I had a great time connecting with holistic nutritionist and owner of Thrival Nutrition; Lahana Vigliano today. We recored podcast episode 52 for her website on the topic of "Infertility" where I outlined the common causes of fertility challenges couples have, the medical assessments that can help uncover these challenges and options for how couples can optimize their fertility from a naturopathic perspective using botanical medicine, nutrition, lifestyle modifications and naturopathic care.
Dive in with me for more information!
Infertility is such an important health topic that doesn’t always get enough attention and education. I’m really happy to be able to share information and bring some light to it. Many of you know that the definition of infertility – is a couple that has been trying to conceive with regular unprotected intercourse for 12 months or more unsuccessfully. Before which you are technically not considered "infertile".
From that definition thought; I’d like to change the way we talk about infertility – I think that word ‘infertility itself often brings with it negative thoughts or feelings that can be a stressor to couples trying to conceive. I want people who have struggled in this area to not hold fast to this term but rather come at this topic from a viewpoint that their fertility has a challenge that’s waiting to be overcome.
To look at the common cause of fertility challenges, we first have to understand how a healthy conception occurs. We can look at the process as 3 steps that need to occur for pregnancy to happen and then look at which point do challenges factor in:
First step - a sperm must be available
Second step - an egg must be available
Third step – the sperm has to meet the egg at a time and place conducive to fertilization
I know the steps sound obvious but at each step there can be certain things that don't line up well and are getting in the way of your healthy conception.
THE 3 STEPS TO CONCEIVE
Step 1 – is a sperm available.
This step is of course where the male factors are coming into play – like the quality of sperm, whether they are intact and viable, their count, their motility, whether antibodies against the sperm are present, the ability of sperm to bind to an egg and penetrate it. These are all examples of male factors that come into play at this step. Many of which will be influenced by a man’s diet and lifestyle.
For example, sperm count may be lowered by smoking and alcohol use, or environmental pollutants. Sperm motility is studies has been shown to be reduced when electromagnetic raditation – so ladies; making sure your men are not keeping their cell phones in their pockets. Things like that.
Anatomically; have there been or are there still any genitourinary infections (for example chlamydia or gonorrhoea) that may has caused inflammation or scar tissue that would impair sperm production and the proper ejaculation. Are there mental/emotional factors of stress that are affecting a man’s hormonal system that would factor into all of the above as well.
Step 2 - an egg must be available.
So now we’re thinking about our female factors which include whether a women is ovulatory and releasing her egg monthly, in the first place. Defects of the ovaries whether a woman is born with them (congenital) or acquires them, anovulatory cycles (when women aren’t ovulating monthly), hormonal imbalances affecting ovulation.
So we can pause here and explore that deeper. For our ovaries to ovulate each month – we need to have the right fluctuations in our female hormones predominantly estrogen, progesterone, FSH and LH.
Starting at Day 1 of your cycle (this is the first day of menses/ bleeding) in our "Follicular Phase" of our cycle, estrogen begins to rise, and so does FSH (follicular stimulation hormone) this combination of hormonal influence on our ovaries is helping to develop one of our follicles into a mature egg. Once estrogen (more specifically estradiol) peaks, around 2 weeks into our monthly cycle; there will be a surge of the lutenziing hormone (LH) (and FSH) that triggers the mature egg to be released. Followed by a quick decline in those hormones.
Then both estrogen, but more predominantly progesterone start to rise in the second phase of our cycle known as the Luteal Phase. Where progesterone is being produced by the corpus luteum which is the small area of the ovary where the develop egg was releases – its whats left over releasing progesterone to keep the uterine lining thick and ready for implantation to occur. In which case, the corpus luteum would keep pumping out progesterone for the first trimester of pregnancy until the placenta has grown big enough to take over the production and again keep the uterine lining thick and nousihing to the growing fetus. If we don’t have implantation we see a decline in both progesterone and estrogen and that decline in hormone triggers our uterine to shed, causing bleeding and Day 1 of the subsequent cycle. Where the fluctuations will start again.
The stimulus for the ovaries to produce hormones in such a way is coming from our pituitary gland in our brain releasing FSH and LH, in response to our hypothalamus part of the brain which controls the pituitary. So we have this beautiful and intricate hormone system that is a constant feedback loop to itself to make this fluctatuations happen cyclically. Also known as the hypothalamic-pituituiary-ovarian axis.
But what happens if we have issues at the hypothalamus level (hypothalamic dysfunction), pituiutary level (pituituary dysfunction for example protlactinemia – where too much prolactin is released affecting FSH and LH secretion), or the ovary level (defects of the ovaries, ovarian cysts, PCOS).
When we think about causes hormonal dysfunction at the level of the brain we’re thinking of the more serious and rare causes – like head trauma, growths, anorexia, genetic abnoralmities. But on a more common and less severe level – we’re thinking of how stress and our diet affects this HPO axis and the feedback mechniams in place that should keep it normal functioning but are so influenced by the rest of our hormone (endocrine system) which includes our thyroid and our adnreal glands. So again for factors of fertility challenges – we’re going to see thyroid disorders like Hyper-or Hypo function gland, including the autoimmune causes like Hashimoto’s affecting our hormone regultation and our proper ovulation. Because they are all conneted.
When we think adrenals gland, a discussion which naturopathic doctors cover with the vast majority of clients – we’re thunking of how our adrenals are affected by again our stressors and our nutrition. The adrenal glands are where our bodies secrete our stress hormones like cortisol and adrenalin. As well as some of our sex hormones – DHEA and testosterone come out of the adrenal gland (and for men, more testosterone is produced in the testis as well as we know). So you can imagine with our fast-paced and often emotionally overwhelming lifestles or experiences we’ve been through or are going through, even including the stress of ‘infertility’ , we’re going to see an impact on our menstrual cycle regularity from these hormonal factors.
Step 3 – the sperm has to meet the egg at a time and place conducive to fertilization
So what challenges do you think might come into play here?
When we think about the egg and sperm having to meet – we’re thinking what might be blocking the way?
The sperm have to travel through the cervical opening. So let’s stop here and think – is there scar tissue from suergical procedures (like cone biopsies, laser ablations, cryotherapy) or previous infections either causing issue of passage of sperm or an issue with the cervical glands that produce the cervical mcuus that is so important for the sperms passage, survival and travel. Where ideally the sperm is meeting the egg in the fallopian tube. Hostile cervical is a term for describing if the mucus present is hindering sperm – either if the pH is imbalanced or there’s presence of antibodies against sperm. Or maybe simply theres too little or inadequate cervical mucus being produced midcycle from a hormonal componenent.
Is there inflammation in the uterine, tubes or ovaries – thinking of ruling out pelvic inflammatory disease. Are there uterine or fallopian adhesions formed that change the structure and easy passage of sperm. Are there uterine fibroid potentially getting in the way. Is there a history of endometriosis (where urterine lining tissue made its way to the outside of the uterus potentially affecting ovaries, as well casuing painful periods) or salpingitis (and infection or inflammation of the fallopian tubes, also referred to as pelvic inflammatory disease) but would be definiately in the way of he travel of the egg and sperm. This can be caused by infections with microorganisms such as Neisseria gonorrhoea, Chlamydia trichomatosis, and others inclyding Eschericia coli. Where we might see bacterial vaginosis commone in these women.
Is there ovarian cysts present and how big are they and what is there location – are they pushing on the fallopian tube and blocking the natural passage of the egg on it’s way to meet sperm. Is there a condition called hydrosalpinx that has developed – where fluid build up in the fallopaisn tubes.
So we can see how at these 3 steps that need to occur there can be challenging factors at play that we need to not only assess well but treat well.
Here are areas where your healthcare practitioners will be assessing you:
Is there any clues in your medical history?
Doctors (both conventional and naturopathic) need to take a thorough medical history to pick up on where fertility challenging factors may be coming into play.
Is there a hormonal imbalance?
What are the menstrual cycle characterisitics?
How long is your cycle, is it regular, how long do you bleed for, whats the flow and color, are there any clots? Do you see fertile signs of cerical mucus changes mid cycle? Are there PMS symptoms like breast tenderness and irritability? Are your periods very painful? These are all questions we need to know answers too when thinking about hormones.
We can can check for underactive thyroid both from blood tests but also from tracking basal body temperature on waking throughout the month.
We can checks levels of estrogen and progesterone in blood or saliva samples. When blood tests don’t give us enough information, a month-long salivary test kit where women collec their saliva samples every 2nd day of a full cycle – and off it goes to a lab in Alberta thatmeasures their estrogen, progesterone, testerone and DHEA levels to look for those monthly fluctuations. So that’s a great specialized test that’s not available through OHIP but is available through naturopathic doctors.
Checking the blood test for high prolactin to catch if there’s potential issues at that pituitary level.
Is ovulation occurring?
Tracking basal body temperature can give us an idea of whether ovulation occurred,
Getting ultrasound imaging to monitor the ovaries around ovulation and looks for signs of it is a great tool often used by fertility specialists but can be requisitioned by your family doctor.
Checking for levels of leutinzing hormone around ovulation – so this is when ovulation predictor kits from yoru local pharmacy are great to check a urine sample and give you the confirmation that you are ovulation. They can be of course if your using multiple tests each month but a great tool.
Checkcking levels of progesterone day 20-23 of the menstrual cycle seeing that it’s elevated in response to an egg having been released and that corpus luteum producing progesterone.
Are the fallopian tubes blocked?
Is there a history of infections, a congential abronoamlity they can see on imaging, a previous ectopic pregnancy (which may have ruptured a tube), a history of lower abdominal surgery (for example for a rupture appendix which may cause a block)
Is there endometriosis, firboids, adhesiosn or scarring.
A hysterosalpinogogram – xray of the uterus and fallopian tubes can be taken after your period and may show structural abornoaltiies that we mentioned previoculy.
Were there any previous infections?
Doctors can run a screen for genitourinary infections – including chlamydia and gonorrhea for both men and women to rule out.
Is cervical mucus friendly to sperm?
A pH test is good to evaluate acidity of cervical mucus
There are more medical testing options for this factor if necessary as well.
Are there any immune-mediated caused?
Autoimmune disease such as SLE (lupus) and thyroid antiboides. – checking bloodwork for this.
For the men - what is the quality and quantity of there sperm?
A semen analysis will dertmine count, motility and presence of antibodies which is a great start. This test can be requisitioned by your naturopathic and family doctors.
Are there emotional factors like stress causing the subtle hormone imbalances that can a huge impact
Naturopaths can run salivary cortisol testing to see adrenal output of stress hormone cotirol so get an idea of adnrela syfunction. Or by assessing your clinical picture well to get an idea of stress coping and resilience.
What is the person's nutritional status?
A detailed looked at your nutrition will also be helpful in guiding your treatment plan and optimizing fertility.
OPTIMIZING YOUR FERTILITY
Firstly start checking for ovulation and fertile signs at home.
Checking basal body temperature - click HERE for a downloadable copy
On waking check your temperature with a thermometer and writing it down. Usually the first half (follicular phase) of a womens cycle temperature will be around 97oF, once ovulation occurs, and progesertone is the dominant hormone – it’s more thermogenic in nature and we will see a small increase in body temperature that remains elevated for approximately 10 days After ovulation before progesterone starts to drop in preparation for menses or conception has occurred in which case temerpature stays elevated and climbs.
Just note: this tool is not used to predict ovulation for the couple and their intercourse timing but rather confirms ovulation occurred retrospectively. When combined with monitoring cervical mucus observations – it can be very informative and valuable tool for couples to use.
Monitoring cervical mucus changes
Daily monitoring of the texture, quality and quantity of cervical mucus secretions can be useful to predict ovulation. Cervical mucus secretions change throughout the cycle under the influence of estrogen and progesterone.
Approximately 2 or 3 days before ovulation occurs, the estrogen levels peak and the nature of the mucus change from a pasty thick or milky consistency to a distinctive stretchy mucus (usually 6-10cm) of wet consistency and opaque colour. It resembles similar texture and nature to raw egg white.
At this stage of the cycle, the mucus is an optimal reservoir to nourish sperm and encourage their survival for conception.
When a woman is monitoring her certical mucus changes, it is recommended that she feel the texture of the mucus (at the vaginal opening) between the forefinger and thumb and not use toilet paper to collec the sample (as it absorbs moisture and may lead to misinterpretation of the mucus viscosity). When estrogen levels are lower in the early follicular phase and midluteal phase of the cycle, the mucus secretions are thin, milky and sparse in nature. We'll talk much more about this in our clinic consultations.
Ovulation test kits
Home test kits that measure urinary LH levels are available for ovulation preduction. These are single use tests and their disadvantage is the expense when used regularly.
Work with a Naturopathic Doctor
Couples are encouraged to participate in a 3-4 month period of preconpation care, in which their overall health can be improved with the use of herbs, nutrition, dietary and lifestyle modifcations.
Together with herbs, acupuncture can be very effective in helping a woman conceive. It will help work on your body's hormonal system as well as address imbalances of other kinds that are affecting your fertility.
I love this quote referring to optimizing fertility with traditional Chinese medicine
“Restoring optimal health permits the expression of our natural fertile state. Our job is simply to be ready for the occasion when the universe says, ‘It’s time.’"
– R Lewis
Using Botanical Medicine
Botanical treatment of infertility cannot addres overt physical impediments to fertility; however, it can provide treatment and support for numerous fertility-related problems; such as hormonal dysregulation, thyroid and adrenal disorders, genitourinary infections, immune dysregulation, and stress-related problems mentioned above, and would be thoroughly assessed by your ND.
Some favourite herbs to use for fertility optimizing include:
Angelica sinensis (Tang kuei), Caulophyllum thalictroides (Blue cohosh), Viburnum opulus (Crampbark), Chamalerium luteum (False unicorn), Mitchella repens (Squaw vine), Rubus idaeus (Red raspberry), Trifolium pratense (Red clover), Urtica dioica (Nettle), and Vitex agnus casti (Chaste tree berry). Your ND or herbalist will understand how and when to use each herb based on your unique health and fertility challenge.
Address nutritional deficiencies that can impact fertility; such as folic acid, zinc, iron, vitamin B6 and iodine. Make sure your diet if nourishing your body and not hindering your fertility success.
We'll talk sleep, stress, and environmental exposures; working to increase your hormonal health through lifestyle modifications that affect your balance.
Give it time
Herbal therapies should be used for a minimum commitment of 3-4 months to improve the fertility of a couple prior to conception
If conception has not resulted after 12 months of naturopathic therapy, then other medical options may be considered.
CONNECT WITH ME
If you're actively trying to get pregnant and having trouble, wondering where fertility challenges may be factoring in, or simply wanting to understand your fertility signs better, then consider working with a naturopathic doctor near you!
For those local to the GTA - book a 15 minute free introductory appointment at either of my clinic locations to meet each other and get to know how a naturopathic doctor can help you optimize your unique fertility.