What a beautiful gift and miracle of life- an opportunity to create another human being and give them unconditional love as their parent.
Unfortunately for many couples, this gift comes wrapped with a number of challenges, heightened stress levels and the emotional roller coaster which follows. According to the World Health Organisation report published in 2012, one in four couples in developing nations have been affected by infertility. The Australian Bureau of Statistics from 2009, stated that one in six Australian couples reported to have fertility issues.
Heartbreaking to hear, 20-25% of these cases are diagnosed as unexplained infertility. (1) What does that mean? Those patients have been delivered inconclusive results from basic fertility related testing, they don’t fit into medically accepted fertility or endocrine related diagnosis, and/or the structure and function of reproductive health falls into population ‘normal range’.
In many of these cases, more detailed detective work and testing would give an indication of imbalances in the body of either one or both parents, that could potentially drive fertility challenges.
OVERLOOKED CAUSES OF FERTILITY CHALLENGES
The following issues are medically accepted, but often may not be initially investigated, or just overlooked through standard infertility evaluation.
PCOS (POLYCYSTIC OVARIES).
In the condition of PCOS, your ovaries aren’t getting the right hormonal signals from your Pituitary gland (in the brain). Drivers of PCOS stem from a high level of Luetenising Hormone (LH), from the pituitary and/ or high insulin production, from the pancreas, which causes higher Testosterone levels. When the LH are at a constant high, the cycle lacks a LH surge, which is needed to stimulate ovulation.
The imbalances in hormones prevents normal ovulation each month, causes growth of benign masses on the ovaries, called ovarian cysts and therefore resulting in fertility challenges. To further add to the hormone havock, lack of ovulation contributes to low Progesterone levels (as Progesterone is produced post ovulation, from the Corpus Luteum). Progesterone is required for the development of the tissue and blood in the uterus, ready for a fertilised egg to be implanted, as well as playing an important role in sustaining a pregnancy. Alarmingly 1 in 5 Australian women have been diagnosed with PCOS. I’m seeing increasingly amount of women in clinic, who are diagnosed with PCOS, after long term use of the oral contraceptive pill.
THYROID IMBALANCES (HYPOTHYROIDISM, HYPERTHYROIDISM).
You can learn more about the thyroid imbalance signs and symtpoms here. Simply put, adequate thyroid hormone production, conversion and function controls your energy production, body temperature and metabolic rate. Sluggish thyroid function has been linked with poor Oestrogen metabolism, contributing to the condition of Oestrogen dominance, a driver for fertility challenges.
ADRENAL INSUFFICIENCY (ADDISON’S DISEASE).
Addison’s Disease is the extreme end of adrenal fatigue and a major cause to sex hormone imbalances. As the body is screaming out for cortisol (produced in the adrenal glands), majority of the mother hormone, Pregnenolone, is stolen down the pathway to produce the stress hormone, Cortisol. The other pathway Pregnenelone can feed is Progesterone production, therefore this Cortisol steal consequently leaves the body in a state of low Progesterone.
Learn more about low adrenal gland function here.
This Oestrogen dominance driven condition, involves tissue growth similar to the inside lining of the uterus found outside of it’s normal location, such as the ovaries, fallopian tubes and ligaments that support the uterus, as well as tissue covering the bladder and rectum. If hindering fertility, a laparoscopy will be performed to remove the tissue.
The condition of Fibroids includes growth of a benign tumour of muscular and fibrous tissues, often developing in the or on a woman’s uterus. You may be more susceptible to fibroids with insulin resistance, obesity, oestrogen dominance, prescence of thyroid nodules and hypothyroidism. Fibroids may be removed, if safe to do so without damaging reproductive organs. This is something you will need to discuss with your gynaecologist.
Coeliacs disease is a severe allergy to the protein gluten. Long term, untreated coeliac disease will often lead to compromised absorption of nutrients, due to damage of the small intestine enterocytes (cells lining the finger like projections in the small intestine). Malabsorption of nutrients, together with higher inflammation levels, can ultimately effect reproductive health.
These conditions are often both overlooked and not explained with a normal medically accepted infertility diagnosis.
You can learn more about Oestrogen dominance here. This hormonal imbalance should be considered with PMT, thyroid issues, breast tenderness before periods, heavy & painful periods, as well as when fibroids and/ or endometrial tissue have been removed, or pose no structural issue to the reproductive organs. Oestrogen dominance is a known driver for these conditions.
GENETIC/ EPIGENETIC CHALLENGES.
MTHFR, COMT and other enzyme gene variants, which control detoxification and hormone metabolism, can potentially affect fertility.
Bacterial Vaginosis is associated with a significantly elevated risk of preclinical pregnancy loss. (3) The prevalence of infections Ureaplasma and Mycoplasma have been to be considerably higher from a high vaginal swab, in infertile females, compared to low prevalence in fertile females. (4) It is highly controversial, however these infections could trigger heightened levels of Natural Killer Cells, which could possibly attack the embryo.
This occurs when your body is attacking your own tissue, by producing antibodies against it. A common cause of fertility challenges is Hashimotos, an autoimmune condition of the Thyroid.
ADRENAL STRESS OR FATIGUE.
Any physical, emotional or chemical stress on the body will stimulate the adrenal glands, to produce the stress hormones cortisol and adrenaline. Continued stress on the adrenals and heightened cortisol production, will eventually cause your adrenals to wear out. When this occurs, cortisol production is limited, causing fatigue and numerous other symptoms (read more here). Although not recognised by the medical profession, stress on the vulnerable adrenal glands can lead to serious imbalances with hormones downstream- the thyroid and sex hormones, particularly low Progesterone levels. When Progesterone plummets, ovulation is delayed and therefore linked to fertility issues.
LUTEAL PHASE DEFECT
When the time from ovulation to the first day of your period is shorter than 11 days, this indicates an infertile cycle.
SUBCLINICAL OR SLUGGISH THYROID
Subclinical thyroid is shown when test results are within population ‘normal’ ranges, but symptoms are presenting. When the thyroid is under active, Oestrogen metabolism is effected and can contribute to Oestrogen dominance in the body. You can read about Thyroid imbalance symptoms in this post.
POOR GUT HEALTH.
Ranging from bad bacteria & parasitic infections, to leaky gut and poor absorption of nutrients. If the gut isn’t functioning well, the reproductive system will suffer. Read more on the impacts of poor gut health here and here.
IMPORTANT TESTS PRE CONCEPTION
After introducing these potential drivers for fertility challenges, consider the following tests to detect potential imbalances linked to your issues conceiving, or maintaining a pregnancy.
- Speak to your GP about being tested for Sexually Transmitted Disease’s (for both you and your partner).
- See your GP for a high vaginal swab for Bacterial Vaginosis, Ureaplasma and Mycoplasma infections.
- Get your fella to undertake a comprehensive Semen Analysis (for count, motility & morphology). Best arranged through an IVF clinic, as they routinely perform these tests and will therefore be more experienced at deciphering the results. The next optional step is a Sperm Chromatin Structure Assay (to detect damaged sperm DNA and and altered proteins in sperms nuclei).
- Your GP can also arrange a Follicle Stimulating Hormone (should be <10) & Oestradiol (should be 125-200) blood test on day 2 of your cycle. Remember day 1 is the 1st day of your period. Progesterone should also be tested at ovulation (should be >45), via bloods, as well as 7 days post ovulation Progesterone (should be >45) and Oestradiol (should be 600-800).
See your Naturopath for:
- A comprehensive hormone panel, including adrenal and sex hormones, as well as their metabolites, 7 days post ovulation, via a Dutch Complete Hormone Test.
- The full Thyroid panel of TSH (should be 1-2), T4 (should be 15-20), T3 (should be 5-6), RT3 and Thyroid Antibodies. More info about the crucial role they play in the body, here. Testing during your menstruation if possible, will allow a true picture of what is happening to the thyroid health, under this monthly stress to the body.
- If you suspect gut issues, you should consider Stool Analysis Testing (for infections, immune health and inflammation markers in the gut) and Food Intolerance Testing (to eliminate food triggers for autoimmunity).
For optimal chances of conception and for a healthy constitution in the bubba to be, I recommend putting aside at least 3 months preconception, to truly concentrate on nurturing yourselves (yep, the guys too) on a cellular level.
This includes a nourishing diet full of whole foods, healthy movement, mindfulness and supplementation plan, to allow for the regeneration process of sperm (3 months) and support healthy development of your follicles (from a primordial follicle to a pre-ovulatory follicle), which can take 6-8 months. Therefore, the longer you can be following a nourishing lifestyle, the healthier you’re sperm and eggs will be.
If you have fertility challenges, consider the above tests and once you’re aware of any weaknesses, I recommend seeking the qualified support of a Naturopath, Herbalist or Integrative GP, for a specific and individualised treatment plan. Patience and persistence is required with treatment, as issues can take months to resolve.
I will always recommend quality fish oil as the omega 3’s improve sperm health, enhance the ability of the sperm to penetrate the egg and provide natural anti-inflammatory support. Probiotics are another must, as they play a crucial role in enhancing gut health and have the ability to protect against infections, such as Bacterial Vaginosis. Fermented foods can also provide you with beneficial bacteria and enzymes, to improve digestive and immune health.
Bone broth for minerals and gut healing support, together with loads of green leafy vegetables, for folate, calcium, iron and omega 3’s are also important dietary nourishment for the body. Daily sources of ethically raised protein sources help to maintain blood sugar balance and support adrenal health.
Reducing the use of Non Steroidal Anti-Inflammatory drugs is important, as they have the potential to deplete your immune system and can effect the bodies natural way of addressing endometrial tissue. Include plenty of anti-inflammatory ginger, turmeric, omega 3’s (through fish, chia, flax, hemp and pumpkin seeds, walnuts and green leafy vegetables) in place. For pain, use Magnesium Chloride spray, Castor Oil Packs (in between cycles) and gain further herbal and nutritional support from your Naturopath.
ADDRESS THE FOUNDATIONS OF FERTILITY
If you’re planning on starting a family, or are experiencing difficulty with conceiving, consider further investigation (from basic fertility testing), to seek underlying imbalances. The health of your hormones, including cortisol, thyroid and sex hormones, play an important role in fertility, as does healthy detoxification, a strong gut and immune system.
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(1) ANZARD Database & Assisted Reproduction and Technology Australia and NZ 2010.
(2)Dr Evelyn Billings; Dr Ann Westmore. The Billings Method. Melbourne: Ann O’Donovan Publishing Pty Ltd; 2008
(3) Hum Reprod. 2013 July; 28(7);1809-15. doi:10.1093/humrep/det096
(4) Iran Red Crescent Med J. 2015 Dec 26;17 (12):e16823.doi:10.5812/ircmj.16823.eCollection 2015.