Fertility and Pregnancy

Fertility and Pregnancy Overview

• Naturopathic Nutrition Year 2 focuses on fertility and pregnancy.
• This lecture covers female and male fertility, investigations (orthodox and functional), assisted reproductive technologies (ART), natural fertility, pregnancy, preparing for birth, and postpartum care.

Definition of Infertility

• Infertility is defined as the lack of pregnancy after one year of unprotected intercourse.
• For women over 36, investigations start after 6 months of unprotected intercourse.
• 84% of couples conceive naturally within 1 year with regular (every 2-3 days) unprotected intercourse.
• One in seven UK couples experiences difficulty conceiving.
• One in six couples uses ART such as IVF.
• In 4 out of 10 cases, male factors contribute to fertility issues.

Female Fertility Factors

• For successful conception, several factors are involved
• Healthy, non-damaged oocyte release
• Sperm production with sufficient motility, DNA integrity, count, and morphology.
• Transport sperm/egg transport to the fallopian tubes for fertilization
• Sperm penetration into the oocyte
• Implantation of the embryo into a healthy uterus lining
• Normal embryo development into a foetus

Structural Abnormalities Affecting Female Fertility

• Cervical stenosis: Narrow or closed cervix.
• Uterine septum: Poor embryo implantation environment due to poor blood supply.
• Uterine polyps and fibroids: disrupt implantation, usually due to oestrogen dominance.
• Fallopian tube obstruction: Pelvic inflammation, STDs, endometriosis, surgery, or ectopic pregnancy.
• Ovarian cysts: Cause infection and scars on fallopian tubes.

Hormonal Issues of Female Infertility

• Polycystic Ovarian Syndrome: high androgens, anovulation, irregular cycles, low uterine lining development, implantation problems.
• Hyper/hypothyroidism: Irregular cycles, ovulatory disorders, miscarriage, preterm birth, pre-eclampsia.
• Amenorrhoea: Hypothalamic dysfunction, pituitary tumours, excess exercise, undereating, low BMI, high stress.
• Obesity/insulin resistance: Lack of ovulation, high androgen levels.
• Premature ovarian failure: ovarian function loss under 40 due to chemotherapy, radiotherapy, genetics, SLE; can use ART.

Oestrogen and Progesterone

• Oestrogen is highest in the first half of the menstrual cycle, creates proliferative endometrium, and supports ovulation.
• Progesterone is highest in the second half, maintains secretory endometrium, and supports embryo implantation/survival.
• Both hormones are produced in the ovaries, adrenals, and placenta and stored in adipose tissue.
• Women are susceptible to oestrogen dominance (high oestrogen: progesterone ratio).

Symptoms of Oestrogen Dominance

• Fibroids, uterine polyps, endometriosis, PCOS.
• Heavy bleeding and clotting, fibrocystic breasts.
• Tender/swollen breasts, PMS, irritability, headaches.
• Shorter menstrual cycles (especially luteal phase).
• Poor memory, brain fog, hypothyroidism, hair loss.
• Insomnia, fatigue, mood swings.
• Gallbladder disease, swelling, bloating.
• Repeated Miscarriages.

Progesterone Dominance

• Breast tenderness, water retention, bloating.
• Shortness of breath, dizziness.
• Drowsiness, lack of concentration.
• Sense of physical instability; Long luteal phase.
• Discomfort/pain in legs, decreased libido.
• Anxiety/panic attacks, weight gain, and insomnia.
• Light periods.

Balancing Oestrogen to Progesterone

• Reducing stress through healthy meals, optimized sleep, reduced exercise, and emotional support.
• Optimizing liver function to detoxify excess oestrogen.
• Avoiding endocrine disruptors, alcohol (increases oestrogen levels), and reducing body weight if obese (oestrogen stored in fat).
• Optimising digestion and elimination and consider herbs like Vitex agnus castus.

Female Fertility Impacting Medications and Drugs

• NSAIDs (long-term use or high dose): Inhibit ovulation and lowers progesterone.
• Chemotherapy: Damages/depletes oocytes.
• Antipsychotic medicines: Increase prolactin levels (anovulation, amenorrhoea).
• Corticosteroids: Suppress immune function, affects gut microbiome, increases blood pressure and blood sugar levels.
• Antihistamines: Dry mucous membranes.
• Tobacco, recreational drugs and marijuana consumption: Poorer oocyte quality.

Environmental Factors Impacting Female Fertility

• Excessive radiation (mobile phones, X-rays, radiotherapy, flying): Damages oocytes.
• Environmental toxin exposure (mercury, lead, phthalates, solvents): Infertility and miscarriage.
• Chronic alcohol consumption: Diminished ovarian reserve and dysfunction.
• Caffeine: Increases cortisol, slows COMT (oestrogen dominance).
• Xenoestrogens, pesticides, endocrine disruptors (plastics, cans, detergents, candles, flame retardants, cosmetics).

Immunological Factors in Female Infertility

• Foetus is genetically different so the mother immune response must be compatible
• Tissue type compatibility: Mother's immune system needs to be compatible with paternal HLA proteins; negative response affects implantation and pregnancy outcome.
• Blood clotting defects: High risk, maternal embolism/stroke, restricted placental blood flow.
• High uterine NK cells: Can trigger TNF-alpha, cytokines, increasing pregnancy loss; BPA exposure is linked to NK cell activity.
• Autoimmunity: Immune system rejects the embryo.

Immunological Factors & Antibodies

• Anti-sperm antibodies (ASAs): Woman's immune system produces ASAs to destroy sperm and cause fertilization issues/miscarriage; ASAs can be found in semen.
• Antiphospholipid syndrome: Autoimmune disorder increases blood clotting/stillbirth, miscarriage, and stillbirth risk.
• Thyroid antibodies: Lead to autoimmune thyroiditis increases pre-term labour risk, and miscarriage.
• Ovarian antibodies: Affect egg/embryo development, and fertilization and pregnancy rates, and implantation failure.

Male Fertility

• Normal sperm sample must have a semen volume of 1.5 ml or more with a pH of 7.2 or higher
• Requires 15 million+ spermatozoa mL; 39 million spermatozoa per ejaculate
• Needs 40% or more motile or 32% or progressive motility; 58% or more live spermatozoa; 4% or more with normal morphology.

Structural Factors Affecting Male Fertility

• Congenital defects: Testes or ejaculatory tract.
• Undescended testes: Decreases sperm count/quality due to heat.
• Testicular cancer: damages sperm and leads to changes in testosterone.
• Surgery/injury to testes: Testicular torsion; being kicked; bicycle injury.
• Ischaemic damage: To testes.
• Infections: Permanent damage to vas deferens/testes, epididymis, STIs and post-pubertal mumps also impact semen transport in ejaculatory ducts.

Hormonal and Other Affecting Factors to Male Fertility

• Hormonal hypogonadism (low function of gonads): Reduces the production sex hormones, caused by drugs, cancer or Klinefelter syndrome, a genetic condition that affect sexual development.
• Obesity: Increases periphery conversion testosterone to oestrogen and reduction luteinizing hormone.
• Cushing Syndrome: Elevated and increased cortisol levels contributes to low sperm count
• Diabetes mellitus: Causes neuropathy, retrograde ejaculation.
• Haemochromatosis: systemic inflammation, iron in gonads decreasing testosterone production.
• Scrotal varicocele: Increase scrotal blood volume increases temperature leading to reduces production
• Acute and chronic illnesses: Associate with gonadotropin release possible through increased in dopamine and cortisol

Medication and Drugs Impacting Sperm

• Sulfasalazine often treats bowel issues affecting reduction
• Anabolic Steroids impair production reduces sperm mobility with permanent damage
• Chemotherapy: Severely decreases sperm
• Long term use Medications (alcohol,cigs and MJ) reduce sperm count,and motility

Male Fertility Environmental Impacts

• Exposure to Pesticides and Disrupters
• Mobile phones: interfere with generation decreasing quality (radiation increasing oxidized stress)
• Heavy Metals; like lead with toxins
• Heat increases temperature reduces production tight clothing use.
• Excessive use of lubricant
• Highly oxidized: leading to breakage and reduces sperm count

Microbiomes and Fertility for Mother

• Mother with periodontal infections can lead can extend approx, 2 months for the mother to conceive.
• Can prevents ovulation increasing IL waste product that cross affecting fetus Fusobacterium infection amniotic fluid and infections

Microbiomes and Fertility for Father

• Father's have causal relationship when using treatment is successful by 20%

Seminal Microbiomes

• Seminal microbiome as an independent microbime, derived mouth and vaginally partner. (Support immune function, Aid offspring immune function.
• Should dominant Bacterial function aid prevent system and improve immune responses.
• Lactobacilius dominant that are know to reduce Ros effect
• Sex during implantation 23%
• Negatively impacts through antibiotics alcohol and poor hygiene
• Ureaplasma leads poor fertility
• Low sperm can can bacteria that lead with stress.

Vaginal Microbiome

• Need Dominance Lactocobillus create inhospitable environment Crisatus higher in implementation Bacterial Vaginosis; increases PH increases misscarriage
• Mycoplasma (Ureaplasma, chamydia trachomatis are bacteria that leads negative affect

Progesterone in VMB

Vaginal Microbiome are impacted negatively through STI, alcohol or hygiene and blood glucose levels Low environment in VM cervical production for glycogen and important to maintain lacto bacteria Positive impacts (reducing infection good blood glucose levels and better estrogen levels), improving bacteria for Pregnancy

Female and Male Combined Fertilizer

• Moderate exercise improves circulation
• Intensive increases and reduces cortisol and progesterone and endorphin can disrupt FSH and LH disruption

Sex- Hormones and Stress

• Stress release cortisone, decreases LH and FSH production reduces testes and gonad function reducing sperm

Contributing Low Birth Rate

• Women born with eggs diminishing in age with poor life style Risk for birth defects, 1/500 by 20s and 1/60 by 40s and decreased mobility function

Issues and Low Sperm Count/Fertilizer

MTHFR Folate: is important metabolite Polymorphisms increases (neural issues, gestal hypertension Increases male fertility from methylation and maturation sperm

Orthodox Fertilizer investigation

Ultrasound scan to rule out structural issues Serum FSH done

T3 panels are important to investigate Good Glucose levels and insulin response

AMH

Amh -Is the Muller hormone marker of Ovarian and produced by follicle High AMH with PCO or low with IVF will lower drugs AFC via scan to both Ovaries

Semen Investigation

Important to determine morphology

Fertility Functional testing

Testing Toxic metals. Genetic Variations in (MTHFR) affecting Oestrogen level. Test for homocysteine and Methylation level Adrenal Support helps fertility

• Blood sample with a oxidative stress

Assisted Technologies - ART

• IVF retrieval sperm are transferred through a stimulation into fetus within.

Sperm is transferred into egg for infection

What may Includes when using IVF

High likely multiple birth issues Premature low weight gain in IVF ovarian Issues bleeding damaged from anesthetics into the system Ectopic preganacy from withing cancer for egg growth stimulant

Natural Fertility

In traditional times a fertilizer diet has provided for six to twelve months: Diet helps and balances nutrition to mother and father Approximately 100 and 70 days for sperm and egg maturation, at least 3 months prior

• Cleansing can also take 13 months before

Avoid factors: Food processed foods (high glycemic index) Coffee Alcohol

• Low fat items