• Thyroid Function and Fertility

    by Breea Johnson, MS RD LDN

    When someone is dealing with infertility, they often scour the world for answers. For a lot of women, they never figure out why they have unexplained infertility or experienced a miscarriage. But for some women, the answer may lie in a simple blood test to measure thyroid function as low thyroid function and thyroid autoimmunity are both associated with infertility and miscarriage.

    Consider Pulling Down the Moon nutrition client, Ann*, a 32 year old, normal weight woman who had two miscarriages with no explanation. After going to a miscarriage specialist, she was found to have hypothyroidism (low thyroid function) and with thyroid medication was successfully able to get pregnant and carry the baby to full term.

    The thyroid gland, one of the largest endocrine glands in the body, is shaped like a butterfly and is located on the front of the neck below the Adam’s apple. While it is very small (only 2 inches across), it affects our entire body, as the hormones it produces and secretes regulate metabolism, growth and development.

    A well-functioning thyroid gland is pivotal for a healthy body and to conceive a healthy child. There is a direct interaction between the thyroid gland and the reproductive organs (the testes in men and ovaries in women). Hypothyroidism (low thyroid function) influences ovarian function by decreasing levels of sex-hormone-binding-globulin (SHBG) and increasing the secretion of prolactin. Prolactin, the hormone which stimulates milk production for breastfeeding, also affects ovulation and menstrual cycles. Prolactin inhibits Follicle-Stimulating Hormone (FSH) and gonadotropin releasing hormone (GnRH). With high levels of prolactin, which can be caused by hypothyroidism, ovulation is not triggered and a woman cannot get pregnant. Additionally, in men, low FSH and GnRH caused by elevated levels of prolactin can prevent the maturation of sperm.

    Another common disorder affecting fertility is Thyroid Autoimmune (TAI) disease (Graves Disease and Hashimoto’s Disease). It’s the most common autoimmune disorder and affects between 5-20% of women of childbearing age (Poppe, 2008). This group of disorders involves both the endocrine and immune systems. Interestingly, there is double the rate of miscarriages in TAI-positive women and TAI has also been found to be increased in women with endometriosis. In one study, researchers found a 75% reduction in miscarriage among TAI-positive women who received levothyroxine (a drug used to treat low thyroid function) during gestation and pregnancy. Subclinical hypothyroidism also may be an issue, as women with TAI show moderately high TSH (Thyroid-Stimulating Hormone) levels before pregnancy, although often within the normal reference range. There has been discussion among endocrinologists to move the limits of TSH (used to measure TAI) to 2.5mIU/l but that is not in effect yet.

    We asked Dr. Christopher Sipe, a Reproductive Endocrinologist and one of our doctor partners at Fertility Centers of Illinois, whether he thinks thyroid disorders go undiagnosed early in the fertility journey when a woman is still with her OB.

    “Because thyroid disorders are so common,” says Dr. Sipe “there are many women walking around who are undiagnosed. Thyroid hormone levels fluctuate in our daily lives and can be affected by diet, exercise, supplements, weight changes, medical conditions and seasonal changes. Therefore, a woman can be normal once but 6-12 months later have an abnormal level. Pregnancy also causes a shift in the normal range of thyroid hormones, further making diagnosis of a thyroid disorder more difficult. It is for this reason that diagnosis pre-pregnancy is ideal and screening should be recommended to any woman considering pregnancy.”

    Dr. Sipe recommends woman have her TSH checked when she is considering becoming pregnant, when she has an irregular menstrual cycle, if she has a family history of thyroid disorder or if she exhibits symptoms of a thyroid disorder. Symptoms of thyroid disorder include inability to lose weight, dry skin, dry hair, depression, fatigue, constipation or muscle aches and pains.

    In the case of a woman who is trying to conceive, testing the thyroid early may save valuable time.

    “Treatment can take three to six months before a steady hormone level is achieved, and then pregnancy can be attempted,” concludes Dr. Sipe.

    *Name withheld for confidentiality reasons.

  • Should You Go Gluten-Free for Fertility?

    by Beth Heller M.S.

    You may be surprised to think of your digestive system as part of your immune system, but our gut actually functions as our body’s first line of defense – eliminating bacteria and other bugs before they can infect our internal environment.   When the digestive system is challenged, by such conditions as stress, illness or food sensitivity, inflammation can result.  Frequent bouts of diarrhea, constipation, intestinal bloating/cramping and heartburn can all be symptoms of an inflamed digestive tract.  Chronic inflammation of the digestive tract can impair our body’s ability to break down and absorb the nutrients in the food we eat.  In addition, gut inflammation may affect other organ systems, including the reproductive organs, which are in close proximity.  These factors, taken together, are why we take a very close look at digestion, and symptoms of food sensitivity, as they relate to fertility.

    Celiac disease, a condition in which an individual cannot tolerate gluten (a protein found naturally in wheat and used as an additive in many foods), is the classic example of a food sensitivity that is associated with infertility.  Population studies suggest that about 1 person in 100 has celiac disease, but studies also suggest that celiac is also under-diagnosed and may be 2.5-3.5% more prevalent in women with unexplained infertility ( http://www.ncbi.nlm.nih.gov/pubmed/17592443?log$=activity )

    In people with celiac disease, dietary intake of gluten (a protein found in many grains) causes a two-fold attack in the small intestine. Antibodies first attack the gluten protein and this attack triggers an autoimmune response in which antibodies attack the endomysium, a smooth muscle component in the small intestine, and damage the tiny, fingerlike protrusions on the wall of the small intestine that serve to absorb nutrients from food called villi. This leads to the most likely link between celiac disease and infertility – the malabsorption of nutrients.

    New research is emerging that suggests that there is a spectrum of gluten sensitivity and that celiac disease gluten sensitivity can cause symptoms similar to Inflammatory Bowel Disease which may negatively impact nutrition status and quality of life in ways similar to Celiac Disease.  ( http://www.ncbi.nlm.nih.gov/pubmed/19455131?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=21 ) Other common food sensitivities besides gluten sensitivity include eggs, soy, peanuts and dairy. Symptoms of food sensitivity are diverse:  diarrhea, constipation, rashes, gas and bloating and headaches – just to name a few.  At the Moon, in cases of repeated miscarriage, multiple failed ART cycles, unexplained infertility and/or Irritable Bowel Syndrome our nutritionists will often recommend our ART Recovery/Preparation Program, an ultra-healing diet that eliminates common allergens from the diet and track any change in digestive function and other symptoms.

    Remember, though, that we do not want to throw the baby out with the bath water.  Potentially allergenic foods, like dairy and soy, are also important sources of vitamins, minerals and dietary protein. They should never be removed from the diet without a solid nutrition plan.  Studies have also shown that one side-effect of a gluten free diet can be a reduction of healthy gut flora ( http://www.ncbi.nlm.nih.gov/pubmed/19445821?log$=activity ) .  As we’ve written before, healthy gut bacteria is critical for optimal digestive function and hormonal regulation, so any plan to eliminate gluten must support the gut.   Don’t forget that any elimination diet should also include a strategy for reintroduction and symptom assessment as the goal of any elimination diet is to determine which foods are causing problems.

    If you suspect food sensitivity may be part of your fertility issues, we highly suggest you seek out treatment with a trained fertility nutritionist.  Eliminating foods from the diet can be hard work, and is not necessary for everyone.   However, at the Moon, we’ve seen that for some patients the potential benefits may indeed be worth the inconvenience.

    To learn more about our nutrition programming, call 312-321-0004 (Chicago-Area) or 301-610-7755 (DC Metro).

    Evans KE et al.  Be vigilant for patients with coeliac disease. Practitioner. 2009 Oct;253(1722):19-22, 2.

    Pellicano R et al. Women and celiac disease:  association with unexplained infertility.  Minerva Med 2007 Jun; 98 (3):217-9.

    Verdu et al. Between celiac disease and irritable bowel syndrome:  the “no man’s land” of gluten sensitivity.  Am J Gastroenterol. 2009 Jun;104 (6):1587-94.


  • Seasonal and Local Eating for Fertility

    Healthy Dinner For optimal health and vitality, traditional medical teachings recommend eating seasonally and locally.  In keeping with the ancient belief that we are healthier and happier when our bodies are in tune with the cycles of nature, it follows we should eat foods that grow in our geographical area while they are in season.  Traditional systems teach that foods and people in the same geographical area have “similar energy.”  This may be true in the sense that plants and the people living as neighbors share the same weather, air, soil and “roots.”  Whether indigenous or adoptive species, plants that thrive in particular areas are there because they are well-suited and have established harmony with their surroundings.  When we eat foods that exist in harmony with our surroundings, it’s believed we allow take some of that harmony into our own bodies.

    Yet as we enter deep fall, some of the most touted fertility foods, like berries and melons, are heading out of season.  But that’s no reason to panic.  Instead of spending a fortune this winter on raspberries that have been shipped from half-way across the world, take a deeper look at your flora.  Farmer’s markets are an obvious way to explore what’s locally and seasonally available in your area.  In addition, many larger grocery chains have begun to label produce as locally-grown when applicable.

    Here are some tips for reaping the best of Fall’s fertility bounty:

    1. Think slow, think stew.  Fall and winter vegetables tend to be tougher and heartier than the delicate sprigs and tender fruits of spring and summer.  Kale, collards and sweet potatoes hold up well to slow-cooking methods like stewing or braising.  The benefit of stews and one-pot-meals is that the veggie cooking liquid is consumed as part of the dish, thus preserving nutrient content.
    2. Turn on the oven.  Cruciferous vegetables, including cauliflower, cabbage and Brussels sprouts release a caramel sweetness when slow roasted in a hot oven.  These vegetables are fertility “must eats” and contain compounds that help regulate our body’s hormone levels.
    3. Experiment with beans.  Bean soups and chili are nourishing dishes that contain fiber that promotes healthy digestion and elimination.
    4. Squashes and sweet potatoes are anti-oxidant powerhouses.  Slow roasted or mashed, they can also quench a sweet tooth.

    For more info about a nutrition consultation with a Pulling Down the Moon nutritionist call 312-321-0004 (Chicago) and 301-610-7755 (Rockville).

  • A New Understanding of Ovarian Reserve

    By Beth Heller, M.S.

    “Under such a concept unrecruited oocytes in primordial follicles, however, cannot  age, as current dogma holds. As long as unrecruited, they have to maintain their original quality. Only once recruited and entering maturation do they risk ” losing quality” if their maturation takes place within a poor quality ovarian environment. Since ovarian environments decline in quality as women age, aging women produce increasingly poor oocytes.” (1)

    This is the conclusion Dr. Norman Gleicher reaches in a recent reconsideration of the traditional understanding of ovarian reserve published in the journal Reproductive Biology and Endocrinology.  On the surface it may seem like thick scientific speak, but when you sit with it and take the time to digest the article, it is quite radical.  Dr. Gleicher is saying what the holistic world has been saying for years – that the environment in which an egg matures is as important as the egg itself.

    The line of reasoning that lead Gleicher and his colleagues to this conclusion is very interesting and is directly related to their work with DHEA supplementation in women with poor ovarian reserve.  In their lab and others, DHEA has been shown to  increase pregnancy rates  in this population of women.  In addition, DHEA treatment has been shown to be associated with lower incidence of miscarriage and aneuploidy.  Gleicher asserts that while the chance of pregnancy in this population is still low, it is more possible than current medical opinion holds it to be.  His lab has documented more than 30 pregnancies in women with severely diminished ovarian reserve.  These reported pregnancies also had a low rate of miscarriage.

    Women are born with all the eggs they will ever have.  Current medical opinion holds that these eggs “age” along with the woman so that the quality of the individual eggs declines irreversibly.  As a result pregnancies from these eggs will result in poor quality embryos, lower implantation rates and more spontaneous miscarriage.  In Gleicher’s research, however, pregnancies in women treated with DHEA had a low rate of miscarriage and aneuploidy and relatively high live-birth rates, suggesting that even older women and women with severely depleted ovarian reserve still have “good eggs.”

    So, are our eggs getting older with us or are they in a state of “suspended animation” waiting to be recruited?

    It will likely take the medical community a while to duke this one out.  From our perspective, while this new argument does not erase the relationship between age and fertility, it does make the relationship more fluid.  Following this line of reasoning opens up new avenues of medical treatment that focus on the four to six months that comprise an oocyte’s full maturation cycle.  Beyond providing a foundation for future medical/pharmacological protocols this understanding gives weight to lifestyle interventions including nutritional therapy, acupuncture and yoga that seek to improve the uterine environment.

    What remains unanswered is what, exactly, is causing the decline in the quality of the ovarian environment in aging women.  It has been suggested that inflammation, oxidative stress, circulating stress hormones and environmental toxins may all play a part in egg quality/egg maturation processes.  It is our hope that the medical community does not limit their focus to new pharmacological interventions and fully considers the potential role of low-cost lifestyle interventions as well.

    1.  Gleicher et al. Reproductive Biology and Endocrinology 2011, 9 :23

  • Alleviating Menstrual Pain with Massage

    Cathleen McCauley L.M.T.

    by Cathy McCauley, LMT

    If painful periods plague you, massage may reduce your discomfort, according to a recent study by the School of Nursing and Midwifery at Isfahan University of Medical Sciences in Isfahan, Iran. Conducted in 2010, the research studied the effects of massage therapy on dysmenorrhea, also referred to as painful periods, caused by endometriosis.

    “Endometriosis is one of the prevalent diseases highly affecting women’s quality of life during childbearing ages…it can cause side effects such as severe pelvic pain, painful intercourse, abnormal uterine bleeding, painful menstruation and decreased fertility. All this can negatively affect women’s ability to work and have familial relations, and reduce their self-confidence,” states the study’s authors.

    The study included 23 female patients, ranging in age from 21 to 40, who had been diagnosed with endometriosis and suffering from dysmenorrhea. Prior to the study nearly 70 percent of the women reported having menstrual pain before and after menstruation. A visual analog scale was used for each patient to rate menstrual pain on three occasions: before receiving any massage treatments, immediately following the first menstruation after the treatments and again six weeks later.

    Treatments consisted of 20 massage sessions, each 20 minutes in length. The participants were treated with massage to specific points on their abdomen, sides and back.

    Results of the study found that massage therapy has immediate and long-term effects on reduction of menstrual pain caused by endometriosis. In fact, pain reduction reached 65.2 percent six weeks after the massage treatments up from 34.8 percent immediately after treatments, showing long-term pain reduction being a significant.

    So whether you’re experiencing painful menstruation, pelvic pain or decreased infertility due to endometriosis, massage may be able to help lessen your pain. To learn more about Pulling Down the Moon’s massage protocols, please contact me at cathleen@pullingdownthemoon.com or 312.321.0004. I look forward to working with you!   To schedule an appointment click here!

    References

    P Bahadoran, N. Ghasemi, R. Heshmat, M. Valiani. Iran J Nurs Midwifery Res. 2010 Autumn; 15(4): 167-171. Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran; International Manual Medicine College of France; and Acupuncture School of Shanghai, Shanghai, China.

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