Functional Fertility - Part 1

Is It a Timing or Production Issue?

So many things can disrupt a female’s hormonal cycle and therefore ovulation that it is amazing any pregnancies occur. I contribute that fully to the grace of God. Stress and oral contraceptives are among the biggest offenders. Women are all too quickly put on birth control pills when there are having any unwanted or uncomfortable cycling issues and these pills almost always wreak havoc on the natural timing and production of hormones that every woman should have. This disruption in timing and production can make conceiving a massive challenge. However, the good news is that it is pretty easy to find these abnormalities and correct them with a functional medicine approach and the right testing.  

A Delicate Situation

This is obviously a delicate and difficult topic for those experiencing difficulty conceiving and there are many factors that can play into the process besides just timing and production of hormones. We will save most of those for a future blog but I wanted to start with optimizing female hormonal cycles first because it is one of the most common causes of fertility issues. Other factors that play in are nutritional status of the male and female.  Sperm motility and quantity is completely dependent on how well they are nourished. The female's eggs (fertilized or not) are protected by certain nutrients in the diet and possibly supplements as needed. A diet high in fast food and soda will leave the body nutritionally deficient and an obvious disadvantage to conceiving. Again we will leave that for a future blog. Even considering some genetic or anatomical disadvantages, optimizing the hormone timing and production will improve the possibility of conception significantly.

How Stress Affects Your Female Hormones

Stress in any form will put the body into the stress response. The stress response was created by God to aid in our survival in stressful situations like famine or escaping the attack of a wild animal. Therefore the stress response is actually a survival response. What happens when the body is trying to survive? Another evidence of a brilliant designer is seen here. If you were trying to survive in a situation where food is sparse and you are having to move your family hundreds of miles to a place where hopefully the situation is better, the last thing you need to be focusing on is reproducing right!? Your body will divert its attention away from making sex hormones like testosterone, estrogen, progesterone and DHEA to make survival hormones like cortisol and adrenaline. Your body will also down regulate your metabolism so you don’t burn calories as fast to conserve and help you survive! Evolutionary chance or brilliant Design? Cover your eyes if you don’t want to see the obvious.

The big point is that any chronic stress will deplete the body over time of its sex hormones and cause hormonal imbalances leading oftentimes to an estrogen-dominant state. Take a look at the chart below. Progesterone is used to synthesize cortisol and therefore will drop fastest during chronic stress. DHEA pathway will also get less attention thereby dropping the testosterone and estrogen levels but not as far as progesterone. This will lead to all sex hormones typically being low but in a relative estrogen dominance. This can definitely be confusing and needs more than a paragraph but in summary,  estrogen dominance is not good. Though it is somewhat over-simplified you can do more reading on this topic by researching "Pregnenolone Steal." It will lead to PMS symptoms, abnormal cycles and bleeding, difficulty conceiving, and increased risk for estrogen driven cancers like uterine, breast and prostate (for the men reading this). 

 

Is PMS normal?

PMS has almost become a household term and an expected time of the month where men stop speaking for several days and children hide in their closets until the storm passes. This is NOT NORMAL. Let me repeat myself...This is NOT NORMAL. Hormonal fluctuations during a female cycle should be smooth and the main noticeable symptom should really only be increased libido around the fertile time of each month. If Dr. Jekyll and Mr. Hyde exist inside of you, please seek out  a functional medicine provider and get your hormones balanced. You really want to see what your entire cycle looks like so find someone who does full month long salivary hormone panels.  

Healthy Cycles = Healthy Fertility

The two main problems within a female cycle that will make conception nearly impossible are a TIMING issue or PRODUCTION issue. By timing, I mean that ovulation is not occurring around day 14 like it should. If you are ovulating on day 3 instead of day 14 then you have almost no time to build up an endometrial lining to house a fertilized egg (aka: a baby!). If you are ovulating too late then your body didn’t have time to have a good progesterone spike and sustain the endometrial lining. Here is an example of poor timing. 

 

As you can see with the two spikes of progesterone that should follow a estrogen rise signifying ovulation, this patient almost looks like she may be ovulating twice - both at the wrong times! Look at a picture below of what a normal cycle should look like. After the hypothalamus and pituitary cause a spike of Luteinizing Hormone ovulation occurs. This delicate cycle can be easily disrupted with years of poorly managed stress and birth control use. The good news is that it is always wanted to get back into balance again and sometimes it does not take as long as you might think.

 

Another common abnormality seen on the month long panel is an insufficient amount of progesterone spike after ovulation occurs. This is unfortunately a common and easily corrected cause of recurrent miscarriages. If you have had one or more miscarriages please visit us or someone who can look at a month long salivary hormone panel on you. Also ask your PCP to run a genetic test called MTHFR and get a fasting serum homocysteine level to make sure there is not a gene mutation that needs significant nutritional support and likely a switch in prenatal vitamins. A urine organic acids test would also benefit you to further look at methylation status and possible nutrient needs. This will be discussed further in Part 2 of Functional Fertility.

Healthy Adrenals = Healthy Hormones

While stress definitely disrupts the female hormone cycle, it is simultaneously disrupting the Adrenal Hormone production. This is critical to grasp because if you try to fix the hormonal cycle without addressing the broken HPA axis (Hypothalamic-Adrenal Axis) then you will spin your wheels. When the stress response is brought under control and adrenal hormone production is supported and balanced, the body’s natural production of sex hormones can be restored! Hence the importance of stress physiology. Please read through some of the other blogs on adrenal health and try to make it to one of our monthly Group Visits on Restoring Balance: Stress Hormones and Your Health. Click HERE to get more info.

One Big Piece of the Puzzle

Though hormonal timing and production issues are not always the root cause of fertility issues, they are one of the most common and a great place to start. Nutrition of both spouses is also critical and will be the topic of the next fertility blog so stay tuned. It is also important to not ever place our complete trust in anything other than God. Sometimes we will never find an answer to the “why” behind our trials but remind yourself of this: God is always working things out for His glory and the good of His people. Do your part and take action. Steward your body well. Eat clean. Give your body adequate rest. Don’t try to play God by worrying about everything. But in the end, no matter what comes your way, trust in the Sovereign Creator and Sustainer of life, Jesus. He is worthy to be praised even if we never receive another blessing from His hand. Here is a good time for a book recommendation. Trusting God: Even When Life Hurts by the late Jerry Bridges is one of the best reads for your soul if you are struggling with recurrent pregnancy loss or any other trial.