FERTILITY Checklist

FERTILITY CHECKLIST

How to Get Pregnant Naturally

By Marie Pace, DNM, HHP, CNC, Health Coach

You’ve most likely been the medical route, maybe even spent THOUSANDS OF DOLLARS at fertility clinics and still no baby. The mental, physical, and emotional toll it takes on you and your spouse can be overwhelming…. leaving you both worn out and utterly frustrated. I get it. Been there myself…. so, I truly understand. 

Let me go over a few basics … yeah, you probably know much of this already with all you’ve done but you might just learn a few tiny pieces that can make all the difference to your success. 

So let’s start at the very beginning…

Sperm meets egg. Sperm fertilizes egg. And a baby is born 9 months later. It sounds like an easy process, but for a woman struggling with infertility, it can be an elusive process – one with no easily explained reason why she can’t get pregnant.

The path to delivering a healthy full-term baby is a multistep, intricate process. If there is a breakdown in any one of the steps, the final result will not occur. If we can understand each step, and potentially correct the issue, the likelihood of conception and delivery increases.

Sperm Meets Egg

It’s easier said than done, so we should focus on making sure that the path of sperm to the woman’s egg is clear and that the timing is correct.

The first step in making sure that sperm meets egg is correct timing. If day 1 is the first day of a menstrual bleed, and day 28 is the day before a woman begins her period again, day 14 is approximately the time of ovulation. Prior to this time, LH (luteinizing hormone) released by the pituitary gland will peak and after this LH surge, an egg will be released approximately 24 to 36 hours later. The egg accompanied by progesterone hormone will then journey through a fallopian tube, where it will be fertilized. An egg is viable for approximately 12 to 24 hours before it starts to disintegrate, so the sperm must be in place prior. In essence, sex must be timed prior to ovulation to give the sperm time to swim up to the egg. The use of ovulation predictor kits might be helpful, as well as looking for fertile cervical fluid, which has a stretchy, egg-white consistency.

As a general rule for clients, I recommend that the couple have sex from day 5, every other day (or daily if sperm counts are normal), until the woman has passed the signs of ovulation. Engaging in enough foreplay to increase male and female secretions is vital as well so that sperm can have enough fluid to swim through. Even though it is not documented in scientific literature, I have seen many women conceive after elevating their hips for 20 minutes after ejaculation. They must not get up to go to the bathroom prior to this time.

To allow for the sperm to meet the egg appropriate lubrication is necessary. Sperm needs an alkaline environment in which to survive. The male and female partners should look to consume an alkaline-promoting diet (avoiding coffee, soda, energy drinks, meat, and white flour), avoid using saliva as a lubricant during sex as it may harm sperm, and avoid using soaps around the time of intercourse, as soap residue can damage sperm. No purchased lubricant should be used with the exception of Pre-Seed. For a woman, these strategies can help increase cervical mucus:

• Increase water and electrolyte consumption to a minimum of 64 oz of water daily
• Guaifenesin 1200 mg twice daily (Mucinex)
• Vitex herb 900-1000mg daily
• DHEA 5-25mg daily (based on proper testing)

Ovulation should occur 14 days prior to menstruation. These last two weeks in a cycle is known as the luteal phase. If, however, the female is NOT ovulating a full 14 days prior to menstruation, she may have what is termed a luteal phase defect. This typically is due to a progesterone deficiency in the last half of the cycle. For many clients, I recommend that they take between 50 and 200 mg of progesterone daily (based on testing YOUR body to determine what you need) after ovulation (starting on day 14 or 16). Progesterone has been shown to prevent miscarriages and improve sperm motility. Medically your doctor might prescribe oral progesterone as that is approved by medical boards. We suggest that most (but not all) use transdermal progesterone which bypasses the liver and gets into your bloodstream the fastest.

For women who have had long-term issues trying to conceive, we MIGHT suggest 2-3 months of using progesterone PRIOR to ovulation. On the 3rd or 4^th month to then use progesterone AFTER ovulation. This can have the effect of allowing the ovaries to heal and stay calm.

If it is not psychologically stressful, I often ask women (and men) to start testing for fertility roadblocks early in their process of family planning. It’s important to know if there is a structural or diagnosable problem immediately. For women, I recommend the following tests (those in BOLD are mandatory):

• CBC
• CMP
• TSH, free T3, free T4, TPO
• ferritin & iron panel
• cycle day 2 FSH and LH
• anti-Müllerian hormone
• vitamin D3 25(OH)
• DHEA-s
• free and total testosterone
• prolactin
• Insulin 
• Saliva hormone testing for adrenal function to balance estrogen/progesterone, cortisol, etc. done on day 19 of cycle. (read this link to understand why we do NOT use blood testing only for adrenal and ovarian hormones)
• ApoB cholesterol test
• HAIR TISSUE MINERAL ANALYSIS

Imaging:

• pelvic ultrasound
  o  which can rule out anatomical abnormalities, uterine fibroids or other uterine abnormalities, ovarian cysts or other ovarian growths or abnormalities
• HSG (hysterosalpingogram)
  o  which can rule out blocked tubes from endometriosis, previous pelvic or abdominal infections or surgeries/procedures resulting in scar tissue

For men, I would recommend the following tests:

Through blood:

• CBC
• CMP
• TSH, Free T3, Free T4
• vitamin D3 25(OH)
• free and total testosterone
• prolactin
• HA1C
• Apo-B
• HAIR TISSUE MINERAL ANALYSIS

Imaging/other:

• semen analysis
• possible testicular ultrasound to rule out varicocele
• Saliva hormone testing for adrenal function to balance estrogen/progesterone, cortisol, etc.

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PCOS & FERTILITY

One of the most common issues affecting female fertility is PCOS, or polycystic ovarian syndrome. Symptoms include hirsutism (or increase in body hair), acne, abdominal obesity, high androgen (male hormone) levels, and possible menstrual cycle irregularities. The crux, however, is the lack of ovulation in these clients, and the key cause is insulin resistance.

What are the causes of insulin resistance?

Let’s take it from the very beginning… the cells of your body need sugar for energy. The sugar they need is glucose, which powers your brain, muscles, and other parts of your body, just as gasoline powers a car. To get glucose into your cells, your body makes insulin, a hormone that acts as a key. It attaches to the surface of your cells, allowing glucose to enter.

Insulin is a hormone that is released by the pancreas in response to rising blood glucose. When you consume carbohydrates, the glucose that enters the bloodstream signals the pancreas to make insulin. Insulin serves as the key that unlocks the door to allow glucose to enter body tissues. It tells your cells “HELLO! Pick up this glucose. It’s all over the place.”

Without insulin, cells in the liver, muscle, and fat have a difficult time vacuuming up glucose from the blood. These tissues can transport only a small percentage (5 to 10 percent) of the glucose in circulation without the help of insulin. When insulin is present, it increases the amount of glucose that can be transported into tissues, allowing them to be properly fed, and keeping blood glucose concentrations in the normal range.

This process of transporting glucose is important because every cell in your body uses glucose for energy. (Besides glucose transport, insulin also escorts amino acids into cells.)

Meanwhile, the glucose that builds up in your blood can harm the blood vessels in your eyes, kidneys, and heart. This condition is called type 2 diabetes, and it has reached epidemic proportions in North America and much of the rest of the world.

There is a significant amount of confusion about what actually causes insulin resistance, and I witness it every day in my work coaching people with diabetes, weight issues, and adrenal issues.

A large gap exists between the scientific research on insulin resistance and what the general public understands about it. Most health professionals even misunderstand the science or are not aware of the latest research. Unfortunately, excellent research does no good if the information is not put in the hands of those who need it. This is certainly the case with insulin resistance.

Excess fat also blocks the action of insulin in bringing sugars to the cells, which leads to diabetes –  Dr. Marie

5 Causes of Insulin Resistance (metabolic syndrome, Type 2 Diabetes)

1. High levels of Trans Fats (animal meats, milks, cheeses & eggs, added oils)
2. Refined carbohydrates
3. High-fructose corn syrup and all added sugars
4. Preservatives, pesticides, toxins
5. Lack of Exercise & Stress

Why are instances of insulin resistance, metabolic syndrome, and type 2 diabetes on the rise? In many cases, the answer lies in the food we eat — and our lack of movement. Our early ancestors focused on hunting and gathering food. This simple act involved two key elements: they were obtaining whole foods straight from their environment and getting a lot of exercise in the process. In modern society, we sit parked at our desks and in our cars for so much of the day, and food is available at almost every turn — much of which depletes the body rather than nourishes it. Meanwhile, the research is mounting that shows how foods high in refined carbohydrates, preservatives, pesticides, trans fats, toxins and sugars like high-fructose corn syrup, and lack of exercise, all contribute to insulin resistance.

Researchers using special scanning techniques found one of the most important contributing factors. Looking into the cells of people with insulin resistance, they found tiny particles of fat. These fat particles are especially common in muscle cells. Like gum in a lock, a buildup of fat particles in cells interferes with insulin’s ability to open the cell membrane and allow glucose inside.

Just as insulin resistance prevents sugar from entering muscle cells, it also prevents amino acids from entering. So now you can’t build or maintain your muscles. You get fatter and you lose muscle.

Your energy level drops, which makes you hungry for more carbohydrates and less willing to exercise. You actually crave more of the poison that is killing you.

BACK TO PCOS…

PCOS is usually suspected by looking at symptoms, blood work, and pelvic ultrasound results. For these clients, I would recommend greatly reducing dietary fats, follow a whole food plant based diet, increasing exercise, and possibly taking supplements to reverse insulin resistance.

A word on metformin: metformin is a medication that is often included in fertility protocols. It makes cells more insulin sensitive, and can thus stimulate ovulation. Taking between 1000 and 1500 mg daily is the general rule. I often have seen this used in fertility protocols, as it does not have any major side effects. We prefer to use a natural supplement that is just as effective as the drug Metformin in clinical trials (our MODULATOR supplement).

To have healthy pelvic organs, circulation must be adequate. Nutrient and hormone delivery to these organs requires good pelvic blood flow. To improve pelvic circulation, there are several practices that may greatly improve fertility:

• Yoga: I recommend the DVD Restoring Fertility, by Drs. Brandon Horn and Wendy Yu, which can be found on www.amazon.com.

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VITAMIN B6 AND PREGNANCY

NOTE FOR PREGNANCY: Folic acid: Low folate is associated with a 47% increased risk of miscarriage; having both low folate and low vitamin B6 increase miscarriage risk by 310%.Vitamin B6 is crucial for the healthy function of the brain and nervous system and thus plays a critical role in the development of your baby. Specifically, it’s necessary for the healthy production of serotonin and norepinephrine, key neurotransmitters.

• Your baby requires a supply of Vitamin B6 for the healthy development of its brain and nervous system
• B6 can resolve some cases of morning sickness
• It helps you maintain healthy blood glucose levels
• It plays a role in preventing several issues in newborns, including eczema and low birth weight

Many women are first recommended B6 supplementation early in pregnancy, when nausea and vomiting are at their worst, as B6 can significantly alleviate the issue.

Vitamin B6 and Miscarriage

High vitamin B6 lowers chance of miscarriage by 50% improves fertility by 120%

Homocysteine, folate, and vitamins B6 and B12 were measured in preconception plasma. Relative to women in the lowest quartile of vitamin B6, those in the third and fourth quartiles had higher odds of conception (odds ratio = 2.2; odds ratio = 1.6, respectively), and the adjusted odds ratio for early miscarriage in conceptive cycles was lower in the fourth quartile (odds ratio=0.5). Women with sufficient vitamin B6 had higher odds of conception (odds ratio = 1.4) and a lower adjusted odds ratio of early miscarriage in conceptive cycles (odds ratio=0.7) than did women with vitamin B6 deficiency. Poor vitamin B6 status appears to decrease the probability of conception and to contribute to the risk of early miscarriage in this population.

http://www.ncbi.nlm.nih.gov/pubmed/17478435

Vitamin B6, B2, B12 and folate lower in women who miscarry

The median levels of all B vitamins examined, i.e. folate, vitamins B2, B6, and B12, were lower in miscarriage cases compared to the controls, although the difference did not reach significance except for vitamin B6 intake, which resulted in the border of significance (2.1 vs. 1.8 mg). It is important to point out that multivitamin supplementation is low in the Mexican population, as was the case in this small study population. Thus, these findings need to be replicated in larger studies to fully evaluate the protective role of these vitamins on miscarriage risk.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890227/

Vitamin B6 can prevent stress from affecting fetal growth

High-dose vitamin B6 may counteract the adverse impact of glucocorticoids (which are increased by stress) on fetal growth.

http://linkinghub.elsevier.com/retrieve/pii/S0306987799909568

Vitamin B6 and Hormones

Vitamin B6 lowers prolactin

Vitamin B6 appears to reduce the production of prolactin, a hormone that causes testosterone to be taken up by tissues.

http://www.bentham.org/cnf/sample/cnf4-4/D0004NF.pdf

Vitamin B6 acts similarly to progesterone

Vitamin B₆ possesses progesterone-like effect but it does not intensify the action of progesterone. On the other hand, vitamin B₁₂ and vitamin A exhibit no progesterone-like effect and do not affect the action progesterone when they were given together.

http://www.springerlink.com/index/n3xp3xt315458323.pdf

Vitamin B6 increases progesterone

Administration of vitamin B6 at doses of 200-800 mg/day reduces blood estrogen, increases progesterone and results in improved symptoms under double-blind conditions.

http://www.ncbi.nlm.nih.gov/pubmed/6684167

We only endorse using the correct form of B6 called P-5-P. (our ASSIST product) . Please do not run to drug store and purchase lower quality, wrong form of B6 which can be toxic!

Sperm Fertilizes Egg
Male factor infertility may account for 30% of all fertility issues. Most male infertility problems can be spotted in an abnormal semen analysis – a fairly inexpensive, quick, and noninvasive process. Lifestyle factors that affect fertility to rule out in men would include bicycling, wearing tight clothing, sauna/hot tub use, obesity, excessive alcohol consumption, and smoking (cigarettes or marijuana).

Simple changes in nutritional status would be a first-line treatment strategy to improve fertility. 

DAD-TO-BE PROTOCOL (if indicated by proper testing)

• Vitamin A: a necessary antioxidant that, in low amounts in the blood, has been shown to correlate with low sperm counts and anovulation (lack of ovulation).
  * Recommended dose of up to 10,000 IU (based on individual test results)
  * Avoid high doses of retinols, which have been shown to cause birth defects in excess amounts.
• Zinc: Low levels of this mineral have been associated with low sperm count and abnormal sperm morphology (shape).
• L-arginine: an amino acid that helps improve blood flow, has been shown to improve ovarian response, endometrial receptivity, and pregnancy rate in those undergoing ovarian stimulation protocols.
  * Recommended dose 1500 to 3000 mg in divided doses, on an empty stomach.*  In men, it has been shown to improve sperm count and quality.
• CoQ10: an energy cofactor in the electron transport chain, which has been shown to improve both sperm quality and motility. * Recommended dose of 100 mg daily per 100 pounds of body weight
• Vitamin D3: a hormone that improves overall hormone function and fertility in the body in both men and women. * Recommended 1000 to 5000 IU daily, depending on blood levels.
• A good multi vitamin for women and men: reduces the incidence of low birth weight babies in women and improves sperm quality in men. * I recommend FOUNDATION multi-vitamin that we have produced by our labs
• N-acetylcysteine: has been shown to improve pregnancy outcomes and ovulation in women with PCOS.
  * Recommended dose of 1200 mg per day.
• EFA (essential fatty acids) status: low essential fatty acid exposure to the fetus has been correlated with lower neurological development after birth. *  Recommended dose of at least 2000 mg EPA/DHA supplementation.

Fertility-Friendly Diet
For men and women, I recommend a diet that excludes alcohol, caffeine, added sugars, dairy, and gluten. High protein lower complex carbs. Think more paleoish. Fertility-Friendly Diet

Exercise
Some evidence concludes that higher intensities of exercise may lower fertility. In one study including 3887 women less than 45 years old, researchers found that after adjusting for age, parity, smoking, and marital status, women who were active on most days were 3.2 times more likely to have fertility problems than inactive women. Exercising to exhaustion was associated with 2.3 times the odds of fertility problems versus low intensity. These findings suggest that, beyond simple alterations of endogenous hormone responses that affect menstrual function, exercise may also contribute to the subtle detriment of the developing follicle.

Testosterone Treatment for MEN

If your guy is taking testosterone… we might need to have a little discussion. Testosterone replacement comes in many forms, including shots, gels, patches, or implantable pellets. However, it is important to know that testosterone treatment usually leads to either low sperm counts or no sperm seen whatsoever in the semen. Interestingly, low testosterone does not directly cause infertility. Sperm production is stimulated by hormones other than testosterone. If your guy stops testosterone treatment while trying to conceive, the sperm should return to the semen within about 3 months, with no permanent damage seen.

It’s a delicate balance as having low testosterone can also affect sperm count. Working with someone who can educate you and treat you correctly is important.

Thyroid and Iodine

Should iodine be used for infertility?

 The element iodine is an essential nutrient utilized by the thyroid glands, and deficiency of this element has been linked to reproductive failures. Iodide transporters are also present in reproductive tissues and cells of embryonic origin such as the endometrium and trophoblasts, respectively. 

PMCID: PMC7511676 PMID: 32353856

Inorganic iodide and/or iodine is required for optimal cellular function in reproductive tissues, and that iodide transporters may potentially be used as a marker for infertility or for probing potential localized iodine deficiency that may not present in a typical thyroid panel analysis.

• National Health and Nutrition Examination Survey studies show that a significant number of women in childbearing age do not have optimal levels of iodine.
• The need for iodine is not limited to the thyroid glands but its modulatory effects and transporters can be observed in a variety of cells.
• Women with reproductive failures had a significant increase of iodide transporters suggesting a localized iodine deficiency.

Iodine is an essential element that cannot be manufactured in the body and must be obtained through dietary means to ensure adequate metabolic functions. Body organs, including the thyroid, concentrate iodine against a gradient and require adequate iodine levels to produce the necessary thyroid hormones. The World Health Organization (WHO) estimates that almost 2 billion people worldwide do not receive sufficient amounts of iodine.

Localized iodine deficiency could be present in tissues such as the endometrium and may contribute to infertility or reproductive failures by affecting the local immune response and/or regulation of gene expression in reproductive tissues. Given that transporters of iodide have been found in endometrial tissue, it is considered that similar to leukocytes and trophoblastic cells, iodine could affect the functional activity of cells in reproductive tissues including the endometrium. There is no question that iodine deficiency in some women with recurrent reproductive failures is occurring. Iodine is an essential component needed for a successful healthy pregnancy.

The requirement for iodine during pregnancy is substantially increased, by >50%, for multiple reasons. First there is an increased demand for T₄ production as it is needed by the fetus in the first trimester. This fetal requirement along with hormonal changes in pregnancy causes alteration in the mother’s thyroid hormone homeostasis and subsequent increased maternal T₄ synthesis (30–100% more than pre-pregnancy levels). Second, the fetus utilizes iodine in later trimesters in order to make fetal thyroid hormones. Third, pregnant women have increased iodine clearance/loss. Alteration of thyroid hormone levels due to iodine deficiencies can lead to fetal neurological damage, congenital hypothyroidism, miscarriages, and eventual reproductive failures. Worldwide analysis by the WHO illustrates that iodine deficiencies are prevalent and that includes women in childbearing age. Although organically bound iodine in the form of hormones is essential, iodides and molecular iodine could also play a part in optimizing reproductive organs and pregnancy. 

ORDER IODINE HERE

Can Iodine be used while a woman is pregnant?

In Japan, the average Japanese woman is eating 13.8 mg of iodine per day while the average American woman consumes 100 times less iodine per day (approximately 0.138 mg per day). Iodine is very crucial in the first three years of life from the development of the fetus inside the womb until two years after birth. In the development of a child’s IQ, I feel that it would be very advantageous for the mother to supplement her diet during pregnancy and, if she is nursing the child, for the first two years after pregnancy. Pregnant women are notoriously iodine deficient. This data was uncovered in the mainstream press recently. The impact on low birth weight and the baby’s IQ is evident in women with even slight iodine deficiencies.

When breastfeeding, evolution has programmed the mother’s dietary iodine to reroute the lion’s share of her iodine toward nourishing the baby. But the baby still may not get enough from breastfeeding if the mother’s intake is low. Unfortunately, moms rely on prenatal vitamins which usually contain inadequate iodine.

ORDER IODINE HERE

HASHIMOTO’S THYROIDITIS

Can Hashimoto’s Thyroiditis cause infertility? If Hashimoto’s Thyroiditis is not well controlled, it can negatively impact reproductive capacity, leading to infertility. Hashimoto’s disease (HT) is the most common autoimmune disease, affecting 5–15% of women of reproductive age. Recent studies have shown that Hashimoto’s thyroiditis can be a risk factor for infertility in women.

This is due to the disruption of thyroid hormones, which can affect ovulation and disrupt the menstrual cycle. Hashimoto’s is a disease, while hypothyroidism is a thyroid condition that can develop because of it. Not everyone with Hashimoto’s disease will develop hypothyroidism, but it is the most common cause. If you have an underactive thyroid, or too little thyroid hormone in your blood due to an issue like Hashimoto’s, the body is unable to function normally. Symptoms of hypothyroidism often include fatigue, weight gain, dry skin, mood swings and irregular periods causing infertility. Getting a proper work-up (labs) done correctly is vitally important. You can read more about HASHIMOTO’S here.

IN SUMMARY

In summary, a couple needs to have done these initial steps to ensure fertility. If pregnancy has not been achieved in 6 months, I would recommend further testing to detect any bacteria or viruses hidden deep in the body that is fighting your body from pregnancy.

• Timing: have sex every day or every other day from cycle day 5 past ovulation.
• Avoid saliva, oral sex, and lubricants besides Pre-Seed.
• Elevate hips (for women) after sex for at least 20 minutes.
• Begin blood work and imaging/procedures for both men and women.
• Diet: a whole food diet that is mainly plant based with clean animal proteins for both male and female partners, avoiding gluten, dairy, eggs, added sugar, alcohol, and high levels of caffeine.
• Do not smoke.
• Increase pelvic circulation through acupuncture, massage, and/or yoga.
• Increase fluids to a minimum of 64 oz of water daily to ensure proper internal lubrication.
  *Consider use of guaifenesin to improve cervical and male fluid quality.
• Supplements fo MEN should include a multivitamin, additional zinc/copper formula, L-arginine, CoQ10, vitamin D3, essential fatty acids.
• Supplements for women should include a well balanced multi vitamin that includes folate. I also recommend L-arginine, vitamin D3, essential fatty acids, iodine, COQ10, and balancing hormones (estrogen, dhea, progesterone, thyroid, etc). NOTE: I put all of our ladies on: FOUNDATION MULTI, IODORAL , MOOD , ACTIVE B COMPLEX , IMMUNITY and determine by testing any additional supplements. You can find each of these on our website with full data on each supplement 
• Get a full and thorough work up on thyroid hormones if suspected issues with thyroid or autoimmune diseases: TSH, Free T4, Free T3, TPO AB, Thyroglobulin AB done with a fasting test! (do not swallow thyroid pills morning of blood draw, do make sure you take correctly the day before test)
• For women, diagnosis and treatment of PCOS should be considered along with additional supplements
• For women, exercise intensity and duration should be considered and adjusted.
• For men and women, avoid hot tubs/saunas or medications (prescriptions and over the counter) that could affect fertility.

I’ve seen correcting small imbalances in fertility help time and time again. I truly believe that a healthy body is a fertile body. Making these changes to lifestyle will go a long way in creating that healthy body and allowing you to create the new life for you and your husband! Sadly, these are the exact points that are NOT considered in most fertility clinics!ON a monthly basis we have clients calling and texting with their successes in getting pregnant! And in 25 years of helping young ladies we have never had one baby diagnosed with autism! I truly believe that a healthy body is a fertile and protective body.

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