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Infertility: what lies beneath? By Dr Simone Silver

Female infertility is a growing health concern in today’s society and often, the journey from diagnosis to treatment (or failure thereof) is fraught with uncertainty and emotional distress for a woman and her partner.

There are many causes of female infertility, which are usually investigated for and diagnosed by a gynaecologist or fertility expert. Problems with egg development, ovulation or even anatomical problems with a woman’s reproductive system may be the culprits. Polycystic Ovarian Syndrome and Endometriosis are well-known examples of female medical conditions that can lead to reduced fertility.
However, there are still a number of cases where, after exhaustive medical investigations, no identifiable cause for the infertility can be found. One may consider environmental causes such as xeno-estrogens or other artificial compounds that behave as hormone disrupters in the human body. One may also consider other, more subtle issues that pertain to a woman’s unique biochemistry and hormonal status. Optimal fertility is an intricate and complex concept dependant on numerous hormonal and metabolic processes that are meant to be in balance- like the harmonious symphony an orchestra will produce if each of its instruments is playing its part. If one instrument is out of tune or plays at the incorrect pitch, the entire symphony will be affected.

The role of hormones…

In addition to oestrogen and progesterone- the two main female hormones responsible for menstruation and pregnancy-thyroid and insulin hormones have an integral role to play in optimal health and fertility. Thyroid hormones are produced by the thyroid gland in the neck and have a role to play in tissue metabolism. Any deviations from the normal range may affect menstrual cycle regularity, ovulation and fertility outcomes. Insulin resistance leads to poor ovulation induction and increased male hormone levels in women suffering from PCOS. It is important to have these hormones thoroughly evaluated as part of a good fertility workup. In particular, thyroid hormone needs to be in a very specific range for optimal fertility and for a healthy pregnancy (acceptable ranges may differ from trimester to trimester).

The role of vitamin D…

A number of research studies have highlighted the importance of adequate Vitamin D (25 hydroxyvitamin D) levels in fertility. Vitamin D deficiency is a fairly common finding amongst patients attending infertility clinics. Correct supplementation has been shown to improve insulin resistance in both obese and PCOS patients. It has also been shown to prolong ovarian reserve and function and also improve fertility outcomes in patients undergoing IVF. Some studies have linked low Vitamin D levels not only to metabolic disturbances like insulin resistance but also to altered production and levels of the sex hormones required to fall pregnant and furthermore, to sustain a pregnancy. The role of vitamin D is also being explored within the context of male infertility. It is important to note, that Vitamin D levels that are too high may also negatively impact fertility and pregnancy. Your doctor should ensure that your levels are within the optimal ranges.

The role of stress and lifestyle..

There is no doubt that we live in a day and age that is high-paced and demanding. Many women today are juggling multiple and demanding roles. Finding a balance between career, parenting, managing a household, being a supportive spouse and caring for extended family members is indeed, a day-to-day challenge. Stress can cause changes in hormones such as progesterone, prolactin and cortisol (a stress hormone produced in the adrenal glands) and also in certain neurochemicals. Each of these changes can have a negative effect on fertility.
The role of diet

A healthy diet consisting of balanced food groups and caloric intake is essential for optimal physical and psychological health. In the setting of optimal fertility, a number of studies have looked at different diets to see what kinds of foods could improve fertility outcomes.
In women, higher consumption of vegetable protein as opposed to animal protein and higher intake of unsaturated fat rather than trans fat dramatically reduced risk of infertility related to impaired ovulation.
A balanced diet is recommended and should include plenty of fruits and vegetables, unsaturated fats and omega 3 fatty acids, low GI carbohydrates which are also high in fibre and good quality protein sources which should include vegetable-based proteins such as lentils, beans and chickpeas. Caffeine intake should be dramatically reduced or avoided altogether. Smoking and alcohol use should also be completely avoided.
Supplementation with folic acid is routinely recommended to avoid neural problems in the developing foetus. A number of studies also recommend supplementation with a multivitamin and omega 3 fatty acids. Iron and vitamin D supplementation are recommended where blood testing reveals low levels.
When it comes to infertility, we don’t always uncover the exact cause. When this is the case, a careful re-examination of some basic hormones, metabolic markers and lifestyle factors is warranted since these factors can each have a subtle yet important influence on not only optimal health in general, but reproductive health more specifically.
References:

1)Neuro Endocrinol Lett. 2013;34(8):756-62.The role of vitamin D in impaired fertility treatment.
Grzechocinska B(1), Dabrowski FA(1), Cyganek A(1), Wielgos M(1).

2)Eur J Endocrinol. 2012 May;166(5):765-78. doi: 10.1530/EJE-11-0984. Epub 2012 Jan
24.Vitamin D and fertility: a systematic review.
Lerchbaum E(1), Obermayer-Pietsch B.
3)Journal of Medicine and Life Vol. 8, Issue 2, April-June 2015, pp.142-145 The Polycystic Ovary Syndrome: An update on metabolic and hormonal mechanisms
Dumitrescu R* ***, Mehedint
4)Obstet Gynecol. 2007 Nov;110(5):1050-8.Diet and lifestyle in the prevention of ovulatory disorder infertility.
Chavarro JE1, Rich-Edwards JW, Rosner BA, Willett WC.
5)Hum Reprod Update. 2007 May-Jun;13(3):209-23. Epub 2007 Jan 5.The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review.
Homan GF1, Davies M, Norman R.
About the Author:

Dr Silver obtained her medical degree from Wits University. In 2008 she completed two US Licensing Examinations and worked within a medical ICU in Denver, Colorado. In 2012, after her community service in Johannesburg, she moved from the hospital setting into general practice to realise her passion of offering holistic and individual-based care.

Dr Silver

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