do that research. We're finally going to have a large enough data set to put the information together to make it usable by doctors to do the studies that are required to change the healthcare system. Because I always say, at the end of the day, the healthcare system is not incentivized to change, right? The only people who really wanted to change are us, or the people who are like, We deserve better healthcare. And so by actually leveraging the power of consumers, we're actually able to then change the healthcare system through the platform that we can build. We very much, we understand why doctors are where they are, and we really want to give them the tools and the research to treat women differently.

Kristyn Hogdon:
That's so important because you're not just selling a product. You're using that data to inform future research and hopefully improve the female experience for the better so, such a fan. That's amazing. And what are you-

Priyanka Jain:
... the number one reason women go to the doctor, we don't have better solutions. I think doctors are just as frustrated as we are. It's pretty crazy.

Kristyn Hogdon:
Oh, and yeah, you're preaching to the choir because I've been talking nonstop about how I've been on like a holistic fertility journey for the past couple of months, just like I said, ruling things out, getting my health back to where it needs to be, and I've seen so many providers. Like I have, and I think this is a common experience for a lot of women, but I have my OB, which I saw this week for an annual. I have my PCP, I have my, I have an autoimmune disease so I have an endocrinologist, I have a reproductive endocrinologist, I have an acupuncturist, I have a registered dietitian.

Priyanka Jain:
Women's health is so fragmented. It's really crazy. It's wild how many different people we have to go to take care of our bodies. And I think there's, I feel very grateful to be building in a time of so many other amazing companies, right? Yours, there are so many other female founders that I know we both are friends with who are really working on how do we bring together these different services, this information, provide women with one front door so they know where to go to get the right care they need. But it is really such a patchwork right now, and it's unfair that it's on you to figure out which of these doctors you need, how to translate the information. But I think that change is coming, I think there's a lot of really amazing innovation that's finally happening.

Kristyn Hogdon:
What do you see as the future of women's health? Do you see it all being interconnected somehow?

Priyanka Jain:
Definitely. And I think I'm biased, but I think that one of the biggest gaps in women's health, as you look at where dollars research investment has gone in the past, I think what we see is two things. One is really innovation on experience and access, which is so important, right? Like we should not be gaslit at the doctor's office. We should be able to go to a doctor's office that feels nice to be at and where it's accessible, whether that's online or it's more local to me, there's been a lot of innovation in that area, and that was, I would say, the first wave of women's health. Then I would say there was a second wave that's been happening around fertility and pregnancy, also very important. I think if you look at overall venture dollars that have gone into digital health, I think 3% of it has gone to women's health. And of that 3%, though, 65% of it has gone to fertility and pregnancy-only focused companies. And I think what that says is that there's still another wave of women's health to happen, which is everything to do with the rest of our healthcare beyond our ability to reproduce, right? So what does it mean to invest in technology and science that will actually improve our quality of life, right? Women live longer, but we suffer more. What does it mean to actually understand autoimmune disease that primarily affects women, or Alzheimer's, which disproportionately affects women? Or all of these conditions like vaginal infections, and endometriosis, and PCOS, that affect our quality of life? And I always say like that part of women's health has been so underinvested in, and I think part of the reason for that is because so much of what has to be done is actually science. Like, we actually are missing a lot of R&D and science, and it's hard to get investors to fund science in the first place, let alone in women's health and vaginas. It's not an easy task, but I think that is actually where there are huge opportunities from a financial return as well. I always joke if you were to put $1 billion into another single mutation for a cancer cell that people have already thrown $10 billion at, you're way less likely to find gold there than if you put that into finding a diagnostic or therapeutic for these conditions that affect 1 in 10, 1 in 5, 1 in 3 women. And I think it's just that part of women's health we are just at the beginning of, and I think that gets me really excited. We're like, no matter where you get care, you can get better care because we finally have the science and the data to deliver the care that we deserve.

Kristyn Hogdon:
That puts into such good context, because a big learning for me when I came into the fertility industry was that like, IVF is only 41 years old, and there's still we don't even know. My hope is that in ten years, like we'll be able to know why every embryo transfer fails, like why every miscarriage happens. But it's, and I think the general public may not understand that, but it's like such a young field still. And because women weren't allowed in clinical research until 1983, like you said, all the research was done as if we were all men, small men. So, yeah, there's so much promise, but there's still a long way to go.

Priyanka Jain:
Completely, and I think obviously am optimistic, I have a lot of hope, we're building in the space, and I think I've been amazed by the response from patients, the response from doctors who are so excited to have better tools, better information from investors like we. I think we are at the beginning of a new revolution, but I also think it's going to take a lot of work, it's going to take a lot of time, and most importantly, I think it's going to take a lot of science and data. And I'm excited that finally, people are realizing that's actually an opportunity.

Kristyn Hogdon:
Yeah. What are some of, what is some exciting data out of, that you've seen so far?

Priyanka Jain:
So many things. I think, where to begin? I think one of the really interesting things is that I was talking about bacterial vaginosis earlier, which is the most common vaginal infection. When you look at it clinically, it's literally defined as an overgrowth of bacteria. It's completely non-specific to the actual bacteria present, how much of it compared to the good bacteria, just very broad. And we diagnosed it today, in my opinion, a somewhat archaic way that includes smelling a swab and counting shapes under a microscope. But my point is really just that for so long, this extremely prevalent condition in women's health has just been categorized at this extremely broad level. One of the things I'm really excited about is that through our data, we're able to start to show that what we thought was just vaginitis. There is literally one ICD ten code, which is how doctors designate a diagnosis. There's one for everything that goes on in the vagina. We have actually stratified that into over 70 different permutations. We started to see these totally different clusters emerge where you can see certain microbes present with certain symptoms that are more common in menopause, or postpartum, or in early pregnancy. And then you're able to take so much more of a personalized approach to how you shift that microbiome. And I think that beginning of understanding that conditions in women's health are so broadly defined that it's actually an impossible task to have effective diagnoses, effective treatments, because they're not defined specifically enough. I think it's a really great example of when you define things more specifically, you actually can improve outcomes.

Kristyn Hogdon:
No, it, makes sense, and I'm likening it to, so I've been working with a registered dietitian, nutritionist, for four months now and learning a lot about like, gut health. And one thing she said was that like, Probiotics are such like, I don't know, marketed as such, like a blanket solution for gut problems. But really, you need to know what strain you actually need, and I would assume it's the same for vaginal health. Correct?

Priyanka Jain:
Completely. And actually, if you have, as you probably saw in your results, when you have a healthy vaginal microbiome, we're telling you not to take probiotics because actually, you don't want to overgrow what's there because that can cause other problems, right? I think keeping it in balance, thinking about it as something that we need to proactively take care of around our periods, around sex, around all of these things that we don't really think about until they become a problem for us. There's actually a lot of personalization that goes into it, and I think that's so exciting to me. In a world in which we're talking about how AI is going to do so many things for us, whether it's AI in healthcare or precision medicine, we are nowhere near precision medicine for women because we don't have data on female bodies. And I think that the first thing we have to do is understand how you define disease, what is the data that's required to define it, and then you can think about how you treat it effectively. So anyways, I just think that I agree with you. Blanket solutions are a thing of the past, but to enable specific solutions for women first, we need data.

Kristyn Hogdon:
Yeah. And so, I'm just, because I got, I was joking with Priyanka before the podcast started that I finally passed a test, like when it came to my health because I had, I think, 99% good bacteria on my test. But if it were to come back as, how would you know that something was amiss, and what would it mean? Do you have to have UTI symptoms or yeast infection symptoms in order to know that something's going on down there?

Priyanka Jain:
Such a great question. Maybe I'll answer your second question first, which is that actually, so like I said, 1 in 3 people have a disrupted vaginal microbiome, meaning that they are not dominated by that healthy bacteria, they're actually a very diverse population of bacteria that are not providing that important barrier quality of the vaginal microbiome. Of those people, though, think it's something like 84% of people are asymptomatic, meaning that they don't actually realize that they have a vaginal microbiome into dysbiosis, which is great for their quality of life, but in terms of having, not having that barrier, you still don't have something protecting you from those microbes, making it up the reproductive tract. And if you took an Evvy test and you did have a disrupted vaginal microbiome, you would see that you probably have a higher disruptive score, and that also, you would see in the bacteria that we find or the fungi, what they are and what they've been associated with in terms of health outcomes. But then, most importantly, we give everyone a very concrete plan of next steps for what to do about it. Okay, If we found this, these are the five things you need to talk to your doctor about. If you have a doctor, it sounds like you have a great doctor, which is amazing; if you don't have a great doctor, I'm very excited that now we can actually offer end-to-end care and offer these very personalized solutions where exactly like you said, with what is the specific strain, what is the specific thing you need, we're actually able to connect you to providers that can prescribe custom compounded vaginal suppositories with exactly the ingredients that are most likely to improve your vaginal microbiome. I'm obviously biased, but I hope that we're able to help more women get back to a state of being dominated by that protective bacteria so that they can get out of the cycle of symptoms, but also so that they can have better health outcomes, whether it's related to their fertility, pregnancy or so many other parts of their life.

Kristyn Hogdon:
I love that because I'm just such a fan of personalized care. And I think the supplement, like supplements are great, but not everything is for everyone. Like otherwise, we would all be taking a hundred different supplements. And so being able to target it specifically to that person's need is so crucial.

Priyanka Jain:
I completely agree. And I think that's obviously the future of healthcare, is that it's personalized. And I think our rant at Evvy is that, for it to be personalized for women, we need to understand what to measure for women. And I think the vaginal microbiome is undoubtedly one of those things.

Kristyn Hogdon:
Amazing. And what are the next, what's the next thing? What else do you really see missing? I know there's a million, but.

Priyanka Jain:
I was gonna say women's health, the list could go on and on. I think at Evvy, the things we're really excited about are, how do we scale access to our testing care now that we've actually clinically validated. We, last year, ran a clinical study showing that we were able to get, I think it was 83% of our participants from full dysbiosis to being fully dominated by protective bacteria, which is really exciting. So like, how do we get that to doctors, to patients? How do we partner with OB-GYNs to help them?

Kristyn Hogdon:
I was just thinking that because, I say this all the time, but like, why doesn't every 27-year-old get a, for like a basic AMH, like fertility evaluation? But for this, it seemed, I just had my annual OB-GYN appointment the other day. It would be so easy while you're in there just.

Priyanka Jain:
Completely, no, obviously I'm biased, but I obviously agree. I think the vaginal microbiome is a marker of so many things. There's so much research not only showing that if you have a healthy vaginal microbiome, we can improve all of these outcomes, but even just the information on exactly the composition of the microbiome can be predictive of things like PCOS, endometriosis, gynecological cancers. There's so many interesting potential diagnostic opportunities as well. So that's one of the other things we're working on, which is where can we actually help develop novel diagnostics for underserved women's health conditions? And then also, how do we think about how we can improve outcomes in these areas where women are so underserved? Like you just said, if so, when someone has a failed transfer like we should be able to reduce the rate of failed transfers drastically by proactively improving all the different variables that go into that, one of them being the vaginal microbiome.

Kristyn Hogdon:
Everything's always reactive versus proactive, and it needs to be the other way around, yeah.

Priyanka Jain:
Exactly. So I think we're really excited about the ways that we can hopefully scale what we've done and then bring it into these different condition areas where the vaginal microbiome is playing a role. But there's a lot of work to do, and we're really excited that we have the data. We have the world's largest data set ever on this topic. And so we're trying to really do the research, bring together the academics, create the collaborations, and we just really hope that the next generation of women who have vaginas just don't have to deal with the same problems that we have.

Kristyn Hogdon:
So do you see the data in these certain areas of women's health bridging the gap between-? Because something I'm personally observing right now is like that Western and Eastern or traditional and functional medicine is so disconnected. Meanwhile, like there are there, I feel like there is a way that they can work together. It's just they're not, whether it's, the data is not there on the functional side or on the more traditional side. They just want to diagnose and treat. There's just not, they're not on the same wavelength.

Priyanka Jain:
I totally agree. I definitely think the vaginal microbiome is a really exciting opportunity to bring microbiome science to the doctor's office. I think, unlike other microbiomes, potentially the vaginal microbiome is already bringing women to the doctor's office more than anything else. So how do we start to give doctors those tools? And I think, to be fair to the healthcare system, there is a level of research and credibility that's required to change standards. I respect that and think that's a challenge for us to rise to, how do we build up the research, the credibility, all of the information necessary to actually change standards in vaginal health? It doesn't happen overnight, but I think that is where we want to get to, is we have enough robust data to prove that it matters to take care of this.

Kristyn Hogdon:
Amazing. And lastly, if someone's listening and they do have vaginal symptoms, what should they look out for aside from the-? It's funny, like you said, ... is the most common. Like I've only ever experienced a yeast infection, so I can only speak to what that feels like. But what are symptoms that you see a lot at Evvy?

Priyanka Jain:
Definitely, and actually, 66% of people who think they have a yeast infection actually have something else. I think this is another interesting topic, which is that, I think yeast infections and UTIs are actually the only infections that we're taught about, so we just assume that every symptom is a yeast infection or a UTI, and my hypothesis for that is because itching and pain are more socially acceptable than odor and discharge. And I think, so because of that, we haven't talked as much about bacterial vaginosis, even though it is much more common. But I think in general, when you feel like something's up down there, there might be something up down there and you shouldn't ignore yourself. And a lot of times, I think women go to the doctor, and their doctors are like, I don't know. My test came back negative because it only looked for three things, and you didn't happen to have those three microbes, so I can't really help, or I can throw an antibiotic at it and hope that something different grows back, but there's not a lot more information there for them. Again, obviously, I'm biased, but that is why we designed Evvy, so that people can get fully comprehensive information about their vaginal microbiomes from the comfort of their homes with, hopefully, as you experienced, a lot of science-backed education on things that we probably should have learned a long time ago with community, with coaches, really just trying to make sure that people feel equipped to take care of this part of their body and advocate for themselves with their partner, advocate for themselves, with their doctor. Because at the end of the day, so many things are playing a role in our vaginal health, whether it's sex, it's the use of condoms, it's our birth control, it's our periods, it's menopause and pregnancy, and it's sitting in your swimsuit for too long, it's the presence of menstrual blood, it's our hormonal cycles, right? There's a lot going on.

Kristyn Hogdon:
Actually, to that point. Like how? So I got a clean bill of health, but like, how long does it take for your microbiome to potentially like change and shift?

Priyanka Jain:
It's a great question. I think people don't fully know the answer to that. This is something we're looking into in our data. I think what we know is that there are many triggers for people. So for a lot of people, sex is a big trigger, especially sex with a new person who might be introducing a new microbiome as well as changing birth controls or things that are really shifting, either the hormonal situation or the PH. So many, there's many hard triggers. I think we currently recommend that people test every 3 to 6 months in hopes that your vaginal microbiome probably is not shifting overnight, again, unless sex or something else does that to you. In general, our idea is let's catch imbalances before they become full-blown infections. While you're 99% protective, let's catch it when you're 80% protective and not when you're zero. And so we're very much trying to stay over here so that we can stay away from having to take antibiotics, bomb the whole microbiome, rebuild it. And so we believe in a world in which we are much more proactive, and so we're on the path.

Kristyn Hogdon:
Love it. Changing the world one vagina at a time.

Priyanka Jain:
Aren't we all?

Kristyn Hogdon:
Aren't we all? Thank you so much, Priyanka. This was wonderful. And where can everyone find Evvy?

Priyanka Jain:
Thank you so much for having me. Evvy is on Instagram at Evvy. We're on TikTok, as you said, I think our TikTok is hilarious, at EvvyBio. And you can find us at Evvy.com, E V V Y.com. And if you have any other feedback, suggestions, thoughts, ways we can help, we are a team of mainly women who are all very dedicated to this problem, and we're always ears to hear from the community. So thank you so much for having us and sharing this with your amazing community.

Kristyn Hogdon:
Absolutely. I think it will help a ton of people. I appreciate you coming on.

Priyanka Jain:
Thank you.

Kristyn Hogdon:
If this podcast means something to you, be sure to hit Follow or Subscribe. This helps you because you'll never miss an episode and it helps us because you'll never miss an episode. For everything you need to know about women's health and fertility, head to Rescripted.com or follow us on social at Fertility.Rescripted.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

Automatically convert your mp3 files to text (txt file), Microsoft Word (docx file), and SubRip Subtitle (srt file) in minutes.

Sonix has many features that you'd love including enterprise-grade admin tools, upload many different filetypes, advanced search, secure transcription and file storage, and easily transcribe your Zoom meetings. Try Sonix for free today.