We want you to be as informed as possible so you can feel confident about every decision you make for you and your future family. Here are our answers to some of the most talked about topics in fertility.
Age and Fertility
Advanced maternal age. Geriatric pregnancy. Elderly primigravida.
If you’re over the age of 35 and trying to conceive (TTC), you’ve probably heard one or several of these terms thrown around by your doctor. Yes, if you’re over 35, you might as well call it quits - it’s all downhill from here...or at least that’s what this popular messaging seems to convey.
Advanced maternal age = AMA. You know what other medical abbreviation is AMA - against medical advice? Coincidence?
There is so much malarkey going on when it comes to women in their 30’s giving birth these days that I just can’t take it any longer. This insanity needs to stop.
As you guys probably know by now, before I became a nutritionist, I was a banker and a consultant for about a decade. And, during that time, I did a ton of research and I built a lot of models. Like a lot. And so, when it comes to challenging these very pervasive messages that we’ve been hearing about women getting pregnant in their 30’s and 40’s, I thought it was time to break out the big guns - the data. Here goes:
The OECD (Organisation for Economic Cooperation and Development) has an incredible Family Database that provides data on family outcomes across 35 OECD countries, including fertility rates. Unfortunately, it doesn’t have data on non-OECD countries (e.g., in Africa, much of South America), which is a bit of a bummer, but we’ll work with what we’ve got!
Of particular interest for us is their data on “fertility rates by women’s age at childbirth”. Now, remember, this does not take into account how many women are trying to get pregnant at any given age, but just the number of births per 1000 women in each age group (e.g., 15-19, 20-24, 35-39).
So, what did we find out?
First of all (and maybe unsurprisingly), the highest fertility rates, on average, occur in the 30-34 age group.
Second (also maybe unsurprising), there is a wide variety in birth rates across countries. For example, in that same 30-34 age category, Netherlands had the highest birth rate at 132 births per 1000 women and Bulgaria had the lowest birth rates at 68 births per 1000 women.
Third, the drop off in birth rates from age 30-34 to age 35-39 is ~50% and from age 35-39 to age 40-44 is ~80%. Basically, women aged 35-39 are having 50% fewer babies than women aged 30-34 and women aged 40-44 are having 80% fewer babies than women aged 35-39. But again,this does not take into account pregnancy attempts, only outcomes.
Finally, and most importantly, there is one country that has a significantly higher than average number of babies born to women aged 35-39. Where? I know you all want to know.
For women aged 35-39, Ireland’s birth rate is 97.2 births per 1000 women. And here’s the kicker - that’s basically equal to the fertility rate in the US for women aged 30-34 (98.7 births per 1000 women). Yes, you read that correctly. The fertility rate for 35-39 year old Irish women is essentially equivalent to the fertility rate for 30-34 year old American women.
This begs the question: what’s going on in Ireland? I’m not quite sure yet, but you better believe I’m on it. And before you chalk it up to genetics, read this post first. What is really driving the difference between the higher birth rate countries (like the Netherlands) and lower birth rate countries (like Bulgaria)?
Regardless, the bigger take-home point here is this: you are not doomed to a childless existence the moment the clock strikes midnight on your 35th birthday. So stop the freaking insanity! The data really does suggest otherwise...and if you stick around here long enough, you just might begin to question the BS you're being told too.
The real reason that pregnancy risk goes up as you age is because the probability of health problems also goes up as you age. And yes, there are natural effects of aging, but even those can be moderated somewhat by lifestyle.
And, as we find pockets of the world that defy the “conventional wisdom” that fertility precipitously drops at age 35, we can take comfort in that fact. Is Ireland an outlier? Absolutely...but it shows us what’s possible. And, I suspect that there are many similar examples among the countries that we don’t even have data for.
Maybe for a moment, rather than focusing on of all the horrible tragedy that can occur when you have a baby later in life, let’s instead take a moment to appreciate the benefits of having children later in life - you are likely more highly educated, financially stable and emotionally grounded. In fact, one study in Sweden even found that “individuals born to older mothers, including those at the oldest ages, are taller, remain longer in the educational system, are more likely to attend university, and perform better on standardized tests than their siblings who were born when their mothers were younger”. How about them apples?
So, let’s just all take a collective sigh of relief. It’s not as bad as others have made it out to be. You’re going to be just fine...and so are your babies.
The Fertility Gap
Dr. Sara Gottfried, New York Times’ bestselling author and Harvard-educated gynecologist, talks about the “the fertility gap” - crucial facts that doctors don’t share with their patients but are critical to their childbearing ability.
There are so many things that mainstream medicine isn’t addressing when it comes to getting and staying pregnant:
The healthier you are, the greater your chances of conceiving and carrying a child full-term. This may seem obvious, but if you are overweight or have one or more chronic diseases (e.g., high blood pressure, diabetes, hypothyroid), both you and your future baby would benefit from addressing them before you conceive.
If you are having period problems, more than likely, you will have trouble conceiving. Period problems can include irregular or absent periods, unusually heavy or long periods, irregular ovulation (as in PCOS) or painful periods. A regular, healthy period is the foundation of a healthy pregnancy.
If you went on birth control for any reason other than pregnancy prevention (e.g., painful periods, acne, heavy bleeding), that means you had an underlying hormonal imbalance (e.g., too much estrogen, too little progesterone). More than likely, that hormonal imbalance still exists but was masked by taking birth control. It can take up to a year to restore healthy hormonal balance (and therefore, a regular period) after going off of birth control. And, this restoration takes targeted intervention - you can’t just cross your fingers and hope it will happen.
If you have PCOS, endometriosis, cysts / fibroids or other estrogen-dominant conditions, you are not relegated to a lifetime of medication and surgery. There are other options to managing (and even reversing) these hormonal conditions. And, again, it benefits you to address this prior to conceiving; it will increase your chances of conceiving and your chances of carrying the baby to term.
How to tell if you're ready to conceive
It’s hard to know exactly, but a state of hormonal balance is central. Here are some good indicators of optimal readiness:
A regular menstrual cycle with a relatively seamless period: Your period comes every 21-35 days and lasts for 2-7 days. You experience minimal PMS or period pain. PMS is common, but it's not normal (i.e., the way your body was designed to operate). If you have lots of period symptoms, that’s an indicator of an underlying hormonal imbalance. For example, breast tenderness or heavy clotting can indicate excess estrogen and spotting can indicate low progesterone. Both of these hormonal states can make it harder to become pregnant and would ideally be corrected before you start trying.
Regular ovulation: Ovulation should be taking place ~12-14 days prior to menstruation each month. Just because you had a period does not mean that you ovulated. Using ovulation strips or progesterone strips is a good way to confirm.
Any chronic conditions are optimally managed for pregnancy (e.g., thyroid disease, autoimmune disease, mood disorders): If you are managing a chronic health condition, it is important that you work with your doctor to confirm that all medications you are on are compatible with fertility and pregnancy. It is also important that your health condition is well-managed. For example, uncontrolled autoimmune disease can predispose you towards miscarriage. The same thing is true for a thyroid function that is not tightly managed (TSH, or thyroid-stimulating hormone, less than 2.5 mIU/L).
Body mass index (or BMI) in the normal range between 18.5-24.9 or body fat between ~20-26%: I’m not a huge fan of BMI measurements, but it’s the most cited clinical measurement that we have to date. I prefer to use body fat measurements, since they are a more accurate reflection of your body composition. Body composition matters because it affects hormone levels. Fat is not inert tissue; it is hormonally-active tissue. The more body fat you have, the more estrogen your body produces. Because of this, as I mentioned above, excess body fat can predispose you to a higher estrogenic state, which can interfere with ovulation. On the opposite end of the spectrum, having too low body fat indicates to your body that you are starving and your body then diverts resources from making your sex hormones to making stress hormones. This means you don’t have the raw materials to make adequate sex hormones and ovulation can be impacted as a result. As a nutritionist who has worked with 100+ women, I recognize that every body is different, but generally speaking, being higher or lower than the ranges listed above can interfere with ovulation.
Balanced blood sugar: Hormones are all intimately connected and interdependent. Too much sugar leads to too much insulin. Too much insulin leads to too much cortisol and too much testosterone. Too much cortisol depletes estrogen and progesterone. Too much insulin and too much cortisol leads to excess body fat. Excess body fat leads to too much estrogen. And the cycle continues. If you know that you have diabetes or pre-diabetes, then it will be important to work with your doctor or a nutritionist to either manage or reverse your diabetes prior to getting pregnant. Other indicators of poor blood sugar management are constant sugar cravings, feeling irritable / lightheaded if you miss a meal, getting tired after eating and feeling weak or shaky often. If you suspect that you have issues with blood sugar, it’s definitely worth exploring further.
There are also lab tests that can check some of these indicators to confirm, but your body gives you a lot of information if you know what to look for and listen to it.
When women are beginning to think about getting pregnant, many of them will ask their ob-gyn’s: “I’m planning to get pregnant in a few months. Is there anything that I should be doing now to prepare?” And, to our dismay, many ob-gyn’s will say “Not really...except starting your prenatal vitamins.”
We couldn’t disagree more vehemently. Anything that improves your health also improves your fertility. Cleaning up your diet, detoxing your home, making movement a priority, moderating your stress levels and sleeping soundly - all of these things absolutely have an impact on your ability to both conceive and carry a baby to term.
Conception is a miraculous thing, but it is also very tenuous. A lot of successive things need to go right in order to make a baby.
You need be be ovulating regularly, which means your ovaries release an egg each monthThat egg needs to make its way from the ovary into the fallopian tube without any obstructionsAnd then that egg needs to have the sustenance and wherewithal to wait for her Prince Charming (i.e. the sperm)
You need to have enough sperm (i.e. sperm count) lurking around to give you a fighting chance of making a babyEnough of those sperm need to be in good shape (i.e. morphology) to tip the odds in your favorThen those sperm need to be vibrant enough (i.e. motility) to make the long, hard journey from your woman’s vulva/cervix to her fallopian tubesFinally, one superhero sperm needs to find the egg and penetrate her within 24 hours of ovulation (fertilization)
For the fertilized egg:
The fertilized egg (zygote) needs to make its way from the fallopian tube into the uterus without any obstructions. The zygote needs to divide in an orderly and appropriate fashionThe zygote needs to implant itself in the uterine lining, which must be thick enough to support the eggAnd then the embryo needs to grow without obstruction to term
Ovulation and potential obstacles
If you want to get pregnant, you need to ovulate. It’s not the only piece of the puzzle, but it’s the centerpiece. Regular ovulation is the foundation of fertility. If you’ve been trying to get pregnant for awhile, you are probably all-too-familiar with the ovulation conundrum.
The challenge is this: our modern lifestyle is a real buzzkill when it comes to ovulation. Common challenges to ovulation include previous hormonal birth control usage, sugar, inflammation, environmental toxins, thyroid dysfunction, prolactin, stress, nutrient deficiencies, and so on. It’s a panoply of insults. And the bottom line is this: if your body is meaningfully out of balance, it will shut down ovulation.
Many of my clients come in with a laundry list of insults just like this. Everything that could have interfered with ovulation has. And, many of them never even knew it because they were on birth control. Maybe you can relate to this?
Ovulation is a divine, but delicate process. Everything needs to go just right in order for that egg to release every month. That’s not to scare you by any means. That’s to empower you. In fact, one of the first steps in your pregnancy journey should be to make sure that you’re ovulating regularly. And remember, just because you had your period does not necessarily mean that you ovulated.
If you haven't been ovulating regularly, get curious.What could be throwing my system off? Where are things out of balance in my life right now? Sometimes, you will know instinctively where things went awry (e.g., a particularly stressful month of work, intense training for a triathlon, the “dessert for breakfast, lunch and dinner” diet). Other times, you will need the help of a skilled functional medicine practitioner to help you look under the hood (e.g., thyroid levels, prolactin levels) and figure out what’s going on. Not ovulating occasionally when life gets bonkers is totally normal; not ovulating regularly is a sign of disorder and will need to be addressed if you want to get pregnant.
The key is to tune in. When ovulation isn’t working the way it should, it’s our body’s way of telling us that things are out of sorts. Rather than pushing and shoving ovulation back into “working order” (e.g., with drugs, with procedures), figure out where the roadblock is first and remove that. Most of the time, your body will heal itself if it’s just given the chance. Sometimes drugs and procedures are absolutely necessary, but that should be a last resort rather than a first exploration.
Your body wants to ovulate; your body is designed to ovulate. And, your body also wants to keep you and your potential babies safe and sound. As I mentioned above, when your body feels like things are out of whack, it will automatically shut down ovulation because it perceives that it’s not an optimal time or place to bring a baby into the world. First, figure out what’s making your body think that you’re living in an unsafe or unstable environment - it may be crazy job stress or your crazy mother-in-law; it may be heavy metal toxicity from your personal care products or your daily tuna salad (yes, that’s possible!); it may be blood sugar dysregulation from too many coffee and bagel breakfasts. Second, recognize that your body is trying to protect you, not sabotage you. Your body is incredibly wise; even if you don’t always understand her, try to trust her. And finally, have faith that once you remove the roadblock or roadblocks, your body will restore its natural function and begin ovulating again.
Modern-day difficulties in conception
1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. It’s pretty dismal...and it’s getting worse. But why?
Because we are maladapted to survive and procreate in our current environment.
As a society, we are simultaneously the "healthiest” that we’ve ever been (e.g., lowest infant mortality rate, fewest communicable diseases, longest lifespan) and yet the most unwell. Today, we have the highest incidence of chronic disease than ever before in our history.
We are living in an environment that has drastically changed over the last century:
• We are eating less real food and more food-like substances.
• We are inundated with more chemicals than our body knows what to do with.
• We are more stressed and stretched than ever before.
• We are also more sedentary and more socially isolated than previous generations.
Our bodies were designed to procreate in peak conditions; today’s environment is a far cry from those peak conditions. When our body is deficient in key nutrients (especially nutrients needed to nurture a pregnancy), it shuts down reproductive function. When our body is stressed (especially if it thinks our environment is unsafe), it shuts down reproductive function. When our body is toxic (especially if these toxins could poison a growing baby), it shuts down reproductive function.
Vegetarian diets and fertility
One study of ~9,000 women found that female vegetarians and semi-vegetarians had more menstrual problems than their non-vegetarian counterparts. They experienced higher incidences of PMS, irregular periods, heavy periods and period pain. Vegetarians and semi-vegetarians also tended to have low iron levels and poor mental health (depression, anxiety, sleeplessness). This is despite the fact that they had higher levels of physical activity and were more likely to be in a healthy BMI range.
Several studies have corroborated the fact that vegetarians tend to have lower hormone levels than their meat-eating counterparts.
Another study showed that after two years on a low fat (<15% of total calories), high carbohydrate diet, women had estrogen levels that were 20% lower, progesterone levels that were 35% lower and FSH that was 7% higher. This might be helpful for women who are at high-risk for estrogen-sensitive cancers, but it’s no bueno for fertility.
Yet another study (though a small one) showed that 9 women each were placed on a vegetarian or non-vegetarian diet for 6 weeks. During this period, 7 of the 9 vegetarian women had anovulatory cycles; in contrast, 7 of the 9 non-vegetarian women maintained ovulation.
I hope you see that this isn’t just one study or one factor. Copious amounts of data confirm the fact that vegetarian women have more menstrual difficulties and irregularities than their non-vegetarian peers.
Why is this happening? Several reasons, of course. Firstly, you need cholesterol and protein to make hormones.
One study actually found that the probability of menstrual irregularities was inversely related to protein and cholesterol content. In other words, the more protein and cholesterol you have in your diet, the less likely you will have menstrual problems. Sounds pretty counter to what we’ve been told for years, huh?
The reason for this is because sex hormones are made from cholesterol. Yes, you read that right. One of the raw materials necessary to make your sex hormones is cholesterol. And, plant sterols (the “cholesterol” equivalent from plants) just doesn’t do it for our bodies in the same way that cholesterol from animal products does. Also, your body does make its own cholesterol, but we often need to supplement with cholesterol from our diet as well to reach optimal levels.
Second, protein from animal products tends to be more bioavailable than protein from plant products. Don’t get me wrong - there are plenty of sources of protein in a vegetarian diet (e.g., quinoa, rice and beans, lentils). However, it’s just not as quickly and easily digested and assimilated as animal protein.
Certain nutrients are only available in animal products, such as vitamin A (retinoids specifically), vitamin D (except maybe mushrooms!) and vitamin B12 (unless foods are fortified with these nutrients). Beyond this, the bioavailability of certain nutrients is better from animal sources than plant sources. For example, the conversion from ALA (from plant sources) to DHA is quite poor; it’s better to get DHA directly from oily fish. Also, heme iron (from animals) is more bioavailable than nonheme iron (from plants). This is likely why vegetarians tend to have lower iron levels than non-vegetarians. And finally, zinc levels are also is also lower on vegetarian diets. As you probably already know, vitamin A, vitamin D, vitamin B12, iron and zinc are all critical for the pre-conception and prenatal periods of development.
What does this all mean?
It means that if you are vegetarian and are currently having menstrual difficulties, you may want to consider strategically adding some meat back into your diet. In some cases, it can be really hard to restore a normal menstrual cycle without animal products.
If you’re happy with your cycles and your fertility, I’m happy too. If you’re not, maybe it’s time to consider another viewpoint of what’s healthy for you right now in the context of your fertility goals.
Stress and how it affects fertility
Stress is a hot topic these days. Headlines abound about how to avoid, minimize or manage stress. Here’s the thing: stress is unavoidable.
There is no such thing as a stress-free life. And, in her book, The Upside of Stress, Kelly McGonigal talks about the benefits of certain types of stress and why we wouldn’t want to get rid of it altogether.
Despite this, the reality is: stress can wreak havoc on our lives and our health if we let it run amuck.
The important nuance here is that it’s mainly chronic stress, not acute stress, that causes health problems...and as a result, infertility problems.
Let’s look at an analogy. In your bank account, there is a monetary reserve. Some weeks, you add to it (savings). Other weeks, you deduct from it (spending). In order to keep a positive balance, you have to do more saving than spending; otherwise, you will deplete your bank account to zero (or even negative).
The same is true of your stress account. Some weeks, you add to it (relaxing and rejuvenating). Other weeks, you deduct from it (stressing and complaining). In order to keep a positive balance, you have to do more relaxing and rejuvenating than stressing and complaining. It’s all about keeping a positive balance.
So, how do you keep a positive balance in your account?
Get rid of chronic stressors! This may include your commute to work, an underlying infection, an exercise routine you hate or even a draining relationship. Over time, anything that depletes your energy more than it elevates your energy should be eliminated.
Recognize that stress is a choice. As I mentioned above, it’s not about avoiding stress; it’s about managing your perceptions of and reactions to it. If there are certain things that you can’t change about your life (#1 above), reframe them or upgrade them. For example, if you are stressed about a big project at work, focus on how much of a badass you are for being given this opportunity and how appreciative you are. If you are stressed about your morning commute, but you can’t eliminate it right now, upgrade it with an amazing playlist, uplifting podcast or daily phone call to your favorite friend.
Don’t stress about being stressed! With the new focus on mindfulness and meditation practices, a lot of my clients are stressing themselves out about having so much stress in their lives. Stress is natural and normal...and at the risk of repeating myself again, unavoidable. It’s okay to be stressed; just don’t make it your default mode.
Play more. Yes, if your mind went there, it could be sex. But, I was talking more broadly. Infuse your life with fun. Real, old-fashioned kind of fun - sing, dance, laugh, imagine. Go on adventures. Create something new. The possibilities are endless. No holds barred, get some freakin’ fun in your life.
Pre-conception care vs prenatal care
Here at Xandara, we are all about pre-conception care. In fact, we think it’s just as important as prenatal care. And, many of the principles that apply to prenatal care also apply to pre-conception care: take prenatal vitamins, move your body regularly, manage stress levels, eat a whole foods diet, etc. However, there are two things that you may consider prior to pregnancy, but that would not be safe during pregnancy.
We all have a toxic body burden. For some of us, that burden is quite heavy. For others, it is not that bad. If you suspect that your toxic burden is an issue, I would encourage you to consider doing a detox at least 6 months prior to conceiving (ideally longer if your toxic burden is substantial...and with the support of a skilled practitioner).
Detoxing your body of toxic compounds can be an important component of pre-conception care. We know that a study by the Environmental Working Group identified over 200 industrial compounds and pollutants in a sample of newborn babies’ umbilical cord blood. This means that some percentage of a mother’s toxic body burden is being transferred to her baby. Because of this, detoxing prior to pregnancy can help minimize the transfer of toxic compounds from mama to baby.
So, why can’t you detox during pregnancy? Because during the detox process, many compounds actually become more potent and harmful prior to being excreted from the body...so you want to take it slowly. And, it takes quite some time for your blood levels to normalize again after slowly releasing these toxins from your body; you wouldn’t want your baby to be exposed to such powerful, detrimental substances for any period of time. It’s just too risky.
Dieting / fat loss
Pregnancy is not the time to be stressing about your love handles. Seriously.
Yes, there is an optimal BMI range for pregnancy, which is aligned with the “normal” BMI range from 18.5 - 25 (Note: I’m not a huge fan of BMI measurements since they grossly oversimplify body mass, but they are the guidelines we have to work with for now. Body fat is a better indicator and would ideally be somewhere around 18-26%, depending on age, body type and other health parameters). We also know that being overweight or underweight can pose serious health risks for you and your baby.
However, trying to lose weight during pregnancy causes two main problems.
First, if you try to limit your food intake to control your weight, your body will preferentially “feed” your body over your baby’s body. If there isn’t enough nutrition to go around, your body will use the nutrition that is available for your needs first. We know this because there have been several studies that have shown newborns with vitamin or mineral deficiencies while their mothers don’t present with these same vitamin or mineral deficiencies. Therefore, if you artificially restrict calories during pregnancy, your baby is likely not to have sufficient nutrition to grow and will likely not develop normally.
Second, many toxins are stored in our fat tissue. When we lose weight, these toxins (such as persistent organic pollutants) are liberated into our bloodstream. For the reasons I mentioned above, we don’t want this to be happening while we are pregnant. No bueno for baby!
Given this, if you need to address your weight, do if BEFORE you get pregnant.
Folate is only one piece of the pregnancy puzzle
If you’re trying to get pregnant, you know about folate. You know that it’s a critical nutrient for early fetal development. Adequate levels of folate can prevent against neural tube defects.
Folate is critical. Pregnant women (and women planning to conceive) should all be getting adequate folate intake or supplementation. However, I think that the folate discussion crowds out discussion of all of the other nutrients that are critical for a baby’s early development (nutrients that are relevant sometimes even before you know that you’re pregnant).
Low maternal vitamin D status is linked with autism, impaired bone development and even asthmaLow maternal B vitamin and zinc status have been associated with cleft lip and palateMaternal copper deficiency and zinc deficiency can both lead to intrauterine growth retardation
And, for mom:
I think you get the point. We need all of these micronutrients (vitamins and minerals) to ensure the health of our baby...and to reinforce our own health.
We need both a balanced diet and targeted supplementation to make sure that we are getting all of these essential nutrients. Rather than over-focusing on folate, let’s ensure that we are getting access to all of the vitamins and minerals that are necessary for optimal health and development.
Birth control and fertility
This isn’t an easy topic to write about. For so many reasons, birth control is intimately linked to women’s rights, women’s liberation and women’s advocacy. Birth control has given many women freedom, flexibility and choice. In many ways, birth control has been an enabler of women’s forward progress. And for that, we hold reverence.
But, as with all light, there is inevitably also a dark side. In the case of birth control, we need to start discussing the underbelly of this powerful tool.
As with ANY medication, there are side effects. Until recently, no one really cared about or talked about the side effects of hormonal birth control (e.g., pill, ring, shot, hormonal IUD). The benefits outweighed the costs...but now we have more data on the costs, so it might be time for a re-evaluation.
Importantly for us here at Xandara, some of these side effects may be playing a role in fertility challenges. So, let’s dive into them:
It depletes the body of key nutrients; many of these nutrients (e.g., B vitamins, vitamin E, zinc, coenzyme Q10) are critical for initiating and maintaining pregnancy. It can alter the gut microbiome. An altered microbiome can be responsible for a number of symptoms, including headaches, yeast infections, lowered immunity and even mood disorders. A dysbiotic gut can also be transferred to your baby, predisposing them to things like asthma and allergies. It can impair detoxification, allowing a toxic hormonal soup to build up in your body. Excess estrogen, for example, is linked to fibroids, endometriosis and even some cancers. Moreover, any time that hormones are imbalanced (too much, too little), fertility problems ensue. It can mask underlying hormonal imbalances. With hormonal birth control, you do not actually get a period each month; rather, it’s a chemically induced “withdrawal bleed”. Practically speaking, this means that your hormones don’t fluctuate normally and naturally; therefore, your body does not produce many of the signs of hormonal dysfunction (e.g., acne, spotting, absent periods) that it otherwise would. Basically, your body’s symptom cascade is “silenced”.
The biggest issue for fertility is the last one. Many women don’t realize that they have hormonal problems until they try to get pregnant. Hormonal birth control covers them up. Sometimes, these underlying hormonal issues have been festering for years; in many cases, they were the initial reason that someone went on birth control (e.g., acne, heavy periods). The thing is: birth control didn’t solve the underlying problem (which was an imbalance of hormones); it only masked the problem by quieting the symptoms. So, when you come off of birth control, you are still left with that underlying problem, which definitely didn’t get resolved and may have even progressed.
This isn’t about birth control being good or bad. As with any medication, it’s about weighing the benefits and risks. And it’s about your unique situation and priorities. It’s just important to be an informed consumer...and you can’t be informed if no one gives you all of the facts.
The big takeaway here is this:
Birth control can mask underlying hormonal imbalances while you are on it. Even once you’re off of it, the effects of hormonal birth control can increase barriers and therefore time to getting pregnant (e.g., through nutrient deficiencies, altered microbiome function and impaired detox). Given this, you may want to give yourself some time to transition off of birth control and ensure that your hormonal system is in good shape before trying to conceive.
When genetics matters in fertility
Nutrigenomics is an emerging field of science that explores how nutrition impacts our genome; nutrigenomics demonstrates that certain nutritional interventions can have a positive, neutral or negative effect on a sub-population of individuals, dependent on their unique genetics.
There is ongoing debate about whether high fat diets are healthy for us. The answer may depend, in part, on your genetic make-up. There are three types of APOE variants (E2, E3 and E4). Since you get one gene from each of your parents, your unique mix of APOE genes (e.g., E2/E3, E4/E4) determines how your body metabolizes cholesterol.
The most common genotype is APO E3/E3. People in this population exhibit normal cholesterol metabolism. However, people with APO E2 or APO E4 gene variants exhibit dysfunctional cholesterol metabolism. APO E2 is associated with lower cholesterol levels whereas APO E4 is associated with higher cholesterol levels.
Several studies have found that diet may influence the effect of the APOE polymorphism on cholesterol levels. Because of how cholesterol is differentially metabolized, it has been suggested that E4 carriers benefit most from lower fat, higher carb diets while E2 carriers benefit most from higher fat, lower carb diets. We now know that the relationship between fat intake and cholesterol levels isn’t as clear as we used to think it was and that sugar intake might actually be a bigger mediator in cholesterol synthesis. However, in this case, the amount of dietary fat that’s optimal for you may very well depend on certain pieces of your genetic blueprint.
The research on coffee consumption has been notoriously mixed. Some studies find that drinking coffee has many health benefits (e.g., owing to the polyphenols, etc). Other studies find that drinking coffee has many health drawbacks (e.g., makes the body overly acidic, leaches minerals, etc.). There is not one, single answer here...and the discrepancy may lie in our genetic make-up.
Several studies have found that the difference in whether coffee is beneficial or detrimental depends on whether you are a fast or slow metabolizer of coffee; one study looked at the risk of heart attack and another looked at the risk of hypertension. Both studies found the same thing: slow metabolizers of caffeine have an increased risk of disease, while fast metabolizers experience no such increased risk. Fast metabolizers are able to clear caffeine from their systems quickly, allowing exposure to the beneficial compounds (like polyphenols) while decreasing the likelihood of negative side effects. Slow metabolizers, on the other hand, took a lot longer to clear the caffeine, which increased the amount of time that caffeine had to wreak havoc on the body. We now know that one gene, CYP1A2, seems to play a role in regulating whether you are a fast or slow metabolizer. Now, it would be remiss of us to stop the discussion there; there are absolutely other genetic and environmental factors that may play a role in how caffeine is metabolized in the body. Several other SNPs have already been implicated. However, CYP1A2 is a great place to start in understanding the role of genetics in informing our daily coffee fix.
MTHFR is one of the most studied SNPs. MTHFR is the enzyme that converts dietary folate (and synthetic folic acid) to the active form of folate (5-mTHF) as well as converting homocysteine to methionine. People with MTHFR SNPs have decreased activity in this enzyme ranging from ~30% to 75%. Given this, for people with one or two MTHFR gene mutations, the research suggests that you should limit intake of folic acid in fortified foods and supplements since you can’t convert folic acid as efficiently into usable folate. You may also want to limit foods that increase homocysteine levels (e.g., processed foods, too much conventionally raised meat, alcohol) and incorporate foods that decrease homocysteine levels (e.g., green leafy vegetables). In addition, detox capacity may be impaired so eating a clean diet (e.g., filtered water, clean animal products, organic produce) is especially important for those with MTHFR mutations. There are many more lifestyle suggestions for managing an MTHFR mutation, but you get the idea.
In the future, when we see conflicting evidence in nutrition studies, we may consider the fact that genetics may play a role in what works for one person but not another. We are just scratching the surface when it comes to understanding gene variants and their impact on our bodies. However, it is important that there is an interplay between our genetics and our lifestyle behaviors. Nutrition is not a one-size-fits-all prescription. As with the Pareto principle, ~80% of dietary recommendations can be applied fairly broadly to the population at large, while ~20% of recommendations may need to be tailored to your unique genetics and circumstances.
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Clinically, miscarriage is defined as the spontaneous loss of a pregnancy before the 20th week.
If you have experienced a miscarriage, your doctor has probably told you that it’s completely normal and incredibly common. And that would be true.
We know that up to 20% of recognized pregnancies end in miscarriage. We are also recognizing pregnancies much earlier given the recent advancements in at-home pregnancy testing. However, the percentage of miscarriages among unrecognized pregnancies may be much higher. As many as 45% of conceptions may end in miscarriage; we don’t know the exact number because a chemical pregnancy is an early pregnancy loss that occurs shortly after implantation. In many cases, a woman will lose the pregnancy before she even realizes that she’s pregnant.
(Sidenote: it’s called a “chemical” pregnancy because urine / blood testing can detect an increase in human chorionic gonadotropin (hCG) levels, but an ultrasound would not be able to detect a fetus yet. Hence, it’s a “chemical” pregnancy as indicated by hCG.)
The thing is: despite these facts, telling you that miscarriage is normal or common doesn’t stop the pain...or the shame and blame.
But what if I told you this instead?
Miscarriage is your body’s wisdom in action. Most miscarriages occur because the fetus isn't developing normally; for example, some pregnancies may produce only a few fetal membranes, an empty sac or a malformed embryo.
Your body is instinctively designed to protect you...and to protect your baby. That mission starts the moment you conceive. Your body is trying to ascertain whether the baby has a good chance of surviving and thriving. If not, it does not make sense for your body to expend the extensive resources needed to build, grow and house a baby for 9 months.
Much of the time, we don’t know the definitive cause of a miscarriage. However, ~50 percent of miscarriages are caused by chromosomal abnormalities. If you were to carry that child to term, the probability is very high that they would suffer birth defects and would not develop normally. And so, your body naturally weeds out those embryos. At the most crude level, miscarriage is a form of natural selection.
Given this, maybe we can shift our perspective on miscarriage. Though you may be cursing your body right now, it is trying to protect you and your future baby. Though you may not always understand the intricacies of how your body works, you might consider trusting her deep and innate wisdom. Reframing miscarriage is about cultivating trust - trust of your body’s wisdom.
Now, that being said, a single miscarriage can be a normal and natural occurrence. However, multiple or recurrent miscarriages is something to explore further as they are most likely related to your overall health. Less than 5 percent of women have two consecutive miscarriages, and only 1 percent have three or more consecutive miscarriages. Possible causes of recurrent miscarriage are broad and I won’t go into detail here, but they may include infections, heavy toxic load, diabetes, thyroid disease or autoimmune disorders. In these cases, you will need to resolve the underlying factors before you can sustain a healthy pregnancy. your customers. Describe a product, share announcements, or welcome customers to your store.