Endometriosis and PCOS: Improving fertility outcomes naturally and in IVF.
When it comes to fertility we always hope it will be easy. We are biologically made to reproduce after all. However with ever increasing infertility rates we instead need to acknowledge we may require some assistance. In 2022 approximately 1 in 4 New Zealanders experience infertility and 1 in 8 require some form of medical assistance to achieve a pregnancy (1,2). This is similar to other high income countries around the world. So how can we improve our fertility whether we are conceiving naturally or through IVF?
Fundamental Foundations
We are born with a certain amount of eggs. This is true, but the quality of those eggs can be affected by what we do throughout our lives. An egg you release on this menstrual cycle has taken 3 months to mature before being released. This is where a strong preconception plan whether you are harvesting eggs for IVF or conceiving naturally is important.
Diet: The diet that has strong evidence for fertility outcomes is the Mediterranean diet with some tweaks (3). Focus on vegetables, wholegrains, nuts and seeds, fruit, herbs and spices. Emphasis eating the rainbow on your plate. Antioxidants are contained in these colorful foods which protect your eggs. Eat fermented foods to build beneficial gut bacteria. The estrobolome is part of our hormonal balance so it's essential we nurture it.
Exercise: Exercise regularly reduces inflammation, increases blood flow and supports an optimal microbiome. Don't over do it though. It's easy to go the other way and be doing so many HIIT classes you send your hormones into an imbalance. 2-3 resistant sessions (30-40minutes) a week with some walks outside daily is a great amount!
PCOS: If you have insulin resistant PCOS you will want to focus on resistant training 3 times per week. This supports increasing lean muscle mass and increasing insulin sensitivity.
Relaxation: Stress impacts our fertility. Stress hormones produced regularly are inflammatory and affect our hormonal production. The precursor for cortisol is pregnenolone which is also the precursor for estrogen and progesterone. And guess what is more important? ….Cortisol!. So increase nervous system practices that regularly put you in the parasympathetic. I recommend a Yoga Nidra 3-4 times per week for 20 to 30 minutes. Walking in Nature, and singing.
Alcohol: This one is a big no go. Alcohol alters our hormonal balance, is a huge oxidative stress and reduces our beneficial gut bacteria. Remove it for at least 3 months prior to egg harvesting or trying naturally, and this goes for your partner in conceiving too.
Environmental Endocrine Disruptor chemicals (EDC’s):
These are contained in our cleaning products, containers, items we use for cooking and much more. They are so rampant in our environment that they have been found to be impacting Female fertility (4). These synthetic compounds have the ability to alter the structure and function of genes and proteins that support optimal ovarian and endometrial functions. This can result in high miscarriages, decrease of the number of high quality embryos in assisted reproductive technology (ART), as well as lower fertilization and embryo implantation rates(5). The most commonly known one BPA, has similar effects as estradiol on female physiology (5).
The first step is doing a clean sweep of your house to check what ECDs are inside. Start by using natural cleaning products, shampoos, skin creams and cosmetics, aim to store your foods in glass rather than plastic and use cast iron cookware. This EDC detox can take some time, be kind to yourself and start making little changes daily. A big exposure is plastic drinking bottles and tap drinking water. Filter your water with a jug or have a filter installed and make sure it contains a carbon filter to remove the EDCs.
Supplements
There are certain therapeutic supplements that have may enhance fertility. They are dependent on your specific hormonal presentation and challenges. One of these is NAC. This was shown to increase fertility rates in endometriosis and decrease endometrial lesions when taken across 3-6 months (6). It's important to work with a health practitioner to get the correct dosages and also create a holistic plan for your specific challenges.
Increased oxidative stress has shown to be a mechanism in infertility (7). COQ10 supplementation has been shown to enhance fertility as it acts to reduce this oxidative stress. It may increase clinical pregnancy outcomes in assisted reproductive therapies such as IVF (7).
What preconception plan is right for me?
These initial steps are foundational to increasing your fertility success rate. It really is all about the egg and ensuring it has the best chance to mature and not have chromosomal abnormalities (the most common cause of miscarriage). There are many other natural herbs and supplements that support optimal fertility and are worth exploring with a health practitioner as you want to make sure you are taking the right supplement for you.
If you are having trouble conceiving hormonal testing such as the Dutch test may also be a great option to understand what is going on with your hormonal picture in more depth.
As you can see there are many options. I have worked with many women of all ages to support them in becoming pregnant naturally. It's one of the biggest joys in my work when I receive an email that a client has a new baby in their lives. Get in touch if you are after a personalized approach to your preconception plan and or help in overcoming fertility challenges.
If you are after support please book a consultation or a clarity call.
References
1 Fertilty Associates NZ. Retrieved from https://www.fertilityassociates.co.nz/understanding-your-fertility.
2. Righarts, A., Dickson, N. P., Ekeroma, A., Gray, A. R., Parkin, L., & Gillett, W. R. (2021). The burden of infertility in New Zealand: A baseline survey of prevalence and service use. The Australian & New Zealand journal of obstetrics & gynaecology, 61(3), 439–447. https://doi.org/10.1111/ajo.13323.
3. Skoracka, K., Ratajczak, A. E., Rychter, A. M., Dobrowolska, A., & Krela-Kaźmierczak, I. (2021). Female Fertility and the Nutritional Approach: The Most Essential Aspects. Advances in nutrition (Bethesda, Md.), 12(6), 2372–2386. https://doi.org/10.1093/advances/nmab068.
4. Vessa, B., Perlman, B., McGovern, P. G., & Morelli, S. S. (2022). Endocrine disruptors and female fertility: a review of pesticide and plasticizer effects. F&S reports, 3(2), 86–90. https://doi.org/10.1016/j.xfre.2022.04.003.
5. Panagopoulos, P., Mavrogianni, D., Christodoulaki, C., Drakaki, E., Chrelias, G., Panagiotopoulos, D., Potiris, A., Drakakis, P., & Stavros, S. (2023). Effects of endocrine disrupting compounds on female fertility. Best practice & research. Clinical obstetrics & gynaecology, 88, 102347. https://doi.org/10.1016/j.bpobgyn.2023.102347.
6. Anastasi, E., Scaramuzzino, S., Viscardi, M. F., Viggiani, V., Piccioni, M. G., Cacciamani, L., Merlino, L., Angeloni, A., Muzii, L., & Porpora, M. G. (2023). Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes. International journal of environmental research and public health, 20(6), 4686. https://doi.org/10.3390/ijerph20064686.
7. Florou, P., Anagnostis, P., Theocharis, P., Chourdakis, M., & Goulis, D. G. (2020). Does coenzyme Q10 supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials. Journal of assisted reproduction and genetics, 37(10), 2377–2387. https://doi.org/10.1007/s10815-020-01906-3.