In today’s fertility blog, we turn to expert and trusted fertility nutritionist, Milena Mastroianni, from Root and Leaf Nutrition, to hear about the five essential functional medicine tests for fertility. It’s so important when you’re trying or struggling to conceive, to understand how to help your fertility and improve IVF success rates (if you’re having fertility treatment). Read on to find out what you should be looking for.
My training in nutrition is based on the approach of Functional Medicine (FM) approach. FM is a new branch of medicine which is becoming more and more popular, because it looks at the body as a whole, not as different organs or systems. Just as the Functional Medicine model looks at a patient as a whole person, it also does not aim to cure symptoms, but it strives to find the root cause of health imbalances, through an individualised, patient-centered and science-backed method, which shows patients how to regain health and vitality. The aim of this approach is also to shine a light on unanswered questions.
One of the examples that is often given to explain this is the one of depression. This may often seem like a symptom of the mind, but in fact, it may originate from different imbalances in the body such as the thyroid, nutritional deficiencies, gut health or even a pre-diabetic state. In the same vein, struggling with (in)fertility or particular hormonal conditions (e.g. PCOS) can be symptomatic of an imbalance, but what is their root cause? That’s when the investigative work starts. One of the ways that Functional-Medicine-trained nutrition practitioners (like me) carry out these investigations is via a certain amount of targeted testing, prioritised with a client’s full medical history in mind. Let’s dive into the most useful tests when it comes to fertility…
The thyroid gland is so important for fertility, and many aspects of our health, because the hormones it produces are needed by every single cell of our body. It’s no surprise that having too much or too little of thyroid hormones may be linked to problems with fertility and baby loss, as well as issues with the foetus development. Making sure your thyroid is in order for your fertility is an important insurance policy for your future pregnancy. Thyroid hormones are essential for conception and maintaining a healthy pregnancy. Unfortunately, standard thyroid tests will often include only limited markers (namely TSH) and offer very wide ranges for them.
In other words, you may have been told that your thyroid hormones for fertility are in range, but they may in fact not be optimal. Even worse, you may actually experience thyroid related symptoms and not be aware of them. In fact, an autoimmune form of hypothyroidism called Hashimoto’s, which counts for 80% of hypothyroid conditions, often goes undiagnosed. The functional medicine approach with the thyroid is to look at a full panel of markers, which not only includes the production of your thyroid hormones, but also any thyroid related antibodies which may be having
an impact on this major gland and your immune resilience, which is also discussed below with Vitamin D.
2. Vitamin D and Fertility
I am sure you have by now heard of the importance of Vitamin D for fertility (and general health), with regards to its immune protective effects. As well as Vitamin D being crucial for fertility, it is also important for a healthy pregnancy. Unfortunately however, Vitamin D deficiency is very common. This is reflected in the fertility community, with studies pointing at lower pregnancy / IVF success rates in women undergoing ART who are deficient in Vitamin D (Lil et al., 2012). Vitamin D levels are super important because this vitamin, which in fact acts more like a hormone, can have an impact on the immune system (during preconception for example) by regulating Natural Killer cells and auto-immunity (Rudick et al, 2012), which in turn can influence the ability to maintain a pregnancy and other factors such as endometrial thickness (womb lining thickness) (Abdullah UH et al, 2016).
Fertility in men is also influenced by their Vitamin D Status. Since we get Vitamin D mostly from sun exposure in the summer months, in the UK and other Northern Hemisphere countries, doctors recommend we take a maintenance dose of Vitamin D in the winter months. However, this may be insufficient in the case of deficiency or suboptimal levels, hence the importance of knowing your exact levels. “Test don’t guess” is a phrase often heard in the Functional Medicine world, exactly because it’s the best way to adjust supplementation recommendations.
3. Blood Sugar
Blood sugar dysregulation is often at the foundation of hormonal imbalances, weight gain, tiredness, fatigue and low moods, as well as other metabolic conditions such as high blood pressure and high cholesterol. No wonder this is crucial to investigate and correct during the trying to conceive period, in order to also minimise the chances of gestational diabetes during pregnancy and/or the risk of developing Type 2 diabetes later in life. Women with PCOS, in particular, often tend to present with insulin resistance, AKA high insulin, in some tissues of the body, which is often in response to increased blood sugar levels.
Excess insulin is caused by repeated/chronic high blood sugar levels, often due – but not always – to the consumption of highly refined carbs in our diet. This can hinder ovulation by increasing male hormones (also called androgens) and creating an imbalance in all the other hormones. A common marker for blood sugar balance called HbA1C is often used by primary care doctors to look at your historic blood sugar levels for the past three months. However, often this is not a sufficient marker and other markers such as fasting glucose and fasting insulin may be more indicative of what is really going on, in terms of how your body responds to blood sugar and its corresponding insulin.
It is very likely that during your TTC (trying to conceive) journey, you would have been offered an assessment of your sex hormones. Whilst this can be very useful (provided that the tests are taken at the correct time of your cycle), it does not always solve all the puzzles around fertility. Other types of hormones, as we have seen for the thyroid, are often neglected. This is the case for our adrenal hormones, which regulate our stress response. One of the adrenal hormones that are typically associated with stress is cortisol. Whilst crucial in so many pathways of our body, continuously elevated cortisol in response to chronic stress has been shown to interfere with a cascade of lots of other hormones, including (and not limited to) our sex hormones and our thyroid.
Are you starting to see how everything in our body is interlinked? Testing cortisol, which can also be added alongside sex hormones, is pretty easily done with urine and saliva samples, and can be beneficial to motivate clients in finding ways to adjust their lifestyle or learning to tone down their response to daily stressors through simple consistent lifestyle modifications.
5. Microbiome Testing
Last but not least, the discovery of the microbiome in the last ten years and its effects on human health has revolutionised science. The microbiome is an umbrella term that indicates all the different bacterial species living on us and within us and it’s estimated that there are more than 100 trillion bacteria in our microbiome, three times the cells of our body! The body system with the most abundant population of bacterial species is our gut. Our gut bacteria regulate our digestion and absorption of nutrients, but also our mood, our immune response, our blood sugar response and sensitivity to the foods we ingest, our elimination of toxins and of extra hormones etc.
Moreover, the gut microbiome is closely linked to the reproductive microbiome, i.e. the female vaginal microbiome. Although the number of species in the reproductive microbiome is not as diverse as the one in the gut, any introduction of pathogens or imbalances in these two microbiomes (also termed dysbiosis) can have a similar detrimental impact to both our health and our ability to conceive.
The good news is that many of these imbalances and deficiencies can be prevented and corrected with diet changes, lifestyle modifications and targeted supplementation. Sometimes only a few changes can make a massive difference, especially if they are addressing a specific root cause. But following new recommendations can become quite hard, as results come from frequency, consistency and also help from a nutrition practitioner who can guide you and encourage you along the way.
If you have any unanswered questions on your path that you have really been dying to find out more about, why not reach out? We can discuss your trying to conceive journey on a free discovery call. It may well make the difference between a negative and a positive pregnancy test or a successful IVF treatment. And at the same time, you will learn how to optimise your health to the max, for the rest of your life.