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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#TTC Obsession – Confessions

Getting pregnant is scary and exciting. The process of wanting to conceive and then waiting to find out…. not priceless. I am intimately aware of this as a Naturopathic Doctor with a focus on In/Fertility. I have also been privately preparing for this moment of my late 30’s when I am ready to conceive.  I have treated and supported many women through this process already. And here I am, alone with my OPK stick in the bathroom, discerning the workings of a secret universe. CONCEPTION.

I am amused at my complete immersion in the consuming nature of trying to predict my own ovulation. I cannot believe how often I think of the subject. I am constantly turning the information over in my mind. I read fertility forums online to gather information; I delve into friends’ personal experiences. Medicine looks so different when one is the patient! Suddenly there are a thousand things I do not know… Ovulation Predictor Kits are only the beginning.

And, in the obsession of pregnancy, it becomes everywhere. Books and television remind me that women have been torturing themselves about the ability to get pregnant forever! First, it was conceiving a boy, and whether or not the First Son would be born.  With rampant infertility, the collective obsession has turned to the BFP and away from gender preference.

We want to be able to control this event with every ounce of heart and mind. We are so used to be able to create what we need, if we only put enough effort into the act! It is maddening to have to develop techniques like trust and patience to achieve our highest goal…. and yet that is what it comes down to in the end. Do we hold the ultimate responsibility of whether or not life occurs in our very body?  It is appears to be the hugest responsibility, and yet it is one we cannot. create. on. our. own.  As my friend said yesterday, “We are accomplished and often privileged women! Powerful creations, and yet…” we cannot read what should be the simplest signs of all from our flesh. Are we ovulating today? Are we pregnant? It’s a huge pressure.

For same sex couples and single folks, there is the additional stress of genetic material to procure. The art of conception (often) looks very different for lesbian and gay couples. Not only will the inseminations need to be precisely timed, but the acquisition of said tools of conception must also be arranged. The cost of becoming pregnant begins with the very first try, an additional ingredient in the pressure-cooker of preparation. (In a call-out to women with biologically male partners, I do understand that when women hit the fertility clinics, we are all in the same machine.  The sex or gender of our partner becomes much less relevant although issues of accessibility to and cost of genetic material remains an additional stress.) It’s a wonder any of us become pregnant at all! But we do, in every increasing numbers.

The minute details, test results, and potential scenarios become an endless gerbil wheel of anxiety. It is important to step back from your own fertility and restore some normalcy to your daily routine. I was wound up over the timing of what was only a pre-cycle. Imagine how physically stressed out I could be for the real thing! One of my friends advised me after her first birth – make it fun. Try to relax around it. And she laughed knowing how hard that would be. I suggest distracting yourself as much as possible from thinking the same old anxious thoughts.  HOW? Listen to music that makes you sing. Watch a movie that engages you. Make time for friends or family who you like talking to and who are interesting. Write in a journal so you can get the thoughts out of your head and onto paper. The less time that is spent obsessing about the timing or prediction of said events will be in your best interest overall!

There is no conclusion to the story. The (new brand of) OPK kits wait for next cycle in my bathroom cupboard. I am going to pray for myself, light candles of hope, and continue to make the daily small offerings I do towards pregnancy – high quality prenatal vitamins, DHA essential fats, green tea, and other things appropriate for my personal care. My sweetheart and I also have a plan B, and C in place to rely on. When I get in the hamster mind of prediction anxiety again, please remind me of this post. Stress inhibits Ovulation!

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Coffee Addiction

I am a coffee lover – dark, black, strong, sometimes sweet.   I am the girl who will get out of bed for a french press. I have known for some time though that I will need to break the addiction – for detoxification, for adrenal fatigue, for hormone health, for fertility. And, I have finally decided that its time to start weaning myself from the dream bean. I know my skin will improve in hydration and texture, that my energy levels will improve (after I get through the caffeine withdrawal) and that my body will thank me in the long run. Coffee is a strong, complex mix of chemicals, and eventually any constant chemical exposure must play its toll.

I don’t intend to become completely abstinent! I just want to break my daily reliance on the drug. I want to become someone who savors the delicate flavors of organic green tea on sunny mornings. I will know a gen mai from a jasmine or sencha, and my cells will bathe in the anti-cancer catechins from the green tea flavonoids. However, I am not there yet. This week I am weaning to “half-caf,” and then to decaf (french press.) I will still have occasional, even weekly hits of delicious (full strength) coffee. I am also using a black/green tea mix to break the coffee habit while also slowly weaning off caffeine.

In her NDNR (Naturopathic Doctors New and Review) article Managing Caffeine Withdrawal in the Patient Undergoing Detoxification (V. 7 Issue 12 p. 8-9) Dr. Erica Peirson ND recommends supplementing Magnesium Citrate, a B Vitamin Complex and Adrenal Botanicals while weaning off caffeine. She also explains how caffeine works as a CNS stimulant. “Blocking adenosine receptors in the brain is a primary way that caffeine acts as a stimulant given its structural similarity to adenosine, Adensoine is not a neurotransmitter but a neuromodulator. Adenosine receptors inhibit the release of neurotransmitters. The release of neurotransmitters is increased when adenosine receptors are blocked by caffeine, resulting in central nervous system stimulation.” She then goes on to explain that the headaches associated with caffeine withdrawal are in part from increased sensitivity of these same receptors leading to dilation of blood vessels and hypotension.

To take the biochemistry of caffeine one step further, the binding of caffeine to the adenosine receptors means instead of slowing down, the brain/nerve cells fire up. The pituitary notices this increased action and sends hormones to tell the adrenal glands to increase production of adrenaline, giving you a boost of fight or flight energy. At the same time, caffeine slows down resorption of dopamine which is our pleasure neurotransmitter. With extra dopamine, you not only feel alert, but you feel good!

All of this is great occasionally – but I know that years and years of this cycle cant possibly be good for me. I am dehydrated, magnesium deficient, and my adrenaline and dopamine levels are pushed beyond their natural limits of production. Stepping off the caffeine / coffee platform will give my body the opportunity to restore adrenal health, balance my brain chemistry, and a great side effect will be improved liver detoxification leading to improved skin texture and color.  Its not going to be all fun – I am sure I will be more tired than usual, need more rest, and I may even be a little grumpy as my dopamine deficiency gets exposed. At least its winter in Maine, and I can tuck in early!

http://science.howstuffworks.com/caffeine5.htm

Arousal effect of caffeine depends on adenosine A2A receptors in the shell of the nucleus accumbens. The Journal Of Neuroscience: The Official Journal Of The Society For Neuroscience [J Neurosci] 2011 Jul 6; Vol. 31 (27), pp. 10067-75.

http://scienceblog.com/community/older/2003/C/2003921.html

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Stress: Applied Physics

Stress =  Force/ Area

Think literally for a minute about your body as a solid object governed by Newtonian Physics. The body as an object seeks constant equilibrium, and often finds it. How can we aid our body in maintaining the balance essential to feeling good?

The equation above gives all the answers, in proper Newtonian fashion. Stress equals a Force that needs to be balanced over an Area large enough to balance it. The Area becomes the places that we can spread out the Force of Stress and diffuse the pressure of modern life. What are the Areas in your life you use to diffuse stress? Look to meditation, time alone, exercise, family, intimacy, sex, reading, massage, acupuncture, counseling, baths, yoga, vacation, down time, friends, nature, and journaling as potential areas to consider for this kind of equation. Wine/ beer/cocktails, pot, white powder drugs, valium, ativan, television and eating are also common “areas” used to relieve stress ~ but these all have additive and addictive elements that create additional stress in a cyclic fashion.

Sometimes a Force in our life suddenly escalates – while the basic life Stress and Areas we balance it with stay the same. This force acts like a nailgun driving the nail of stress into your health. Therefore, it is imperative in times of high stress like a family illness, death, marital problems, a significant move or an exam period to reduce the force of other stresses and increase the area to contain them! During these periods of spiked pressure, improving nutrition is an important way to decrease oxidative stress and add another area of health to your equation. Simple changes like reducing sugar and coffee and increasing green vegetables and whole grains will make a big difference in the way your body reacts.

We all have stress – it’s a fundamental component of life. Even on a desert island with perfect weather, abundant food and no work, stress would present (eventually.) We are made to withstand stress, and even thrive in stressful environments. But when the Force of Stress cannot be spread over a large enough Area, or when Stress escalates in addition to basic Forces, equilibrium is lost and physical, mental and emotional  health problems ensue.

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