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The Stress Hormone That May Be Preventing Your Pregnancy

Hmmm, struggling with infertility...

You can call it a vicious cycle. You can say it’s a which-came-first-the-chicken-or-the-egg situation. But the fact of the matter is that stress can be a cause of infertility.

And infertility causes stress.

And no one telling you to “just relax” is the solution, that’s for sure.

It’s awful to know that your stress can be affecting your fertility because, of course, that’s just going to stress you out more. But if we break down the whys and the hows of the stress-infertility connection, it can help us better understand what to do about it.

 

Understanding Hormones and the Menstrual Cycle

Before we look at stress, it’s vital to have a general understanding of the menstrual cycle and the key hormones involved. This is because of how hormones are impacted by stress.

As most women know from their own personal experience and those of other women in our lives, everyone’s cycle is different. Usually, this cycle lasts anywhere from 21 to 40 days, although 24 to 38 days tends to be more typical.

Ignore the fact that many sources will depict a cycle as 28 days and act like consistency in the length is the only way to be healthy. We know the truth is that every body is different and so is every experience.

The cycle begins as menstruation starts, shedding the lining of the uterus that is not needed if there is no pregnancy. At this point, both progesterone and estrogen are at their lowest.

The low hormone levels trigger the brain’s pituitary gland to release follicle-stimulating hormone (FSH), causing an egg in the ovarian follicle to start to mature.

As the egg matures, estrogen begins to be released by the ovary. This estrogen tells the pituitary gland to signal the production of luteinizing hormone (LH), causing ovulation, or the release of the egg. Estrogen is now at its highest in the cycle.

The used follicle, called a corpus luteum, now releases progesterone and, to a smaller degree, more estrogen.

The progesterone causes the uterus to begin to build up the lining that will house and protect the egg once it reaches the uterus. Progesterone is at its highest just before the uterine lining is at its thickest.

As the corpus luteum starts to break down, it produces less hormones, which continue to decline toward the end of the cycle.

If the egg is not fertilized, the lining is no longer necessary and will start to shed again, starting the cycle all over.

You can see from this that hormones play a very crucial role throughout the process. And any interruption of those hormones can greatly impact how it all plays out.

The Relationship Between Sex Hormones and Stress Hormones

Despite how it is often villainized, cholesterol is actually the back bone for a number of steroid hormones. (I like to think of cholesterol and “Mother Hormone.”)  Cholesterol is converted into whatever hormones the body needs most at that moment.

First, cholesterol is converted into pregnenolone. Then, depending on what is being prioritized by the body, pregnenolone is converted to progesterone or DHEA.

DHEA is a precursor for both testosterone and estrogen. But progesterone can become cortisol, one of the most important stress hormones. In fact, progesterone can be bypassed in favor of making cortisol, so that very little progesterone is actually produced (more on this in a bit).

Adrenaline is the stress hormone for short-term stress, think of our ancestors being chased by saber tooth tigers. Cortisol is the long-term stress hormone. In this case, think of our ancestors going through times of drought and famine, when food might be scarce for months on end.

It is cortisol that stays at high levels when we have stressful jobs, daily traffic and money problems that loom.

In these times of stress, our body is more likely to prioritize creating cortisol instead of sex hormones.

Cortisol has also been found to inhibit gonadotropin-releasing hormone (GnRH), which is what triggers the pituitary gland’s release of LH.

Living in Fight-or-Flight Affects Fertility

If you aren’t familiar with the terms sympathetic and parasympathetic modes, you may be aware of their more casual names: fight-or-flight and rest-and-digest, respectively.

Parasympathetic mode, also known as rest-and-digest, is the mode of the nervous system that we are in when we are calm and not stressed out. During this time, our bodies are allowed to focus on proper and healthy digestion, meaning they can better break down food and absorb nutrients. We have better and more consistent bowel movements in this mode.

Our bodies can also focus on reproducing.

But when we are in sympathetic mode, aka fight-or-flight, all we are focusing on is survival. Digestion and reproduction are secondary in that moment.

Because when we’re running from the saber tooth tiger, making babies is not a priority.

And this is not necessarily a bad thing. Stress allows us to survive. But not necessarily thrive, especially long-term.

In fact, cortisol is highly inflammatory.

And as we’ve learned, it also “steals” our sex hormones - as mentioned above - the production of progesterone can be bypassed in favor of making cortisol, so that very little progesterone is actually produced. And, remember, progesterone supports fertility.

Ok, ready for some examples of this in real life?

Menstrual Cycle Under Stress

Let’s review each step of the menstrual cycle and look at how stress, and specifically cortisol, affects them.

Here we go...

Imagine your menstruation is over and your estrogen and progesterone levels are low (as they should be at this point). But you’ve had a bad week at work, the holidays are coming up, the house is a mess and you have no idea what’s for dinner.

Instead of your estrogen levels starting to rise, your body has used that cholesterol to create cortisol. Estrogen may still be created but at lower levels than usual, so the pituitary gland isn’t triggered. Or, if it is, cortisol additionally blocks the release of LH via the GnRH. The follicle isn’t triggered to release the egg, or it is released later than usual, throwing off your usual cycle.

As the stress continues, progesterone that should be released next is instead converted into more cortisol. Without adequate progesterone, your uterine living isn’t building up enough or in time to support the growth of a fertilized egg.

SUMMARY: High stress levels - and therefore your body’s need for cortisol to deal with that stress - has affected your chances for pregnancy in two different stages of your cycle.

Additional Ways Stress Impacts Fertility

Women aren’t the only ones affected by stress in ways that may prevent pregnancy. When men are under stress, they too need cortisol, taking it away from testosterone production.

This has a huge effect on sperm count and quality, as well as being a leading cause of erectile dysfunction and low libido.

Both men and women can experience stress affecting lifestyle and choices they make that are factors in fertility.

Stress can influence sleep, eating habits, exercise consistency, interest in sex, and drinking and caffeine intake. These can all be pieces of the puzzle when struggling with infertility.

How You Can Manage Stress, Not Avoid It

There is nothing that irritates me more than someone telling a woman struggling with infertility to not stress about it. For real.

First of all, if you’ve been struggling with trying to get pregnant (and I don’t care how long because when you want a baby, any wait feels too long), the idea of being able to just let go of that stress is laughable.

It also does not give someone the tools to manage their stress, only acts like they have the ability to remove stressors from their life.

The truth is that money problems don’t just disappear; that traffic will not clear up magically; you will still have nights when you burn dinner; the list goes on and on.

If we had the ability to remove what stresses us out, no one would be stressed. But that is far from the world we live in.

Instead, we need to be talking about how to manage the feelings of stress.

And to make things more difficult, what works may be different for everyone. And what works one day may not work the next.

These are some stress management techniques that work well for some people:

  • Breathing exercises
  • Yoga
  • Massage/body work
  • Meditation or guided imagery
  • Journaling
  • Talk therapy
  • Social media breaks
  • Cutting back or eliminating caffeine
  • Cutting back or eliminating alcohol
  • Exercise
  • Walk or run
  • Nature
  • Aromatherapy
  • Art or art therapy
  • Music, dancing
  • Spending time with family or friends (as long as this doesn’t increase stress, catch my drift?)
  • Hugs
  • Pets

Stress as an Infertility Piece of the Puzzle

For better or worse, there is no one thing that causes infertility.

But there is no denying that stress plays a role in it.

If you have struggled trying to conceive, you probably have already stressed about it and I certainly don’t want to add to that stress. But if you do think it may be a factor in your struggles, there are ways to manage it.

The great news is that most forms of stress management are quite enjoyable. (That is the idea after all.)

Remember to try what appeals to you at that time, knowing that it may help you relax one day but not the next. It is important to prioritize the time you need to make that happen, even if it means asking for help.

The next time someone tells you not to stress may just be the perfect time for that calming breathing exercise.

Whether it’s infertility, autoimmunity or general health support, if you need nutrition therapy that is tailored to you and your lifestyle, my Happy & Healthy Adult Program will have you feeling better than you have in a long time. This is the right fit for you if you already know that underlying health issues, stress patterns or hormonal imbalances are part of the picture.

It’s the perfect place to start if you haven’t worked with me before and don’t know how to begin making changes to your nutrition and your life.

Hormones / Trying to Conceive / Uncategorized - 11/17/2021
infertility

Infertility Rising: 4 Hidden Reasons Why Many Women Can't Conceive

A Story about overcoming infertility challenges

Two years ago, Jenny was diagnosed with diminished ovarian reserve. It is a condition in which the ovary loses its normal reproductive potential, compromising fertility.

Both Rob and Jenny are just 32 years old. And, they have a lot riding on an upcoming in-vitro-fertilization (IVF) procedure.

At the time, doctors suggested a procedure for harvesting her remaining eggs, so that someday, they would be able to have a baby through IVF.

Rob and Jenny came to see me recently in an effort to incorporate holistic nutrition with the medical approach suggested by their doctors.

Jenny is taking birth control pills, which her doctor told her would help “regulate her cycle”. But she has been experiencing some unpleasant side effects, such as bloating, moodiness and trouble sleeping.

She is conscientious about her diet, and takes the supplements recommended by the fertility clinic prior to the IVF transfer.

But, with just one month until their big day, Rob and Jenny want to make sure they are doing everything right.

After all, the couple’s dream of having a baby and starting their family is on the line.

Fertility Procedures are Becoming Commonplace

If Rob and Jenny’s story sounds familiar, or if you have struggled to get pregnant naturally, you're not alone.

There are many different causes of infertility. This blog post addresses specifically the four hidden reasons affecting many women today.

In the United States, it is estimated that 1 in 8 couples have trouble getting or staying pregnant.

For the woman, getting pregnant relies on the ovaries releasing healthy eggs.

The reproductive tract must allow an egg to pass into the fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining.

(Quick definition: Infertility is clinically defined as not being able to get pregnant despite having frequent, unprotected sex for at least one year. Often, one or more complications in the scenario described above may be present for various reasons.)

Infertility is something that, at first glance, just doesn’t make much sense.

Why in the world - in this age full of technology and medical advancements - are infertility rates on the rise?

In my nutrition practice, I have recently seen more women in their 20’s and 30’s having difficulty conceiving with no known cause.

One theory: Our bodies are quite amazing, and infertility may in fact be a protective mechanism of the body.

Until the underlying causes are addressed, it may continue to be difficult to conceive.

OK, on to the list of the four hidden reasons why many women are experiencing fertility problems...

1. Health in Crisis: Disease-Associated Infertility

While not exactly a hidden cause of infertility among women, it’s important to recognize that strong links have been found between the rise of infertility in women of childbearing age with the increasing prevalence of other health complications, such as diabetes and obesity.

It is not surprising that hormonal imbalances associated with these diseases are undoubtedly a contributing factor to infertility issues.

Women with Polycystic Ovary Syndrome (PCOS) have trouble getting pregnant

When a woman receives a diagnosis of polycystic ovary syndrome (PCOS), one of the first things she may be told is that getting pregnant will be a challenge.

Indeed, PCOS is a leading cause of infertility and is a common hormonal disorder, Among women who have trouble getting pregnant, it’s estimated that half have PCOS.

Contrary to the name, cysts do not cause PCOS. Cysts are simply a symptom of the metabolic and hormonal storm that’s going on in the body.

The cysts are egg follicles that were not released when ovulation was meant to occur.

Rather than being released, they remain ‘stuck’ on the ovary and appear as cysts.

Up to 25% of ‘normal’ woman have poly (many) cystic ovaries. However, to have a true PCOS diagnosis, you also need to have the high levels of androgens.

The ovaries produce hormones, which are chemicals that control functions in the body. One of the hormones that the ovaries make is estrogen, a hormone predominantly found in women.

But the ovaries also make androgens, which are sometimes called "male hormones" because men's bodies make more of them than women's bodies do.

(Fun fact: Men and women need certain levels of both hormones for normal health.)
In a woman with PCOS, the hormones are out of balance.

So, a woman with PCOS may have higher-than-normal levels of androgens and may have lower-than-normal levels of estrogen.

Essentially, the cause of PCOS is high androgen levels.

And, subsequently, most of the symptoms of PCOS are caused by higher-than-normal levels of androgens.

High levels of androgens can:

  • interfere with signals from the brain that normally result in ovulation, so that ovulation does not occur regularly
  • cause the ovarian follicles (small, fluid-filled cysts within the ovaries in which eggs grow and mature) to enlarge, forming cysts
  • produce other symptoms of PCOS, including excess hair growth and acne

Inflammation and insulin resistance are the biggest contributors to PCOS.

Insulin:

Insulin is our storage hormone. When we eat, our body detects a rise in blood sugar.

When blood sugar is high for prolonged periods of time, our body doesn’t like it.

This is because it can lead to damage in the cells of our brain, liver, pancreas, heart, and eyes. Therefore, the body stores excess blood sugar in muscle and liver cells for later use.

Insulin is the hormone that tells the cells to open up and let glucose in. It’s excreted by the pancreas and binds to a receptor on the cell. This works in a similar way to a key opening a lock.

When the key has been used too much, or there is chronic low-grade inflammation, the lock starts to get a bit worn and clogged up. The key no longer fits. This is insulin resistance.

High insulin levels stimulate the ovaries to produce more androgens. They also reduce the amount of Sex Hormone Binding Globulin (SHBG) in the blood.

SHBG is like a sponge for excess hormones.

If levels of SHBG are low, then the levels of hormones in the blood will be much higher.

Inflammation:

Inflammation occurs when your immune system is chronically activated. Studies have now shown that inflammation can cause insulin resistance.

It may also have to be present for insulin resistance to occur in the first place.

Many things can cause inflammation, including:

Inflammation has been shown to increase androgens and impair ovulation, even without insulin resistance.

If you get recurrent infections or are sick all the time, this could be an indicator that you have chronic inflammation.

Other signs of inflammation include: seasonal allergies, asthma, sore joints, irritable bowel syndrome (IBS) or skin problems like eczema.

Undiagnosed (AKA Subclinical) Hashimoto’s or Hypothyroidism Can Cause Infertility

Autoimmune thyroid disease is very common in women of childbearing age.

It can lead to either an overactive (Graves’ disease, hyperthyroidism) or underactive thyroid (Hashimoto’s thyroiditis, hypothyroidism).

Autoimmune thyroid disease occurs when the body makes antibodies that attack the thyroid.

This is characterized by positive thyroid peroxidase (TPO) and/or thyroglobulin antibodies. It is also most commonly associated with an increased risk of developing hypothyroidism.

Hashimoto’s is the name of the autoimmune disease, while hypothyroidism is a thyroid condition that can develop because of it.

Not everyone with Hashimoto’s disease will develop hypothyroidism, but it is the most common cause.

If you have an underactive thyroid, or too little thyroid hormone in your blood due to an issue like Hashimoto’s, the body is unable to function normally.

Symptoms of hypothyroidism often include fatigue, weight gain, dry skin, mood swings and irregular periods causing infertility.

Autoimmune thyroid disease has been shown to be more common in women seeking treatment for infertility.

The significance of thyroid issues for women hoping to conceive is important because often times the disease is overlooked, undiagnosed, or untreated. This is usually due to incomplete testing with blood labs and “inconclusive” results.

Women with positive TPO antibodies have been shown to have an increased risk of pregnancy complications, including miscarriage and preterm labor.

When the thyroid is functioning at a lower than normal level, it will impact other functions of the body - pregnancy is no exception.

Evidence is still inconclusive regarding first trimester miscarriages.

However, a Chinese study in 2014 found that women with both early/mild hypothyroidism and thyroid autoimmunity have a greater risk of miscarriage between weeks 4 and 8.

I believe that Hashimoto’s and hypothyroidism are conditions that should be tested for, addressed and treated as quickly as possible.

Especially so, if a woman is experiencing fertility concerns, and especially during pregnancy, to reduce the risk of miscarriage.

If you have a thyroid disorder and is seeking the right nutrition to support your thyroid and fertility, you can check out my 4-week Hashimoto's Fertility Meal Plan to help you take charge of your hormones, your menstrual health and tackle fertility!

2. Planet in Crisis: Toxin-Associated Infertility

With rising infertility rates, very few experts in reproductive health are pointing to negative factors such as environmental toxin exposure.

But we should be examining the health of our environment as a powerful contributor to decreased fertility.

Exposure to environmental toxins has proven to be a major contributor to infertility on a global scale.

Everywhere we turn there are more chemicals and technological improvements that have negative consequences on health.

Electro-Magnetic Frequency (EMF)

More people on earth now own and use a cellular device than ever before in history. And, researchers believe this change in our surrounding environment may be contributing to increases in male infertility.

EMF radiation is a form of energy emitted by all electronic devices, and this energy has been found to interfere with our body’s cells.

EMF radiation can cause a cellular stress response, which can lead to more concerns, including DNA fragmentation and free radical damage. Other biological effects include cell death (apoptosis) and changes in cell membranes.

This type of damage occurs in both males and females.

A study found that people living close to cell phone base stations had “significantly higher” concentrations of alpha-amylase (a marker of stress) in their bodies.

At the same time, higher levels of stress, as measured by alpha-amylase, have been linked to an increased risk of infertility in women.

So, if we put two and two together, increased exposure to cell phone radiation leads to higher stress, which compromises a woman’s fertility.

Water

A new report by the non-profit Environmental Working Group and Northeastern University finds people in nearly every state are exposed to unhealthy drinking water.

According to the researchers, 43 states have locations, including drinking water sites, contaminated with Per- and polyfluoroalkyl substances (PFAS) chemicals.

The CDC says these chemicals have been linked to health issues that include birth defects, cancers and infertility.

Recently, research on the water crisis in Flint, Michigan showed the actual impact on fertility after lead contamination in the city's drinking water.

The results: fertility rates dropped by 12 percent and fetal deaths rose by 58 percent.

Lead

A recent working paper from the National Bureau of Economic Research, “Toxic Truth: Lead and Fertility,” confirms a connection between effects of lead exposure and fertility.

For the first time, they provided causal evidence of the effects of lead exposure on fertility for large portions of the U.S. population, both male and female.

They even found that increased levels of lead in the air increased the probability of a person seeking treatment for infertility.

Plastics

Another example of a pervasive environmental pollutant is the endocrine disruptor bisphenol-A (BPA).

The chemical BPA, which makes plastic hard and clear, has been used in many consumer products such as reusable water bottles.

It also is found in epoxy resins, that form a protective lining inside metal food and beverage cans.

This chemical has been shown to compromise the quality of a woman’s eggs retrieved for in vitro fertilization (IVF).

A small-scale University of California, San Francisco-led study has found the first human evidence of a relationship between BPA and fertility.

It showed that when exposed to bisphenol A (BPA), the percentage of eggs that fertilized normally declined by 50 percent.

3. Ethics in Crisis: Pharmaceutical-Associated Infertility

Pharmaceutical drugs that are prescribed to help manage and treat certain illnesses and diseases can sometimes have a negative effect on both male and female fertility.

If you are trying to conceive, it is important to speak with your health-care provider about the possible effects that your prescribed medication may have on your fertility.

Prescription drugs including hormonal contraceptives (birth control pills), steroids, high blood pressure medication, and antidepressants can all negatively affect the reproductive system.

The most common side effect of these medications is loss of libido, however, some of these medications can also lead to:

  • lowered sperm count
  • erectile dysfunction
  • menstrual irregularities
  • nutrient deficiencies that may result in hormonal imbalances

Birth Control Pills

Birth control is commonly prescribed for preventing pregnancy and to control acne.

The pills are also prescribed for a variety of fertility issues. This includes endometriosis, PCOS, ovarian cysts, pain associated with fertility issues, PMS, and irregular menstrual cycles etc.

An abundance of case reports and research suggests that taking the Pill can negatively impact long-term fertility.

1. Menstrual cycle disruption

Normally, a female’s menstrual cycle is influenced by the ebb and flow of various hormones in the body.

Each month, these hormones encourage the lining to grow and thicken to prepare it for the possibility of receiving a fertilized egg cell.

When fertilization does not occur, the uterine lining is shed in the form of menstrual flow. When you take the pill, you introduce synthetic hormones into your system.

These artificial hormones in the pill suppress the pituitary glands to inhibit ovulation or the release of the egg from the ovary. They also prevent the uterine lining from growing.

These hormonal changes caused by the pill can significantly affect the regularity of your menstrual cycle. When your uterine lining doesn’t thicken, there is very little to shed, so you bleed less than usual.

On the other hand, when you’re on the placebo week, there are no hormones in the pill, so you get your period.

If you are on the pill, chances are you will experience irregular bleeding, bleeding between periods, or no period at all.

2. Hormone imbalance

Synthetic hormone-containing birth control may provide symptom relief.

However, it does not address the underlying imbalance that is fueling or contributing to the fertility issue being dealt with.

What the Pill is doing is introducing synthetic forms of estrogen and progesterone to the body. These synthetic forms then prevent the body’s natural, beneficial hormones from bonding to hormone receptor sites.

Introducing synthetic hormones into the body may further exacerbate hormone imbalance by overloading it.

3. Disrupted ovulation

The synthetic hormones contained in birth control regulate release and timing of specific hormones in the body to prevent ovulation.

This is not how the normal release of hormones plays out in a naturally occurring menstrual cycle.

It is necessary to ovulate a mature, healthy follicle (egg) in order to achieve natural pregnancy.

The Pill prevents the maturation of a follicle for ovulation, one of the ovaries most important jobs.

Over time, the ovaries may “forget” how to do their job on their own. Just because they haven’t been signaled with the right hormones at the correct time in the menstrual cycle.

4. Cervical mucus changes

The Pill has been shown to change cervical mucus so that sperm cannot reach the egg.

Healthy cervical mucus is important for conception because it helps sperm travel through the vagina and the cervix to meet and fertilize an egg.

5. Changes the uterine lining

The Pill changes the uterine lining to make it unreceptive to the implantation of a fertilized egg.

It controls the body’s estrogen and progesterone levels with synthetic hormones. And, it also prevents the proper levels of progesterone to build a healthy uterine lining for implantation.

Many women begin taking the pill at a very young age and don’t stop until they want to begin trying to conceive.

The Pill doesn’t cause infertility but impacts long-term fertility by silencing a woman’s biological clock.

In other cases, women ignore or forget they are dealing with a fertility issue because the symptoms have gone away.

The bottom line is: women trying to control the symptoms of a fertility issue by taking the Pill are not addressing the underlying imbalance that is fueling or contributing to the fertility issue.

Instead, they are using a synthetic medication to control the symptoms of the problem while simultaneously allowing the body to defy nature.

Human Papilloma Virus (HPV) Vaccine

In 2006, Gardasil, sometimes referred to as the human papilloma virus (HPV) vaccine, was approved by the Food and Drug Administration.

Gardasil is administered in three shots over the course of six months, to protect against HPV infection and its complications, including cervical cancers in women.

The vaccine is also marketed as offering protection against genital warts, as well as cancers of the anus, vulva and vagina.

Gardasil is given to males as well as females between the ages of 9 and 20.

A study published in the Journal of Toxicology and Environmental Health examined the childbearing capacity of women who received the HPV vaccine and those who didn’t.

Study results suggest the following:

  • Females who received the HPV shot were less likely to have ever been pregnant than women in the same age group who did not receive the shot.
  • The birth rate had declined in America in recent years - from 118 per 1,000 in 2007, to 105 in 2015 for the population cohort aged 25 to 29.

Opponents of the vaccine, including physicians, pose valid questions about the safety, risks, benefits and aggressive marketing of Gardasil.

Between 2006 and 2014, the Vaccine Adverse Event Reporting System (VAERS) cited 48 cases of ovarian damage associated with autoimmune reactions in HPV vaccine recipients.

VAERS also catalogued other reproductive issues including: spontaneous abortion (256 cases), amenorrhea (172 cases), and irregular menstruation (172 cases). These are all likely under-reported symptoms following administration of the vaccine.

One way to better understand the risk/benefit analysis of all medication (including vaccines) is to thoroughly review materials produced directly by the manufacturer.

I have personally read the patient insert which accompanies the Gardasil vaccine.

My concerns with some of the ingredients in Gardasil:

The best advice about the HPV vaccine comes from Dr. Kelly Brogan. She encourages parents to inform themselves on the safety of the vaccine before subjecting their children to the injections.

4. Lives in Crisis: Stress-Associated Infertility

Today, researchers have data that suggests preconception stress plays a role in infertility. The study findings appear online in the journal Human Reproduction.

Courtney Denning-Johnson Lynch, director of reproductive epidemiology at The Ohio State University Wexner Medical Center, and colleagues found that stress and infertility are related.

The findings showed that women with high levels of alpha-amylase - a biomarker of stress -  are 29 percent less likely to get pregnant each month.

Also, these women are more than twice as likely to meet the clinical definition of infertility. i.e. They remained not pregnant despite 12 months of regular unprotected intercourse) compared to women with low levels of this protein enzyme.

Researchers tracked 501 American women ages 18 to 40 years who were free from known fertility problems and had just started trying to conceive.

The researchers followed them for 12 months or until they became pregnant as part of the Longitudinal Investigation of Fertility and the Environment (LIFE) Study.

Saliva samples were collected from participants the morning following enrollment. And, samples were also collected again the morning following the first day of their first study-observed menstrual cycle.

Specimens were available for 373 women and were measured for the presence of salivary alpha-amylase and cortisol, two biomarkers of stress.

The researchers showed that stress is associated with a greater than two-fold increased risk of infertility among women.

This results should encourage women experiencing difficulty getting pregnant to consider managing their stress using stress reduction techniques.

However, as indicated above, stress is not the only or most important factor involved in a woman’s ability to get pregnant.

Rob and Jenny’s Health Discoveries…

Rob and Jenny, whom I mentioned at the beginning, have been looking deeper into their own risk factors for infertility and eliminating them one at a time.

Here are a few facts about Jenny’s health history that she believes may have played a role in her diminished ovarian reserve:

  • When Jenny was 20 years old she received a course of 3 HPV vaccinations in a 6-month period.
  • At 21, Jenny was hospitalized with a pulmonary embolism. A genetic test revealed Jenny is compound heterozygous for the MTHFR genetic variation, which is associated with increased risk of blood clots.
  • In her late 20s, Jenny was diagnosed with hypothyroidism, and began taking Levothyroxine. Until recently, she did not know her hypothyroidism was the autoimmune disease Hashimoto’s.

Nutrition & Lifestyle Can Help

Here’s the thing, Jenny has always been pretty careful about her eating. She likes fruits and veggies and tries to consume adequate protein.

She admits she has a sweet tooth and likes her coffee but recently she is cutting back on both. Jenny has taken a women’s one-a-day multivitamin from the drug store for nearly a decade.

Aside from the history above, Jenny hasn’t had too many issues with her health.

Infertility came as a bit of a surprise.

When Rob and Jenny came to see me, they wanted to know about the comprehensive nutrition and lifestyle options that would support their plans for IVF transfer.

Together, we thoughtfully embarked on a holistic nutrition plan for optimal fertility:

  • Spectracell micronutrient testing showed us that Jenny had nutrient deficiencies, and specific nutritional needs to support her MTHFR status. With additional methylfolate, b-complex vitamins, carnitine and antioxidants, Jenny is feeling stronger and more energetic than ever. SAMPLE  Spectracell Micronutrient TEST REPORT
  • Food Inflammation Testing (FIT testing) revealed hidden inflammation from frequent foods in Jenny’s diet. Following elimination of the inflammatory foods, Jenny’s digestive system is feeling much better. It has less gas and bloating, fewer aches and pains in her joints and more energy throughout the day. SAMPLE FIT TEST REPORT
  • Avoidance of common food, household and skincare chemicals is helping both Rob and Jenny reduce their toxic load. This is important for helping Jenny’s thyroid be more productive (remember, she has Hashimoto’s). Through daily detox practices, both Rob and Jenny have enjoyed fewer complaints of dry/itchy skin, seasonal allergies, fatigue after meals and digestive disturbances.
  • Rob installed a whole-house Aquasana water filtration system in their home. Pure, clean water has given them the peace of mind that the common chemical residues found in municipal tap is not a threat to them or their future family.
  • Rob and Jenny put EMF radiation reduction devices on their laptops, cell phones and ipads.
  • Finally, they have begun a morning yoga routine together. It incorporates both movement and meditation - for reducing stress and getting more exercise.

You Have the Power To Resolve Your Fertility Challenges

Here’s the good news: some of the things a woman can do to help resolve fertility issues involve making major lifestyle choices.

A woman can focus on what is within her control, such as: nutrition, sleep, managing stress, and chemical exposure.

We each hold tremendous power over our own health and fertility status by choosing healthy lifestyle habits.

The above information hopefully gets you on a path towards resolving your fertility concerns.

But, if this leaves you feeling like additional support is right for you, please consider my Happy & Healthy Adult Program.

I can help you uncover your root cause and get you on a path towards greater health and achieving all your goals and dreams.

Family Nutrition / Trying to Conceive - 10/03/2019
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Hashimoto’s and Miscarriage – What You Need to Know So You Can Have a Healthy Pregnancy

I recently watched an interview with former First Lady, Michelle Obama, on the TODAY Show who opened up about her experience with infertility.

In the interview, Mrs. Obama shared about her miscarriage before giving birth to her daughters.

And, she talked about how women keep their secrets about miscarriage. About how couples hide their pain around infertility.

As I watched, I got the feeling that many women would instantly relate to what this high-profile, public figure had to say about her private life and struggle to start a family.

I could relate.

Nourished and Renewed with Hashimoto's

Miscarriage Shame & Statistics

Miscarriage is such a seemingly taboo subject among women.

We all know miscarriages can and do happen. Statistically, as many as 75 percent of fertilized eggs do not go on to result in a full-term pregnancy.

Yet, women still experience shame, isolation and depression as a result of having a miscarriage.

After having gone through a miscarriage, women suffer from all sorts of physical and emotional pain like having the feeling of failure, guilt and having let everyone down.

But, these emotions are kept silent for so many reasons.

Infertility and pregnancy loss is such a broad subject in the realm of family planning, nutrition and couple’s health and hormone balance.

In particular, women who have Hashimoto’s autoimmune thyroid disease have more complicated statistics related to pregnancy loss.

Researchers in a 2011 study published in the British Medical Journal conducted a systematic review of 31 studies involving over 31,000 women.

According to the researchers, they found thyroid antibodies increased the risk of miscarriage by 290%!

Without a doubt, women with autoimmune thyroid disease face greater challenges with fertility than the general population.

Sara Peternell Hashimotos Checklist blog

My Experience with Recurrent Miscarriages

I have Hashimoto’s and I had three pregnancy losses.

The first miscarriage was the most difficult loss emotionally (and still to this day brings tears to my eyes to remember what my husband and I went through).

Before my first miscarriage, I didn’t know my disease could affect my chances for a healthy pregnancy.

I didn’t know that taking synthetic thyroid hormone (Synthroid) was alone not enough to support healthy reproductive function.

I didn’t know that certain nutritional deficiencies were likely at the root cause for my hormone imbalance/low progesterone that ultimately led to three losses.

I also didn’t know that there were corresponding endocrine dysfunction issues. And this prevented my body from being healthy enough to carry a baby to term.

The first miscarriage was definitely an eye-opening experience. It led me to research, read, and learn about the implications of thyroid health (or lack thereof) on pregnancy.

And, through reading and learning, I found it important to talk about my experiences with all three miscarriages.

I wanted to share with other women in hopes of helping ease the pain and loss for someone else.

Connecting the Dots to Prevent Miscarriage with Hashimoto’s

For me, not getting pregnant was not the issue. I was fertile. I could easily get pregnant.

This is often the case with women who have Hashimoto’s disease.

Conception occurs but the pregnancy terminates, usually within the first 8 weeks. These early miscarriages, common in Hashimoto’s, are often called “chemical pregnancies.”

There are many factors in Hashimoto’s contributing to miscarriage:

  • A woman may not know she has Hashimoto’s and may not yet be receiving medication treatment prior to pregnancy. I recommend women get their thyroid panels checked, (including antibodies) before trying to conceive.

 

  • A woman may not be on the proper dosage of medication. Higher levels of thyroid hormone are needed during pregnancy. In women with normal thyroid function, the thyroid gland increases the production of thyroid hormone to meet this increased need. In hypothyroid women, this often means that the dose of Levothyroxine needs to be increased during pregnancy. Many endocrinologists advise pregnant women take a higher dose of synthetic thyroid hormone (like Synthroid) as soon as pregnancy is confirmed. Regular blood tests for TSH to ensure that the level remains normal are also highly encouraged.

 

 

  • A woman may have abnormal Natural Killer (NK) cell activity. They are responsible for protecting us from bacteria, viruses and foreign bodies, and organ transplants rejections. This problem can switch on and off, so some of the women may have 1 or more normal pregnancies as well as recurrent miscarriages.

 

How to Reduce Risk of Miscarriage if You Have Hashimoto's Disease

Most doctors recommend that all women at high risk for thyroid disease should have a TSH and an estimate of free thyroxine blood tests.

Women who are experiencing symptoms of the disease should also go for these tests. Where necessary, other thyroid blood tests should also be considered.

A woman is at a high risk if she has a history of thyroid disease or thyroid autoimmunity, family history of thyroid disease, type 1 diabetes mellitus or other autoimmune condition.

Anyone with these risk factors should be sure to tell their obstetrician or family physician.

Ideally, women should be tested prior to becoming pregnant or as soon as they know they are pregnant.

Thyroid and Antibodies Testing Before Conception

As part of my overall approach to healthy conception and pregnancy, a complete thyroid panel work-up is really the best place to start.

You can request a thyroid panel from your doctor’s office.

You want your doctor to test all of the serum (blood) markers pertinent to the thyroid. The thyroid panel is especially helpful in understanding health impacts of hypothyroidism, Hashimoto's, autoimmune disease, blood sugar control and cholesterol levels.

Other nutritional deficiencies could also be identified. I will explain more about that in a minute.

But, listen, you don’t have to know what each of the test names/acronyms below mean - this list is widely recognized by health care practitioners and standard labs.

So, feel free to print this list off and take it in to your doctor’s office if you are requesting labs.

Comprehensive Wellness Panel + Thyroid/Antibodies panel

  • CBC (includes Differential and Platelets)
  • Comprehensive Metabolic Panel (CMP-14)
  • Ferritin
  • Hemoglobin A1c with eAG
  • Iron, Total and Total Iron Binding Capacity
  • Lipid Panel
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS
  • T3, Free (FT3)
  • T4, Free (FT4)
  • THYROID PANEL & TSH
  • Thyroid Peroxidase and Thyroglobulin Antibodies
  • Vitamin B12 (Cobalamin) and Folate Panel

TSH and Thyroid Medication Dosage Adjustment During Pregnancy

If you are being treated for hypothyroidism, it’s imperative to have at least a TSH level checked as soon as your pregnancy is detected. The TSH level results will indicate what adjustments have to be made to your medication levels.

TSH levels may be checked one to two weeks after the initial dose adjustment to be sure it’s normalizing. Once the TSH levels drop, less frequent check-ups are necessary during your pregnancy.

Although thyroid hormone requirements are likely to increase throughout the pregnancy, they tend to eventually stabilize by mid-pregnancy.

Levothyroxine/Synthroid and desiccated thyroid hormone (such as Armor) medication is safe for use during pregnancy.

I suggest that for best absorption of the medication, you ought to take your thyroid hormone pills at least one-half hour to one hour before eating breakfast.

If you are consuming iron-containing prenatal vitamins and calcium supplements, be sure you take your thyroid medication at least one-half hour to one hour beforehand.

In addition, nutritional counseling to help lower antibody levels is ideal prior to conception to help support both the mother and baby’s health.

Nutritional Testing for Pregnancy If You Have Hashimotos

Ok, this is where we get in to the stuff that I really love about holistic nutrition!

Alert: Nerdy Movie Reference Here.

Do you remember that 80s movie "Inner Space" with Dennis Quaid, Meg Ryan and Martin Short?  You know how they miniaturize themselves so they can travel around inside a person's body?

And at one point, Dennis Quaid's character is traveling in his mini space capsule through Meg Ryan's body and he discovers she is pregnant!  It's so cool!

Well, it would be amazing if I could go exploring inside a body to determine what each individual needs as far as nutrients.  But, I can't (and that might be weird).

Spectracell Micronutrient test

So, the next best thing is the Spectracell Micronutrient test. This test analyzes 32 nutrients and metabolites of nutrients which are critical to you and your baby’s optimal health.

The test is not diagnostic, but rather predictive and preventative. This means if we correct deficiencies today, health problems related to Hashimoto’s (including miscarriage) are less likely in the future.

I love to use the Spectracell Micronutrient test to assess each woman’s individual nutrient needs.

This test makes clear your deficiencies, borderline nutrients, nutritional patterns and possible disease correlations.

This information can help you to understand exactly what your body needs in terms of foods and vitamins.

The nutrients we replenish thoughtfully will likely improve your Hashimoto’s, restore your health and support a healthy, full-term pregnancy.

Food Inflammation (FIT) test

Another very cool pre-conception test is the Food Inflammation Test (FIT test).

This test measures 132 edible compounds and determines if your body is reacting in a negative way to those foods and chemicals.

WHY IS THIS SO IMPORTANT? If you know your immune and digestive system’s negative reaction to specific foods, it's easier to avoid them.

You will hear me say more than once that "all health begins in the gut." So, starting with the gut is a great idea.

Inflammation from food reactions shows up in a variety of ways. This includes digestive, skin, sleep, mood, malnutrition and immune system disorders.

Managing inflammation is a key factor in reproductive system healing.

The FIT test detects both Immunoglobulin G (IgG) antibodies and complement antigens. This will determine your reactivity to 132 foods, colorings and additives.

The IgG and antigen methods yield more complete profiles of the various foods that may cause food sensitivities. The FIT test is the most sensitive food inflammation test available.

The information we glean from this test helps us assess your gut and immune health. And this can steer us in the right direction for making concrete and effective changes to your nutrition plan.

If you have a diagnosis of Hashimoto’s or another autoimmune disease but with few complaints or symptoms, you will still benefit from FIT testing.

The results gives clarity into what level of support is needed to enhance your health and vitality through foods.

A Nutrition Plan to Ensure Pregnancy Success

I get it. This part is sometimes easier said than done: make sure to eat a balanced diet everyday!

Sometimes, in early pregnancy, all you want to eat is potato chips or curry. Or chocolate bars.

But, balance is such an important piece of the nutritional puzzle when it comes to supporting healthy moms-to-be and beautiful new babies.

Below is a list of macronutrient categories to focus on when you are trying to become pregnant.

These suggestions are appropriate for anyone, not just those with Hashimoto’s.

Fats

Fats are necessary to produce hormones. Fats are not the enemy, they provide essential vitamins (such as vitamin A) not found anywhere else. We also need to eat a variety of fats - fats from animals, plants, nuts, etc.

Focus on clean fats from clean animals and coconut, olive, flax and fish oils.

Protein

Proteins are needed for every function of the body. For this healthy conception and pregnancy food plan we will need to eat 70-100 grams of protein a day.

This can be a combination of meats, fish, dairy (raw), eggs (the best), protein powders (rarely), vegetables, beans and nuts.

Carbohydrates

Carbs are a misjudged villain. The types of carbs we are talking about which support healthy pregnancies are whole grains that are in their natural state, un-messed-around-with by manufacturing and processing and contain all their original nutrients.

Also, when you sprout a grain the protein content increases. Sprouting makes the grains easier to digest, causes less inflammation in the body.

Fresh fruits and vegetables

Fruits and vegetables supply the body with minerals, vitamins, enzymes, antioxidants, fiber and water. Oh, and the magic! The magic of food is in veggies and fruits: color, flavor, freshness, texture and aroma.

You should eat a rainbow of fresh fruits and veggies to get all of the different nutrients you and your baby need.

Optimized Diet for Hashimoto’s Disease if you are trying to conceive

If you have Hashimoto’s and are hoping to conceive and stay pregnant, make sure you are eating a healthy, balanced diet rich in the following vitamins:

  • vitamin E, sources: whole grains, broccoli, alfalfa, nuts, seeds, leafy greens
  • vitamin A, sources: cruciferous vegetables (broccoli, Brussels sprouts, cabbage, bok choy, collards, kale, cauliflower,) alfalfa
  • vitamin C, sources: cruciferous vegetables, orange juice, citrus fruits, red bell peppers, kiwi
  • vitamin D, sources: alfalfa, raw dairy products, salmon, mushrooms, sunshine!
  • calcium, sources: broccoli, bok choy, alfalfa, raw dairy products, salmon, anchovies or sardines with bones
  • iron, sources: grass fed beef, liver, blackstrap molasses, dried fruit, alfalfa, leafy greens
  • zinc, sources: nuts, seeds, oysters, liver, grass fed beef, oysters (preferably cooked if you are pregnant)
  • folate, sources: leafy greens, whole grains, citrus fruits, whole grains
  • essential fatty acids, sources: salmon, other wild-caught fatty fishes, nuts, seeds, grass fed beef, pastured eggs

 

What to Avoid

Here's a list of things to avoid which may be related to miscarriages:

  • alcohol
  • artificial sweeteners
  • food coloring
  • ginger, ginger ale, ginger beer (ginger can be stimulating to the uterus)
  • quinine, key ingredient in tonic water
  • caffeine (chocolate, sodas, coffee, tea, some pain and cold remedies) (*Caffeine has been shown to be related to miscarriage.)
  • monosodium glutamate (MSG), butylated hydroxyanisole (BHA) - both food preservatives - and all other food additives (if you cannot pronounce it, best not to eat it!)
  • partially or uncooked foods due to bacterial contamination
  • crash, fad, or ultra-low carb diets due to restrictive calories preventing successful implantation and pregnancy
  • No soy of any form unless fermented such as miso or tempeh

What to Eat More Of

  • fruits and vegetables organic
  • dairy products pasture-raised, raw or organic
  • red meats grass fed and organic
  • chicken and eggs pasture-raised, free range/organic
  • grains in whole, natural form
  • something high in enzymes with every meal – a good example is fresh papaya or pineapple

Prenatal Vitamins To Support A Healthy Pregnancy

The most important thing to know about vitamins and minerals is that they are best absorbed and utilized by your body when taken in food form rather than pill or supplement form.

Also, it is possible to overuse certain vitamin supplements, creating a dietary situation that is actually more harmful than helpful.

One exception to this rule is folate. There is a strong correlation between folate deficiency and neural birth defects. So, it should be supplemented by pill (approximately 800 mcg per day) in addition to food sources.

I prefer the “methylfolate” form of this vitamin because of its superior absorbability.

In general, I recommend a whole-food based prenatal nutrition supplement during pregnancy. It should contain the appropriate amount of vitamins, minerals and essential fatty acids for a healthy mom and baby.

What Does an Ideal Pregnancy Diet to Prevent Miscarriage Really Look Like?

Raw Milk (if you can tolerate dairy, many with Hashimoto’s cannot)

Or raw cheese, yogurt, kefir and always choose organic.
You can drink it with a meal or use it in your morning smoothies.

Most people who are lactose intolerant can drink raw milk because it has live enzymes intact. If you are unable to get raw milk, or not much into it, skip dairy milk all together.

New to raw milk? Learn more!

Non-Dairy “milk”

You can use rice, coconut, flax or almond milk if you need a "milk" for tea. It’s best not to drink soy milk. Processed soy has so many problems such as GMOs and estrogenic effects. It can also cause endocrine disruption for the unborn baby.

Eggs (fresh farm, pasture-raised, free range, organic)

Pasture-raised eggs are one of the best sources of digestible proteins. Cook them any way you like them or add the raw yolks raw to a smoothie.

Fresh Seafood (2-4x a week)

Seafood supplies vital essential fatty acids that are not produced by our bodies. Make sure to eat wild-caught salmon only.

Avoid all large, high mercury fish such as tuna, mackerel and shark.

Bone Broths (chicken, beef, turkey, fish)

Broths are really easy to make and supply calcium, minerals, protein and immune system boosters. You can make stocks in a crock pot using the bones from chickens, fish or beef.

Add water, vegetables and a splash of apple cider vinegar and cook on low in the crock for 12 hours or more.

Check out my favorite bone broth (Kettle & Fire) on my Resources page.

Coconut Oil

This essential fat supplies lauric acid, which boosts the immune system and is necessary for important functions in the body, such as assimilating vitamins.

Avocado (5+x a week)

Avocados are an excellent “healthy fat.” Add them to a sandwich or salad for another opportunity to get some more essential fatty acids into the diet.

Fermented Foods (kefir, yogurt, kombucha, kimchi)

Fermented foods provide our bodies with good bacteria to aid in digestion and immunity. They are cheap and easy to make. Eat with a meal to aid digestion.

Beef and Lamb (grass fed organic)

Grass fed meats provide protein, and essential fatty acids. Grass fed beef and lamb have more beneficial essential fatty acids (EFAs) in them than their conventional counterparts. Grass fed beef are active and eat grass (instead of grains). They are low in cholesterol and can have the same amounts of healthy EFA's as fish.

We get our clean, healthy, grass fed meat from ButcherBox. You can find more information about this company on my Resources page.

Fresh Fruits

Eat a wide range of organic, fresh fruits that are in season. Fruits supply your antioxidants, vitamins and enzymes. You can make a smoothie in the morning with lots of fruit in it.

Fresh fruit/veggie smoothies will give you many of the essential vitamins for your day.

Fresh Veggies

Eating one salad a day and a dark green vegetable with dinner is a great start to getting plenty of vegetables in your diet. Lightly steaming or eating your vegetables raw is ideal.

Add some grass fed organic butter and they will taste really good. Butter also helps nutrient absorption.

Sprouted Whole Grains

Sprouted grains are easier to digest and have more protein than regular grains.

Fresh-pressed Organic Juices (no more than 12 oz a day)

Focus on greens and herbs in your fresh juice. You can make your own at home, or buy occasionally from juice stores in the area. I love the Hurom juicer and use it every week!

Fresh juice is the easiest way to get your daily veggies and one of the best habits you can have for the long run.

Couple Fertility Divider 7

My Hashimoto's Pregnancy Success Story

So, remember, I had three miscarriages. All were early in pregnancy, and all were likely due to the complications of Hashimoto’s disease.

While my husband and I were starting our family, I was in nutrition school. And I learned all the ways in which the right foods could help heal my condition.

Thankfully, I was my own best guinea pig.

During my advanced studies to become an Master Nutrition Therapist, I researched on anti-inflammatory nutritional protocols. These protocols could improve or reverse autoimmune disease, including Hashimoto’s.

I applied core nutrition principles to my own life and I healed (reversed!) my autoimmune diseases. It sounded like a miracle to some! But I knew Hashimoto’s was reversible through changing diet and lifestyle habits and balancing the immune system.

Despite our losses, I never gave up. I worked closely with my doctor to determine the best time to “try again.”

Despite having Hashimoto's, I finally Got Pregnant After 3 Miscarriages

Exactly one month after my third miscarriage I took a pregnancy test and it was positive! We actually were not even trying yet, but Molly had other plans. I texted my husband who was on the golf course with my Dad. Neither of us could believe it!

The outcome to this story?

My two amazing kids - Clay who is now 10, and Molly, 8. They are great kids. And, I am so lucky to be their mom.

And, so lucky to have found nutrition when I did.

I talk about these personal experiences all the time. And I want people to have the same hope and belief in the body’s ability to heal with the right tools in place.

I want couples to know that they will be able to start a family. And that their bodies will be the healthiest they can be thanks to nutrition as their foundation.

I was successful in starting a family with Hashimoto’s - you can be too.

Do you have Hashimoto's Thyroiditis and need guidance for a successful pregnancy?

So, if you read this whole post and some lightbulbs are going off for you...good.

You have so much more knowledge now than you did earlier.

You can manage your Hashimoto's and have a successful pregnancy.

You can share all of this information with your health care provider. Inform them of your choice to implement as many of these nutritional protocols as possible. And, request the tests which will guide your health decisions.

I offer nutrition programs which can help ease the transition and guide you to success.

If you are after more in-depth information about Hashimoto's and your total health to prepare for future pregnancies, my self-paced online program "Nourished and Renewed with Hashimoto's" is a great start.

If you have Hashimoto's and are already pregnant, the Adult Advanced program will be a good fit.

The Adult Advanced program is also a good place to start if you and your partner have had any issues with trying for a baby so far.

For some, the Super Guy/Super Girl program gives you just the right amount of information for feeding yourself well and meeting your unique nutritional needs.

Change is underway for you and your future family. And it all starts with pre-conception nutrition planning.

Hashimoto's / Pregnancy / Trying to Conceive - 11/16/2018

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The information on this website is for educational purposes only and should not be considered medical advice. This information is provided to help you make informed decisions about your health. It is not meant to replace the advice of your primary physician.

Choosing a holistic approach to health care through nutrition means choosing personal responsibility for your health care. Sara Peternell, MNT, is not liable or responsible for any harm, damage or illness arising from the use of the information contained herein or through any of the nutritional therapy programs available for purchase.

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