Female-Factor Fertility
Intro
In my last blog post, I focused on male-factor fertility since a lot of fertility journeys are focused on the female half of the picture, and I wanted to highlight why it’s important to also consider the male half too. In regards to fertility, it is estimated that 72 million couples experience infertility and the World Health Organization (WHO) reported that in 37% of infertility cases, female infertility was the cause. In this blog post, I am going to focus solely on female-factor fertility, where you will learn:
Some of the potential causes of female fertility issues
Evidence behind integrative options to support female fertility
NOTE: THIS BLOG POST IS MEANT TO BE EDUCATIONAL ONLY, AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS.
Causes
Multiple factors play roles when speaking about changes to female fertility. Sometimes shifts in hormones can play a role in changes to fertility, other times it can be due to structural changes of the uterus, ovaries, and the fallopian tubes, and sometimes it can be a combination of different factors! So, working with a provider who will be able to identify the root cause of changes to female fertility will be most-helpful.
Continue down below for more in-depth explanations:
Age
In a study completed by the National Survey of Family Growth, it revealed that as a female gets older, the chance of infertility increases. Authors reported that females 15-34 years old had an infertility rate of 7.3-9.1%, that females 35-39 years old had an infertility rate of 25%, and that females aged 40-44 y/o had an infertility rate of 30%. And, the American College of Obstetricians and Gynecologists (ACOG) reported that “[female fertility] decreases gradually but significantly beginning approximately at age 32 years and decreases more rapidly after age 37 years.” And, the ACOG recommends that females over the age of 35 years old “should receive expedited evaluation and treatment after 6 months of failed attempts to conceive or earlier, if clinically indicated,” and that females older than 40 years old receive “immediate evaluation and treatment.”
Ovulation & hormones
Ovulation is the time of the menstrual cycle when an egg is released from the ovary. Once an egg is released, there is an opportunity for fertilization. Issues with ovulation can cause changes in female fertility, and there are many types of ovulation issues and many possible causes for each of them.
Anovulation: Anovulation is described as no release of an egg during the menstrual cycle, which can lead to irregular or absent menstrual cycles. Different types of conditions can have anovulatory cycles, such as: functional hypothalamic amenorrhea, polycystic ovarian syndrome (PCOS), premature ovarian failure, hypothyroidism, and more. The causes behind these conditions can be complex, and have hormone imbalance playing a contributing role.
With functional hypothalamic amenorrhea, it occurs when the body is experiencing a state of constant stress, and some common causes are: psychological stress, excessive exercise, and disordered eating.
In regards to PCOS, it is a condition when female hormone imbalance takes place because of metabolic dysfunction, with blood sugar issues and insulin resistance playing a role in hormone shifts that contribute to constellation of symptoms, such as hormonal acne, facial and body hair growth, scalp hair loss, and irregular menstrual cycles.
With premature ovarian failure, it is described by the Mayo Clnic as a condition when the ovaries stop functioning appropriately before the age of 40. When someone has this condition, the Mayo Clinic lists that they may experience irregular menstrual cycles, difficulty getting pregnant, hot flashes, night sweats, low libido, and more.
And lastly, with hypothyroidism is a condition when someone has low thyroid hormone. Low thyroid hormone can trigger the brain to release high levels of the hormone prolactin, which can cause irregular menstrual cycles.
Structural changes
Structural changes to the ovaries, uterus, and the fallopian tubes could also play a role in changes to female fertility. A study completed by the WHO revealed that some common structural causes of female fertility issues are: Endometriosis, occurring in 15% of cases; pelvic adhesions, occurring in 12% of cases; tubal blockages, occurring in 11% of cases; and more. To assess for structural issues, a pelvic exam is necessary, and some imaging and procedures may be completed for better identification of structural issues.
Do know that there are more causes of female fertility issues, and the ones listed above are just some of them. So, make sure to always work with a licensed provider who can assess for and identify possible causes for the best-indicated treatment options.
Integrative & conventional management
Licensed Naturopathic Doctors (NDs) are primarily trained to provide holistic, integrative primary medical care, and there are specialized naturopathic endocrinologists that are board-certified by the Endocrinology Association of Naturopathic Physicians (EndoANP). This entails that licensed NDs are knowledgable in both pharmaceutical/conventional treatments and natural treatments. And, in regards to how licensed NDs treat their patients, they try to identify and treat root causes of their patient’s symptoms, which usually leads to more-holistic and personalized treatment plans. And since licensed NDs have knowledge in both conventional and natural treatments, licensed NDs can provide a balanced perspective on when to recommend natural and conventional treatments. Licensed NDs will refer out to reproductive endocrinologists, and other specialists for procedures and work-up that are out of their scope of practice.
TO LEARN MORE ABOUT NATUROPATHIC MEDICINE, NATUROPATHIC MEDICAL EDUCATION, AND NATUROPATHIC MEDICAL LICENSURE, CLICK HERE.
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Foundational health & Wellness optimization
Foundational health, lifestyle, and environmental exposures: Foundational health and lifestyle can play a role in female fertility changes. Diet, exercise, environmental exposures, and more have all been connected to changes in ovulation and female fertility. In regards to diet, a study completed in 2008 revealed that diets replacing carbohydrates with animal protein negatively affected ovulation, and that replacing carbohydrates with vegetable protein had a protective effect. And an interesting study looking at the effect of multivitamins and ovulation showed that regular use of multivitamins may decrease risk of ovulation issues. Additionally, exercise in obese females have been shown to have a positive effect on ovulation. However, it should be noted that excess exercise can lead to functional hypothalamic amenorrhea. So, it’s all about a balance with exercise! Moreover, cigarette smoking and other environmental exposures have been reported to have an effect on ovulation. A systematic review revealed that females who regularly smoked cigarettes had higher odds of experiencing infertility compared to non-smokers. Additionally, literature reveals that females who smoked cigarettes had higher incidence of diminished ovarian reserve, which could explain why females who smoke cigarettes could experience changes to fertility. Beyond that, environmental exposures have been connected to changes in female fertility.
To learn more about environmental exposures on hormones and fertility, click here to read my blog about it.
Hormones & ovulation
Functional hypothalamic amenorrhea & PCOS: For those experiencing anovulation, finding the root cause with proper work-up will be necessary. For those experiencing functional hypothalamic amenorrhea, it will be helpful to identify the stressor to the body and treat that stressor as best as possible. For those with PCOS, labs, imaging, and an in-depth medical intake will be helpful. Since there are various conditions that can look like PCOS, doing labs will help providers understand what could be going on. In addition to this, doing an in-depth medical intake will help providers holistically understand what factors could be playing contributing roles to symptoms of PCOS. Once PCOS is diagnosed and once the root cause is identified, there are various conventional and natural options that could be recommended, and depending on the severity of a patient’s symptoms integrative treatment may lean more towards natural options or conventional options.
To learn more about PCOS, check out my PCOS blogs (Part 1: Diagnosis; Part 2: Root Causes; and Part 3: Naturopathic Options).
Hypothyroidism: For those with hypothyroidism, an in-depth medical intake will be helpful, but labs would be the most helpful. Labs will help providers identify what kind of hypothyroidism a person is experiencing, and there are various conventional and naturopathic options that may be recommended. The ultimate goal with hypothyroidism treatment is to increase a person’s thyroid hormone levels to reduce their symptoms.
Click here to learn more about hypothyroidism symptoms, labs, causes, and integrative options.
Ovarian stimulation: Ovarian stimulation may be recommended to some individuals to increase output of eggs from the ovaries to increase chance of fertilization. When there is an undetermined cause of female infertility, the first-line conventional medication is clomiphene citrate, which causes ovarian stimulation to release eggs. When this medication is prescribed by a physician, couples are recommended to have unprotected intercourse daily 5 days after the course of clomiphene is completed. Intrauterine insemination may also be completed after clomiphene. For females with PCOS, letrazole is usually prescribed in place of clomiphene. And for more intensive treatment, gonadotropin therapy my be recommended by a physician.
Premature ovarian failure: For those with premature ovarian failure, there is a decrease in the number of follicles in the ovary. And, follicles are where eggs are. Premature ovarian failure is a complex condition, and there have been various causes that have been identified to play a role in the development of premature ovarian failure, such a chromosomal changes and autoimmunity. For those with premature ovarian failure and wanting to conceive, a 2019 systemic review reported that “egg donation is often the only solution for subsequent infertility” and “in 5–10% of cases of [premature ovarian failure], however, pregnancy can occur naturally, with hormone replacement therapy (HRT), IVF, or, more recently, in-vitro maturation (IVM) or with stem cell therapy.”
Antioxidants & egg quality
Optimizing egg quality may be recommended by licensed naturopathic providers to support female fertility. When optimizing egg quality, it can mean supporting antioxidant profile with the use of diet, lifestyle, environmental medicine, nutrient supplementation, and more. Antioxidants are important since they are responsible for neutralizing free radicals. Free radicals, when left on their own in the body, have been shown to contribute to mitochondrial dysfunction in cells. And, mitochondria are necessary for the production of cellular energy (called ATP), and dysfunction with mitochondria has been related to a decline in egg quality
CoQ10: CoQ10 is a component of the mitochondria that helps with the formation of ATP and also plays a role in various antioxidant reactions. Higher CoQ10 levels in follicles have been associated with improved embryo quality and higher pregnancy rates, and pre-treatment of CoQ10 before ovarian stimulation increased ovarian response, fertilization rate, and number of high-quality embryos in females with decreased ovarian reserve.
Melatonin: Melatonin is a hormone that is made in the brain that is responsible for the feeling of sleepiness, and is affected by light-dark exposure. Melatonin also acts as an antioxidant, and it has been shown to support fertility in females by improving egg quality and improving fertilization rates.
There are many other antioxidants other than CoQ10 and melatonin that a provider may recommend. So, make sure to talk to a licensed provider before trying anything new!
options for structural changes
Fibroids: Fibroids can affect female fertility by blocking proper embryo implantation after an egg is fertilized by a sperm. To treat this, a physician may recommend surgical removal of the fibroid.
Tubal and pelvic adhesions: Adhesions can occur because of infections, inflammation, endometriosis, and more. In regards to infection, pelvic inflammatory disease (PID) is a condition that occurs with Chlamydia. When occurs, it could possibly lead to the development of adhesions in the pelvis and fallopian tubes. For those with tubal adhesions, a physician may recommend in vitro fertilization (IVF).
These are just some general options that providers may recommend to patients. As always, speak to a licensed provider before trying anything new, and work with a provider who can best assess for causes of fertility issues in order to receive the best treatment options. Do know that there are many more options that a provider may recommend, and having a healthcare team of adjunctive providers may be able to provide added benefit in a person’s fertility journey.
Summary & Takeaways
This blog post was all about female fertility, as my last blog post was all about male fertility. In this blog post, you learned some of the causes of female fertility issues, and why it is important to get proper evaluation by a licensed provider to get the most-indicated treatment. You also learned about some of the conventional treatments for some of the causes of female fertility issues in addition to integrative and natural options, and why it's important to speak to a provider first before trying anything new. In regards to integrative and natural options, you also learned that supporting foundational health by looking at diet, lifestyle, and environmental exposures may be helpful, and could be a point of conversation when speaking to your trusted doctor.
I hope you found this blog post helpful and educational, and empowers you to feel confident when speaking to your trusted provider about your personal fertility journey.
If you want to read my blog post about male-factor fertility, click here.
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