The World Health Organization predicts that infertility and sterility will be the most prevalent condition after cancer and cardiovascular disease in the 21st sanctuary. Currently, 1 in 8 couples have difficulties in women getting pregnant or sustaining the pregnancy. Interestingly, 1/ 3 cases of infertility is attributed to females and 1/ 3 to males, making the rest attributed to both partners, which is contradictory to the old-fashioned public belief that females are predominantly responsible for not “becoming pregnant”.
What is infertility?
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse if you are less than 35 years old or after 6 months of unprotected intercourse if you are more than 35 years old. Typically, couples try for years to conceive before asking for professional help. Losing the physiologically “fertile time” often leads to an unsuccessful outcome.
According to the Centre for Disease Control (USA), the following percentage illustrates infertility cases in certain age groups:
- age 25- 30: 7% infertility
- age 30-35: 11% infertility
- age 35- 40: 35% infertility
- age 40-45: 87%infertility
In the past decade, there has been a huge trend to have a child later in life, putting the carrier, traveling, education etc., first, often resulting in an inability to conceive later. The number of invitro fertilization is progressively inclining partly due to this fact, and partly due to hormonal disbalance that is almost an epidemic in modern women in reproductive age.
Almost 50 % of female infertility results from hormonal issues causing ovulatory dysfunction that is potentially treatable with hormone-balancing innervations. This approach is imperious in Integrative Medicine, correcting hormonal problems in women struggling to conceive.
Hormonal issues in women struggling to fall pregnant
Early menopause and premature ovarian failure are more prevalent than one could expect. Women suffering from it stop producing Estrogen and Progesterone as their follicles are not sustainable anymore.
About 10% of the female population is struggling with early menopause, that can considerably affect the ability to conceive, and this number uprising. Some of the causes of why patients go into premature ovarian failure are well established, but some are still unknown. One reason for premature ovarian failure and early menopause is ovarian inflammation. Chronic inflammation is also implicated in PCOS (polycystic ovarian syndrome) and speeded aging of ovaries. Autoimmune ovarian inflammation (Oophoritis), similar to other autoimmunities is the ‘whole body disease’ manifesting in ovaries. We often see young women suffering from it: low estrogen and a similar hormonal profile that we see in menopause. Some of these patients also develop “adrenal fatigue; they simultaneously create antibodies against the adrenal cortex.
During the Restorative Medicine Congress (USA) held a few years back, it was discussed that the alarming decrease in fertility could be due to the use of the pill in the teenage population before their ovulation has been established firmly. There are also some preliminary studies about it. Are we creating a new generation of infertile women by introducing the birth control pill to teenage girls too early to treat acne, heavy flow, irregular cycles, and cramps?
PCOS is one of the leading causes of infertility. It often goes undiagnosed due to variety of symptoms: androgenic features ( facial hair, acne, hair loss etc.), light period or absence of menstrual periods, abdominal obesity, infertility, etc. It takes at least 2 years and 3 different doctors to see before diagnosing PCOS – reported Cross-sectional survey study that investigated PCOS diagnosis experience. Besides hereditary causes, the cases we see nowadays are related to insulin resistance. Insulin resistance is a cytokine-driven condition that increases inflammation, increasing androgen production (male hormones). Elevated insulin also alters the function of ‘brain hormones’( FSH, LH), causing more testosterone to be made and the absence of ovulation. When ovulation does not occur, estrogen is not balanced with progesterone, which leads to estrogen dominance. High insulin additionally causes low SHBG – a protein that carries on testosterone and estrogen, further perpetuating the process. Any woman with increased facial hair, acne in the lower part of the face and neck, and abdominal obesity should suspect PCOS and ask for an assessment by an integrative medical doctor. She would be also at risk of developing infertility, type 2 diabetes, cardiovascular complications, and uterine cancer. Finding the underlying cause of insulin resistance and PCOS is paramount for successful treatments of PCOS and infertility. In addition to genetic predisposition, binging on a high carbohydrate food, heavy metal toxicity, high cortisol, and nutritional depletions of magnesium, chromium, vitamin D, the gut issues , all play a huge role in developing PCOS. A recent study found that changes in gut bacterial flora with eating high carbs and processed food diet, with additional high stress, can lead to increased gut permeability. This condition, popularly called “leaky gut,” increases inflammatory response on insulin receptors contributing to the severity of PCOS and insulin resistance. The study showed that the marker for “leaky” gut called Zonulin was increased in PCOS patients. Evidently, treating PCOS and its Infertility cases would need a Functional Medicine approach, including treating gut.
Nowadays and what I often see in my practice in females in their reproductive years (even from the age of 20) is what we call a Luteal Phase Dysfunction (LPD). These patients are presented with low progesterone, anxiety, and heavy periods. They are also less likely to conceive. Failure to ovulate and produce sufficient progesterone can come from different underlying causes affecting preovulatory LH peak, such as : consuming junk and processed food, low fat diet, excessive exercise, and high-stress levels. Stress with high cortisol production is particularly unhealthy as the body intends to “swing” from producing sex hormones into producing cortisol- described as cortisol steal.
Furthermore, other hormonal issues can cause LPD: high prolactin, thyroid dysfunction, hypothalamic dysfunction etc. LPD is not only characterized by low progesterone but also estrogen dominance symptoms such as inability to lose weight in the thighs area, mood swings and fatigue. It is essential to assess this condition with a Functional Medicine approach, treating the cause. However, we temporarily give these patients bioidentical progesterone and nutriceuticals that increase progesterone production while finding and removing the cause.
Endometriosis is a disorder characterized by endometrial tissue moving outside the uterus and going through the same cyclic hormonal changes with each period. It usually affects the ovaries, tubes, the lining of the abdomen, and on the bowel or bladder. During a period, the blood produced in the endometriosis growths has nowhere to go, becoming trapped, causing inflammation, swelling, and pain. Most patients with endometriosis experience painful, heavy, or irregular periods, pain in the lower abdomen, pelvis, or lower back, bloating and constipation, spotting between periods, etc. Some patients will be without symptoms finding about endometriosis only when they experience problems getting pregnant. Although many patients will opt for surgical removal of endometriosis, Functional Medicine doctors will, however insist to find the cause of endometriosis and treat accordingly. It is found that endometriosis can run in families, suggesting a genetic component. Furthermore finding the high level of immune cells in the peritoneal fluid of women with endometriosis insinuate an autoimmune component. A recent study showed that women with endometriosis have 3,5 times higer problems with gut issues. Lack of exercise, high processed food and sugar intake, and exposure to xenoestrogens, and hormone disruptors (PCBs, plastics, toxins, aluminium) are all playing a part. Poor detoxification and certain genetic predisposition for improper clearing of excess oestrogen can also contribute to development of endometriosis.
As much as the dysfunctions mentioned above sound horrifying, there has been many studies proving that Functional Medicine approach in treating underlying causes a managed to restore the balance in which pregnancy becomes the effortless event.
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Tags: Aging Of Ovaries, Autoimmune ovarian inflammation (Oophoritis), Autoimmunity, Epidemic, High Prolactin, Infertility, Ovulatory Dysfunction, PCOS, Thyroid Dysfunction