The Foundation of Fertility
I have no doubt that the rising incidence of hormone imbalance is behind the steady rise in infertility. Our diet, lifestyle, and work habits have all changed in ways that invite or even create these imbalances. Because of our busy schedules, we gravitate toward fast foods and prepackaged meals that are high in unhealthy carbohydrates and fats. Eating poorly can easily lead to hormonal chaos, reducing your chance of conception or increasing your risk of pregnancy complications. We’ve also become less active, and some of us, completely sedentary, and we accept stress and a lack of sleep as a part of life. Yet better food choices, regular exercise, adequate rest, and stress-reducing activities can improve your health enormously and enhance your ability to conceive.
We are also exposed to a growing number of chemicals each year through our food, air, water, cleaning products, gardening chemicals, and personal care products. Some people are also exposed to more chemicals at work. Fertility and hormone specialists have become increasingly concerned about these chemicals because many have the ability to disrupt your own hormone functions, which in turn can affect your fertility. These chemicals also may contribute to miscarriage or compromise the health of your baby. But in many cases you can restore hormone harmony through simple changes in your lifestyle, and, in so doing, you will improve your fertility, your health, and your well-being.
THE HORMONE DANCE
Your hormones are constantly shifting based on what is happening in your body on any given day. Each organ and each system has its own agenda, sending out hormonal signals to alert the others and elicit their cooperation. For instance, your digestive system calls upon your circulatory system for more blood flow after a meal to help distribute fuel and nutrients throughout your body. On the other hand, if you’re under stress, hormones will shift your blood flow away from your digestive system and direct it to your muscles to prepare you for dealing with the danger at hand. Your brain’s hypothalamus is at the helm, listening in on all the hormone cross talk and prioritizing messages, so that you’re not falling asleep when you sit down to eat, perspiring when your body temperature is low, or menstruating when a fertilized egg is trying to implant in your womb.
Your brain also initiates many bodily events, often in response to what you’re experiencing or what’s going on hormonally. If you’re frightened, your brain sends hormonal messages that override other biological functions like sleepiness or hunger. When you’re sexually aroused, your brain sends hormones that signal your body to prepare for intimate acts. If you’re determined to complete a task, your brain sends pick-me-up hormones to fend off fatigue. And if your body doesn’t have enough stored calories to support a pregnancy, your brain blocks signals to your ovaries—effectively preventing ovulation. The hormone-brain connection is the key to understanding why achieving hormonal balance is necessary to improve your chances of conception and having a healthy baby.
It is equally important for couples who have had a baby but are having difficulty conceiving again, a condition called secondary infertility. Many of these couples have developed a hormone imbalance since the delivery of their last child. The imbalance is what is keeping them from becoming pregnant again. Before jumping into treatment, these couples need to consider the importance of their hormones and how their diet, weight, lifestyle, or health may have changed in the intervening years.
Because there are so many hormones, and many that have similar jobs, I like to group them together based on their functions. Each of the four groups I have identified needs to be in a state of equilibrium. I like to think of these groups as the elements of a mobile, with the brain at the pinnacle monitoring your dynamic state of hormone balance.
When subtle imbalances occur within a group, they might not disrupt the other groups. For example, your hypothalamus might make minor adjustments to your levels of estrogen and progesterone, keeping them in relative balance and not adversely affecting your fertility. But if one hormone gets too high or too low, and the others can’t balance it out, then this discordance can affect the other hormone groups and disrupt your health completely—especially your fertility. Since conception and reproduction are not essential for your survival, I place these hormones in the most vulnerable position of the mobile to reflect their reliance on everything else being near perfect. Below are the four categories of hormones and what they do, how they interact, and how they affect your fertility. Please note that I will provide descriptions and details on all of these hormones later in the book.
1. Rest-and-digest hormones (key hormones include insulin, leptin, growth hormone, ghrelin, and melatonin). This group controls growth, digestion, and weight, as well as repair and rejuvenation. Because of their role in weight gain and loss, imbalances can lead to obesity, diabetes, and a host of related diseases. I will focus a great deal on this group in the program since your weight and the balance of these hormones have an enormous impact on your fertility, and because you have some control over them. There are clear and effective steps you can take to restore their balance, including making better food choices.
2. Tend-and-befriend hormones (key hormones include thyroid hormone, prolactin, and diuretic hormones like aldosterone). This group is in charge of tending to your body’s basic physiological needs, such as maintaining your temperature and hydration, and meeting your oxygen needs. Some of these hormones, like prolactin, also impact your emotional bonding with others. Imbalances, though, can make you more susceptible to infections, less able to turn off your stress response, less adaptable to temperature and altitude changes, and can put you at a higher risk of disorders like chronic fatigue and anemia. When tend-and-befriend hormones are out of sync, they shift your body’s resources away from reproduction, contributing to infertility.
3. Fight-and-flight hormones (key hormones are adrenaline, cortisol, endorphins, and corticotropin releasing hormone). These are the well-known stress hormones, released when you believe you’re in danger or your health is threatened. They help redirect necessary resources toward survival against an imminent threat or a perceived hazard that may not even exist. When stress hormones are chronically elevated, you may experience depression, anxiety, sleep disorders, or chronic pain, and you may have difficulty getting pregnant. To your stressed body, pregnancy is one more major challenge, or stressor, so to “protect” you, your brain halts all events and hormonal triggers geared toward conceiving.
4. Relate-and-mate hormones (key hormones are estrogen, testosterone, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These sex and pregnancy hormones are the most important hormones for fertility and reproduction. They guide the production and release of fertile eggs and healthy sperm. They also play a role in cementing the bonds of your intimate relationships with your sexual partner as well as with your children— these are more potent bonding agents than the tend-and-befriend hormones. Imbalances in this group are the most obvious ones to consider when diagnosing infertility. They can interfere with the growth and release of a mature egg each month or cause a low sperm count in your partner, or even affect how successfully the fertilized egg implants in your uterus. Imbalances can also cause sexual dysfunction, such as low libido and erectile dysfunction or pain associated with sex.
Many doctors often forget to ask their fertility patients the basic question: “How are you feeling?” Or if they ask, they don’t listen carefully to the answer. Yet, that’s the information that I find most revealing because it’s the best indicator of whether your hormones are in a state of equilibrium. This idea of considering your symptoms when looking at fertility issues is just now beginning to catch on
in the medical community. It is well supported by brain imaging research showing how hormone imbalances detected by your brain trigger symptoms throughout your body. We can correlate brain activity in precise areas of the brain to specific symptoms. For instance, chronic fatigue is associated with reduced hormone activity in the base of your brain, whereas anxiety is associated with an increase in activity in the area behind your forehead.
Symptoms will arise when your brain unsuccessfully attempts to correct hormone imbalances. Hormone-related symptoms are not always as obvious or easy to interpret as symptoms of the flu or an injury. They can be subtle, like an inability to stay asleep, or slow but steady unexplained weight gain. Yes, there are symptoms that appear to have a clear connection to fertility, such as abnormal menstrual cycles or recurrent miscarriages. But the symptoms that don’t appear remotely related to your fertility may be the ones preventing you from becoming pregnant. Recall the hormone mobile and how imbalances in any one group can affect your fertility.
Being overweight is one of the most common symptoms of hormone imbalance, and it’s a common cause of infertility. Overweight women who lose as little as 5 percent of their body weight can dramatically improve their fertility. When overweight men lose this much weight, it can boost their sperm count as well as their libido. But other symptoms are telling as well. If you suffer from insomnia, acne, depression, or even sexual dysfunction, these may be clues to hormone imbalances.
Focusing on how you and your partner have been feeling can help you gauge how close the both of you are to hormonal balance. Imbalances are by far the most common obstacles to pregnancy and among the most common reasons for miscarriage. Creating hormonal balance through changes in your diet, activity level, stress-reducing activities, and exposure to BioMutagens—all topics I discuss in Part Two—is the first step to improving your fertility, if not restoring it altogether.
Protecting Your Fertility
Balancing your hormones to improve your reproductive health is a whole-body approach that has an impact on all levels of your reproductive process. It affects the genetic code (DNA) of your eggs and your partner’s sperm, the hormones that stimulate their development, whether egg and sperm meet up, and if the fertilized egg, or embryo, can implant in your uterus. So before you progress to the nuts and bolts of my program, I want to provide you with a general understanding of the reproductive process—specifically, the journey your eggs and your partner’s sperm take through your lifetimes. If you are in the midst of or on the threshold of fertility treatment, refer to chapters 8 and 9 for more detailed accounts of the life cycle of sperm and eggs.
GAZILLIONS OF SPERM
With every heartbeat, a man produces about 1,500 microscopic sperm, and with each ejaculation, he typically releases over 20 million. This prolific production continues for 50 to 60 years, but it is fraught with imperfections. Every sperm develops out of a primitive cell, called a spermatagonium, which, like all other cells in the human body, has 46 chromosomes—23 pairs containing the DNA, or genetic code, that is necessary for the body to function. To become a mature sperm that can fertilize an egg, a spermatagonium has to shed one chromosome from each pair (your egg goes through the same process just before ovulation), so that when egg and sperm come together, their DNA will form 23 new pairs of chromosomes that will create a unique being—your child. In men, the process of maturation is called spermatogenesis, and takes about 90 days to complete.
During this time, sperm are highly susceptible to damage. They divide so rapidly, generating heat with each division, that they require the outer-body home of the testicles to keep cool. High temperatures—from a hot tub or a sauna—can make them more susceptible to genetic damage and slight imperfections. They are also highly vulnerable to hormonal imbalances and nutritional deficiencies. Sperm analysis studies have shown that in fertile men as few as 12 percent of sperm meet certain strict criteria—based upon their size, shape, and appearance—to be considered normal. Many sperm will have structural problems or minor flaws in their DNA, some of which are caused by hormonal imbalances and exposure to pollutants. Sperm are also unable to store energy and have a very limited life span. Many of the recommendations in my Perfect Balance program are aimed at creating hormone balance in order to minimize DNA damage to sperm and developing eggs.
AN EGG’S RISE TO DOMINANCE—AND OVULATION
Compared to the billions of sperm your partner produces, you will ovulate about 400 eggs in your lifetime. A mature egg, called an oocyte (pronounced oh-oh-site) is one of the largest cells in a woman’s body—about the size of the period at the end of this sentence (sperm are microscopic and some of the smallest cells in a man’s body). While sperm are solitary cells that often travel in packs but abide by the credo “every sperm for himself,” each oocyte is like a queen with its own attached entourage of handmaidens that provide hormones and nutrients to the maturing egg. Sounds like a cooperative system, but each month several queens compete for dominance over the others. Ovulation is a competitive process.
It takes about 290 days for each egg to come out of dormancy, complete maturation, and be readied for release. Like male sperm, an immature egg has to lose one copy of each of its 23 pairs of chromosome. Each month, the competitive race begins among a dozen or so activated eggs that simultaneously begin making genetic and metabolic changes to prepare themselves for ovulation. A few eggs begin to dominate and release hormones that halt the maturation of the other eggs in their group. Eventually, one egg (occasionally two) wins the contest and is prepared for ovulation, while the other eggs atrophy.
The final two months in which these eggs are maturing and preparing for ovulation are an important time for your hormones to be in balance. Your eggs are maturing rapidly and need a large supply of energy, nutrients, and hormones to help them function and mature properly. Hormonal imbalances during this time are a major contributor to infertility. Dramatic dieting or overexercising, for example, can limit the nutrients surrounding the egg and compromise egg development and maturation.
The longer an egg has waited in your ovaries, the more likely it is to encounter problems when it becomes activated, explaining the decrease in fertility experienced by women in their late reproductive years. By following the diet and lifestyle recommendations in my program, you can help protect and extend the health of your eggs.
FERTILIZATION AND IMPLANTATION
Having healthy eggs and viable sperm sets the stage for conception and a successful pregnancy, but it doesn’t guarantee it. A couple considered fertile only has about a one in five chance of conception on any given month—assuming they have sex at the right time.
Excerpted from Perfect Hormone Balance for Fertility by Robert A. Greene, M.D., and Laurie Tarkan. Copyright © 2008 by Robert A. Greene, M.D.. Excerpted by permission of Harmony, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.