FERTILITY Checklist

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FERTILITY CHECKLIST

How to Get Pregnant Naturally

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

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, and so we must focus on making sure that the path of sperm to the woman’s egg is clear and that 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. Use of ovulation predictor kits is 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 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 after ovulation (starting on day 14 or 16). Progesterone has been shown to prevent miscarriages and improve sperm motility.

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 4th 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
  • cycle day 2 FSH and LH
  • anti-Müllerian hormone
  • vitamin D3 25(OH)
  • DHEA-s
  • Lupus Anticoag DRVV & Lupus Anticoag
  • free and total testosterone
  • prolactin
  • Saliva hormone testing for adrenal function to balance estrogen/progesterone, cortisol, etc. done on day 19 of cycle.

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

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 like 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. Trans Fats (animal meats, milks, cheeses & eggs)
  2. Refined carbohydrates
  3. High-fructose corn syrup
  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 nourishing it. Meanwhile, the research is mounting that shows how foods high in refined carbohydrates, preservatives, pesticides, trans fats, toxins and super 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 require 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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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. These are some of the first nutrients that I would consider for the “Dad to Be” but only if indicated by testing properly:

  • 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).
    o  Recommended dose of up to 10,000 IU (based on individual test results)
    o  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.
    o  Recommended dose 1500 to 3000 mg in divided doses, on an empty stomach.
    o  In men, 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.
    o  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.
    o  Recommended dose of 1000 to 5000 IU daily, depending on blood levels.
  • A good multi vitamin for women and men: reduced the incidence of low birth weight babies in women and improves sperm quality in men.
    o  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.
    o  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.
    o  Recommended dose of at least 200 mg VEGAN EPA/DHA supplementation.

Fertility-Friendly Diet
For men and women, I recommend a diet that excludes alcohol, caffeine, sugar, dairy, and gluten. Plant fats, avocados, organic fruits, organic vegetables, and beans, whole grains, and good starches should be the bulk of a patient’s diet. There has been some talk about high protein diet negatively affecting fertility – especially from animal sources. Ultimately, super high-protein diets may be too acidifying in the body.

Exercise
There is some evidence that 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.

IN SUMMARY

In summary, a couple needs to have done these initial steps to insure 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: an alkaline diet that is mainly plant based for both male and female partners, avoiding gluten, dairy, eggs, sugar, alcohol, and 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.
    o  Consider use of guaifenesin to improve cervical and male fluid quality.
  • Supplements for 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 folic acid. I also recommend L-arginine, vitamin D3, essential fatty acids and VITEX and iodine (MOTION), balancing hormones (estrogen, dhea, progesterone, thyroid, etc).
  • 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!

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