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Balancing Hormones for Fertility

Hormones are chemical signals that are always being produced, secreted, traveling, and, if their respective receptors are available, attaching to those receptors to cause an effect. To the average female, heavy menstrual bleeding or a lack of menstruation, acne, migraines and weight gain, or significant mood disturbances could all indicate a hormonal imbalance. In men, abnormal hormone levels can cause low libido, sexual dysfunction, depression, and gynecomastia (breast tissue growth in genetic males).

There are so many factors that affect hormones. Although some hormone imbalances may seem benign, they could indicate a larger issue. For example, abnormally high estrogen levels could indicate the presence of a cyst, fibroids, or endometriosis, each of which can interfere with infertility depending on their size and location. Similarly, low luteal progesterone could indicate a lack of ovulation or poor egg quality.

For these reasons, it’s best to start preparing for conception as early as possible, especially if one is already experiencing symptoms of hormonal imbalance. This includes thyroid and adrenal hormones. When trying to optimize fertility, we have to consider the whole picture including immune function, the microbiome, and all the factors that affect the normal functioning of these systems.  

Imbalances in Sex Hormones

First, let’s talk about specific and common hormonal imbalances. In a normal menstrual cycle, estrogen first peaks in the follicular phase that leads to the rise in luteinizing hormone (LH) and subsequent ovulation.

Problems can occur though when we have excess estrogen or when the ratio of estrogen to progesterone is significantly high. The presence of fibroids and endometrial lesions are both associated with these forms of estrogen dominance. Women with this type of imbalance can experience:

  • Long and/or heavy periods
  • Painful periods
  • Migraines or cyclical headaches
  • Anxiety, irritability or rage

Low estrogen levels can also cause fertility problems. During the follicular phase, preantral follicles in the ovaries (before they’ve matured) produce testosterone that is then converted to estrogen. Too much testosterone will promote the abnormal growth of these early follicles which can then lead to polycystic ovaries. Alternatively, the body can turn that testosterone into DHT which can cause unwanted symptoms of facial hair growth and acne. Too little testosterone can prevent follicles from growing, common in primary ovarian insufficiency.

In the luteal phase of the menstrual cycle, progesterone signals the endometrium to thicken and prepare for implantation. This progesterone actually comes from the corpus luteum (part of the released/ovulated egg) itself. So by measuring progesterone approximately seven days post-ovulation, we can find out if ovulation did in fact take place, and if the egg was healthy enough to produce enough progesterone.

Low progesterone is associated with the same symptoms of excess estrogen – remember, the ratio is important here – but can also include mid-cycle spotting and irregular cycles.  Remember, if no implantation occurs, progesterone levels drop and this signals menstruation. High progesterone, on the other hand, can also cause its own set of symptoms such as bloating, brain fog, breast tenderness, constipation, low mood, sleep disturbances and weepiness.

Keep in mind these are common imbalances, but not an extensive list of all the imbalances that can affect fertility.

What can we do to help increase fertility?

Maintain a healthy body fat % and a healthy BMI

Okay, before you start rolling your eyes, yes, we know that BMI (body-mass index) isn’t the greatest predictor of a healthy body composition, but it can act as a preliminary marker to identify underweight or overweight individuals. A proper measurement of body fat and body lean mass percentages will provide a more accurate assessment. In particular, women should aim for between 20 to 24% body fat. Any less and there’s the risk of anovulation, any more and it could increase the risk of metabolic disorders and hormone dysfunction, both scenarios having a negative effect on fertility.

Eat an adequate amount of protein

The average daily requirement of protein is 0.8 to 1.2 grams per kg of body weight. Protein is necessary for building muscle mass and in doing so can assist with reducing adipose tissue in overweight women, and can increase body weight in low-body-fat, low-BMI women. Remember, proteins are broken down into incredibly important amino acids that are our body’s building blocks. We need them to make eggs and sperm, to produce hormone receptors and for the enzymes in your liver that metabolize hormones.

Studies in female mammals have indicated the importance of dietary proteins on the function of sex hormones. Diets higher in protein can increase ovarian activity, enhance the release of LH, and act locally by increasing the sensitivity of follicles to FSH while regulating egg quality.1 By contrast; mammals given low-protein diets actually had delayed puberty.1

Consider following a Mediterranean diet

The Mediterranean diet focuses on whole foods, vegetables, fruits, and healthy fats such as olive oil and omega-3 fatty acids from fish. It’s also low in refined carbohydrates and sugars – important for maintaining insulin sensitivity. Include brassica vegetables (also called cruciferous vegetables) in the diet such as broccoli, brussels sprouts, cauliflower, and bok choy. This family of vegetables contains a compound called indole-3-carbinol (I3C) which helps eliminate old estrogen metabolites. This is especially helpful in cases of estrogen excess.

Avoid alcohol

One glass of wine might not have a huge effect on your fertility but that comes down to your unique ability to metabolize and detoxify alcohol. Although it might seem like a great way to decompress at the end of the night, we can’t forget that alcohol is a toxin, alcoholic beverages contribute to our daily calorie consumption, and it affects our hormones. One to five drinks per week has been reported to significantly increase the time to pregnancy, decrease the probability of conception by over 50%, decrease implantation rate and can cause dysfunction in ovulation and the luteal phase.2

Reduce exposure to xenoestrogens and endocrine disrupting chemicals

Yes, we have a liver that can help us detoxify and eliminate these chemicals, and most of them have very short half-lives (about six to12 hours). But what if you have a slow liver pathway? What if genetically you have slower functioning enzymes? What if you’re exposure is so high that your body can’t keep up with the demand? We can help support detoxification by improving elimination. Chemicals detoxified by the liver can be removed from the body via sweat, urine, or stool. This means increasing water intake and supporting light healthy sweating.

Manage your reactions to stress

Stress is something we all experience in one way or another. A healthy stress reaction consists of a relatively short alarm phase and a recovery phase. When we stay chronically alarmed, experiencing anxiety and/or panic, or if we are under stress for long periods of time with no recovery, this can be detrimental to our health.

One common outcome of elevated cortisol, one of our stress reaction hormones, is sleep disturbance. Melatonin and cortisol have opposing cycles. When bedtime cortisol is too high, it can be difficult to fall asleep and/or stay asleep. When we’re under increasing stress, or suffering from generalized anxiety, it’s common to have sleep disturbances, waking between the hours of 2:00am-4:00am.

Stress can also suppress reproductive function. When under a sufficient amount of stress, the body tries to prevent pregnancy, as the conditions aren’t optimal for growing offspring. Women experiencing a stressful event often will miss their period that cycle from suppression of ovulation.

Finding effective coping strategies can mitigate these effects. These might include doing regular guided meditations, spending time in nature, doing yoga or tai-chi, journaling, engaging in therapy (or cognitive behavioural therapy) and breathing exercises, each of which can help manage and decrease stress.

In any fertility journey, it’s important to lay a healthy foundation. The number of reactions that have to occur for a successful fertilization, implantation and fetal growth are substantial. It’s important to give these processes as much support as we can and eliminate any barriers that can contribute to infertility. Of course, these suggestions are only part of the journey, but the effect they can have is significant.

 

References

  1. Fontana R and Torre SD. (2016). The deep correlation between energy metabolism and reproduction: a view on the effects of nutrition for women fertility. Nutrients. 8(2): 87
  2. Sharma R, Biedenharn KR, Fedor JM, Agarwal A. (2013). Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol. 11:66
Dr. Sarah Zadek, ND

About The Author

Dr. Sarah Zadek is a licensed naturopathic doctor in Ontario with a clinical focus on women’s health, endocrinology and fertility. Sarah graduated from Nipissing University with an honours degree in biology after completing her thesis on genetics, oxidative stress and immune function. Her working background includes 14 years in pharmacy. Sarah is also an author and has written for multiple publications across North America including the NaturalPath, Naturopathic News and Review (NDNR), Naturopathic Currents, and Eco Parent Magazine online. Dr. Sarah Zadek is a naturopathic doctor with Conceive Health, practicing at Lakeridge Fertility in Whitby, and is a technical writer for Advanced Orthomolecular Research (AOR).

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