Fertility is the New Holy Grail

Resolve to know more about the underling factors affecting conception and alternative family possibilities. * This article was originally written for the February 2015 Digital Issue of Essential Living Maine*

I had two stepmothers who were infertile for various reasons, and have an adopted baby brother. Several of my close friends and family member have used IVF to conceive, and I have my eggs cryopreserved. A few of my good friends have fostered and adopted, and others have intentionally chosen childfree lives. As lesbian and gay marriage has normalized, and divorce rates have climbed, more and more alternative families are being created using sperm banks, surrogates, egg donors, known sperm donors and more. The quest for fertility is all around us, and has been for the past 30 years in ever-increasing numbers.

The Internet has an enormous amount of information available on this topic, as the World Wide Web offers an enormous cross cultural support network for women trying to conceive (#TTC.) Infertility is usually a silent disease without any visible disability associated; however, it draws deeply on the mind/body and soul in underground ways that cannot be explained to those who do not have to undergo its trails and tribulations. Thus, the web is a great way to connect, share information, and do research while maintaining public anonymity.

220px-Sangreal-1Integrative Medicine is key to enhancing fertility. Integrative Medicine combines the best of modern medicine (reproductive technology) with time-honored complementary and alternative medicines (botanical therapies, clinical nutrition, homeopathy, acupuncture, and stress management support.) The quest to get pregnant (and stay pregnant!) has been a calling of doctors and midwives since the beginning of time and across all cultures.

After ten years of fertility specialization, here are my Top Ten Integrative Medicine Fertility Fundamentals to know about when mapping your journey:

  1. First, while on oral contraceptive pills, rings, or IUD’s and for at least 6 months coming off them, it is important to supplement with a good quality multivitamin that contains at least 10-20mg of all of the B vitamins, magnesium, vitamin C, and 800mg folic acid. These are depleted by synthetic estrogens, and a deficiency can cause long term fertility issues down the road.
  1. If you have a family hx of miscarriage, have had a miscarriage yourself, or have any anemia or high homocysteine on lab work, you may want to test for a genetic defect called MTHFR that leads to a folic acid absorption issue. http://www.apothecarybydesign.com/blog/archives/332
  1. DHEA is a fat-soluble antioxidant and hormone precursor produced by the adrenal glands. DHEA is also a key player in egg health, showing improved embryo quality and higher live birth rates than controls. Studies have used 75 mg of DHEA daily. 1 DHEA supplementation also evidenced higher rates of spontaneous pregnancies in long-term poor responders to IVF in another study using 25 mg three times per day. 2 DHEA supplementation slows the aging process by preventing lipid oxidation while improving energy and metabolism.
  1. CoQ10 is imperative to egg health. Egg division from 46 to 23 chromosomes requires effective mitochondrial function. 3. It has been suggested that mitochondrial DNA defects that effect metabolic capacity may be a cause of failure in egg maturation, fertilization, or early embryonic development. 4. Aged eggs have decreased mitochondrial energy which can result in deficient energy to divide properly resulting in Downs’s syndrome and other genetic anomalies. All women over 30 who are still considering pregnancy should be on 100mg of ubiquinol daily to maintain efficient mitochondrial activity.
  1. Test your hormones early, and keep testing every few years for an objective measurement of fertility reserves. Follicle Stimulating Hormone (FSH) levels must be tested on day 3 of the menstrual cycle with Anti Mullerian Levels (AMH) levels before beginning fertility protocols. FSH reflects the relationship between the ovaries and pituitary and higher levels indicate perimenopause and poor ovarian function. Therefore, levels of FSH under 10 are best. AMH is also called the “egg timer” as it gives an accurate level of the follicular reserves of the ovaries. AMH levels do not fluctuate throughout a cycle and can be tested at any time. Serum AMH levels decline throughout ones reproductive life cycle, and are undetectable after menopause; therefore, higher levels are more desirable.
  1. Don’t wait too long to consider IVF. If you have been #TTC for more than 9 months and have not become pregnant with regular, timed inseminations, IUI’s or intercourse, make appointments with a fertility clinic and an Integrative fertility specialist. Having a Plan B will decrease stress, and it takes time to consider the financial and medical burdens associated with reproductive technology. However, it is worth it to have that baby in your arms! If IVF is needed, committing to the process earlier in your fertility journey can increase your chances for that #BFP (Big Fat Positive) on your first attempt.
  1. Don’t forget the men! At least 30% of infertility is male factor. Too often one half of the couple is doing everything possible (yoga, clean eating, no caffeine, no alcohol, meditation, support group, acupuncture, etc) while the other half is the root cause of the issue. Getting a sperm analysis is one of the first steps in a fertility evaluation, and can bypass months of angst from non-conception.
  1. Sperm need fertility enhancing supplements too! Omega 3 fats, 15 mg zinc, and stress busting herbs like Maca or Ashwaganda will improve sperm health, tonify libido and boost fertility.
  1. Have your thyroid hormones including TSH, Free T3 and Free T4 and your progesterone levels tested. Low thyroid function leads to low progesterone, which leads to frequent miscarriage in a classic vicious cycle. Some Endocrinologists and Family Docs may have conservative opinions on these levels and may use outdated reference ranges or be unwilling to test for Free T3. Consulting an Integrative Medicine Doc, Naturopathic Doctor or anti-aging Hormone Doctor may give you more information about optimizing your hormone levels rather than operating at a subclinical deficiency.
  1. Consider alternatives to the traditional nuclear family. There are many beautiful babies who want safe, stable, loving homes and need fostering and adoption. I know three amazing families of beautiful fostered babies! There are also women able and willing to carry babies to create families that are not their own. While a biological birth is what we are taught to dream for, this is not the answer for some. Infertility is tragic and real for people who have always assumed they would be able to birth when they are ready. Allow your self to grieve as a couple, but do not close the door on other options even if they seem inconceivable at first.

On another note, childfree living also has many blessings. Our culture is slowly shifting away from the definition of having a (nuclear) family as the ultimate success. Childfree living allows for a more relaxed and abundant lifestyle with more freedom, ability to travel, and heightened romance for a couple. We are an overpopulated planet, and I know from my life, having an auntie that is invested and involved in my life is incredibly valuable. Here are many ways to be a part of a family, and each version needs to be recognized as equally valuable and important!

I could keep typing another ten set of treatments supports, and probably another ten after that,  I am so passionate about fertility! However, as I said earlier the Internet is a rich resource. Some other articles I have written on the topic include:

I wish each of you success on your Holy Grail of Fertility. May your journey connect you to your own Divine nature as you experience one of the great, uncontrollable mysteries of life: Conception!

References

  1. Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500Accessed September 13 2013
  1. Leonidas mamas, Eudoxia Mamas. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Current Opinion in Obstetrics and Gynecology 2009, 21:306-308.
  1. David Meldrum, MD. Aging gonads, glands, and gametes: immutable or partially reversible changes? Fertility and Sterility 2013; 99:1-4.
  1. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5.

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A Note from Behind the Curtain

So many patients are looking for answers. As a doctor I know that the best answers are in each individual. Usually, we do not want to know the real answer. We want a pill, or a cream, or a smoothie containing the essential nutrients that will add up to the ultimate results. Dont get me wrong – products will help. Testing can uncover imbalances and deficiencies to be corrected and appropriate formulations to improve symptomology. However… until you are actually ready to change something – that thing- – which needs changing in your personal landscape, it is unlikely that you will find your own true answer to health. I will use myself as an example.

After I graduated from Naturopathic Medical School in 2000, I opened a clinic in downtown Toronto with some of my classmates. Over the next 12 years I developed my professional identity, grew my patient base, and pursued my personal passion of fertility medicine. I had a wonderful partner, a beautiful home and fantastic friends. I was never fully content, despite my abundance. I doubted my career and profession, and was constantly seeking something outside of myself to fill the inherent void. No amount of adrenal supplements, detox regimes or magnesium quieted the inner voice. This was not an organic condition, it was a calling that took me many years to acknowledge.

Eventually, I moved to Portland Maine in March 2011. I sold my clinic, left my clinic faculty position, and my sweetheart and I parted ways. Here, life is different. I smell the ocean every day. I do yoga (occasionally.) I walk the dog. I drink green tea. I am redefining myself as a Naturopathic Doctor and am inspired by the new turns my professional identity is taking. I am becoming a better doctor – the best version of myself. It has been a massively stressful process to redefine my life in my late 30’s. However – the gray hairs are worth the evolution. I am happy in a way I have never been. And it is not because my physical, emotional, or mental health has changed drastically. It is because I have found my own answer.

Not everyone’s answer will involve so many miles and such upheaval. The answer to your own health and wellness questions may simple or complex. Part of my job as a Naturopathic Doctor is to look beyond pills and dietary restrictions to see your truth behind your curtain, and support you in finding your own evolutions. If I can do it, I am sure to believe in you.

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Alternative Medicine

A friend of mine recently asked me what Alternative Medicine was. Ask 50 people, and you may get 50 answers! I can tell you my answer. It is intricately tied in with Sociology, Cultural Studies, and Anthropology. To understand a cultures medicine is to have a clear window into their worldview. Modern American “Alternative Medicine” is a broad spectrum of many cultures traditional medical practices – Asian Medicine and Acupuncture, Indian Aruveda, Native American and “Eclectic (European western) Herbalism, German Homeopathy, and many others.

Alternative Medicine is the other side of Allopathic Medicine. Allopathic Medicine is the current model of western medicine implemented in 1909 by Flexner and the newly formed American Medicine Association at the turn of the century. Alternative Medicine and Allopathic Medicine differ in their basic model of patient care. The former is patient-based, where an individual story, environment, life experiences and constitution all play some role in the current health problem. The latter is based on symptom assessment and diagnosis, with an emphasis on pharmaceutical and surgical management. Truly – both are needed in modern medicine. The best care comes from a marriage of the two.

When this friend asked, I answered her with a reply of what Naturopathic Medicine is.  I believe Naturopathic Medicine represents the best of Alternative Medicine! It combines evidence-based medicine with a body of knowledge that is evidenced by time. Naturopathic Medicine is an umbrella term that relates to an Alternative Medical practices that all adhere to a general principle of care that is combined with modern cutting edge diagnostic and clinical-medical training. Naturopathic Doctors must complete a 4-year post-graduate program with licensing and board exams to ensure that the skills needing to be a “Doctor” as well as “Naturopathic” are met.

The basic theory of Naturopathic Medicine is in the Latin phrase vis medicatrix naturae. The vis is the inner ability of the body to heal itself – the guiding inner principle that all Alternative Medicines have (and most traditional cultures recognize.) Medicatrix is medicine. And naturae is Nature. The body has the inner medical ability to heal itself, with the help of nature. The Naturopathic toolbox assists in returning one to a state of health, and includes Asian medicine, botanical medicine, homeopathy, lifestyle counseling, massage (and other hands-on bodywork techniques), and nutrition. In some states and provinces ND’s are also able to prescribe some pharmaceuticals and perform minor surgery.

To summarize – Alternative Medicine is a broad term that includes many different cultures traditional medicines. Naturopathic Medicine is a branch of Alternative Medicine that unifies the practices under a licensed scope of care. A Naturopathic Doctor is the Alternative Medicine Physician, providing patient-based care founded on the theory that your body has an innate ability to heal, when given the proper nature-based treatments.

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Caffeine, Detoxification, and the Healing Crisis

Days after quitting caffeine, I started coughing up and eliminating nasty amounts of toxic looking phlegm from my sinus and lungs. (sorry for the descriptors.) I had been suffering from sneezing, clear drippy nose and “allergy” or “cold” symptoms for a couple of months previous to this. So, while I was disappointed to be getting sick over the holidays, it felt like I was finally getting “something out” of my system that had been brewing for a long time.

I have searched many databases for evidence based articles linking caffeine and sinus and have only found articles related to caffeine and heart disease. Apparently there is no evidence based link. However, in searching Dr. Google for other peoples opinions on caffeine and sinus health, there is a relationship between the two. Caffeine diminishes adrenal health by deleting epinephrine and affecting cortisol levels. This in turn affects the immune system and inflammatory levels, which can lead to increased candida levels causing chronic sinusitis.

The body wants to be in homeostasis. This means, the body seeks balance. In its natural state, without drugs, the human body will naturally produce secretions to eliminate microbes and return to its state of best health. This is one of the basic tenets of Naturopathic Medicine. This can produce what is known as a healing crisis. Fevers, vomiting, diarrhea, vaginal discharge, phlegm – secretions of various kinds are produced to aid the body in returning to its natural state. It can feel pretty awful to be in a healing crisis, but if you are able to trust that the body is actually working towards a state of improved health rather than spiraling towards destruction, it can bring about an awesome recovery. (This is also often what modern medicine is appropriate,  when medications or other medical interventions are appropriate interventions. The differential between the safe healing crisis and the situation needing medical intervention is the job of a ND.)

I haven’t felt too awful with this current “sinus and bronchial infection.” Although I have had copious elimination of some nasty stuff, my energy, appetite and general mood have been pretty good. I have been able to lay low, watch TV, do castor oil packs for my lungs, make soups, drink Cold Care and Throat Coat teas, and take anti-fungal and lung herbs to support the elimination. Overall although I am sick in a classical sense, I feel a renewal taking place. And, I have finally been able to kick the caffeine and headaches while avoiding the fatigue by resting so much! I will need to continue to work on my adrenal health and decrease sugar intake as candida has been flagged as a potential long term issue by this detox experience.

Everyone will have a different experience, and a different potential for a healing crisis. Age, stress levels, number of years on caffeine, gender, diet and nutrition levels all play into the effect caffeine has on the body, and the resulting effect its elimination can inspire.

Exerpt from http://www.health4youonline.com/article_sherridan_stock_conquering_candida.htm#Hypoadrenia

Hypoadrenia 

Several years ago we noted a correlation between healthy adrenal glands and the absence of candidiasis, and formed the opinion that healthy adrenal glands help protect against candidiasis. We now realize that the other side of the coin is perhaps more important: Candida commonly impairs adrenal functioning, sometimes severely so.

Having made this latter observation, we wondered about the possible mechanism.  Initially we supposed that the Candida infection constituted an adrenal stressor, like any other infection.  We then saw a lady in whom candidiasis was a major cause of hypoadrenia, and noted that the amino acids that supported her adrenal glands best were taurine, cysteine, and glycine – all antioxidants.  Following up this clue we then ascertained that Candida and its toxins appeared to be exerting a direct cytotoxic effect on the adrenal glands via free-radical activity.

Another mechanism suggested by our testing is that of Candida-induced autoimmune damage to the adrenal glands.  Several studies do, in fact, implicate Candida as a major cause of autoimmunity since it can reduce suppressor T-cell activity.(3)  Further, it is possible that because of a similarity between the protein sequence of the cell walls of Candida and that of human cells, antibodies directed at Candida may cross-react with human cells.(5)  We also wonder whether the presence of Candida and its toxins within a tissue causes the body to regard that tissue as non-self and therefore to initiate autoimmune attack.

Additionally, Candida toxins interfere with acetyl coenzyme A activity,(3) which could inhibit the synthesis of adrenal steroids, and further, it is believed that Candida possesses receptor sites that can bind adrenal steroids thus competing with host cells, producing apparent adrenal insufficiency.(3)

Exerpt: CONQUERING CANDIDA by Sherridan L. Stock BSc(Hons) CBiol FBiol FZS FRES

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Boutique Medicine Designed

I am very excited about my new logo designed by www.theportlanddesigner.com. I was speaking with a valued mentor and friend today about Boutique Medicine and the innovative and yet old-fashioned concept of having a Dr on call, able to come to your home when s/he is needed, or to answer a medical phone call after hours or one weekends…. And I had the image of the old physicians bag come to mind. I have been branding the yellow cross – yellow for intellect, optimism, happiness and communication – and of course health care, and this is the brilliant marriage of the two!

Boutique medicine (home, skype or phone visits) are often combined with what is called Concierge Medicine. Patients “sign on” with a physician for a set monthly fee, which gives them unlimited access to the MD, ND, or DO for the year. This fee is usually derived from a simple math equation that includes the average # of visits per year, at an average cost per visit, divided by 12 and paid on a monthly basis. Concierge Doctors work outside of the standardized healthcare system, thus avoiding insurance companies entirely. At this point, I am only working on the Boutique model, but I may implement Concierge Medicine in the future. Would you be interested? Email me your opinions at thewrightnd@gmail.com, I would love to know! All emails are confidential.

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Introducing……

The kitchen table has seen generations of families, friends, and lovers sit down to talk about what is really wrong. Its where we cry fresh tears, or hold them back. Its where we open mail, check email, or sit down for a long phone chat. Its a place of connection, convenience, and commiseration. The kitchen is the heart of every household, and the center of a families nourishment. Kitchen Table Naturopathics is all of this and more!

Based on the modern concept of boutique medicine and the classic model of country family physician, Kitchen Table Naturopathics offers phone sessions, skype consultations, and at home visits at your kitchen table or mine. Free initial 15 minute assessments are available in person or over the phone, to ensure we can work well together.

Please call for a Fee Schedule or email thewrightnd@gmail.com to set up an appointment. I look forward to seeing you soon!

 

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