Fertility "Misconceptions" Debunked - Part 1/2


When it comes to fertility, there are certainly a lot of myths and misconceptions floating around. Regardless of whether you heard them as “old wives’ tales” from your grandma or read them yourself on the Internet, being misinformed may only delay your time to conception unnecessarily. In this two-part article I will discuss and dispel the top fertility misconceptions that I encounter most among patients. It’s time to finally set the record straight and learn about what you can do to start optimizing your fertility today!

1. “Age is just a number – it won’t influence my fertility.”

Unfortunately, age is one of the most important predictors of fertility in both men and women. In fact, our risk for infertility, miscarriage, obstetric complications, and fetal anomalies is greater with advancing age. Many people are aware of this concept, however most are surprised to learn just how soon in life it takes effect. Studies show that our fertility starts to decline in our early 30’s, drops off significantly around the age of 35 for women and the age of 40 for men, and continues to fall as time goes on. If that last sentence provoked a sudden state of panic (sorry!), you may be relieved to hear that many couples will successfully conceive and go on to have healthy babies well into their 30’s and early 40’s – they may just require more time and some extra support. Since aging lessens the quality/quantity of our eggs and sperm, makes us more susceptible conditions that influence our overall fertility, and induces shifts in our hormone levels, there are many different avenues where support can be offered from a naturopathic standpoint. Often the best place to start is by improving upon the quality of our eggs/sperm. Since it takes ~100 days for both to mature, a window of opportunity exists for implementing therapies such as diet/lifestyle modifications, nutrients, antioxidants, botanicals, and acupuncture in the months leading up to conception. Your naturopathic doctor will create a treatment plan that is customized to your individual needs based on your case history and will work in conjunction with any other practitioners that you may be seeing.

2. “Infertility is primarily due to a problem with the female partner.”

Contrary to popular belief, it is simply not true that infertility is solely a “woman’s problem”. In fact, approximately 30% of all infertility cases are attributed to a factor in the male partner alone, with an additional 20% of cases resulting from a combination of both the male and female factors. Only about 40% of all infertility cases are due to a factor primarily in the female partner, which stresses the need to thoroughly assess both members of the couple. For men, this involves taking a detailed case history that looks at their past/current medical history, underlying lifestyle factors, use of medications/supplements, and sources of environmental exposure, along with a physical examination and a comprehensive semen analysis. Depending on the case, additional procedures and tests may be performed to gain further information, including hormonal testing, ultrasound, genetic screening, and other specialized assessments that look for reactive oxygen species, DNA integrity, and antisperm antibodies. The underlying cause of fertility problems in men usually stems from a problem with sperm production, transport, hormonal imbalance, the presence of sperm antibodies, and sexual dysfunction. Fortunately, naturopathic medicine has a lot to offer for men struggling with infertility. Your naturopathic doctor will aim to correct the problem at its root and will create a plan that is tailored to you through the use of evidence based diet/lifestyle interventions, nutrients, botanicals, and acupuncture.

3. “I will get pregnant if I have sex on day fourteen of my cycle.”

The widely held belief that ovulation always occurs on day fourteen of a woman’s cycle is probably one of the biggest fertility misconceptions out there! While it may indeed be true for some, it certainly does not apply to everyone and should not automatically be relied upon when timing intercourse for conception. For one, having intercourse at the “right time” does not guarantee a pregnancy will occur. It’s important to understand that conception may take time (even in the “healthiest” of people) because it is such an intricate process that is dependent on a number of interconnected steps. Additionally, the length of what constitutes a medically “normal” menstrual cycle ranges from 21-35 days, with 28 days simply being the average length. The timing at which ovulation occurs (if it does) depends on many factors and can easily change from cycle to cycle. Once an egg is released it is only viable for 12-24 hours, which significantly limits the amount of time that you are fertile in a given month. Since sperm can live up to 5 days in the reproductive tract (given that the environmental conditions are optimal) it is just as important to have intercourse in the days leading up to ovulation as it is at the time of ovulation because the chance of conception will be greater within this extended window of time. When it comes to fertility, details are key! Cycles vary substantially among women in terms of length, flow, and symptoms experienced throughout. Your naturopathic doctor will use these details in conjunction with objective data such as hormone levels measured on specific cycle days to assess your hormone function, predict your fertile window, and determine where improvements can be made.

4. “Since I had a ‘period’, it means that I ovulated.”

Again, this is another widely held belief that is not necessarily true. It is very common for women to mistake what is referred to as “anovulatory bleeding” for an actual menstrual period. This type of bleeding differs from a regular menstrual period in that it occurs in the absence of ovulation and results from the shedding of the uterine lining in an abnormal way. During a regular cycle hormones released from the brain stimulate the ovaries to produce a mature egg and release estrogen, which helps to prepare for ovulation and causes the uterine lining to grow. Once ovulation has occurred, the empty follicle that once housed the egg releases progesterone in order to stabilize and prepare the uterine lining for pregnancy. If conception does not ensue, progesterone secretion declines and the menstrual period commences. When ovulation does not take place, progesterone is not produced from the remnant of the follicle but the estrogen that is made goes unopposed, allowing the uterine lining to proliferate in excess without having the added structural support it would normally obtain from progesterone. This underlying imbalance of hormones leads to the spontaneous shedding of the lining when it can no longer maintain itself, which results in bleeding that is at irregular intervals. It is important to note that while common, this type of presentation is not always the case with anovulation because many different factors come into play and affect each person’s hormones differently. These factors can include anything from stress, medications, and being over/underweight to environmental toxins, excessive physical activity, and chronic medical conditions such as polycystic ovarian syndrome, thyroid dysfunction, diabetes, and even poor dental health. So what is the best way to know if you are actually ovulating? Unless you have the pleasure of working with a fertility clinic where your cycles are monitored with regular blood work and ultrasound, an alternative yet effective way is with the use of basal body temperature (BBT) charting. BBT charting is a valuable tool for fertility because it can be used to provide insight on the timing of ovulation (retrospectively) and can help to identify the length of each phase of the cycle and ultimately the way that your hormones are functioning. To measure your BBT, first purchase a thermometer that specifically takes readings within 2 decimal places at your local drugstore. Keep it on your bedside table and take your temperature each morning upon waking, before you do anything else (i.e. stand up, use the washroom, have breakfast, etc.). Try to take a reading around the same time each day when you have had a minimum of 3 hours of uninterrupted sleep and be sure to record it for later. Plot the data on a graph, either by hand or with an App such as Kindara or Fertility Friend. A normal chart should reveal a biphasic pattern, meaning that it is divided into 2 identifiable parts or “phases”. If ovulation has occurred, your basal body temperature should dramatically increase by 0.3-0.5 degrees Celsius between the first phase and the second phase. Ovulation usually occurs on the final day of the lower temperatures, right before the shift in temperature that occurs between the 2 phases. It is important to note that this information must be used in conjunction with other fertile signs (i.e. cervical fluid) to more accurately time intercourse because once the temperature rises it means that ovulation has passed and your chance of conception will be next to none if you wait.

Are you and your partner trying to conceive or planning to become pregnant in the near future? If you are looking to optimize your fertility but are unsure of what naturopathic medicine is all about or want simply want to learn more, I offer complimentary 15-minute consults so that all your questions can be answered. To book an appointment or consult, please call Health Over All at 905-892-1318. Be sure to stay tuned for part 2 of this article in the coming weeks to continue learning about the top fertility misconceptions!

Dr. Jessica Geil, HBSc, ND

Naturopathic Doctor

Team Health Over All

References

  1. Lundsberg LS, Pal L, Gariepy AM, Chu MC, Illuzzi JL. Knowledge, attitudes, and practices regarding conception and fertility: a population-based survey among reproductive-age United States women. Fertility & Sterility. 2014; 101(3): 767-774. Available from: http://www.fertstert.org/article/S0015-0282(13)03425-0/fulltext

  2. Suer MV. Reproduction at an advanced maternal age and maternal health. Fertility & Sterility. 2015; 103(5): 1136-1143. Available from: http://www.fertstert.org/article/S0015-0282(15)00203-4/abstract

  3. Fett R. It Starts With The Egg. 2014. New York, NY: Franklin Fox Publishing.

  4. Fertility. 2013 Feb 4. Government of Canada. [accessed 2016 Dec 8]. Available from: http://healthycanadians.gc.ca/healthy-living-vie-saine/pregnancy-grossesse/fertility-fertilite/fert-eng.php

  5. Jarow J, Sigman M. The optimal evaluation of the infertile male: AUA best practice statement. American Urological Association. 2011. Available from: https://www.auanet.org/education/guidelines/male-infertility-d.cfm

  6. Male Infertility Workup. 2016 Jun 7. Medscape. [accessed 2016 Dec 8]. Available from: http://emedicine.medscape.com/article/436829-workup

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