Issues with fertility and conception are increasing in Australia, as are the number of couples utilising IVF and assisted fertility treatments. Sadly, IVF isn’t always successful because it isn’t just fertilisation and implantation that are the issue. For many couples, the quality of the sperm and ovum isn’t always optimal and issues with blood supply and nutrient delivery to the growing foetus may be impaired. This could help to clarify why some women experience unexplained recurrent miscarriage.
Nutrition is often the missing link
Nutrigenomics profiling can help couples identify potential issues and provide powerful, individualised nutritional support to improve their chances of having a healthy pregnancy, birth and, most importantly, a healthy baby at the end.
What does the test cover?
It is recommended that individuals complete a full genomic profile that includes the following:
Nutrigenomics (individual nutrient requirements e.g. Vitamin D, B12, etc.)
Methylation (e.g. MTHFR) and liver detoxification
Hormones and fertility.
It’s not just all about MTHFR
The MTHFR (the gene that provides instructions for making the methyl enzyme) genetic variant has received a lot of attention and exposure in the last few years. The reality is it’s only one gene (yes, an important one) in a pathway involving many genes. For example, we find that many women require more choline to support their methylation pathway (and hence fertility and conception) yet this important nutrient is rarely considered.
DNA testing is just one small part of the picture
Nutrigenomics (or DNA) testing is important, however it is essential to consider these results alongside any pathology testing, presenting symptoms and your full case history.
I’m sure many of you have heard of vitamin D but do you fully understand what it does within your body?
Vitamin D plays a number of import roles within your body which enable normal functioning of a range of metabolic and physiological functions. Insufficient levels of this nutrient can result in disruption to these functions, leading to detrimental effects on our health and also giving rise to various disease states, particularly related to our immune system (1). A number of studies have found links between vitamin D deficiency and adverse health outcomes such as cardiovascular disease, autoimmune diseases, diabetes, cancer and an increased risk of mortality (2). Vitamin D has been shown to be particularly beneficial for our immunity, our fertility and during pregnancy and for our musculoskeletal system, as discussed below.
The need to provide your body with nutrients which the immune system loves is particularly important coming into the winter months – and vitamin D is one of these.
Vitamin D is an immune-system regulator in that it enhances the body’s immune response to both bacterial and viral infections. Vitamin D’s immunomodulation effects work through a number of mechanisms that ensure specific immune cells respond appropriately to pathogens (3). A recent randomised, placebo-controlled and double-blinded study on individuals who frequently experienced respiratory tract infections found significant decreases in the prevalence of infections during a twelve-month period in individuals taking vitamin D supplementation when compared with the placebo group (4). This study demonstrates the beneficial effects of an adequate vitamin D status on strengthening the immune system. Vitamin D also contributes to inhibition of adaptive immunity through its role in down regulating the inflammatory response of specific cells. This mechanism has demonstrated particularly beneficial relevance for autoimmune conditions such as type 1 diabetes, rheumatoid arthritis, multiple sclerosis and Crohn’s disease (3, 5).
Fertility and pregnancy
Vitamin D receptors are found within reproductive tissue including ovaries, endometrium, placenta, testes, spermatozoa and pituitary gland. This suggests vitamin D plays an active role within these tissues (6). Two studies have demonstrated promising effects of increased vitamin D status in women undergoing both donor egg and non-donor egg in-vitro fertilisation (IVF) on achieving clinical pregnancy than women with lower levels of the vitamin (7, 8). Evidence is suggesting vitamin D deficiency may also be the cause of insulin resistance and metabolic syndrome in women with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility (6). (Read more on PCOS here.)
Vitamin D deficiency in men has been associated with a number of implications regarding sperm quality such as a lower proportion of motile, progressive motile and morphologically normal spermatozoa which can have negative influences on male fertility (2). Vitamin D supplementation has been shown to have beneficial influences on some of these parameters such as motility and progressive motility – in other words, how well sperm swim and the direction in which they swim! (2).
Pregnant women are found to have significantly lower levels of vitamin D than non-pregnant women. Maternal vitamin D deficiency has been associated with an elevated risk of gestational diabetes, pre-eclampsia and bacterial vaginosis, as well as small-for-gestational-age babies and babies with disorders such as rickets, reduced bone density, asthma and schizophrenia (2). Studies on supplementation of vitamin D during pregnancy have shown to be both safe and effective in achieving sufficient vitamin D status. Vitamin D supplementation has demonstrated beneficial health outcomes of reducing the risk of preterm delivery, as well as reducing infections, diabetes mellitus, hypertension and pre-eclampsia in mothers (2).
Vitamin D plays an integral role in the intestinal absorption of calcium, balancing levels of both calcium and phosphorus in the blood, together with the process of formation and demineralisation of the bones. As a result of these functions, among others, there is a correlation between decreased vitamin D levels and decreased bone mass density, resulting in conditions such as rickets, osteomalacia, osteoporosis and an increased risk of fracture (6). Vitamin D also plays a role in muscular health and strength, demonstrated through vitamin D deficient individuals experiencing muscular weakness and pain, difficulty walking and increased falls (5).
What are optimal vitamin D levels?
Doctors often refer to having ‘optimal’ levels of vitamin D when concentrations within the blood are within the reference range. But studies have indicated that even levels within this range can result in deficiency symptoms and impaired vitamin D functioning within the body. For this reason, it is important to ensure your levels are considered to be within the ideal range of >100nmol/L to optimise body function and prevent associated deficiency conditions. Due to the essential role vitamin D plays in immune health, as previously discussed, it is vital to ensure levels are also optimal for ensuring your immune system is functioning at its best, especially coming into the winter months (1).
Vitamin D concentration in the blood:
Optimal levels should be >100nmol/L
Mild deficiency is considered at levels 25–50nmol/L
Moderate deficiency considered at levels 12.5–25nmol/L
Severe deficiency considered at levels <12.5nmol/L
How do we get vitamin D and why do we need to test for it?
According to a 2012 national population-based study of Australians aged 25–95 years, 73 per cent of the population had vitamin D levels that were below the ideal range, with nearly one-third of the population being deficient and four per cent of the population having a severe vitamin D deficiency (9). Alongside this, the prevalence of deficiency was more common among women than men and vitamin D status also decreased with age (9). This study also found that levels of vitamin D decreased greatly during winter and spring, with 58 per cent of women and 35 per cent of men in southern regions of Australia being deficient during this time (9).
Vitamin D can be found in the diet most substantially in food sources of animal origin, however dietary intake alone is unlikely to meet your body’s requirements. The key source of vitamin D comes from your body’s ability to synthesise this nutrient within your skin through ultraviolet (UV) radiation produced by the sun (5, 1). Deficiency of vitamin D can be a result of insufficient dietary intake, reduced sun exposure and/or metabolic or malabsorption diseases (3). Due to the primary source of vitamin D being through sunlight exposure, reduced sunlight experienced during winter – particularly in Victoria – reduces the levels able to be made and therefore your vitamin D status may be diminished. For this reason, testing of vitamin D levels prior to winter is extremely important to ensure you are aware of, and maintaining, your levels throughout the cooler months as needed.
How much sunlight exposure do we need to receive adequate vitamin D levels?
From October to March, 10–15 minutes of unprotected sunlight exposure to 15 per cent of the body outside of the hours of 10am to 3pm, 2–3 times per week is sufficient for adequate synthesis of vitamin D (3, 1). However, due to lowered levels of sunlight between March and October, up to one hour is required to maintain adequate vitamin D synthesis during the cooler months (3). Short bursts of sunlight exposure are considered more effective for vitamin D synthesis than longer periods, as excessive UV exposure can inactivate the newly formed vitamin D within the skin (3).
Why you should supplement with vitamin D
Groups at higher risk of vitamin D deficiency (1):
people who avoid dairy and processed foods (sources of fortified vitamin D)
people who are unable to attain sunlight exposure
people with malabsorption conditions such as: irritable bowel syndrome, Crohn’s disease and ulcerative colitis
To discuss this topic in more detail, please contact our naturopath, Karly, at firstname.lastname@example.org or to make an appointment click here. Please note, Karly recommends bringing any recent blood tests with you to your appointment.
(1) Hechtman, L. 2012, Clinical naturopathic medicine, Elsevier Australia, Chatswood
Polycystic ovarian syndrome (PCOS) affects 6–10 per cent of reproductive-aged women and is the most common cause of anovulatory infertility (1).
What is PCOS
PCOS is a complex hormonal condition that involves two or all of the following:
Oligo-anovulation (irregular, infrequent or absent ovulation)
Hyperandrogenism (excessive secretion and activity of androgen hormones)
Polycystic ovaries (multiple partially formed follicles on the ovaries)
This means there is excess secretion and activity of the androgen hormone which causes abnormalities in ovarian function (1). Failure of the ovaries to regularly ovulate causes disruption to a host of hormones including lowered progesterone and oestradiol as well as elevated testosterone (2). These abnormal hormone levels, among others, cause a number of the symptoms associated with PCOS (2).
PCOS is also associated with various metabolic syndromes such as obesity, abnormal insulin activity, type 2 diabetes mellitus and cardiovascular disease (3, 4). Alongside these associated conditions is the prevalence of psychological issues including mood disorders and eating disorders (3). Another huge contributing factor for PCOS patients is high stress and cortisol production.
Menstrual abnormalities (irregular, infrequent, heavy or absent menstruation)
Hirsutism (excess body and facial hair)
Acanthosis nigricans (dark colouring on the back of the neck and underarms)
Alopecia (hair loss on the scalp)
Polycystic appearing ovaries (numerous cysts on the ovaries and enlarged ovaries)
Obesity, particularly central adiposity
Abnormal hormone levels
Key nutrients that can help with PCOS
Nutritional supplementation can aid many aspects of this syndrome including stabilisation of female hormones, reducing the formation of ovarian cysts, regulating the timing of ovulation, supporting and preventing associated metabolic syndrome, improving and managing weight balance, stabilising blood sugar levels, reducing insulin resistance and supporting adrenal function (4). Below are just a few of the many nutrients that can assist with the management of PCOS. Please be aware that correct dosages and time frames are essential when treating PCOS. Discussing your health with a qualified naturopath is vital to achieving improvements.
Due to their important role as cofactors in metabolising carbohydrates and fats, B vitamins may be beneficial to improving insulin sensitivity in women with metabolic syndrome associated with PCOS. They may also be helpful in decreasing risk factors of cardiovascular disease for women with PCOS who take some forms of diabetic medication (4).
Omega-3 fatty acids
Omega-3 fatty acids are beneficial in a number of ways for women with PCOS. Not only do they have anti-inflammatory properties, important in reducing cardiovascular disease risk, they also improve insulin sensitivity and have been shown to have a positive effect on liver fat content and other cardiovascular risk factors in women with PCOS (4).
A randomised, double-blind, placebo-controlled trial evaluating the effects of zinc supplementation on a number of endocrine outcomes in women with PCOS over an eight week time period, showed a number of significant results. Zinc supplementation on this group of women demonstrated beneficial effects on symptoms associated with PCOS such as decreasing alopecia, hirsutism and plasma Malondialdehyde—a biomarker of oxidative stress (5). Alongside these benefits, zinc also plays a key role in modulating insulin and may also help with acne associated with PCOS (4).
Adequate iodine concentration in the ovaries promotes healthy ovulation, reduces ovulation pain and prevents ovarian cysts (6). Iodine affects the reproductive hormones oestrogen and progesterone through promoting oestrogen detoxification and desensitising oestrogen receptor cells, as well as elevating progesterone through ovulation (6).
Inositol has had beneficial results for women with PCOS in increasing fertility rates and improving embryo quality (7, 8). These benefits were demonstrated in two studies: a randomised control trial with PCOS patients who underwent IVF-ET and were treated with a combination of different forms of inositol (7), and a randomised placebo control group study with PCOS patients undergoing IVF treatments and using a combination of inositol and folic acid (8). Both studies resulted in improved oocyte and embryo quality as well as improved rates of fertilisation (7, 8). Alongside this, a further study on the presence of ovulation in women with PCOS with inositol supplementation in comparison to a placebo group demonstrated successful ovulation in 19 out of 22 women as compared with 6 out of 22 women in the placebo group (9).
Key herbal medicine that can help with PCOS
There are a range of herbal medicines that can be used to help women who have PCOS. Two of the main herbs which are commonly used in combination are Glycyrrhiza glabra and Paeonia lactiflora. Trials have demonstrated that these herbs in combination can reduce follicle stimulating hormone and luteinizing hormone (FSH:LH) ratio and ovarian testosterone production, and improve ovulation. Glycyrrhiza glabra can also play a significant role in PCOS patients who are highly stressed with elevated cortisol production. This is due to the cortisol lowering actions this herb also exerts. Naturopaths will also assess the individual and create herbal mixtures with additional herbs based on their symptoms and contributing factors.
How diet can assist with the management of PCOS
As women with PCOS are at a higher risk of metabolic syndrome and cardiovascular disease, diet has a massive impact on prevention of these associated conditions (4). There are a number of dietary changes that aid in the management of PCOS. These are targeted around improving weight balance, healthy weight management, reducing insulin resistance, stabilising blood sugar levels and supporting and preventing metabolic syndrome associated with PCOS (4).
If you would like to discuss how we can help in the management of PCOS or if you would like to know more about the condition, click here to make an appointment with Karly.
Kismet Health Clinic can help you create and achieve a preconception plan that allows you to improve your health and lifestyle and potentially increase your chances on conception and the future health of your baby. We are passionate about creating a healthy you, so that we can create healthy children in North East Victoria and regional NSW.
Preconception care is all about getting both parents to be as healthy as possible, because healthy people make healthy babies. A healthy you will mean, healthy cells, eggs and sperm all of which will create your baby and determine the health of your baby.
Evidence now demonstrates that the health of both parents before and during pregnancy is strongly associated with healthy development and general health in adulthood. This is especially true in relation to obesity, cardiovascular disease, mental health, risk of cancer, gut health and immune functioning.
Now men, the health of your baby also comes down to you, I love it when the male partner turns up to the appointment when couples are trying to have babies, it literally does take two to tango. The health and quality of your sperm is important for successful conception and also the health of your baby. Evidence shows that men who have poor diet, high stress, smoke and drink large amounts of alcohol have lower sperm count, can experience difficulties when it comes to conception and are also at an increased risk of miscarriage. This means that when both partners get on board you are likely to have increased success.
The best thing about preconception care is that it’s an overall health change, kind of like a health kick. It will give both of you achievable changes to both your diet and lifestyle which you’ll both be able to maintain long-term. All advise is practical, realistic and easy to achieve. Plus it’s nice to know that you have someone to help you through one of the most important stages of your life and to get professional advice along the way.
So what does getting healthy and pregnant involve?
Approximately 100 days (3 months) is the ideal time frame for preconception care, however we have also worked with couples for longer then this depending on their current health status, the time frame is determined in your initial consultation. This amount of time is required because sperm and eggs take this long to develop or mature. It means that while they are developing/maturing they get the benefit of all the changes you are making to improve your overall health.
Some of the things that may be involved in your preconception plan are listed below – these are however tailored specifically to what you need as a couple as not everyone is the same.
An in depth and thorough health screen including nutritional deficiencies, gut health, hormonal health, genitourinary and other infections.
Referrals to other health professionals, such as acupuncture for proven support.
Who would it benefit?
Couples, single women or same sex couples who want to give their baby the best possible start to life.
Couples or single women who have general infertility with or without known cause, including problems with sperm quality, anovulation, PCOS, endometriosis etc.
Couples who have experienced one or more miscarriages
Couples who have experienced previous complications such as prematurity, low birth weight, stillbirth or sudden infant death syndrome.
Couples or single women currently doing IVF
A note of IVF
If you are already doing IVF, you may not feel like there is time to take a break, or alternatively you may feel like some time off is what you need. Either way we are able to work with you to create a plan that will work for you no matter where you are in your fertility journey. It is possible to continue trying to conceive or doing IVF and incorporate some preconception principals as you go.
If you would like to create a healthy you so that you can create a healthy baby you can book and appointment HERE to start your preconception plan!
Naturopath & Nutritionist (BHSc)
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