Updated: Oct 12, 2022
If you're here reading this blog, chances are, you've already tried the conventional route to getting pregnant: sex while ovulating, basic hormone testing, vitamins and supplements--and if that didn't work, maybe a prescription medication or two. Perhaps you've already done the ultrasounds, had your partner's sperm tested, tried IUI and are considering moving onto IVF or have already tried IVF.
You may very well be feeling very discouraged and losing hope at this point, open to other approaches or ideas.
You aren't alone--one in eight couples in the US has trouble getting pregnant or sustaining a pregnancy. There are many theories & hypotheses as to why this is the case--Poor nutrition, increased weight, eating disorders, increased age, stress, smoking, alcohol, inflammation, nutrient deficiencies, and toxins are thought to be major factors contributing to infertility.
Functional Medicine (FM) is a whole-systems, whole-person approach to find and correct the root cause of infertility.
Almost any problem regarding reproductive health is a systemic issue, and one that needs to be approached from a variety of angles. All our body systems work together, like a symphony. Bacteria in our gut transform, make and absorb nutrients needed for hormone production. If one only measures hormones but ignores gut health, they're only getting a partial picture.
The FM approach is likely not an approach your mainstream doctors have tried. Unfortunately, most providers don’t explore areas like nutrient deficiency, gut health, thyroid support, metabolic syndrome, sleep and the adrenal system as underlying root causes. Further, few have received training in functional root-cause medicine. Even fewer have knowledge on herbs, supplements, and the role of the gut microbiome on hormones and fertility.
That’s where functional medicine comes in. We do a thorough assessment of ALL systems and their interplay and domino effects.
Fertility is a direct reflection of someone’s overall health and/or their partner's.
It is also important to note that the traditional medical focus is mostly on the woman, According to the American Society of Reproductive Medicine, in 40% of infertility cases it is the male who is the cause of or contributes to infertility, and semen analysis is only one piece of the puzzle. Sperm cell membranes are comprised of polyunsaturated fatty acids which are highly vulnerable to oxidation (damage). Supporting sperm health is a priority in functional medicine.
Getting started with a functional medicine approach
Most often, infertility has its roots is one or more of the following 4 areas:
digestive function and gut health,
blood sugar and insulin imbalances
adrenal health or stress management.
Inflammation and oxidative stress underlie these four areas so working holistically to optimize all, will lower overall inflammation in the body, thus maximizing chances of conception. Every system function in the body depends on nutrients. Typically when we develop a patient-specific plan, we first address/test/treat adrenal health, hormonal health, inflammation, gut health, detoxification, and balancing blood sugar. Focusing on these areas will improve egg and sperm quality, balance hormones, increase chances of implantation and embryo development, reduce risk of miscarriage, and optimize birth outcomes.
Addressing root causes for infertility such as a short luteal phase, estrogen dominance, inflammation, HPA-axis, low progesterone, PCOS, hypothyroidism, insulin resistance, autoimmune disease, nutrient deficiency, poor sleep hygiene, and gut dysbiosis (imbalance of the gut microbiome) is often not even considered in traditional medicine.
Functional Fertility Testing
“Test don’t guess” is a phrase often heard in the Functional Medicine world, because there is rarely a "one size fits all approach" to health, especially fertility.
In integrative functional medicine, we test for a much wider array of labs that impact fertility than in the conventional approach, because we are looking at the interplay of many different body systems, not just the reproductive system--we understand that problems with fertility often are a downstream effect of a domino cascade from something happening further upstream, such as high cortisol levels, inflammation, nutrient deficiency.
1. Reproductive Hormones
This is such a big topic that we wrote an entire separate blog on what tests we offer here:
The following are just a few of the questions we ask:
-Is there estrogen dominance (too much estrogen in comparison to progesterone)? If so, we help you balance your hormones.
-Is there too little progesterone (a common problem infertility!) If so, why? We can get to the source of the problem, but sometimes we need to offer progesterone hormone too.
-Is there underlying PCOS (polycystic ovarian syndrome) or endometriosis? If so, what is driving that? Let's go upstream and work on reversing and calming that!
-Is there a problem with the pituitary gland in the brain?
We test reproductive and adrenal hormones using using specialized functional medicine tests using dried urine samples (DUTCH) along with conventional blood hormone levels (in conventional medicine, urine and saliva hormone levels are often not assessed).
Example of functional hormone test: https://dutchtest.com/wp-content/uploads/2022/06/Sample-Report_DUTCH-Complete_Female_RevB1-062022.pdf
2. Heavy metals and Environmental Toxin Levels
A common piece of infertility is toxicity and inability to detoxify efficiently. We work to support the body’s natural detoxification processes. There are many toxins that impact our hormones, like BPA, phthalates, parabens, and pesticides, just to name a few. In FM, we test for toxins as well as detoxification pathways to see how we can support your body's natural detoxification.
Example of nutrient/toxicity testing: https://www.gdx.net/files/downloads/NutrEval-FMV-Sample-Report.pdf
Many hormonal imbalances are due to environmental exposures to endocrine disruptors (chemicals in make-up, lotions, sunscreens, plastic food and water containers) and heavy metals like mercury, arsenic, and lead in our environment. Testing for these chemicals and giving the body natural support in detoxifying these, can help lead it to a state of balance.
In FM, we emphasize supporting the body's natural detox pathways through regular bowel movements, nutrition, sufficient fiber intake, drinking enough water, exercising, & sweating.
Additionally, cruciferous vegetables (broccoli, cauliflower, cabbage, and kale) help support detox and can balance out excess estrogen. Further, we check the balance of good bacteria in the gut, since imbalances can hinder detoxification and excretion of excess hormones. Fermented foods, resistant starch, and probiotics can all be useful in balancing the microbiome when imbalances are present.
3. Adrenal Health and the HPA-Axis
Too much stress results in sympathetic dominance, which means your body is stuck in a chronic “fight-flight-or freeze” mode. When the body perceives this stress it sends hormonal messages to both female and male reproductive organs that it’s not a good time to reproduce. Your body responds to stress via a hormone called cortisol--cortisol often impedes fertility. This stress can be mental or physical, from too much or too little exercise, too much or too little weight, from lack of sleep, from inflammation in the body, from rapidly fluctuating blood sugars levels and more. When your body is trying to make more cortisol, it "steals" from progesterone and nutrients needed for reproductive health to make more cortisol. In FM, we call the this "cortisol steal." The higher the cortisol demand, the greater the steal.
Example of cortisol testing: https://dutchtest.com/wp-content/uploads/2020/11/DUTCH-Adrenal-Female-Sample-Report-Ref112720.pdf
In men, increased stress has negative impact on sperm quality and motility according to study results.
4. Sleep (highly needed for reproduction)
Many of us are not getting enough rest, so we can work towards getting 7-9 hours of high-quality sleep to support our adrenals. Acupuncture can reduce cortisol and support conception. Also, a large number of Americans suffer from undiagnosed sleep apnea (if you snore or always wake up feeling tired or with a headache, this could be a clue). Sleep apnea drives inflammation and high cortisol which again impedes fertility. Sometimes we will order a sleep study in-home test as part of our work up.
Melatonin, the hormone that helps you sleep at night, impacts egg quality and hormone function, so if you are not sleeping, we need to figure out why and help you get more restful sleep. In FM, we like to run a test that checks your melatonin and cortisol levels in the morning and evening and offer plant-based medicine that improves cortisol levels. To learn more about natural ways to treat anxiety and insomnia, read our blog here: https://www.hearthsidemedicine.com/post/calming-anxiety-and-insomnia-without-meds
5. Gut health and stool tests
Gut bacteria regulate our digestion and absorption of nutrients, our mood, our immune response, blood sugar, sensitivity to the foods we ingest, and the elimination of toxins and excess hormones. Bacteria are actually responsible for helping convert unusable thyroid hormone (T4) into a useable form (T3), and without a well-functioning thyroid gland, it is often difficult to conceive.
Stress, birth control, alcohol, anti-inflammatories (like ibuprofen and aleve) and environmental toxins all damage the gut microbiome and deplete the very vitamins and minerals needed to support conception. The good news: we can heal our gut & microbiome!
As part of the FM approach and work up, we test your actual stool for the different types of bacteria present and markers of inflammation. We also can learn about your digestion and nutrient absorption this way. Most importantly, we can offer tangible ways to heal, balance and restore your gut health.
An example of the gut health testing we offer: https://www.gdx.net/core/sample-reports/gi-effects-2200-sample-report.pdf
6. Micronutrient deficiency and nutritional-herbal fertility support
We tend to think of nutrient deficiencies being a developing world problem--but in reality, our soils are heavily over farmed and sprayed with chemicals, resulting in produce that is nutrient-poor. Most of us eat a shameful amount of produce in comparison to what our bodies need. High cortisol levels, alcohol and caffeine further deplete our nutritional stores. Nutrient deficiency greatly impacts reproductive health; thus, we do in-depth nutrient testing in FM and work closely on nutrient-dense eating.
Screening for Celiac disease and other autoimmune conditions such as autoimmune thyroiditis, can also provide us with valuable information, as these can cause malabsorption, inflammation, and nutrient deficiencies that lead to infertility.
There are two main ways we test for deficiencies and suboptimal nutrient levels-Quest offers a great micronutrient/mineral/antioxidant/heavy metal panel, and Genova Labs offers a highly in-depth test called the NutrEval. Both can be billed to insurance, like many functional labs. We look for underlying autoimmune disease with an autoimmune panel.
There are several micronutrients, plants/herbs, supplements that can support healthy hormones and fertility for both men and women--so many in fact, we had to write a whole separate blog on them here: https://www.hearthsidemedicine.com/post/functional-fertility-supplements-herbs-for-men-women
7. Food intolerances and inflammation
It may come as a surprise that your favorite morning bagel with cream cheese is driving antibodies that are then driving inflammation and contributing to infertility, but gluten and dairy are high-inflammatory foods. Gluten in particular is correlated to gut lining damage and autoimmune diseases in many people. In FM, we can test for food antibodies and gut damage. We like to test for food intolerances using IgG/IgA antibody testing such as this one: https://www.gdx.net/core/sample-reports/1001-IgG-Food-Antibodies-Sample-Report.pdf
8. Blood sugar levels
Blood sugar imbalance is often the driver of hormonal imbalances, weight gain, exhaustion, mood swings, high blood pressure, and high cholesterol, thus it's crucial to test and correct if trying to conceive. It's also important to have healthy blood sugar levels to minimise risk of gestational diabetes during pregnancy & development of Type 2 diabetes. One very common fertility problem linked to blood sugar imbalance is polycystic ovarian syndrome (PCOS).
PCOS is prevalent in our society. People with PCOS may have infrequent or prolonged menstrual periods or excess testosterone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. Those with PCOS tend to present have insulin resistance, AKA high insulin, in some tissues of the body, which is often in response to increased blood sugar levels. PCOS is really a nutritional and metabolic problem that adversely affects insulin and other hormones. Symptoms may include irregular or heavy periods, acne, facial hair, scalp hair loss, increased belly fat, and increased levels of testosterone.
Excess insulin is caused by chronic high blood sugar levels, often due to a high carb diet without sufficient exercise to compensate. Unused carbs convert to sugar in the body, and then to fat and inflammation. This can hinder ovulation by increasing testosterone and creating an imbalance in all the other hormones. In FM, we do a more in-depth test to measure one's insulin resistance involvement and help patients correct these levels naturally, sometimes with medication or supplements if needed. We can help our patients reverse PCOS--it does NOT have to be a lifetime diagnosis.
We test for insulin resistance via different labs, but one of our favorites is the Insulin Resistance Panel through Quest. By lowering a patient's insulin resistance score, we can often help them in their fertility journey. If there are signs of insulin resistance, it is time to follow a low-glycemic diet, which we help our patients with. “Low-glycemic” means the foods eaten do not spike blood sugar. Some examples of low-glycemic foods are healthy fats like avocados and nuts, fibrous non-starchy plants like kale and cauliflower, low-sugar fruits like berries, and high-quality protein from meat and fish. Examples of high-glycemic foods are white sugar and refined flours, bread, white rice, pineapple, juice, and even non-fat sweetened yogurt.
Insulin, your fat-storage hormone, wrecks havoc on the body if constantly high. It causes weight gain around the stomach, drives inflammation and oxidative stress, and is associated with downstream effects such as high blood pressure, high cholesterol, low HDL, high triglycerides, poor sex drive, infertility, thickening of the blood, and increased risk of cancer, Alzheimer’s, and depression.
In PCOS, excess sugar consumption (think too many carbs or alcohol) and subsequent belly fat drive hormonal imbalances and potentiate infertility. Metformin in a prescription medication that can help with blood sugar control and fertility, but a natural equivalent that works almost equally as well in clinical studies is berberine.
Massively under-addressed in conventional medicine is the topic of inflammation. Where there is systemic inflammation, there is a hostile environment for conception. What drives inflammation and inflammatory markers in the blood? Stress, sleep apnea, chronically high blood sugars and insulin, certain high-inflammatory foods and food allergies, excess weight--just to name a few. In FM, we measure your inflammatory markers like CRP-hs, ferritin, SED rate, ferritin, homocysteine etc and work with you to bring these down!
Endometriosis is a condition in which endometrial tissue develops outside the womb, most commonly around the ovaries, fallopian tubes, lining of the abdomen and on the bowel or bladder. Endometriosis is present in 15% of infertile women and can cause infertility! It is believed to be closely associated with inflammation and estrogen dominance, both issues that we test for and can minimize/correct in FM! Endometriosis can cause terrible cramps and stomach pain for some people. We can offer our patients natural ways to decrease endometriosis.
11. Thyroid health
In conventional medicine, typically your gynecologist or PCP will only check basic thyroid labs, like a TSH. In FM, we conduct a much more through thyroid panel test.
Inadequate thyroid hormone levels is a frequent cause of infertility. Foods rich in iodine (seaweed), selenium (Brazil nuts, just 1-2 daily) and iron all support the thyroid to function properly. Be careful with iodine supplementation—getting too much can negatively impact your thyroid, which is why food sources are safer than supplements. Gluten in wheat products is highly implicated in malfunctioning thyroid glands, as are some underlying infections, nutrient deficiencies, and chronic stress/high cortisol. As mentioned earlier, thyroid hormone production depends on healthy levels of gut bacteria (microbiome) to convert unusable thyroid hormone into usable thyroid hormone. Again, everything is connected!
12. Weight, exercise and the fertility connection
We often see women experience infertility due to over exercising and/or undereating.
Too much exercise can backfire by dropping hormone levels too low and increasing cortisol stress hormone too high. If our period stops, it's often a sign we're exercising too much or not eating enough calories to support our fitness level. Also, women don’t often continue to lose more weight with more exercise. Conversely, not enough exercise contributes to infertility through high blood sugars, insulin, inflammation, and weight gain. Balance and moderation is key.
In women, excess weight is associated with estrogen dominance, low progesterone, high testosterone, insulin resistance/high blood sugars, high inflammatory markers, and more difficulty with conceiving.
In men, excess weight (especially in the abdominal region) is associated with lower sperm counts, sperm concentration, sperm morphology, sperm motility, and testosterone levels. We offer a LOT of men's health and fertility support in our practice, including testosterone replacement.
Read the other parts of this functional fertility blog series to see more of the tests we order and nutrients/supplements we may suggest:
I encourage you to work with a Functional Medicine provider in conjunction with a gynecologist or fertility specialist to identify, address and correct and underlying root causes. Havilah Brodhead, FNP, CMO, CEO of Hearthside Medicine Family Care offers virtual visits to residents of Washington and Oregon, as well as in-person visits at her clinic in Bend, Oregon.
About the Author:
Havilah Brodhead, FNP, CEO, CMO
Hearthside Medicine Family Care
Havilah is an integrative, functional medicine nurse practitioner with a solid background in conventional medicine, including women's health, maternal-child health, mental health, gut health, hormones, family medicine, urgent care, men's health. She is passionate about helping patients find root causes to their health concerns and treating naturally whenever possible. She is accepting new patients for functional medicine consultations and care in both Washington and Oregon and accepts most insurances.
Havilah resides in Bend, Oregon and co-owns Hearthside Medicine Family Care with her husband Jeremy Brodhead, NP, who specializes in men's health. Hearthside is an integrative and primary care practice for all ages. She is mom to little girls and loves to mountain bike and practice yoga in addition to being a mommy and medical provider.
Appointment requests can be made easily online here: https://www.hearthsidemedicine.com/schedule-appointment
**Add in tomorrow: https://centrespringmd.com/the-integrative-medicine-guide-to-infertility/