Fertility Kitchen

The thyroid is a tiny gland with an enormous impact on the health and wellbeing of the entire body. Underfunctioning of this gland, or hypothyroidism, affects approximately 1 out of every 12 women. However, thyroid conditions can be sub-clinical or go unnoticed for many years. Every cell in the body needs small amounts of thyroid hormone for optimal functioning. So, when this gland is compromised, many aspects of health can diminish, including fertility.

Many women suffer unnecessarily with symptoms such as fatigue, decreased libido, hair loss, water retention, depression, insomnia, and menstrual irregularity and may experience fertility challenges such as recurrent miscarriages.

Chinese medicine groups many of these symptoms into the "Kidney" system, which loosely correlates to the endocrine system, including thyroid, adrenal and ovarian function. Chinese medicine practitioners assess not only standard lab tests (measurements of TSH, T3 and T4) but also delve into aspects of health history such as immunity, energy levels and sleep patterns that have interrelationships to the thyroid function in order to arrive at an understanding of the entire "Kidney" system.

Both Chinese and Western medicine recognize that stress, overwork and poor diet may negatively impact the "Kidney" or endocrine system. Conversely, applying acupuncture and appropriate lifestyle modifications may help improve endocrine health and in turn, reproductive function.

The insertion of acupuncture needles at specific points on the body propagates sensation to the brain (specifically the hypothalamus), which in turn helps regulate the Hypothalamus-Pituitary-Ovarian Axis to impact hormone regulation and improve thyroid function.

Chinese medical nutrition traditionally employs substances from the sea that are rich in iodine, such as oyster shells and seaweed, to treat thyroid nodules. With the current availability of iodine (an essential component of the thyroid) in our regular food sources, these substances may not be as necessary, but a well-balanced diet, including good sources of protein (deep sea fish, hormone-free meat and poultry), complex carbohydrates (squash, asparagus, brown rice, beans, sweet potatoes), have shown to contribute toward healthy thyroid function. Foods to avoid include alcohol, sugar and goitrogens (peanuts, pine nuts, tapioca and sorgum).

Stress reduction techniques and immune-restoring activities such as yoga and meditation help to re-balance and restore thyroid function. Cognitive therapy has also shown an effect on the thyroid axis similar to that of antidepressant treatments.

Proper diagnosis and treatment of hypothyroidism can significantly improve reproductive health and overall quality of life.

As an homage to Pride Month, my last few posts were about LGBT parenting options. Today I want to delve more into the choice of using donor eggs. There are multiple circumstances in which using donor eggs is the best (or only) solution for growing your family. Although, it can be a difficult paradigm shift, using someone else's eggs and/or sperm doesn't translate into it not being your child. Once you go through a pregnancy with your baby in your belly and give birth, the bond is the same. In many cases it's the best way to get lucky children in the hands of wonderful parents.

The New York Times recently published an article stating that roughly 6,000 children are born each year via egg donation. (And a million living adults are the biological children of sperm donors!) This was an informative article, but I felt that it portrayed children conceived by egg or sperm donor as being inherently fraught with angst about the means to their conception, which has not been my direct experience while seeing many families make this choice. As you continue your own evaluation, you can check the article out for some fodder in order to consider all the angles.

In my years of working with couples dedicated to trying anything to form a family, my experience with children who originated from the thoughtful choice of egg donation, has been very positive. The patients who visit me seeking help in getting pregnant are usually extremely mature, emotionally-grounded adults who understand the gravity of bringing a child into the world and are ready to commit their lives to raising their children... by whatever means those children come about. In this scenario, everyone benefits.

Laurel Fertility Care is a local San Francisco fertility clinic with, in my opinion, an outstanding egg donation service by virtue of caring and informed physicians as well as diverse donors.

Should you want more help exploring this topic, I highly recommend seeking out a therapist who can counsel you on the emotional grey areas of choosing egg donation.

L-argenine, L-carnetine, CO Q10, and zinc are all great "sperm booster shots" to add into your supplement mix.

It's a tragic fact about fertility therapy that women tend to take the burden of the blame for issues with conceiving. After all, we are the ones who are able (or not) to get pregnant... right?

As with everything in nature—which loves to tend toward complexity—there are a myriad of factors that determine whether a woman gets pregnant. And some of these factors belong in the man's camp. In fact, up to 40% of infertility issues are thought to be "male factor."

Out of the millions of sperm that are produced (about 6 thousand per heartbeat), only a few have any chance of ever reaching the egg. You can see how good sperm count and mobility is crucial to the possibility of conception.

The good news: Arming yourself with all the information about conception allows both partners to beef up their health as best they can to increase chances of conception. In my acupuncture practice, I often treat men having issues with sperm count, motility and morphology, as well as those who by Western standards are seemingly perfectly healthy, but who may need a boost to their Qi.

Looked at from a Chinese medical perspective, some common causes of infertility in men are:

• Deficiency of the kidney yang (which can loosely translate to erectile dysfunction, low libido, or poor sperm count)
• Deficiency of kidney yin (which Western medicine might view as low fluid volume in their ejaculate)
• Liver Qi stagnation (typically matching a western diagnosis of low motility)
• Damp/heat issues (usually due to dietary and lifestyle stressors; can affect sperm count and quality)
• Qi/blood deficiency (stress can lead to low sperm count and a short life span for your guy's little guys)
• Blood stagnation (varicoceles or morphology issues)

What science says:

Fertility and Sterility, one of the leading professional journals on infertility, advocates acupuncture as a potential way to address male factor issues. They published a recent study that tracked 28 men who were diagnosed with idiopathic infertility as they received acupuncture twice a week over a period of 5 weeks.

"Compared to the control group, motility levels increased significantly in semen samples in the men receiving acupuncture. While median motility levels increased from 32% to 37% in the control group, they increased from 44.5% to 50% in the acupuncture group."

Acupuncture can indeed be a powerful healing tool for those struggling to conceive. Often, I address male fertility issues with Chinese herbs custom-formulated to their particular constitution. One of my favorite formulas draws on the idea of "like treats like"—or the doctrine of similarities. It is called the 5 Seed Formula and really does use seeds to treat "the seeds."

The sun gets a bad rap in the health community, particularly in regard to its effects on our skin. But sunshine is absolutely essential to our health, not just for reasons of mood, but because it's the primary way that our bodies acquire Vitamin D... a prohormone we certainly can't live without.

Vitamin D is particularly important to bone strength. D deficiencies lead to nasty disorders such as rickets and osteomalacia.

Vitamin D is not naturally found in many foods. To some extent, it can be gleaned from fish, eggs, fortified milk, and cod liver oil. However, with fish being a variable in our diet, milk causing a lot of people lactose issues, and cod liver oil being, well, disgusting, chances are you're not getting adequate D from your food.

In fact, our bodies were designed to manufacture D from sunlight.

What does Vitamin D have to do with fertility?

One study has found a link between low levels of Vitamin D and problems with ovulation. The relationship between Vitamin D and ovulation was presented at an American Society for Reproductive Medicine meeting in San Francisco.

The team from Yale University School of Medicine took Vitamin D measures from 67 infertile women. Only 7% of them showed normal Vitamin D levels, and the rest had either insufficient levels or actual clinical deficiency.

Current research is suggesting that a bolster of up to 4,000 IUs of Vitamin D should be tried to improve ovulation. This research may offer one solution for women to try on their own, or in conjunction with their current fertility treatments.

What else science says

According to the Mayo Clinic, "The major biologic function of Vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. Recently, research also suggests vitamin D may provide protection from osteoporosis, hypertension (high blood pressure), cancer, and several autoimmune diseases."

How to make sure you're getting enough Vitamin D

According to the Weston A. Price Foundation,  it's important to get Vitamin D both from the sun and from diet.

I love this particular quote from their site: "Primitive peoples instinctively chose vitamin-D-rich foods including the intestines, organ meats, skin and fat from certain land animals, as well as shellfish, oily fish and insects. Many of these foods are unacceptable to the modern palate."

The reality is, we still have plenty of foods left to choose from that are acceptable to our "modern palate" and will provide Vitamin D. However, never underestimate the healing effects of our good old life-giver, the sun!

And speaking of the sun, here's a fun article about how mating turkeys take advantage of sunlight when wooing their beloveds...

On a lighter note, this time of year is perfect for hunkering down at home for a marathon movie session. Humor and laughter are guaranteed soul-healing activities, and they also have scientifically-proven health benefits, such as improving immune function, increasing tolerance of pain, and decreasing negative response to stress.

With that in mind, here are some of my fertility-boosting recommendations for movie night. (Netflix links are built in for you whenever possible!

1. The Baby Dance with Stockard Channing
2. A Smile Like Yours with Greg Kinnear and Lauren Holly (netflix)
3. Raising Arizona with Holly Hunter and Nicholas Cage (netflix)
4. Funny about Love with Gene Wilder  (netflix)
5. The Good Girl with Jennifer Aniston (netflix)
6. Penny Serenade with Cary Grant (netflix)
7. Forget Paris with Billy Crystal and Debra Winger (netflix)
8. Maybe Baby with Hugh Laurie and Joely Richardson (netflix)
9. Up (the Pixar animation) (netflix)
10. Juno with Ellen Page (netflix)
11. Baby Mama with Tina Fey (netflix)
12. Then She Found Me With Helen Hunt (netflix)

The shifting of the seasons can affect health and fertility. As we head into winter, the Greek myth of Persephone is an apt one to share, as it's a poetic metaphor for our dynamic (and sometimes challenging) relationship to fertility and our own "seasons." Persephone was consider to be the incarnate embodiment of the earth's fertility. Her story can serve as an archetypal guide for the fertility journey.

Persephone was innocently picking flowers when Hades came from the underworld to abduct her. The nymphs she was with were changed into Sirens, and the bounty of the earth began to wither as the devastated Demeter (goddess of the Earth) searched everywhere for her lost daughter. Helios, the sun (who sees everything), eventually told Demeter what had happened.

Finally, Zeus, pressured by the deities, could not put up with the dying earth and forced Hades to return Persephone... but before she was released to Hermes—who had been sent to retrieve her—Hades tricked her into eating pomegranate seeds, which forced her to return to the underworld for one season each year. When Demeter and her daughter were united, the earth flourished with vegetation and color, but for four months each year, when Persephone returned to the underworld, the earth once again became a barren realm.

Originally a story to explain the seasons, the myth of Persephone and Demeter can also represent some of the emotional struggles or "seasons" associated with infertility. This myth touches upon the natural process of change, or ups and downs. We tend to more naturally align ourselves with the full expressions of ourselves—our successes, and reject our dormancy—or perceived failures. In the fertility journey, you are asked to go to the deepest depths of your capacity to wait and hope for Spring, or fecundity, to arrive. It can feel like, buried under the responsibility and agony of waiting in the unknown, it is hard to imagine emerging.

But if we draw on nature and archetypal patterns, we see that this grief and hope is a natural (albeit difficult) cycle. Persephone will go underground for some time, but come out again; the trees may lose their Autumn leaves, but we can have absolute assurance that the leaves will return in Spring. Although in the fertility journey there is not such a predictable outcome, we can draw upon the inspiration that there is the capacity for renewed energy and growth, even after despair.

Demeter was full of grief and anger when her daughter Persephone was taken from her. You may also feel angry and grief-struck at the prospect that something so dear to your heart isn't available to you right now. But, as in the myth, it may just be buried in the realms of the unknown, waiting for your unique environment to be ready to cultivate a family.  The mythologist Karl Kerenyi identified Persephone as "mistress of the labyrinth," and this journey toward a child does indeed lead us through a winding labyrinth, with dead ends that often cause us to try another path.

When Demeter did finally find Persephone, the joy that Demeter felt was overwhelming. When you allow whatever possibility may exist to comfort you, whether it is a natural conception, an assisted reproductive therapy, or an adoption that brings you toward a child, the joy is overwhelming and a new journey begins.

Chinese Medicine is based on recognizing how the seasons and other environmental factors influence our each and every constitution, our internal patterns, and our tendencies toward imbalances. Western medicine also recognizes cyclical, seasonal patterns. By studying how both systems of medicine interpret, track and treat these interrelationships, we can strategize about ways to complement seasonal changes to optimize our health and fertility.

This time of year—autumn into winter—represents a dormant stage for our bodies. Our energy slows down in symbolic preparation for hibernation. As the days get shorter and the temperature drops, we may find ourselves craving more food, more sleep and less activity. If we fight this natural inclination, sickness is not an uncommon result.

With fertility issues, it's also useful to pay attention to seasonal cycles when determining our course of treatment.

What Research Says

Results from various research studios show how seasonal shifts can affect fertility in various global cultures. Although the findings are contradictory and varied, we can draw some conclusions from them.

• In rural Bolivia, where seasonal shifts in available food sources and workload are consistent and marked, scientists found that the rate of anovulation (the condition during a normal menstrual cycle where the ovaries fail to release an egg during a particular cycle) was higher during the more arduous seasons. (Source: Am J Hum Biol. 2009 Jul-Aug;21, "Seasonal modulation of reproductive effort during early pregnancy in humans." Vitzthum VJ, Thornburg J, Spielvogel H.)
• Another study showed that among the Tamang women of Nepal, natural weight loss due to excess workload during the monsoon season proved to lower ovarian function. Similarly, Polish farmwomen, who work more in the summers, experience lower ovarian function that time of year. These studies show that overworking can be detrimental to our ovarian functioning. (Source: Annu Rev Anthropol. 1994)

The message? When you're trying to get pregnant, it's time to slow down!

Winter is the perfect time to listen to the body's natural desire to hibernate. (And it's also the perfect time of year to spend more time in bed, which fulfills a few purposes.)

• Studies centered around fertility treatment have shown that fall and winter are actually ideal times of year to pursue a medical boost. A retrospective analysis of the sperm parameters of 294 men in 2009 concluded that "FSF values [functional sperm fraction] showed a better response to active treatment during autumn and winter, indicating that commencement of empirical treatment at this time in IO men [in other words, men with the condition known as idiopathic oligozoospermia] may stand a better chance to succeed." (Source: Andrologia. 2009 Apr;41(2):118-24."Seasonality in sperm parameters in normal men and dyspermic patients on medical intervention." Adamopoulos DA, Pappa A, Billa E, Nicopoulou SC, Koukkou E, Venaki E.)

The Lesson

What can we learn from all of this? What are the chances of conception—facilitated or natural—during the winter months?

Well, obviously, winter conception happens all the time. Otherwise, we wouldn't see babies born in the late summer and early fall. However, our approach to fertility treatment can shift in order to accommodate the swing of the seasons.

During the winter months, it's crucial to emphasize rest, nutrition and relaxation while you are undergoing fertility treatment. At my two clinics, Acupuncture Kitchen and Laurel Fertility Care, our goal is to help you reach your ultimate goal of family by supporting you in these endeavors.

Three or more cups of coffee a day during pregnancy has been associated with increased miscarriage rates. Surprisingly, drinking decaffeinated coffee has been shown to have an even higher association with miscarriage.

Reference:

"In evaluating 5,144 pregnant women prospectively, the odds ratio for spontaneous abortion and caffeine consumption during pregnancy was 1.3 for 300 mg of caffeine. For women who did not report any alcohol or tobacco consumption before or during pregnancy, the adjusted odds ratio at 300 mg was 1.5. Decaffeinated coffee consumption was more strongly associated with the risk of spontaneous abortion. The adjusted odds ratio for 3 cups of decaffeinated coffee per day was 2.0, and for nonsmoking, non-drinking women, the adjusted odds ratio was 2.5."

"A Prospective Study of Caffeine Consumption and Spontaneous Abortion," Fenster L, Hubbard A, Windham G, et al, Am J Epidemiol, 1996;143:S25 (Ab#99).

We can learn a lot about the relationship between stress and conception from studying how stressors affect other animals. Case in point: our super sensitive friends the pandas.

Pandas are not great breeders, which is one of several reasons why their species is in danger. For one thing, they ovulate for a mere 24 to 72 hour window every two or three years! And even during their optimal breeding time, they aren't known for their high sex drive or their libidinous skills. In China, efforts to restore panda populations are being taken very seriously.

Another poignant reason that pandas are a fading breed seems to be that pregnant pandas show a high rate of miscarriage when subjected to environmental stressors. A part of the reason for this is that the implantation phase of a panda pregnancy is a tedious three to six months. In women, on the other hand, implantation occurs within the first two weeks. We also ovulate roughly every twenty-eight days, so, comparably, we have a lot going for us.

But humans, unfortunately, are still subject to miscarriages. As a matter of fact, approximately one in three women experience this hardship. Although human miscarriage is certainly not as simple as just being about stress, the observation of the panda mamas shows us that stress may indeed be a contributory factor.

In my practice, I always address a client's lifestyle and stress levels when assessing how to improve the opportunity to successfully hold a pregnancy. Emphasizing stress-management during your pregnancy is not just for your uterus. It is important for the whole you to help you cope and be well, regardless of what challenges you may face while moving toward having a family.

Western science's viewpoint

There have been multiple studies conducted on stress's relationship to fertility and pregnancy. However, the fact-finding has been mixed. Most doctors will agree that stress has some negative influence on pregnancy. A hormone released by the brain during excessive stress—corticotropin-releasing hormone—may contribute to miscarriage because it happens to be the same hormone released during labor to trigger uterine contraction. Regardless of controversial theories, the general consensus is that excessive stress is not good for pregnancy or overall health.

The Chinese medicine interpretation

Stressors (both emotional and chemical) impact the uterine environment. Just as there is a link between environmental stress/toxins and infertility, there is a relationship between what we ingest emotionally and physically while pregnant, and the wellbeing of our pregnancy.

I see so many of my patients rushing in for their appointments while juggling their full time jobs, bustling social lives, and demanding family obligations. My advice to them, across the board, is to slow down, take better care of yourself, and make sure you are nurturing your body just as you would nurture a pregnancy. This starts to set the stage for a harmonious inner environment.

Looking on the bright side

Early human (and panda) life is fragile and unpredictable. However, people are born every day-every minute, in fact-and plenty of those births are resilient results of stressful pregnancies. Stress is a normal part of evolution. The lesson here is to take the best possible care of yourself, do your best to minimize stress through activities such as mindful breathing, hiking in beautiful places, yoga, etc... and most importantly, don't stress out about stress!