14a. FERTILITY Flashcards
(28 cards)
Definition of infertility
Lack of pregnancy after one year of unprotected intercourse
What structural abnormalities can cause female fertility issues? (5)
- Cervical stenosis: Narrow / closed cervix.
- Uterine septum: Divided uterus.
- Uterine polyps and fibroids.
- Fallopian tube obstruction.
- Ovarian cysts.
What hormonal issues can cause female fertility issues? Why and/or what from? (5)
- Polycystic Ovarian Syndrome — elevated androgens, anovulation, irregular cycles, implantation issues.
- Obesity / insulin resistance — same as PCOS
- Amenorrhoea — excess exercise, undereating, low BMI, high stress.
- Hyper or hypothyroidism — irregular cycles, ovulatory disorders, miscarriage, pre-term birth, pre-eclampsia.
- Premature ovarian failure — loss of ovarian function < 40 due to chemotherapy / radiotherapy, genetic
Which hormone is highest in the first half of the reproductive cycle and what is its function?
Which hormone is highest in the second half of the cycle and what is its’ function?
Oestrogen: Prepares the endometrium (thickening of lining), important for ovulation
Progesterone: Maintains the endometrium, implantation & survival of embryo
- Where are oestrogen and progesterone produced?
- Where are they stored?
Ovaries, adrenals, placenta.
Adipose tissue.
Signs & symptoms of female oestrogen dominance (16)
Similar for oestrogen & progesterone dominance
* Breast tenderness
* Bloating
* Insomnia
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Neuroloical:
* PMS and irritability
* Headaches
* Poor memory, brain fog
* Fatigue
Physical:
* Heavy bleeding and clotting
* Shorter menstrual cycles
* Hair loss
Medical:
* Fibroids and uterine polyps
* Endometriosis
* PCOS
* Fibrocystic breasts
* Hypothyroidism
* Miscarriages
Signs & symptoms of female progesterone dominance (11)
Similar for oestrogen & progesterone dominance:
* Breast tenderness
* Bloating
* Insomnia
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Neurological:
* Dizziness
* Drowsiness / lack of concentration
* Decreased libido
* Anxiety / panic attacks
Physical:
* Shortness of breath
* Weight gain
* Light periods
* Water retention
How to optimise oestrogen / progesterone ratio (8)
- Reduce stress — regular healthy meals, ↓ over-exercising, address emotional stressors.
- Optimise sleep
- Optimise liver function — to detoxify excess oestrogen.
- Optimise digestion and elimination —to excrete excess oestrogen.
- Avoid xenoestrogens (e.g., home / personal products).
- Avoid alcohol — ↑ oestrogen levels
- Reduce body weight if obese — oestrogen is stored and produced in fat cells.
- Vitex agnus castus.
What drugs cause female infertility & how? (4)
- NSAIDs (long-term use or ↑ dosage) — inhibit ovulation and lower progesterone levels.
- Chemotherapy — damage / depletion of oocytes.
- Corticosteroids — suppress immune function, affect gut microbiome
- Antihistamines — dry the mucous membranes.
What environmental / lifestyle factors cause female infertility & how? (11)
- Stress - raised cortisol decreases progesterone (by downregulation of LH & FSH)
- Excessive exercise - raised cortisol decreases progesterone (by downregulation of LH & FSH)
- Increased age - decreased oocyte numbers/quality, implantation failure, increased miscarriage risk.
- Periodontal disease - prevents ovulation, increases inflammation
- Dysbiosis of vaginal microbiome - causes miscarriage
- Radiation (mobile phones, x-rays and radiotherapy, frequent flying) — damages oocytes.
- Environmental toxin exposure (e.g., mercury, lead, phthalates) — infertility and miscarriage.
- Chronic alcohol consumption — diminished ovarian reserve and ovulatory dysfunction.
(Note: First 8 above are shared with men - just with different hormones)
- Caffeine — increases cortisol production, slows COMT causing oestrogen dominance.
- Xenoestrogens, endocrine disruptors - altered hormone levels
- Genetic SNP on MTHFR or B6/B9/12 deficiency - elevated oestrogen, poor egg quality, neural tube defect
What immunological factors can cause foetal rejection? (3)
- Tissue compatibility issues - immune system rejects HLA proteins from father
- Auto-immune response - immune system rejects the embryo
- Anti-sperm antibodies - immune system destroys sperm
What is the dominant species in the vaginal microbiome?
What strains are raised in BV and what can they cause in pregnancy?
Lactobacillus.
Ureaplasma, Gardnerella - miscarriage
What factors can negatively affect the vaginal microbiome? (8)
- STIs
- Alcohol
- Smoking
- Poor vaginal or oral hygiene
- Increased blood glucose levels
- Copper IUD coil
- Vitamin A, C, D, and E deficiencies
- Antibiotics
What are conventional fertility investigations? (6)
- Ultrasound - to check for structural abnormalities and follicle count
- Serum FSH, oestrogen & progesterone
- Thyroid function
- Glucose & insulin levels
- STI / UTI testing
- Anti-Mullerian Hormone - to check ovarian reserve
What functional testing might we conduct to investigate female fertility issues? (6)
- Toxic metals (hair / urine)
- MTHFR & COMT DNA testing
- Homocysteine as a marker of methylation issues
- Adrenal stress profile - due to impact of cortisol on fertility
- Comprehensive hormone panels - DUTCH (1 day sex & adrenal hormones) / Rythm Plus (28 days)
- Vaginal ecology - evaluate the vaginal microbiome
What structural abnormalities can cause male fertility issues? (4)
- Undescended testes ― ↓ sperm count and quality due to heat.
- Testicular cancer ― damages sperm and causes changes in testosterone levels.
- Surgery or injury to testes such as testicular torsion, being kicked; bicycle injury.
- STIs - Damage to testes, vas deferens or epididymis.
What hormonal issues can cause male fertility issues? Why and/or what from? (3)
- Obesity - Increased conversion of testosterone to oestrogen (aromatisation)
- Cushing syndrome / stress - Increased cortisol results in low sperm count.
*Illnesses ― suppresses gonadotropin release
What environmental / lifestyle factors cause male infertility & how? (9)
All below decrease / damages sperm
* Stress
* Excessive exercise
* Increased age
* Periodontal disease
* Dysbiosis of seminal microbiome (from antibiotics, antifungals, obesity, STI’s)
* Radiation (mobile phones, x-rays and radiotherapy, frequent flying)
* Environmental toxin exposure (e.g., mercury, lead, phthalates)
* Chronic alcohol consumption
(Note: first 8 above are shared with females - just with different hormones)
- Heat exposure of testes (hot baths, tight clothes)
What are the conventional fertility treatments and what do they involve? (4)
- In vitro fertilisation (IVF): Stimulation of ovaries, egg retrieval, fertilised in vitro with sperm, fertilised embryos transferred into uterus.
- Intracytoplasmic sperm injection (ICSI): Sperm is injected into egg in vitro (if fertility issue is due to sperm abnormalities).
- Intrauterine insemination (IUI) — sperm is placed inside uterus around ovulation to facilitate fertilisation.
- Sperm, oocyte, or embryo cryopreservation (e.g. before cancer treatment).
What are possible complications of IVF treatment? (4 + 2)
- Multiple births — if more than one embryo is transferred into uterus.
- Premature delivery and low birth weight ― ↑ risk with IVF.
- Ectopic pregnancy — 2–5% of women who use IVF.
- Cancer — egg growth stimulation drugs are linked with the development of a specific type of ovarian tumour
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Also: - Ovarian hyperstimulation syndrome — swollen and painful ovaries due to injected fertility drugs.
- Egg retrieval procedure complications — aspirating needle use could cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Also risks with anaesthesia.
How long does it take for eggs and sperm to mature and what is the recommended preconception preparation period?
Egg - 100 days to prepare for ovulation
Sperm - 72–76 days to mature.
* Preconception preparation should start at least 3 months before planned conception.
What should you avoid (7) and include (11) during a preconception preparation plan? (incl diet & lifestyle)
The same as for every other plan! CNM naturopathic diet with a focus on:
AVOID
* Processed food - promotes oxidative damage.
* Caffeine - increases cortisol, slows COMT (causing oestrogen dominance)
* Alcohol ― impacts ovulation; ↓ sperm motility and count.
* Unnecessary medications
* Intense exercise: running, spinning, HIIT, CrossFit
* Stress
* Environmental toxins
INCLUDE
* Local, seasonal whole foods - cooked to maintain nutrients
* Encourage optimum digestion - e.g. chewing well, digestive support
* Antioxidant rich foods - eat the rainbow
* Liver detox foods - cruciferous veg, legumes (fibre)
* Organic eggs - cholesterol for steroid hormone production
* Healthy fats - nuts, seeds, EVOO, oily fish
* Moderate exercise: Yoga, Pilates, walking and swimming
* Optimise sleep
* Positive mindset work
* Holistic therapies (massage, reflexology, acupuncture)
* Castor oil packs
What is the ideal BMI for fertility?
20 - 25%
What supplements would you use to support male fertility? Give dose & mechanism (5 + 2)
Think antioxidants & mitochondrial support + sperm motility!
Zinc (15 - 30mg)
- Supports testosterone production and promotes spermatogenesis.
- Antioxidant
Selenium (200–600 mcg)
- An essential component in the antioxidant glutathione peroxidase.
- Improves sperm motility
B complex / B6, 9, 12
- Mitochondrial support (for pregnenolone synthesis).
- Methylation support
CoQ10 (200mg)
- Antioxidant
- Improves sperm motility
Fish oil (>900mg DHA)
- Cell membrane fluidity - required for egg penetration
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Also:
L-Carnitine (1g)
- Antioxidant
- Improves sperm motility
- Sperm maturation
N-acetyl cysteine (600mg)
- Antioxidant (supports glutathione production)
