Infertility

Infertility is on the rise, affecting 12% of the population of reproductive-aged adults. Of those, some 25% of infertile couples have more than one factor at play.

This study from 1992 showed that over a 50 year period until that point, sperm count halved, from 113 million sperm per milliliter to 66 million sperm per milliliter. Today, above 20 million sperm per milliliter is considered “normal.”

Why this might be: a leading theory is the decline in testosterone levels even in younger men and, in cases of increased body fat especially, increased levels of estrogen due to aromitization. Adipose tissue (fat cells) contain the enzyme aromitase, which converts testosterone into estrogen. Thus, the higher the body fat, the lower the testosterone levels (leading to lower sperm production) and the higher the estrogen levels. The obesity trends, therefore, probably have a lot to do with the lower sperm rates.

Other strong contenders for this phenomenon include chemicals that act like estrogen in the body, especially BPA (which lines canned foods), and phthalates in flexible plastics (disposable water and food containers, and seran wrap). Phthalates also show up in personal care products very frequently. There are quite a few other chemicals that act like estrogen as well, though—read here for the big ones.

Why sperm count and quality matters: some 30% of infertility issues are on the male partner’s side, and it’s a lot easier to test sperm count, morphology (make sure they’re not mutated) and motility (make sure they move well) than it is to put a woman through the much more invasive tests a female infertility workup requires. So start with the guy first.

Obesity, of course, goes hand in hand with insulin resistance, as does PCOS in many cases (below). Too much insulin decreases Sex Hormone Binding Globulin (SHBG), which leads to more circulating testosterone and estrogen. Since low progesterone (luteal phase defects, below) are often a problem for getting pregnant, and estrogen opposes progesterone, this is one possible issue associated with obesity; another is anovulation (not ovulating), which happens from estrogen dominance as well.

It doesn’t take that much— even losing 5-10% total body weight can restore ovulation!

Hypothyroidism decreases SHBG as well, and conversely, high estrogen levels can increase the Thyroid Binding Globulin, contributing to hypothyroidism. So the problem with fertility probably isn’t the thyroid itself—it’s more the effects that has on sex hormones, especially increased estrogen.

Along these lines—early stage Adrenal Fatigue can also contribute, since the direct precursor for cortisol (the stress hormone) is progesterone. When you’re stressed, your demand for cortisol goes up, which means progesterone (necessary for implantation—see Luteal Phase Defect below) goes down.

I wrote about PCOS here; the issue with PCOS, aside from the fact that there’s always hormone imbalance associated with it, is that it often causes anovulation.

The menstrual cycle starts out with the follicular phase, thickening the endometrial lining, and then ovulation happens, followed by the luteal phase, which is the phase of elevated progesterone (think pro-gestation). This helps to nourish a fetus after implantation, if it has occurred. If an entire cycle is less than 26 days or the luteal phase (post-ovulation) is less than 11 days, it’s too short: it has to be long enough to allow implantation, because you only have about a two day window at best for that to occur.

Generally this is due to low progesterone levels. Another possible cause is too little melatonin.

If a woman is still having periods but just not ovulating, it’s again usually estrogen dominance. Look for estrogenic chemicals as a possible cause!

If not menstruating (amenorrhea: no period for over 6 months), there are a number of possible causes. The obvious ones to rule out are excessive exercise or eating disorders, but chemical exposure, hypothyroidism, a pituitary tumor (below), a zinc deficiency, or even late-stage adrenal fatigue can cause this as well.

A woman is born with all the eggs she will ever produce, so the ovarian reserve matters (higher is better, and the number declines with age). However, the quality of the eggs she has left also matters; this too declines with advanced maternal age. Lab markers, such as AMH (Anti-Mullerian Hormone), and FSH and Estradiol on Day 3 of the cycle, help to indicate the quality of the eggs. There are a few natural interventions that can improve egg quality, if the labs suggest that the ovaries are underachieving.

By the time a patient sees me for infertility, most of these have already been worked up. But if not, they’re worth investigating:

• Clotting issues
• Fibroids (depending on the size of the fibroids)
• History of PID (Pelvic Inflammatory Disease): this can lead to tubal scarring
• Other structural abnormalities
• Endometriosis (there is always estrogen dominance in these cases!)
• Autoimmunity, especially untreated Celiac Disease.
• Pituitary adenomas

I certainly do refer out for more advanced testing when necessary; however, we can tell a lot from simple blood tests, and specific interventions will depend on the results. Nearly everything I’ve listed here is treatable!

As a general rule, though, to optimize fertility for BOTH genders:

• AVOID SOLVENT Chemicals, especially BPA, phthalates, and really everything else on this list. It is possible to test for solvents like these (it’s a urine test), but generally speaking, if you avoid exposure, levels drop in about 2 weeks. Along those lines:
• Get a HEPA filter. I like Blue Air, because it’s a good compromise between quality and cost—     “>here’s an affiliate link for the one I have. I’d recommend keeping it in your bedroom if you only get one, because you spend up to a third of your life in there. (Or at least you should, if you’re sleeping enough.) On that note: 
• Maintain a normal sleep cycle. This guest post gives some great tips on how to achieve this.
• Avoid heavy metals. These also can disrupt your hormones, especially mercury and lead.
• Minimize your caffeine. Caffeine increases circulating estrogen (check out the linked article for more on how); if you keep the coffee under about 12 oz a day, though, the effect should be negligible.
• Lose weight. This is huge for reducing insulin sensitivity and restoring ovulation for women, and improving sperm count for men!
• De-stress. Easier said than done, but trying to conceive is obviously very stressful. This increases cortisol, both lowering progesterone and contributing to hypothyroidism, which in turn leads to estrogen dominance. Perhaps for this reason at least in part, this study shows that fertility support groups involving relaxation and imagery helped 55% of couples to get pregnant (compared to 20% in a control group). So start meditating! Go out and have fun. Go on vacation. Do what feeds your soul.