Female Fertility Screening

As naturopathic doctors, we take a preventative or proactive approach to health; treating the root cause is a significant part of what we do. We want to encourage and empower women to understand their reproductive health to make informed, insightful decisions, and look into this aspect of health earlier. This means looking at our reproductive health earlier.

Another consideration is that women are not engaging in the reproductive process as early - beginning to plan families is commonly happening around age 30 as opposed to 20. There is a lack of information for women when it comes to this, and often we hear "I wish I knew about this earlier."

What we look to do is understand what changes occur physiologically at this age, and how to support the reproductive process given this cultural shift. That being said, our philosophy is to inform and empower you to understand where your body is at, what it is going through, and how to best manage your health.

Hormones tell us a lot about what is happening and can be analyzed through blood work. Timing bloodwork is an integral part of the process as hormone levels drastically fluctuate in a 24-hour period. We'll discuss timing of testing and the importance of hormones in conjunction with timing.

We determine optimal days to test based on where you are at in your cycle. Your cycle day 1 is the first day of bleeding, we then count cycle days until the start of bleeding in your next cycle. A normal cycle will last roughly 26-34 days.

On day 3 of your cycle (3rd day of bleeding), we want to test:
TSH (thyroid-stimulating hormone)
Prolactin
Estradiol
FSH (follicle-stimulating hormone).

A low FSH reading alongside low estradiol is ideal. FSH is the main hormone involved in producing mature eggs in the ovaries. If FSH levels are normal with elevated estradiol, the estradiol can ‘suppress’ the FSH level indicating possible decreased egg quality and quantity.

Prolactin inhibits FSH production, which is important as FSH triggers ovulation, so we do not want it to be suppressed. If prolactin levels are elevated in the blood, this can be indicative of suppressed ovulation.

TSH affects ovulation - an over or underactive thyroid can hinder fertility, and balanced levels are crucial for growth and development during pregnancy.

On day 21 of the cycle, checking progesterone levels can confirm whether ovulation has occurred. Low levels on day 21 can suggest that no egg was produced (the cycle was anovulatory) - and if no egg is produced, then pregnancy cannot occur. The suspected highest levels of progesterone occur on the suspected or theoretical 7th day post-ovulation, so we look at these levels for insight into ovulation. This is why chatting with a naturopathic doctor about your cycle is important; your best day to test progesterone will be determined on your ovulation day, which may not necessarily always be day 21.

Some considerations: 

SUPPLEMENTATION:

Prenatal Vitamins: Prenatals are an essential part of a healthy pregnancy and ensuring a healthy newborn. A main reason for pregnancy complications are lack of proper nutrients and/or vitamin deficiencies. These complications could be mitigated by proper supplementation and correction of deficiencies. In addition to this, a review of the literature demonstrated that children of moms taking poor quality prenatals, ended up with significantly more illnesses early in life due to heavy metal toxicity in-utero. We love discussing what makes a great prenatal with you!

Folic Acid: Folic acid is one of the most important vitamins in early fetal development and decreases the risk of neural tube defects. When folic acid is taken in its “methylated” form, you no longer need to rely on the body’s enzymes to use the vitamin, making it an obvious and more absorbable form of folic acid. A methylated folic acid is crucial because we’d rather assume everyone is missing the enzyme then risk using a form that you cannot use to support your pregnancy. It’s important that your prenatal also contains methylated folic acid because taking two versions of folic acid at the same time (one methylated and the other not) actually inhibits the body from absorbing the methylated version if there is in fact an enzyme defect.

Omega Fatty Acids: Quality omegas (aka fish oils) are incredibly beneficial in fertility. They help support healthy cholesterol levels which are important for hormone production, are anti-inflammatory, and are essential for fetal and newborn brain development. A major consideration is sourcing, as fish such as sardines and anchovies are lower in heavy metals and mercury since they do not feed on other fish, but algae! We consider the ratio of EPA and DHA (two omega-3 fatty acids) during the prenatal period, pregnancy, and post-partum to ensure proper balance.

Vitamin D: This may be surprising, but 80% of North Americans deficient in this vitamin. It is best absorbed in liquid form, taken underneath the tongue to help it effectively enter the bloodstream. Achieving optimized levels will normalize hormone responsiveness in the uterus. Vitamin D is crucial throughout the reproductive process as it prevents:

• postpartum depression
• gestational diabetes
• preeclampsia
• preterm birth
• low birth weight.

CoQ10: CoQ10 has the most evidence-based supplement for improving egg quality and pregnancy outcomes, and is an important molecule in the generation of cellular energy for the oocyte (the immature egg cell - so we want these to be vital and healthy to divide properly!) Supporting these cellular processes can help support the healthy growth of an embryo.

LIFESTYLE:

Smoking: Smoking can also reduce likelihood of conception by causing damage to eggs while they're in the ovaries, and cause issues with fallopian tube function.

Stress: By now we know that stress plays a major role in a lot of our health complaints, so it comes as no surprise that it implicates our reproductive health as well. t is has been confirmed that stress has an enormous negative influence on our reproductive health. It can be  stressful when trying to conceive and being uncertain, a troublesome cycle since stress is a contributing factor in the first place!

Implementing stress reduction techniques can make a significant impact on overall health, therefore supporting fertility. Regular exercise, deep breathing exercises, yoga or mindful movement and meditation are all great practices. 

Chemical/Environmental Toxin Exposure: Exposure to environmental toxins and chemicals such as lead, mercury, phthalates, and pesticides, have implications both during pregnancy and post-partum. The main concern with these substances is that they can cause issues in fetal neurological development.

Alcohol: Alcohol has also been shown to be harmful to egg health. We know that consuming alcohol during pregnancy isn't advised at all, but often it isn't discussed that avoiding alcohol pre-conception can have an impact on fertility outcomes!

DIET:

Consume organic, well-sourced meats: These meats contain beneficial B vitamins and fatty acids to support overall health, and iron and protein which are two major components of a healthy fertility diet. They also contain vitamin A, vitamin E, and micronutrients like potassium, iron, zinc, phosphorus, and sodium. 

Fat Intake: We love good healthy fats. Although a fat that should be avoided is trans fat - a type of unsaturated fat that can increase insulin resistance, and decrease both chance of ovulation and conception.

Good fats, however, work wonders in the fertility process. Previously mentioned omega fatty acids help to manufacture hormones, help eggs mature and support implantation! Great sources are wild caught salmon, sardines, mackerel, and nuts and seeds (flax, chia, walnuts are powerhouses).

Other great sources of healthy fats are extra virgin olive oil, and unrefined virgin coconut oil.

Berries: Anti-oxidant rich berries help to decrease inflammation in the body, which is a factor in support of fertility. They are also fibre rich, helping encourage proper digestive elimination to help the body detoxify excess hormones! Berries contain vitamin C and folic acid as well which help support fetal development.

As always we are here to help and answer any questions that you may have!