Factors in Fertility

Posted: October, 2022
Author: Sharlene Bennett | BHSc, AdvDip Nat, AdvDip Med Herb

Fertility is influenced by a combination of factors from stress, hormonal conditions, genetics, lifestyle choices and diet. Early, proactive clinical intervention is ideal, allowing a total of three months or more to encourage and reset healthy reproductive body hormone cycles.

While optimal timing for fertilisation of a released egg is often considered, it is important to note that the production, maturation and release of viable sperm also take up to 80 days.(6,7) A holistic approach to pre-conception treatment enables both emotional and physical support for the reproductive health and vitality of both men and women.

Nutritional status
What we eat has a significant influence over how our body is able to function. This is also crucial in mitigating some of the environmental toxins that we are exposed to on a daily basis, many of which are out of our control.

Deficiencies in nutrients such as folate, vitamin D, vitamin C, selenium, and low overall antioxidant status all impact reproductive health and fertility potential, and is closely linked to subfertility.

Vitamin C has shown to be of help in supporting fertility outcomes in women with luteal phase defects, while vitamin D has demonstrated some success in modulating the reproductive process in both men and women.

Hypovitaminosis D can aggravate or drive the development of insulin resistance and metabolic syndrome in women with polycystic ovarian syndrome (PCOS). In men, adequate levels of vitamin D helps sperm motility and healthy androgen levels.
Other nutrients required for male fertility health include coenzyme Q10, vitamin C, vitamin E, beta carotene, folate and zinc. These are all essential ingredients for optimal semen quality and reproductive health. (1,2)

The long-term effects of stress
Long term stress negatively impacts the Hypothalamic Pituitary Adrenal (HPA) axis by acting on the adrenal sex hormone release and production, including cortisol. This produces a negative effect on reproductive health, altering normal ovulation cycles and oestrogen and progesterone levels for women, and sperm quality and total production in men.

The HPA axis also regulates thyroid function. Low thyroid activity and production slow down biological, cellular and metabolic pathways in the body that influence reproduction, such as egg quality and development, and spermatogenesis. Chronic stress contributes to nutrient deficiency and affects the long-term health of the HPA axis.(7)

Healthy detoxification
Healthy detoxification processes support reproductive health via the removal of toxic substances and excessive circulating hormones. Ensuring the three phases of detoxification are working effectively will help subfertility and encourage homeostasis, particularly if chronic inflammatory conditions are present.

Phase I: Bioactivation
Waste products go through the liver and cytochrome P450 enzyme system, where enzymes break toxins into their intermediate forms for bioactivation. Most by-products and bioactivated forms then need to go through conjugation via one of the phase 2 detoxification pathways.

Phase II: Conjugation
A two-step process known as reduction or oxidation and conjugation enables a toxin or substance to be ready for travelling out of the liver. Phase 2 works to make the substance less toxic by binding a water-soluble group and allowing waste removal through the bowel.

Phase III: Transport
Phase 3 detoxification transports toxins out of body through the bowel via the gallbladder and the bile acids alongside the emulsification process.

Toxins will ultimately be reabsorbed into the bloodstream if they are not eliminated through the bowel via the normal peristalsis movement, including hormones such as androgens and oestrogen metabolites.

The inflammatory crisis
Common inflammatory hormone conditions like endometriosis, PCOS and Irritable Bowel Disease (IBD), such as Crohns and colitis, can impact fertility by driving chronic inflammation, causing excessive cytokine release.

Cytokine and tumour necrosis factor release encourage molecular pain, as does excessive prostaglandin release by cyclooxygenase-1 (COX-1) or cyclooxygenase-2 (COX-2) enzymes. COX-1 is constitutively expressed in the gastrointestinal tract, while COX-2 predominates at sites of inflammation.

Each of these factors contribute to systemic inflammation, driving chronic inflammatory pathways and secondary disease.5

Phytotherapy
We are spoilt for choice with herbs that help healthy fertility and reproduction. Here are our favourite herbs for fertility support in clinic.

Vitex agnus-castus (Chaste tree)
A herb that acts on progesterone and oestrogen balance, this herb is a true hormone modulator. An ideal candidate for healthy cycles and balanced hormone production.

Paeonia lactiflora (Paeony)
A traditional remedy, when paired with liquorice, for healthy hormone, progesterone and cortisol balance. This herb can support hormone equilibrium in cases of androgen and oestrogen excess.

Glycyrrhiza glabra (Liquorice)
A natural anti-inflammatory and an ideal herb for adrenal exhaustion or support. It is commonly used for PCOS, infertility and androgen excess.

Turner diffusa (Damiana)
A well-known nervine tonic and herb for libido enhancement or impotence for both men and women.

Tribulus terrestris (Tribulus)
An oestrogenic tonic for women and male infertility and impotence support, alongside helping with fatigue and physical stress.

Withania somnifera (Withania)
A potent adaptogen for adrenal health and a male tonic for physical performance alongside healthy sperm production. Withania helps to support healthy adrenal function, lower anxiety, stress, and sex hormone release such as cortisol, supporting mood and exhaustion recovery.

Dioscorea villosa (Wild yam)
An anti-inflammatory herb commonly used as hormonal support and infertility tonic.

Silybum marianum (Milk thistle)
The cleansing and detoxing ability of Milk thistle can help with excessive oestrogen and androgen-like conditions such as PCOS and endometriosis. It helps to improve and support healthy detoxification of hormones and general liver function.

References
1. Braun L, Cohen M. Herbs & Natural Supplements: An evidence-based guide. 3rd ed. Chatswood: Elsevier; 2010.

2. Sarris J, Wardle J. Clinical Naturopathy: An evidence-based guide. 2nd ed. Chatswood: Elsevier; 2014.

3. Grieger JA. Preconception diet, fertility, and later health in pregnancy. Current opinion in obstetrics & gynecology [Internet]. 2020 [cited 2022]; 32(3): 227–232. Available from: https://doi.org/10.1097/GCO.0000000000000629

4. Jensen A, Wrede J. Fertility Awareness-Based Methods for Family Planning: A Literature Review. Journal of Christian nursing: a quarterly publication of Nurses Christian Fellowship [Internet] 2021 [cited 2022]; 37(4): 212–220. Available from: https://doi.org/10.1097/CNJ.000000000000075

5. Hawkey CJ. COX-1 and COX-2 inhibitors. Best practice & research. Clinical gastroenterology. [Internet] 2001 [cited 2022]; 15(5), 801–820. https://doi.org/10.1053/bega.2001.0236

6. MacLaughlin SM, McMillen IC. Impact of periconceptional undernutrition on the development of the hypothalamus-pituitary-adrenal axis: does the timing of parturition start at conception. Current drug targets [Internet] 2007 [cited 2022]; 8(8):880–887. Available from: https://doi.org/10.2174/138945007781386848

7. Stanford JB, White GL, Hatasaka H. Timing intercourse to achieve pregnancy: current evidence. Obstetrics and gynecology [Internet]. 2002 [cited 2022]; 100(6):1333–1341. Available from: https://doi.org/10.1016/s0029-7844(02)02382-7