Laying the Foundations
Conventional medicine is still not at the forefront of nutrition but being told that nutrition and lifestyle cannot make a difference when the basics of building a baby come down to the health of an egg and a sperm is something I often question. Hormones, genetics, DNA, a healthy functioning thyroid in both the male and female and the immune system as well as the microbiome (vaginal, gut, oral and seminal) are all implicated in fertility success. This makes me question why nutrition and lifestyle isn’t the first thing doctors suggest patients investigate. Yes, I’m a nutritional therapist maybe I’m biased. But hear me out.
I want to give a quick overview on just a few things that nutritional therapy can have an impact on when it comes to fertility success. First things first, the microbiome.
The microbiome. It’s spoken about A LOT nowadays, but did you know your microbiome can affect your fertility. Now, I’ll try and keep this simple, but EVERYTHING has a microbiome, and that includes your gut, mouth (known as your oral microbiome), the vaginal and seminal microbiome. They are even starting to realise that the placenta is not sterile like they first thought.
So how does the microbiome affect fertility success?
Recent research has found that women with recurrent pregnancy loss show a higher prevalence of abnormal intestinal permeability and depression. Undiagnosed gut disorders are often found to contribute to inflammatory reactions in the body. The researchers hypothesized that the inflammatory reaction caused by leaky gut may be contributing to miscarriage pathogenesis. The authors recommended diagnosis and treatment of intestinal disorders in order to improve pregnancy outcomes in women with recurrent pregnancy loss. Nutritional therapy can have a huge impact on the health of the microbiome and we have many fantastic tools at our finger tips now that are conducive and supportive for our therapeutic aims.
Additionally, the primary regulator of circulating oestrogens is the gut microbiome. A dysbiotic gut microbiome results in decreased circulating oestrogens – this may contribute to development of conditions that contribute to infertility such as endometriosis, metabolic syndrome and PCOS. Liver and gut function is extremely important in the processing and excretion of excessive oestrogens.
With regards to ART (assisted reproductive methods), such as IVF, a dysbiotic female reproductive tract has been found to impact implantation success. One study found that steroidal hormonal imbalances (hormone imbalances basically) along with immune dysfunction (inflammation) are two of many systemic factors that disrupt implantation – this involves both the gut and vaginal microbiome. Not all bugs are created equal, and it’s important to note that bugs aren’t ‘bad’, but if they grow a weed patch too big and take over your gut or vaginal garden, it can have a huge impact on the success of a pregnancy.
A noteworthy study found that, ‘on the progesterone-resistant endometrium, it is possible that failure of implantation might be explained, in part, by alteration in the uterine microbiome in response to inflammation, leading to the development of a progesterone-resistant endometrium’ – this is a huge finding for those that find themselves in the frustrating position of going through IVF cycles with no light as to why they might be unsuccessful (note this is not everything and interaction between genes and the environment also have part to play, but even epigenetics are MODIFIABLE factors).
Inflammation is a root cause of pretty much every NCD (non-communicable disease), and as you read above, and it too plays a massive part in fertility.
What about the seminal microbiome?
Male factor infertility is attributable to 50% of cases of infertility. In vitro studies demonstrate that bacteria can negatively impact sperm function. A study found ‘Ureaplasma urealyticum, Enterococcus faecalis, Mycoplasma hominis and Prevotella negatively impact semen parameters, whereas Lactobacillus appears to protect sperm quality.’ Treating the seminal microbiome through diet and supplements can have an impact on the infertility picture. What’s more often bacterium that are unfavourable in the semen can often be passed onto the female and vice versa. Ureaplasma can also be passed from mother to child (causing pregnancy complications and pre-term birth). Evidence is also coming to light that it isn’t just egg quality that is important in the offsprings life-long health but also the seminal health, including the microbiome.
Nutrient deficiencies and modifiable diet and lifestyle factors
Smoking, elevated consumption of caffeine and alcohol, chronic exposure to environmental pollutants and other nutritional habits all have a negative impact on a women’s fertility. Metabolic diseases, all of which are modifiable lifestyle related factors including diabetes, obesity and hyperlipidaemia, all impact a women’s’ fertility by either direct damage to egg health or indirect interference with the HPA axis, resulting in dysfunctional development of the egg. Reduced insulin sensitivity in the pathogenesis of PCOS can be improved by non-pharmalogical interventions through diet and lifestyle changes (rather than just going straight for Clomid to trigger ovulation)!
Blood sugar balancing and ovulation
Insulin resistance and hyperinsulinemia are the primary pathogenic mechanism impairing the physiology of ovulatory function. A diet consisting of the right fats, antioxidants and dietary supplements have been found to shorten the time to conception. The study concluded ‘a correct balance of proteins, carbohydrates, lipids, antioxidant and folate in the daily diet provides essential benefit for an optimal female reproductive health and reduces the risk of infertility.’
Coeliac disease and infertility
The systemic inflammatory disease of Coeliac disease has contradictory findings as to its impact on fertility, with the consensus being that it affects male fertility more so than female, HOWEVER, the link with gut dysbiosis and its impact on fertility by way of hormone production/processing and absorption of nutrients makes me question why it’s not more recognised as a root cause for females too. A study found that ‘Coeliac is more prevalent in women with ‘all-cause’ infertility and ‘unexplained’ infertility than that in general population.’
Immune health and fertility
A female has a different immune system function to a male, purely so that we can conceive. The immune system has to tolerate the growing foetus without thinking is as a foreign object that it then rejects. It is of upmost important for those that suffer with autoimmune disorders to ensure they are well supported before looking to conceive, In addition and interestingly, oral contraception influences the IgA as well as IgG levels in the cervical mucus, one study found that IgA is almost one third higher than in cervical mucus of naturally cycling women… women on the oral contraception have IgA as the predominant antibody present in cervical mucus’. This is a problem as it can cascade into an ‘allergic’ reaction to presented antigens, SPERM!
OCP depleted nutrients
Key nutrient depletions from the OCP include: folic acid, vitamins B2, B6, B12, vitamin C and E and minerals magnesium, selenium and zinc – noted that malabsorption pathologies may play a role here also, but guess what – oral oestrogen has been shown to modify intestinal permeability (adding to the mentioned issue above), exogenous hormones also enhance the development if an imbalanced Th1 and Th2 arm o the immune system (increasing the Th2 mediated inflammatory diseases!, and influences autoimmune diseases.
Overall, nutritional therapy can have a huge impact on laying the foundations for a successful pregnancy. But it’s important to note that the key to all of this foundation work is one thing… TIME. I ask all my clients to come to me at least 3 months prior to looking to conceive whether naturally or via an ART process.
Fertility is not often linked with our diet and lifestyle habits. Coeliac disease impacts male fertility, really? Thyroid issues in a female can impact a woman’s ability to regulate and sustain menstrual cycles? Yup! PCOS symptoms can be managed (if not reversed) with nutritional therapy by getting to the root cause of symptoms? It really can.
When trying to conceive, looking for a nutritional therapist to support you through your journey may be the last thing on your mind. I often get approached when my client has been trying to conceive for a while, with either no successful conception or they have just been told by their GP or medical practitioner that they have ‘unexplained fertility’. They may have been told that they have PCOS (with no explanation as to how they diagnosed it) and just told ‘you might need help to have a baby’. Often my clients are told at a young age that they may have issues with conception, put on the OCP to mask root causes and manage. Then they go back to the GP in 10 years’ time, thinking about perhaps conceiving and realise when they come off the OCP the underlying issues or root cause of the hormonal imbalances still hasn’t been addressed, just masked!
Now, trying to conceive (TTC) can mean a myriad of things. For some it might be that you are just starting to think about conception, for others it might be that you’ve just been given the diagnosis of ‘unexplained fertility’ or a condition that you know could impact fertility (endometriosis, low sperm count, fibroids, PCOS, sperm health issues, just a few that can impact in no particular order) or you are going through or have gone through IVF or other forms of ART (assisted reproductive technology).
So how can nutrition and lifestyle impact fertility? Evidence is mounting that it has, in fact, quite an impact. Not only is more evidence accumulating that female disorders such as PCOS and endometriosis can be managed via diet and lifestyle changes, but sperm health can also be overhauled DRAMATICALLY given the right building blocks and TIME.
References
Silvestris, E. et al. (2019). ‘Nutrition and Female Fertility: An Interdependent Correlation’
Baker, J. et al. (2017). ‘Estrogen-gut microbiome axis: physiological and clinical implications’
Singh, P. et al. (2016). ‘Celiac Disease in Women with Infertility: A meta-analysis’
Brazdova, A. (2016). ‘Immune Aspects of Female Infertility’
Palmery, M. (2013). ‘Oral contraceptives and changes in nutritional requirements’
