The Health Concerns That Impact Optimal Fertility

One in ten couples has a challenge conceiving. If you have experienced trouble getting pregnant, or lost a pregnancy, it is normal to want to know why. While many couples conceive easily, fertility requires a complex network of systems—in both males and females—to work together. Sometimes, we do not fully understand why infertility or a pregnancy loss occurs. Thankfully, there are many tools to help couples pursue a healthy pregnancy.

While the fertility industry often focuses just on getting pregnant and having a baby, it is important to foster the best health for both mother and baby. Achieving pregnancy should be pursued with intentionality for the most robust outcomes.

Functional medicine looks at the body as an interconnected whole. When evaluating an individual through this framework, we strive to investigate various mechanisms that could impact fertility or contribute to miscarriage or recurring pregnancy losses. Blood work, hormone testing, genetic testing, and other functional lab tests are helpful in identifying what could be contributing to pregnancy concerns.

Hormone Dysfunction

When pursuing optimal fertility, understanding hormone function is of vital importance. Men and women at all stages and of all ages can experience endocrine dysfunction that influences fertility. Hormones determine each step toward conception, such as the development of the uterine lining, ovulation, and egg and sperm quality.

For women to conceive, a regular menstrual cycle is critical as it sets the stage for a healthy pregnancy. Each month, there is a coordinated cascade of events: The pituitary gland releases follicle stimulating hormone (FSH), which promotes maturation of the follicle and causes estrogen levels to go up, which initiates a surge in luteinizing hormone (LH), ovulation, and the development of the corpus luteum, responsible for progesterone production in the second half of the cycle. Any disruption to this intricate cascade can hinder pregnancy.

Known as the HPTA axis, an intimate communication network between the brain and the endocrine system exists in both males and females. The brain—namely the hypothalamus and pituitary glands—communicates with the thyroid gland, adrenal glands, pancreas, and ovaries. The HPTA axis needs to work properly for conception and a healthy pregnancy to be achieved; any imbalances in this interaction may throw off fertility.

For example, stress can increase cortisol levels, which can disrupt adrenal gland function and the pancreas’s ability to respond with appropriate blood glucose, throw off the thyroid gland, and disrupt the proper signaling needed for ovaries to produce the hormones to ovulate. Other contributing factors to hormone dysregulation include nutrient status, infections, body fat composition, and environmental toxin exposure. Any disruption in this communication network can shift hormone function and fertility.

Gut Health

Gut integrity is intimately involved in preconception health. Intestinal hyperpermeability, also known as “leaky gut,” is associated with trouble conceiving. The gut epithelial lining is just one cell layer thick. Various factors, such as stress, poor diet, certain medications, etc. can damage this barrier. If this gut barrier is not intact, it allows pathogens, food particles, environmental toxins, and endotoxins to infiltrate the body. Furthermore, a leaky gut increases the risk of food sensitivities, chemical sensitivities, and autoimmune diseases.

Also, the gut microbiota must be in balance. For proper endocrine function, men and women must have robust beneficial microbes within the gut. Additionally, opportunistic microbes including bacteria, fungi, viruses, and parasites can proliferate in the gut and fuel inflammation and immune dysregulation, and can elevate levels of the stress hormone, cortisol, that can further damage the gut. Pathogens and gut imbalances can burden the liver and disturb proper hormone metabolism. Furthermore, any imbalances within the organisms that comprise the gut microbiota can lead to thyroid dysfunction, which can impact fertility and potentially increase the chance of pregnancy loss.

Proper gut health depends on proper digestion. Low stomach acid, digestive enzyme deficiency, and insufficient bile acid production can significantly disrupt the gut microbiome as well as contribute to nutrient deficiencies.

Nutrition

Various nutrients are pivotal for fetal development. These include folate (vitamin B9), vitamins B12, A, D, E, and K, iron, magnesium, zinc, and essential fatty acids. A deficiency in any of these nutrients can increase the risk of infertility, miscarriage, and pregnancy problems. Furthermore, certain nutrients specifically support the mitochondria and therefore enhance egg and sperm quality. These include health-promoting fats, B vitamins, L-carnitine, CoQ10, N-Acetyl Cysteine (NAC), glutathione, magnesium, and alpha-lipoic acid. Herbs such as chaste berry, maca, and ashwagandha can promote fertility in both men and women.

These nutrients not only need to be consumed on a regular basis, but they also need to be well assimilated. As mentioned above, low stomach acid, enzyme deficiency, pathogens, or other gut problems can hinder nutrient absorption. These potential problems need to be addressed for optimal nutrient status.

Autoimmunity

Autoimmunity is a leading cause of infertility. In fact, 85 percent of Americans who suffer from autoimmune conditions are women. Autoimmunity occurs when the immune system perceives its own tissues or cells as foreign. The immune system then mounts an attack on these structures which causes inflammation and damage. Often, the body’s immune response toward itself causes dysfunction and symptoms. Autoimmunity can occur in any structure of the body including the thyroid, pancreas, brain, ovaries, and even DNA.

Common Autoimmune Conditions Linked to Infertility

Antiphospholipid Syndrome: APS is the leading cause of miscarriage and should be screened in any woman hoping to achieve a healthy pregnancy. Antibodies are produced that target proteins attached to fat molecules (phospholipids), which makes the blood more likely to clot. This condition increases the likelihood of blood clots within the placenta, and various other pregnancy complications.

Thyroid Autoimmunity and Disease: Sufficient thyroid hormone is needed in order for every cell in the body to function properly. Thyroid autoimmunity can cause dysfunction within the thyroid gland and disrupt thyroid hormone levels. Getting a full thyroid panel run including TSH, T4, free T4, T3, free T3, reverse T3, anti-thyroid peroxidase antibody (TPO Ab), and anti-thyroglobulin antibody (Tg Ab) is crucial for men and women hoping to conceive.

Ovaries: Autoimmunity can occur against the ovaries and sway the ovarian reserve. If this is suspected, test FSH (follicle stimulating hormone) and AMH (anti-mullerian hormone).

Sperm: If a high number of sperm antibodies contact a man’s sperm, it may deter fertilization. This is called immunologic infertility.

While autoimmune conditions cannot be fully healed, they can go into remission, utilizing various lifestyle and dietary interventions.

Environmental Toxins

Environmental toxins are ubiquitous in our world today. They interact with the body at the cellular level and have the potential to cause dysfunction at cellular receptor sites. It has been widely established that many environmental toxins are endocrine disruptors, carcinogens, and neurotoxins. Exposure to environmental toxins has been associated with miscarriage. Being mindful of reducing exposures to toxins and taking part in safe, specific detoxification can go a long way in fostering proper hormone function and promoting fertility.

Epigenetics

Sperm quality and quantity are of utmost importance to achieve a healthy pregnancy. While some genetic factors can contribute to pregnancy problems, you are not a slave to your genetics. It has been said that genes load the gun, and the environment pulls the trigger. This means you have a powerful influence over genetic expression through environmental factors including diet, quality sleep, stress management, and proper supplementation. Some genetic variants that could result in pregnancy complications include MTHFR, PAI-1, Factor V Leiden, and ApoE2, among others.

Anatomy

It also needs to be mentioned that anatomical causes of fertility must be considered. Women with dysfunction in the pelvic region including the ovaries, fallopian tubes, cervix, or uterus may be unable to achieve pregnancy. For males, retrograde ejaculation is an anatomical reason for not being able to achieve pregnancy.

Time

Aging and time impacts fertility. Ovarian reserve wanes as women age. Therefore, the probability of healthy pregnancy goes down as you get older. By the age of 35, dramatic changes in the ovarian reserve can begin to occur. While there is a significant drop in fertility over the age of 35, various chronic health concerns such as autoimmunity, genetic expression, and blood sugar dysfunction can also impact ovarian reserve in some individuals.

The Male Factor

The health of both the male and the female are important in conceiving a healthy baby. The male, known as the male factor, solely accounts for about one-third of all infertility. About one-third of infertility is attributed to the female alone, and about one-third comprises combined male and female involvement. This means that males have the potential to contribute to about two thirds of infertility cases. This may seem surprising, as the focus is usually on the woman when it comes to fertility, and it is important to understand that many of the above factors have the potential to prevent male fertility and should be addressed in couples trying to conceive.

As you can see, a vast array of health concerns can affect achieving pregnancy and, ultimately, having a healthy baby. Many of these variables are intimately connected and need to function optimally for a healthy baby to be conceived.