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Posted by Candace Burch on Wednesday, 27 April 2016

Clinical Pearls on Fertility, Infertility & Hormones


In this engaging and wide-ranging discussion of Fertility, Infertility and the Role of Hormone TestingDr. Alison McAllister, lead clinical consultant at ZRT, shares her considerable knowledge about the challenges of infertility and the heartbreak of those struggling to have a baby of their own.

Sadly, it is a growing problem that affects 1 in 8 couples and millions of people around the world. As a naturopath who looks at all aspects of infertility: physical, mental and emotional, McAllister aims not only to help couples become pregnant, but stay pregnant for the 9 months until a healthy baby is delivered into their arms.

Infertility is commonly defined as the inability to get pregnant within 1 year of unprotected intercourse, or within 6 months in women over 35, or 3 months in women after the age of 40. But infertility is not just an affliction of women: 30% of all cases are due to female factors, another 30% are linked to male factors, and the remaining 40% can be traced back to both.

Yet, despite the equal-opportunity nature of the problem, far fewer men than women in couples trying to get pregnant have ever had a workup.

"I see it all the time and its one of my biggest pet peeves," says McAllister. "The women are out there getting invasive procedures, and even laparoscopic surgery, while their spouse hasn't had a sperm count!" This is an oversight couples can’t afford to make, she warns, especially given the good news that almost all male infertility can be overcome. "A man can have no sperm whatsoever," she says, "but if his tissue can be biopsied and they find even a trace, that couple can ultimately have a biological child."

Screening for hormonal causes is one of the first recommended steps because simple adjustments can result in fertility.

Thus she strongly advises patients in opposite-sex relationships to get both a female workup and male workup to determine the cause of their reproductive woes. When a couple under the age of 35 has been trying for over a year, (or 6 months over the age of 35) screening for fertility hormones as a cause is one of the first recommended steps. This is because even simple adjustments to thyroid and/or progesterone can sometimes result in fertility.

Leaving no stone unturned in this webinar, McAllister takes providers through the ins and outs of infertility and what is needed to help overcome the problem. Some of the highlights of her presentation include but are not limited to discussion of:

  • Structural and functional disorders from faulty sperm and anatomical problems in men, to anovulation and pelvic factors in women: for example in men the lack of an intact blood/testes barrier due to trauma or infection can trigger antibodies against his own sperm; in women, endometriosis, fallopian tube defects or fibroids to name but a few common causes, can disrupt ovulation, fetal development in utero and/or successful delivery
  • Key labs to detect underlying issues, from the all-important ovarian assessment of day 3 FSH levels and LH surges, hormone testing to rule out PCOS, estrogen/progesterone and cortisol imbalances, thyroid, iodine and Vitamin D testing (often missed in fertility workups), to evaluation of heavy metal exposure
  • Pros & cons of conventional and complementary treatments e.g. Clomid, Vitex, Inositol, EFAs, natural progesterone
  • Dietary and lifestyle improvements to reverse insulin resistance, Vitamin D deficiency, elevated cortisol
  • Avoidance of Environmental toxins (cadmium, lead, arsenic, mercury) and xenoestrogens: BPAs, plasticizers etc., disrupt egg development and increase miscarriage recurrences

There are plenty of clinical pearls here for providers to ponder: from a consideration of "smart sperm" to cervical mucus (is it there and is it stretchy enough?), to lower global sperm counts (what’s now considered normal may be too low and should be double checked), and the number of babies born with thyroid problems to mothers who take too much iodine (question the right amount of iodine during pregnancy).

As a naturopath many patients ask McAllister if she’s against using fertility medication. The answer is "no," however she does have concerns that too many women are being set up to fail these treatments. What does she mean by that? "A fertility specialist will generally 'allow' approximately 3 tries with oral medications before recommending IVF, which is great, but very expensive. So, of course you want to see people have success within those 3 tries."

"Our aim should be to generally optimize her body for health & fertility, then use oral medications or IVF, knowing that success rates are going to be much higher per cycle." - Dr. McAllister

But rather than rushing into IVF treatment, McAllister feels strongly that women be allowed a period of at least 3 months on average, so that everything that can be done, is done, to identify silent conditions undermining infertility, like undetected TSH levels over 2.5, or low iodine (the ovaries actually have the second highest level of iodine content in the body), associated with a dramatic drop in fertility rates. 

Conditions like these, if unrecognized and left untreated make it much less likely that patients will be able to become pregnant with IVF, and also more prone to miscarrying once pregnant. "Our aim should be to generally optimize her body for health and fertility," says McAllister, "then use oral medications or IVF, knowing that success rates are going to be much higher per cycle."

For example, women with PCOS (associated with 70% of all cases of infertility) are all too often told they won’t be able to have a child, but "nothing could be further from the truth," says McAllister. In fact, these women often have plenty of eggs, and 80% of them can get pregnant – especially with complementary care to balance the diet, blood sugars and insulin levels.

There is plenty here for clinicians who also want to use complementary therapies to support fertility treatment. McAllister shares some of her favorites for restoring normal cycles and ovulation: Vitex, the "natural version of Clomid," an herb used for centuries by women to regulate periods; she is a big fan of Inositol: "follicle studies show that the best eggs have higher inositol levels," and adequate progesterone to "make the endometrium work."   

She often finds herself reminding patients stressed about stress that if women can get pregnant during wartime, "you can get pregnant too." She conjectures that one day we’ll find out that our own natural endorphins that trigger happiness and feelings of well-being have the biggest impact on reproductive skills, more so even than stress relief.

Fertility being a multi-generational phenomenon will always keep providers and researchers guessing to some extent, but there are many answers here, and a world of practical information that providers can use to assist patients in the successful creation of their own little miracle.

Watch Addressing Cases of Infertility Webinar

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Tagged in: Hormone Balance Fertility Toxins PCOS Xenoestrogens