Abnormal Cervical Mucous
Optimal cervical mucous is sometimes ignored in a fertility work-up. It is essential to have good quality cervical mucous at the right time in the menstrual cycle (in the days leading up to ovulation). If the cervical mucous is too scanty, it can inhibit conception as this is the channel that sperm use to travel through the vaginal canal to the cervix. Other factors related to cervical fluid are immune related, where the fluid becomes ‘hostile’ to sperm and they do not survive in it. And finally, chronic infections especially yeast can cause changes in cervical fluid making it sticky and thick instead of clear and egg-white texture. Keys to treating cervical fluid issues are to improve hormone balance, treat underlying infection and to look for immune factors and then modulate the immune system.
Advanced Maternal Age
Amenorrhea and Anovulation
Amenorrhea and Anovulation is a common cause of infertility that many women do not recognize until they start trying to conceive. Again with this condition, we need to determine the cause – is there some degree of polycystic ovarian syndrome? thyroid imbalance? have you just stopped oral contraceptives? Amenorrhea is an extension of this where there is no menstruation. Here, if we are able to first determine the cause (stress, weight loss, over-exercise, coming off oral contraceptives, PCOS, thyroid imbalance, to name a few), then it can be reversed and fertility restored.
With autoimmune infertility, the immune system may react against sperm, embryo implantation or hormones. To treat autoimmune conditions, we first need to determine what is causing the immune system to over-react. This often means testing for food sensitivities, supplements to support optimal immune system function, stress management and treatment of the digestive tract. When the immune system has settled down, the autoimmune component of fertility will settle too and then conception occurs. This is one of the most common causes of ‘unexplained’ infertility – where the body’s own immune system is blocking conception.
Endometriosis is a condition that causes severe menstrual pain, pelvic scarring and adhesions and often affects fertility. Our approach to endometriosis involves several components – calming an overactive immune system, minimizing inflammation, correcting estrogen dominance, reducing internal scarring and adhesions, and addressing mental / emotional components that are often present with this condition. By treating the underlying causes, the pain of endometriosis is often greatly reduced, and fertility can follow. This condition may take a little longer to treat than our typical program as there are many components affecting fertility.
High FSH is a condition that is often very frightening in a fertility assessment. When FSH is high, it simply means that the ovaries are not responding to the pituitary gland’s message. In some cases we are able to lower the FSH prior to conception, and in others, women successfully conceive in spite of a higher than optimal FSH. Best results are seen in the FSH 10-15 range, although I have seen numbers drop from much higher, and result in successful pregnancies.
There are many supplements available to support egg quality now (the most well known being Coenzyme Q10 – although as a Naturopathic Doctor, I am aware of many others too), and this combined with treatment for hormone balance can actually ‘turn back time’ enough to allow pregnancy in many cases!
There are many types of hormone imbalance that affect fertility – for example low estrogen, low progesterone, estrogen dominance, thyroid imbalance, high testosterone. Hormone is carefully diagnosed through lab testing, in order to thoroughly understand how to support your fertility best.
Luteal Phase Defect
The length of the period after ovulation which is known as the luteal phase is one essential component in maintaining a pregnancy. To successfully conceive this period needs to be at least 10 days in duration. There are several approaches that can assist this ranging from dietary changes, to nutritional supplements to acupuncture. It is also essential to address stress hormones, as progesterone levels are strongly affected by cortisol.
Male Factor Infertility
Male Factor Fertility: Men’s health is just as important for fertility as women’s health. In many cases, impaired fertility is due to male factors such as low sperm could, poor sperm morphology, low sperm motility or DNA fragmentation. In these cases, treating the male partner with dietary recommendations, a supplement program as well as acupuncture is very effective in getting the levels up to normal. It typically take 3-4 months of treatment to see results. Other important details to discuss are: any medications your partner is taking, alcohol intake, smoking, weight, blood pressure, nutrition and stress levels – not only the numbers on a semen analysis.
Ovulation dysfunction can occur due to issues related to the hypothalamus, pituitary or ovaries. If ovulation is occurring periodically, but not every cycle this is very treatable with natural medicine and acupuncture. The key is to determine where the ovulation dysfunction is coming from. Again, here is where diagnostic testing becomes invaluable. For an accurate treatment, we need to understand the cause, some of which could include: stress levels, thyroid imbalance, polycystic ovarian syndrome, being under or overweight, over-exercising, ovarian cysts, or others.
Polycystic Ovarian Syndrome (PCOS)
PCOS has become a common disorder affecting women’s fertility and ovulation, and there are many cases with ‘borderline’ diagnoses. Treatment approach uses a combination of dietary changes, optimal exercise, supplements to support ovulation / hormone balance / blood sugar levels, and in some cases acupuncture. With treatment, ovulation resumes and pregnancy can follow, even in difficult cases.
Premature Ovarian Insufficiency / Failure
These are cases where the reproductive system shows sign of menopause early. In some cases this can be reversed, particularly when there is a hormone imbalance related to the adrenal glands or thyroid involved as all of our endocrine systems are interrelated. In cases where menstruation has stopped after a prolonged period of high stress or illness, supporting the adrenal glands, lowering stress and optimizing hormonal balance may restore fertility.
If however, menopausal changes are in full effect, then support the body for conventional fertility treatment with IVF / egg donor is an option. Here, Naturopathic Medicine and acupuncture play a supportive role in preparing the body for the best possible outcome.
In cases of recurrent miscarriage, I have had many successes in supporting women to maintain a full pregnancy. A full assessment is required to determine if there are factors such as:
- autoimmune markers
- thyroid disorder (even when borderline)
- high stress levels
- structural abnormalities (uterine shape or
- clotting disorders
- egg quality issues
These are a few of the factors to examine with recurrent miscarriage, although a full fertility assessment is part of any initial consultation.
Secondary infertility is when you have conceived before, but are having difficulty conceiving a subsequent time. In these cases, the key is determining the cause of difficult fertility and reversing this. The good news is that we already know you can get pregnant – half of the variables are taken care of. Factors to examine here include:
- age-related changes (high FSH or decline in ovarian reserve)
- structural abnormalities from a difficult birth or pregnancy
- changes in thyroid function
- stress levels
- emotional trauma from previous pregnancy or birth
- growth of fibroids or progression of endometriosis
Stress and Fertility
Stress and Fertility: I strongly believe that stress affects fertility and routinely test stress hormone levels to show an imbalance. Since all of your endocrine systems are interrelated (adrenals, thyroid, ovaries), when one is out of balance, it can easily pull the others out of balance too. Reproductive hormones are not functioning optimally when you are under high stress.
The impact of stress include:
- Stress affects progesterone production in the luteal phase of the menstrual cycle. This can cause ‘luteal phase defect’, or simply affect implantation in the luteal phase.
- Stress affects blood sugar regulation which in turn will worsen hormone balance in women with polycystic ovarian syndrome (PCOS).
- Stress increases inflammation in the body and can worsen inflammatory conditions related to infertility: hypothyroidism, autoimmune conditions, endometriosis and the presence of any autoimmune antibodies.
- Stress increases prolactin levels which then inhibits ovulation.
- Stress also affects the surge or LH (luteinizing hormone), which is a pituitary hormone responsible for beginning ovulation.
- Stress has also been found to reduce cervical mucous, and reduce the thickness of the endometrium by affecting estrogen levels.
Thyroid Disorders and Infertility: Thyroid disorders are a common cause of infertility, and from a naturopathic perspective they are often misdiagnosed. An under active thyroid for example can cause a lack of ovulation, a disruption in the luteal phase, irregular menstruation or miscarriage to name a few. This is a condition that we are very careful to assess and diagnose as it plays such an important role in fertility. There has been much discussion in the past decade on the optimal range for “TSH” testing, with many people symptomatic with levels in the so-called normal range. For optimal fertility and to reduce miscarriage risk, it is essential that thyroid function be in an ‘optimal’ range of testing – this often means a more detailed assessment with blood tests for TSH, free T4, free T3, thyroid antibodies, and basal body temperatures.
Also called myomas, uterine fibroids can mechanically obstruct and inhibit implantation. In some cases, we can work on shrinking fibroids prior to conception, and in others the focus is on reducing hormonal stimulation of the fibroids by correcting the underlying hormone imbalances (estrogen dominance and often thyroid involvement).