What to Do After a Miscarriage

Almost 15% of pregnancies will end in miscarriage, most often during the first few weeks of pregnancy. Even knowing the statistics, miscarriages are heartbreaking.

The sorrow often comes with questions – why did it happen and what can be done to prevent it from happening again?

Tests Performed After a Miscarriage

After a miscarriage, your doctor may want to investigate why it happened through several clinical test procedures. Testing for the root cause is even more important after multiple miscarriages.

Tests that your doctor orders may include:

  • Hysterosalpingogram: an x-ray with contrast to check the structure of the uterus.

  • Hysteroscopy: an examination of the uterus with a fiberoptic telescope.

  • Saline sonohysterogram: an ultrasound of the uterus filled with saline.

  • Vaginal ultrasound: examines the uterus, ovaries, and fallopian tubes.

  • Endometrial biopsy: looking for infection in the endometrial tissue

  • Uterine lining testing: an endometrial biopsy on cycle day 21 to test for thickness of the uterine lining.

  • Hormone tests: usually checking prolactin, progesterone, and thyroid levels

  • Antibodies testing: looking for lupus antibodies or antiphospholipid antibodies.

  • Genetic testing of either the parents or the fetus: 50-70% of early miscarriages are due to genetic abnormalities of the embryo. (study)

Not all of these tests are necessary for every woman after a miscarriage.

But what do you do if all the tests come back negative? If your uterus is structurally perfect and your hormone levels are within range – what next?

This is a frustrating situation that many women face, especially after age 35!

Digging deeper into miscarriage risk

As women age, it becomes more and more important to optimize for a healthy pregnancy.

But what is “healthy” and how do you know if your health is optimal when trying to conceive?

Several common blood tests can help you to quantify – to actually KNOW – what your levels are for several important biomarkers.

Your doctor can order these tests.  Many of the tests mentioned below are covered by insurance but check first so you don't get an unexpected bill.

If you have a high deductible, it may make more sense to pay out-of-pocket for blood work and submit your receipt to the insurance company to see if your expenditure can count towards your deductible.

If you don't have insurance or you have a high deductible, you can order and pay for your own blood tests to quickly get the information you want.

In most US states (except NY, NJ, RI), you can order your own blood tests online. Note that health insurance will not cover the lab tests that you order online, but you may be able to use your HSA or FSA account to pay for the tests.

The links provided below for online tests are with the company I work with who I found to have the best prices.  They offer tests at a fraction of the cost that insurance would charge.

The testing process is simple.  Using my affiliate links (full disclosure: I get a commission) provided below, you add the test to your shopping cart.  After you pay for the test, you will get an order form to print out and take to a local blood draw location at Quest Diagnostics. Then you go to get the blood draw done whenever it is convenient for you. The test results are sent to the company, which notifies you via email when your results are available to print out. It normally takes a couple of days to get the test results.

You can take the results to your doctor for advice or share them with your fertility coach.

Testing for Autoimmune Thyroid Diseases:

A TPO (thyroid peroxidase) antibody test looks for indications of autoimmune thyroid diseases such as Hashimoto’s or Grave’s disease.

Several studies have shown that women with TPO antibodies are at a higher risk of miscarriage – with one study showing a 2-fold increase in risk! (study)(study)(study)

You can order a TPO antibody test here.

A full thyroid test panel is recommended to get a more complete picture of your thyroid function.  That can ordered here.

What can you do about TPO antibodies?

While TPO antibodies can be present without thyroid disease, a positive TPO antibodies test is something that you should discuss with your doctor. Further testing may be needed to determine if you should be prescribed thyroid medication.

Adopting a healthy diet is helpful in managing autoimmune thyroid conditions.

Look into environmental or dietary triggers for TPO antibodies such as mold, iodine excess, and heavy metals. Make sure you are getting an adequate amount of selenium in your diet. (study)

Homocysteine Levels:

Homocysteine is an important marker for increased risk of heart disease. High homocysteine levels are also associated with increased risk of fertility problems.  Women with high homocysteine are at an increased risk for placental abruption, recurrent miscarriages, and high blood pressure during pregnancy. (study)(study)(study)(study)

A simple blood test can tell you if you have a high homocysteine level. Order here.

 Solutions for high homocysteine levels:

Diet plays a big role in homocysteine levels. Make sure you are getting plenty of folate, vitamin B6, and vitamin B12.

If you aren’t getting enough of these vital micronutrients via your diet, consider taking a good prenatal vitamin that contains the active forms of these B-vitamins: methylfolate, methylcobalamin, and P5P.    For more information about folate and vitamin B12, click here.

Vitamin D testing:

Many studies have shown that women with low vitamin D levels are at a higher risk for miscarriages. Women undergoing IVF are more likely to get pregnant if their vitamin D levels are “sufficient”. (study)(study)(study)

How much vitamin D do you need? Vitamin D deficiency is defined as having a 25(OH)D level less than 20 ng/ML, and vitamin D insufficiency is defined as having levels between 20-32 ng/ml.  Normal levels in sunny countries are between 54-90ng/ml. (study)

Instead of guessing, a simple 25(OH)D test can tell you what your vitamin D level is. The test can be ordered here.

Solutions for low vitamin D:

 Your body makes vitamin D through exposure to sunshine on your bare skin. The best time of the day to get plenty of sunshine is between 10 am and 2 pm.  If your test results show that your vitamin D levels are less than optimal and you can’t get enough sunshine, you can  also supplement with vitamin D. Look for a brand that includes the vitamin D with a good source of fat.

Read more: How Vitamin D Improves Fertility and Egg Quality

Testing for Inflammation:

C-reactive protein (CRP) is a biomarker that shows your overall inflammation level.  CRP is an inflammatory marker that is released by the liver. If it is elevated, it indicates inflammation, but it doesn’t tell you what is causing the inflammation.

Several studies have shown that women with higher CRP levels are at an increased risk of having multiple miscarriages. (study)(study)(study)

When ordering a CRP test, the high sensitivity CRP test is your better option.  Order here.

Solutions for high CRP:

 Talk with your doctor about low dose aspirin therapy if you have high CRP levels. A recent study showed that for women with high CRP daily aspirin brought their miscarriage risk back down to normal. (study)

Testing for Iron Deficiency:

A simple blood test for anemia can tell you if you have low iron levels that could be affecting your ability to conceive.  Order online here.

Women with severe anemia are at a much higher risk of miscarriages.(study)(study)

Solutions for iron deficient anemia:

Iron-deficient anemia can be reversed by eating foods high in iron, such as liver. Iron supplements are also available, but if you are taking a prenatal vitamin, check the label first to see if it already has iron in it.  Lactoferrin is a good alternative to iron supplements, especially for women with clotting disorders. (study)

Testing for Clotting Disorders:

Blood clots can be a cause of recurrent miscarriages. More about that here.

If you have a family history of clotting disorders, such as a first degree relative who has had a deep vein thrombosis or pulmonary embolism, you should talk with your doctor about testing for clotting disorders.

A PTT (partial thromboplastin time) test and PT/INR test can tell you if your blood clots slowly or quickly. Many doctors and fertility specialists can do this test in the office for you.  You can also order here.

A low PT result shows that your blood clots more quickly than normal. Your doctor or fertility specialist may want to investigate further to see if you carry genetic variants that cause clotting disorders such as factor V Leiden.

An antiphospholipid antibodies (anticardiolipin antibodies) test can tell you if you have an autoimmune condition that causes your blood to clot more rapidly. Your doctor can order this test for you, or you could order it through an online lab company ($147 from Walk In Lab).

Solutions for clotting disorders:

Your doctor should determine if the clotting disorder is serious enough to warrant anticoagulant medications.

If you aren’t in need of prescription medications, add natural blood thinners to your diet.  Fish oil is a natural blood thinner. Adding more fish to your diet is great when trying to conceive. Just make sure to choose fish that are low in mercury.  Or a high quality fish oil supplement is an easy addition to your daily routine.

Natural compounds in cacao have a blood thinning effect like low-dose aspirin! (study)(study)  Try snacking on a handful of organic cacao nibs for an afternoon pick-me-up.

Moving forward:

Taking steps to optimize your health can be powerful in recovery from a miscarriage!

Testing can help you map out a plan to move forward when you are ready to try again to conceive.

Read More

Does Early Menopause Mean Infertility?

Are your periods changing as you get older?  Maybe they're getting lighter, coming less frequently, and are more irregular.  This can be disheartening when you're trying to get pregnant.  Does this mean you're headed into early menopause?

Menopause is defined by the lack of getting your period for 12 months along with hormone level changes.  According to WomensHealth.gov, the average age in the US that women go through menopause is 52.

Early menopause, which happens before age 46, affects about 5% of women. Some health professionals break it down further and apply the term ‘premature menopause’ to women who go through these changes before age 40.

No matter how you define it, when menopause happens earlier than expected, there can be lasting health effects and a heartbreaking inability to conceive naturally.

Causes of Early and Premature Menopause:

Often doctors will apply the term ‘idiopathic’ to early menopause, indicating that the cause is unknown. Digging into the root of this condition shows that, for most women, the underlying cause usually falls into one of the following categories:

  • Smoking

  • Environmental toxins

  • Genetics

  • Metabolic

  • Autoimmune

  • Infection

Smoking:

Studies have shown that smoking increases the risk of early menopause.

men3.jpg

The longer a woman smokes and the more packs of cigarettes smoked, the higher the risk.

Current smokers are considered to be at a doubled risk of premature and early menopause. Someone with a 15 – 20 year history of smoking will have a seven-fold increase in the risk. (study)

Environmental Exposure and Toxins:

There are several common environmental toxins linked to early menopause caused by ovarian failure.

Phthalates, a component of plastics, have been shown in animal studies to decrease reproductive lifespan. (study) Human studies on phthalates show an association in women with higher urinary phthalate levels with a decrease in ovarian reserve. (study)

Perfluorooctanoate (PFOA) and perfluoroocatane sulfonate (PFOS) have both been associated with an increased risk of early menopause in several studies. These compounds are found in non-stick cookware, stain resistant fabrics and carpet, and some food packaging. One of the largest source, though, is through drinking groundwater that has been contaminated by the compounds. (study)

It’s not just your exposure to toxins that impacts early menopause risk, what you were exposed to in-utero actually still matters! Women whose mothers took the medication diethylstilbestrol (DES) are two times more likely to experience early menopause. (study) If your mother smoked while pregnant with you, it may also add a little to the risk of early menopause. (study) Researchers are still trying to figure out all of the effects on fertility from BPA, flame retardants, diesel fumes, and more. (study)

Genetics:

Genetic variants, both rare and more common, affect the onset of menopause.  Researchers estimate that genetics drive about 70% of the variation in the normal age of menopause.

Numerous genes associated with DNA repair, immune function, and mitochondrial production are linked to the minor variations in the age at which women reach menopause.(study)

The importance of these genetic pathways makes sense when you think about how important mitochondrial health and DNA repair is for healthy eggs.  Check out the article on CoQ10 and on DHEA for suggestions on improving egg quality through mitochondrial health.

For a small percentage of women who have early menopause, chromosomal abnormalities may play a role. Women who are missing an X chromosome or who have a partial deletion of an X chromosome are at an increased risk of early menopause and reproductive problems.

Fragile X syndrome is another genetic player in early menopause. This is caused by a repeated part of the MFR1 gene, and a higher number of repeats has been shown to increase premature ovarian insufficiency risk by 20%. This is not something that is normally tested by 23andMe or other direct to consumer testing. (study)(study)

If you do have genetic information from 23andMe or another testing company, there is a gene that is linked to earlier menopause timing that you can check.

The MCM8 gene codes for a protein that is important in cell replication – especially in egg cells.  The studies have linked the variant to earlier menopause; if combined with other factors such as environmental toxins, smoking, or other genetic variants, the MCM8 variant could play an important role in early menopause. (study)

Check your genetic data for rs16991615:

  • AA: increased risk of early menopause, almost 2-year earlier menopause on average

  • AG: almost one year earlier menopause on average

  • GG: normal

Another gene that is tied to problems with ovarian insufficiency or early menopause is the XPO5 gene. This gene codes for a microRNA that is essential in regulating the processes needed for egg cell formation. (study)

Check your genetic data for rs2257082:

  • AA: 2-fold increased risk of the loss of ovarian function before age 40

  • AG: increased risk of the loss of ovarian function

  • GG: normal

Variants in the MTHFR gene (read all about it here) have also been linked to an increase in the risk for premature ovarian failure.

Metabolic Causes:

men4.jpg

There are several metabolic disorders, such as 17 alpha- hydroxylase deficiency and galactosemia, that have been linked to early menopause. (study) These are rare disorders caused by genetic mutation.

Researchers have also investigated how weight impacts the age at which women reach menopause. Being overweight or obese is not a risk factor for early menopause, but being underweight (BMI <18.5) can increase the risk of early menopause by 30%. (study)

While being underweight is a risk factor, a large study of over 100,000 women found that physical activity level – whether low or high – was not a factor in early menopause. (study)

Autoimmune and Infectious Causes:

The studies on autoimmune conditions and early menopause show a variety of conclusions with some studies linking diseases such as lupus to decreased ovarian reserve and other studies showing no statistical link.(study)(study)(study)(study)(study)

Some studies even hint at a direct cause of autoimmune antibodies specifically causing premature ovarian insufficiency.(study)

Prior exposure to infectious diseases such as mumps or HIV can also cause early and premature menopause. (study)(study)

Action Steps and Treatment Options:

Knowing the possible causes of early menopause can help you decide on actions you could take.

If you are a smoker or exposed to second hand smoke, eliminating this risk factor is an obvious first step.

Exposure to environmental toxins such as PFOAs and phthalates can be reduced by filtering your water and carefully choosing what you expose yourself to.

Simple steps like avoiding cooking in plastics or using artificial air fresheners can help to cut down on phthalate exposure. A recent study also found that PFAO and PFAS levels were increased in women who used Oral-B Glide floss or lived in a house with stain resistant carpet and furniture. (study)

Autoimmune conditions such as lupus and autoimmune thyroiditis can sometimes be helped and even reversed through making dietary changes. Eating fresh, whole foods and eliminating most packaged foods and fast foods are an excellent start.  (study)

In-vitro fertilization is still an option for some women with premature menopause. Sometimes donor eggs are used, while for others ovulation may still be induced. (study)(study) Hormone replacement therapy may also be an option. (study)

For premature menopause caused by ovarian failure, acupuncture may be a solution. A small study with 31 participants receiving acupuncture treatment three times per week resulted in 20% of the women resuming their menstrual cycle. (study)

All of the different causes and variety of possible treatments should drive home the fact that premature and early menopause is unique to the individual and should be treated as such. Individual answers that are specific to you!

Show me how to improve my fertility naturally with daily email tips

Melatonin’s Effect on Egg Quality and Fertility

Melatonin is well known as a ‘sleep hormone’ and often taken as a supplement to help improve sleep quality.  But, less familiar, is melatonin's role in fertility and protecting egg quality.

So how does melatonin help when trying to get pregnant, especially as a woman ages?  Melatonin protects the egg from damage due to free radicals, controls the release of reproductive hormones like LH and FSH, and helps with implantation of the embryo.

Melatonin is produced at night:

We all know that sleep is important – just think about how awful you feel the next day after a sleepless night or two.

But what is going on ‘behind the scenes’ in the body at night is also foundational to your health.

You may have heard of the term circadian rhythm, which is applied to all types of functions in the body that go on in a cyclical fashion over the course of the day.

The obvious examples are your sleep/wake cycle and how your body temperature rises and falls over the course of the day.

Scientists, though, have recently found that about 40% of the molecules produced in your body rise or fall over the course of the day, governed by your circadian clock system. (study)

A big part of this core circadian clock is melatonin, which is produced in the pineal gland, located in your brain. Melatonin levels rise at night (starting around 9pm) and then quickly drops in the morning, as exposure to light causes the production of the molecule to stop.

Not only does melatonin encourage sleep by signaling to other molecules in the brain, but it also regulates other hormonal rhythms as well as acting within the cell as an antioxidant.

How is melatonin important in fertility?

In addition to promoting sleep, melatonin acts in a number of ways to help the reproductive cycle.

In a nutshell, melatonin:

  • Acts as an antioxidant within the egg cell, improving egg quality.

  • Acts as a signaling molecule in the brain, controlling reproductive hormone rhythm.

  • Acts within the uterus, protecting the embryo and facilitating implantation.

Melatonin as an antioxidant:

Egg quality is vitally important, especially as you age.

One main factor affecting your egg quality is the production of reactive oxygen species (ROS) within the egg, specifically within the mitochondria of the egg cell.

This buildup of ROS is called oxidative stress and is a natural byproduct of aging so can't be avoided.  But significant increases in ROS is often due to environmental toxins like poor quality food, harmful lifestyle choices, chronic stress - basically, living in a modern day society.

Several antioxidants protect your cells from the effects of ROS.

One of the most important and potent your body produces naturally is melatonin.

Melatonin is found at higher levels within the ovaries and the egg follicle as compared to the rest of the body.  It acts as an antioxidant there to neutralize the damage from excess ROS. (study)( study)

Melatonin is a unique hormone in that it can pass easily through the outer membrane of the mitochondria, the power plant of the cell.

In addition to acting directly as an antioxidant within the mitochondria, melatonin also stimulates the body to create other natural antioxidants such as glutathione, catalase, and superoxide dismutase (SOD). These antioxidants work together to protect the cell’s nuclear DNA from damage (so important for egg cells!) as well as protecting other parts of the cell. (study)(study)

Not only can melatonin protect eggs from oxidative stress, it may actually speed the growth and maturation of ovarian follicles, according to promising preliminary animal studies. (study)

Melatonin and Ovulation:

The reproductive hormone cycles are both intricate and simply amazing.

Women everywhere understand the monthly cycling of hormone levels involved in menstruation.

Your reproductive hormones also have a daily rhythm, rising and falling in concert over the course of 24 hours.

Recent studies have shown that melatonin regulates gonadotropin-releasing hormone (GnRH), one of the key players in your reproductive hormones. (study)(study) GnRH, in turn, is in control of luteinizing hormone (LH) and follicular stimulating hormone (FSH), both of which are vital to ovulation.

Your hormones need to rise and fall at the right levels and the right time – like an orchestra playing a complicated sonata. The conductor of this orchestra is GnRH, with melatonin in the drum section helping with the tempo; LH and FSH are important soloists, coming in at just the right time.

Melatonin in implantation:

Within a successful reproductive cycle, a good quality egg matures, released from the ovary during ovulation, fertilizes, and finally, implants into the uterine.

Melatonin is important in all of this – including implantation.

Invader alert!  Your body needs to down-regulate the local immune system, so that you don’t react to the embryo as foreign, and your body also needs to increase certain proteins that are important for implantation in the uterine wall. Melatonin actually helps to make both of those activities take place.  (study)(study)

How is melatonin made?

Melatonin is secreted mainly by the pineal gland. Serotonin, a neurotransmitter, is converted into melatonin via a couple of steps, one of which includes adding a methyl group.  A methyl group is a small molecule made of one carbon surrounded by three hydrogen atoms. This ties back to your need for folate during conception in order to have enough methyl groups.

When light (specifically light in the blue wavelength) hits your eye, it causes a signal to be sent to the brain that suppresses melatonin. Thus during the day, your body has very low levels of melatonin. At night, melatonin levels begin to rise again around sunset. Your melatonin levels normally peak in the middle of your sleep cycle.

Studies on supplementing with melatonin for fertility:

There have been several recent studies and clinical trials using melatonin for increasing fertility.

  • Women with PCOS who struggled with fertility participated in a 6 month trial with supplemental melatonin. The results showed that melatonin regulated the reproductive hormones (FSH, anti-Mullerian, and androgens) and restored the menstrual cycle for many of the women. (study)

  • A study of over 100 women undergoing IVF found that 3 mg of melatonin each night increased fertilization rates by 30%. (study)

  • A large IVF trial in women with PCOS found that a combination of melatonin and myo-inositol increased in-vitro fertilization rates. (study)

  • Not all trials have shown a statistically significant outcome, though. A recent trial in Australia found that while women taking melatonin during IVF trended towards higher pregnancy rates, the effect wasn’t large enough to be statistically significant. (study)

Studies on melatonin as a sleep supplement have very mixed results. One study specifically looked at using melatonin for women with both sleep problems and fertility issues. The results showed that the women supplementing with melatonin had better results for egg retrieval in IVF, but they didn’t have much improvement with their sleep problems. (study)(study)

Supplemental Melatonin:

Melatonin is available over-the-counter in several forms: tablets, gummies, liquid, fast-melts, and timed-release capsules. Melatonin is quickly absorbed and raises serum levels to a peak within one to two hours of taking it. (study)

The timed-release formulations better mimic natural melatonin levels and sustain the levels over the course of the night so is recommended, especially if you have difficulties sleeping.

While most of the trials for fertility used doses of 3 mg/night, people tolerate melatonin supplements differently, and some report side effects of headaches, slight nausea, or grogginess after taking too much melatonin. So this may be something that you want to try first on a weekend, and you may need to try several different doses to find the right fit for your body.

Why are your melatonin levels low?

Light in the morning is your body’s signal to turn off the melatonin production. Similarly, light in the blue wavelengths at night also suppresses the rise of melatonin levels.

Throughout human history, the only light at night was from the moon and from fire (torches, candles, oil lanterns, etc.) Light from a fire has little to no blue wavelengths, and thus it has very little to no impact on melatonin levels.

Fast-forward to our modern era of watching TV while simultaneously surfing smartphones in the evening. Everything with a screen gives off lots of light in the blue wavelengths.  To make it worse, the new energy-saving LED lightbulbs are also full of light in the blue spectrum.

Genetics and Melatonin:

Melatonin is made in the body by converting serotonin to melatonin. Most people don’t have a genetic problem producing melatonin, rather the production is limited more by environmental factors such as light.

Like most hormones, melatonin is a molecular signal, and it interacts with melatonin receptors in the cell.

Genetic variants of those receptors can cause a decrease in how well they function, thus impacting how much melatonin is needed in the body.

MTNR1B is the gene coding for one of the melatonin receptors. Changes to this gene have been linked to an increased risk for diabetes and gestational diabetes, as well as an increase in insulin resistance in women with PCOS. (study)(study) This is due to the action of melatonin in regulating insulin levels at night.

The MTNR1B variant is an excellent example of how understanding your genetic variants can help you bypass the problems they can cause. Studies have shown that people with this variant are at a much higher risk of diabetes – but only if they eat dinner later at night. Simply moving their evening meal to an earlier time can completely prevent the increase in diabetes risk. (study)

Check your genetic data for rs10830963:

  • GG: linked to higher risk of diabetes, increased fasting glucose – don’t eat dinner late

  • CG: linked to higher risk of diabetes, increased fasting glucose – don’t eat dinner late

  • CC: normal MTNR1B variant

Another melatonin receptor, MTNR1A, is important in IVF. It is specifically found in the egg cell and also upregulated in the uterus for implantation. (study)(study)(study)

Variants in the MTNR1A gene have been linked to being more susceptible to exhaustion and sleep disturbance when staying up late or working the late shift. The researchers believe this was due to the variant causing fewer melatonin receptors and a greater impact from light at night. (study)

Check your genetic data for rs12506228:

  • AA: likely fewer melatonin receptors in the brain, a greater impact from light at night

  • AC: somewhat fewer melatonin receptors, somewhat greater impact from light at night

  • CC: normal MTNR1A variant

This is all newly emerging research on how genetic variants in the melatonin receptors impact an individual’s need for melatonin. New discoveries on the topic are coming out all the time, but at this point, few variants have been found that decrease your need for melatonin. So your best bet is to assume that melatonin is important for your health and your fertility.

How can you raise your melatonin levels naturally?

Blocking out blue light at night will raise your natural production of melatonin. There are a couple of ways to do this:

  • Shut off your electronics two hours before bed and turn off the bright overhead lights. Then you can use low watt lamps with either incandescent bulbs or the antique-looking Edison bulbs. You could read a book (a real book, not from a back-lit e-reader), take up a hobby, relax in the bathtub, listen to music, or enjoy some conversation time with family and friends. (study)

  • Alternatively, there are blue-blocking glasses available that block 100% of blue wavelengths (orange colored lenses)

How much will blocking out blue light at night actually boost your melatonin levels? A study of people using blue light blocking glasses for three hours before bed found that their melatonin levels rose an average of 50% over the course of wearing the glasses at night for a week. Other studies have shown that wearing the orange lensed glasses increases sleep quality and helps people fall asleep faster. (study)(study)

The flip side of blocking out light at night is that you need bright light during the daytime. Getting outside, or at least exposing yourself to the brightest possible indoor lighting, will help to shut down melatonin during the day and also increase melatonin levels at night. (study)

The advantage to raising your melatonin levels naturally is that it increases the levels at the right time of the night. The disadvantage is that it is socially awkward to go around wearing orange glasses at night!

You may find that your best bet is a combination of all three ways of raising melatonin:

  • blocking blue light at night when you can

  • adding supplemental melatonin at the level that is right for you

  • getting sunlight during the day

What about your male partner? Is melatonin important for sperm?

The antioxidant properties of melatonin make it very important for sperm quality. We are all exposed every day to various chemicals and heavy metals through our food and environment. Melatonin can help lessen the damage to sperm from these compounds.

  • In sperm samples, melatonin was found to protect the sperm from impacts of mercury exposure. (study)

  • Melatonin was also found to protect sperm against the damage from organophosphorus pesticides. (study)

  • BPA, commonly found in plastics, has been shown to damage sperm DNA. Melatonin can protect the sperm from BPA-induced changes to the DNA. (study)(study)

Wrapping up and recapping:

Timing is everything when it comes to getting pregnant. At the heart of your body’s timing mechanism is melatonin.

Melatonin is foundational for a healthy pregnancy. It acts as an important antioxidant to improve egg and sperm quality.  It  also regulates the hormones needed for ovulation and then implantation. Melatonin is naturally produced by the body at night, and exposure to light at night decreases your melatonin production. Supplemental melatonin has been shown to improve in vitro fertilization rate.

Show me how to improve my fertility naturally with daily email tips

How DHEA Improves Egg Quality

If you’ve done IVF, your doctor might have recommended DHEA supplementation before your IVF cycle started.  Or you might have come across DHEA as a way to improve egg quality in your research.

So does DHEA improve fertility?  Research indicates promising results with the use of DHEA supplementation.  Some doctors offer it for women with diminished ovarian reserve (DOR) as indicated by low AMH and/or high FSH, premature ovarian aging (POA), poor responders to previous IVF cycles, and for women over 40 whose ovarian reserve is declining due to aging.

What is DHEA?

Read More

How does CoQ10 Improve Egg Health in the Older Woman?

Choosing the right supplements when trying to get pregnant is confusing with all the choices available.  However, some become increasingly important as you get older.  One of them is CoQ10.

How does CoQ10 improve egg quality to help a woman in her late 30s or 40s get pregnant?  CoQ10 helps the eggs produce the vast amount of energy needed for all stages of conception – from ovulation, fertilization, implantation, to division from one cell into a healthy baby.  CoQ10 is also a powerful antioxidant which protects the eggs from damage caused by aging, inflammation, and environmental sources.

Read More

How to Get Pregnant Into Your 40s

Trying to get pregnant and 1 or more of the following applies to you?

  • You’re over 37 years old, possibly in your 40s

  • Diagnosed with low AMH, high FSH, premature ovarian failure (POF), premature ovarian insufficiency (POI), poor egg quality, diminished ovarian reserve (DOR), or advanced maternal age (AMA)

  • You’ve been told by your fertility doctors that it’s too late for you to get pregnant with your own eggs so you should consider donor eggs.

Despite what mainstream medicine may tell you, many women can still get pregnant with their own child into their 40s.  Increasing your chances for a healthy baby in this stage of your life requires approaching your fertility in a more holistic way.

Don't think of your ability to get pregnant from the common reductionistic viewpoint of just your reproductive organs.  Rather, reframe your fertility as a natural outflow of optimal overall health.  In that way, many opportunities open up for you to increase your success.

Why is getting pregnant into your 40s more difficult than when you were younger?

Before we get into ways to improve your fertility, understanding what happens to your fertility as you get older is important so you know the why to the what.

As you age, your cells become less efficient.  Like a car, the parts wear down over time and with use.  

Part of the reason for the decreased efficiency is that the longer you’re alive on this planet, the more toxins you’re exposed to.  Those toxins accumulate in your cells to impair ALL functions, including those that get you pregnant.

Your metabolism slows so you have to watch what you're eating.   You can't run as fast.  Your vision worsens.  Your skin is less youthful.  You're more forgetful.

Your eggs are just as vulnerable as any other cell to the effects of aging.  

This is why your chances of getting pregnant decrease as you get older.  Any online fertility calculator will show your odds decreasing with each year.  The fertility statistics are dismal as you get further into your 40s.

In fact, pregnancy chances get so low that IVF doctors (specialists known as reproductive endocrinologists or more simply, REs) either recommend doing in vitro fertilization (IVF) right away or going straight to donor eggs.

But there may still be hope for you to conceive.  Naturally or with IVF.

Before we get to the good news, let's get a little more understanding of the medical side of fertility treatments.

How do fertility doctors determine if you can still get pregnant?

With blood tests & ultrasound...

Ultrasound 

The ultrasound visualizes how many potential eggs you may have - the basal antral follicle count (AFC).  

The AFC can give an indication of your ovarian reserve, or how many eggs you have left.  

An antral (resting) follicle is a small, fluid-filled sac that contains an immature egg.  Follicles are not the same thing as eggs.  However, in using them interchangeably for simplicity's sake, even by doctors, they create a lot of confusion. 

What you see with the baseline AFC ultrasound are NOT your eggs, but the follicles that your eggs are in.  You need a microscope to see an egg - it's too small to see with an ultrasound.

Remember that baggie of goldfish you got from the state fair when you were a girl?  Think of the bag as the follicle, the water as the follicular fluid, and the egg as the goldfish.  Remember that image whenever you hear “follicle.”

Lab-test-2-206x300.png

Blood tests - AMH & FSH

Doctors also look at your cycle day 3 blood hormone levels to gauge your fertility potential.  

One of the most important is the AMH level. Anti-Müllerian hormone (AMH) is a hormone secreted by the follicles in your ovaries.  For many fertility doctors, AMH has replaced day 3 FSH (follicle stimulating hormone) to measure ovarian reserve.

The AFC and Cycle Day 3 hormone levels are used as indicators for estimating ovarian reserve and your chances for pregnancy with in vitro fertilization (IVF).  

Based on those results, fertility doctors will recommend a course of action.  If both AMH and AFC are low, typically donor eggs are recommended.  Unfortunately, this devastating news can come as quite a shock, especially if it's given at the very first consult you have with your doctor.

However, these results don’t predict your future to get pregnant naturally.

Those results merely help with gauging how well their fertility treatments like IVF and inseminations will likely work for you.  

The antral follicles are a good predictor of the number of mature follicles in a woman’s ovaries that can be stimulated by IVF medications. The number of eggs retrieved from those follicles correlates directly with IVF success rates.  The more eggs retrieved, then the better the results expected from the IVF.

Are your chances decreased due to low AMH levels or low ovarian reserve?  Yes

Does low AMH or low AFC mean that you can’t get pregnant? Possibly but maybe not.  

They don’t take into consideration that your body is a fluid system, constantly changing.  And that you have the ability to influence your outcome depending on the choices you make.

Yes, you’re born with all the eggs you will have.  Unlike men who are constantly making sperm, you can’t make more eggs.

However, you ABSOLUTELY CAN influence how the eggs you already have mature as they get ready for ovulation.

What can you can do to improve your chances of getting pregnant naturally or with IVF?

A LOT!

mitochondria-256x300.jpg

Let’s go over a little science first so you understand why you can still get pregnant despite being of “advanced maternal age” or told it’s too late.

Mitochondria are known as the “powerhouses” of cells.  They convert calories from food, heat from the sun, and oxygen into energy to power the activities of the egg. They’re the “engine” of your eggs.  

Mitochondria are so important that as eggs mature to prepare for ovulation, they increase exponentially from between 5,000-10,000 mitochondria  to 100,000–500,000 or more mitochondria in fully mature eggs.

The reason for this staggering increase is because the egg is actively preparing itself for the increased energy demands of successful fertilization and eventual embryo development.  

So if the mitochondria can’t produce energy, you now by definition have poor egg quality which then contributes to poor embryo quality, if the egg even gets fertilized at all.  

Unfortunately, as you age, the number and efficiency of mitochondria decline.  This happens to both women and men. In all cells. Not just the eggs. This decrease is a result of aging so every person is affected.  

Studies show that the mitochondria of older eggs produce significantly less ATP, which is the source of cellular energy.

This has a significant impact on fertility, as the rate of division and successful implantation of embryos have more to do with how much energy the egg has than with your actual age.

Your egg has direct access to your blood circulation because it’s physically attached to you before ovulation.  If it’s fertilized and becomes an embryo, it reconnects to your body after implantation.

Here's the interesting thing...in contrast, during the time between ovulation and implantation (up to 7 days), the embryo is more or less free floating, dependent on energy produced by the mitochondria already in the egg at the moment of ovulation.  More mitochondria are made only after implantation.

The older egg might have enough mitochondria (and therefore energy) to allow for fertilization and the initial stages of embryonic development.   However, if there isn’t a surplus of mitochondria, the embryo will run out of “juice” and stop dividing before implantation can be achieved and able to use your body’s resources again.

To increase the egg quality so that fertilization and implantation of a healthy embryo can occur, you therefore need to increase the number and improve the efficiency of the mitochondria.  

And this is where supplements, nutrition, exercise, and lifestyle changes come into play.

Here are some things you can do immediately to improve your egg quality.

It's important to note that although quality can be enhanced, it's not as likely that quantity (the number) of eggs can increase significantly enough to use IVF successfully.

This is why trying to get pregnant naturally and/or using natural IVF may be the best solutions for women over 40 or with diagnoses of low AMH, high FSH, premature ovarian failure (POF), premature ovarian insufficiency (POI), poor egg quality, diminished ovarian reserve (DOR), or advanced maternal age (AMA).

Sleep

When you sleep, you produce melatonin.  

Melatonin is an antioxidant - in that it neutralizes toxins that are naturally produced by the mitochondria as a result of creating energy - like how our urine and stool are byproducts of digesting the foods we eat and drink.  A certain amount of free radicals is normal and healthy. But if there are too much, they become poisonous and can damage the eggs. So melatonin protects the eggs, just like an antidote to a poison protects the person. In order to have adequate production of melatonin, you need enough sleep.   

In addition to its antioxidant properties in shielding the eggs from damage, melatonin is a hormone and directly affects ovarian function, especially in egg maturation and embryo development.

For most women when trying to conceive, 8-9 hours EVERY night is needed.

Supplements

The idea that you can get all your nutrients from food is fine in theory, but virtually impossible in practice, especially if you’re trying to achieve a specific health goal...like getting pregnant with a healthy baby after years of trying.  

As much as we want to eat the right foods 100% of the time, it’s not realistic.  Busy schedules, vacations, and temptations all work against us to shop and cook nutrient-dense foods every day.

Supplements help to bridge the nutritional gap that processed foods create from eating convenient foods with very little nutrients.

Supplements are the ultimate hack.  They’re shortcuts to get your body functioning optimally.  They’re concentrated so they help to shorten the time to your end goal of getting pregnant. 

Some of the reasons why we can’t rely on foods alone to get our nutrients are:

  • Soil depletion - Our soils are depleted of nutrients from improper farming practices.  On top of that, most plants are not harvested fresh. They sit on trucks, shelves, and counters for weeks before being eaten. Over time, the nutrient content of these plants decreases.

  • Water depletion - Water filtration is essential to remove toxins.  But the process strips the water of important minerals.

  • Food and environmental toxins - Your body needs nutrients to deal with toxins.  The more toxins you’re exposed to, the more need for nutrients.

  • Poor absorption - As you age, hydrochloric acid and digestive enzyme production naturally declines, making it difficult for you to break down and absorb nutrients from your foods. That’s why heartburn and acid reflux become more of a problem.  As you get older, you also often begin taking medications which can interfere with nutrient absorption. This means you need to compensate with more nutrients in the most absorbable form possible.

  • Optimal function - This is the most important reason for supplementing when trying to get pregnant.  If your body has low nutrient levels, this might manifest with low energy, poor willpower, decreased mental clarity and focus, and, of course, not getting pregnant.  Your body has to direct its nutrient reserves to critical, life-giving functions first. Stuff like digestion, breathing, movement, thinking. It doesn’t have the extra reserves for activities that aren’t life-threatening, like getting pregnant.  In times of perceived famine, your body will stop reproducing. It thinks there’s not enough food for both you and a baby. Obviously, we don’t live in times of famine. But we often make poor food choices by eating convenient processed, pre-packaged foods that have little nutrients  which your brain then perceives that you don’t have enough nutrients to support another life.

If the nutrient deficiencies go on long enough, they can cause DNA damage and make you age faster, resulting in poor egg quality.

the-best-supplements-for-detox-620x360.jpg

Helpful supplements to improve egg quality

  • Folate prevents birth defects and reduces the risk of miscarriage.  Recommended daily dosage: 800 mcg

  • Vitamin D increases AMH, helps with implantation, and is vital to a healthy pregnancy.  Test your vitamin D levels to see if you need supplementation.

  • CoQ10 is used by every cell in your body.  95% of all cellular energy production depends on it.  Aside from its protective qualities as an antioxidant, it also helps produce more energy for your cells.  As you age, you make less CoQ10. So restoring CoQ10 levels can slow and reverse aging.  Recommended daily dosage: up to 600 mg in divided doses.

  • Magnesium is involved in hundreds of processes in your body.  It’s essential for energy function, ensuring proper blood supply to the uterus,  producing progesterone (one of the most essential hormones for a healthy pregnancy), reducing risk of miscarriage, keeping cortisol (the stress hormone), under control, and detoxification.  Probably magnesium’s most important job in the pre-conception stage is protecting and repairing your DNA.  Recommended daily dosage: up to bowel tolerance, taken at night

Nutrition

The proper conception diet is critical to providing the essential nutrients needed for any TTC diet.

Choosing the right fertility foods to eat when trying to conceive will increase your chances of getting pregnant dramatically.  Certain foods good for fertility improve female egg quality more than others.  These foods help ovulation as well.

Water

Water is the single most important food that makes you fertile.

Adequate water intake is essential for...

  • Healthy egg maturation because without sufficient water, your body can't process nutrients and hormones.

  • ...which leads to dehydration interfering with or preventing ovulation

  • The cervical mucus, which is important in transporting the sperm to the fallopian tubes for egg fertilization.  Having little to no cervical mucus can be an indication that you’re dehydrated. You should see 2-3 days of egg white, stretchy cervical mucus around ovulation.  Without enough water, the cervical mucus that balances vaginal pH also becomes too acidic, harming the sperm.

  • Implantation -  Water is necessary for cell division and metabolism. The cells of the uterine wall must be healthy for the embryo to implant.

For the fetus, staying hydrated is critical for fetal development.  Water helps carry nutrients to the placenta and is an important part of all aspects of development from the time of fertilization. Without water, a developing baby cannot survive, increasing the risk of miscarriage.

Fats

Eating the right fats is important for baby...

The brain is made largely of fat (~60%) and the majority of that fat in the brain is saturated. The myelin sheath that surrounds the nerves in the brain and ensures their proper function is also largely made of saturated fat and cholesterol.  For that reason, consuming saturated fats is extremely important, especially when trying to conceive and during pregnancy as these are times of rapid brain development for babies.

Having enough high quality saturated fat as  a reserve for a future pregnancy can reduce the risk of miscarriage.

Eating the right fats is also important for you when trying to get pregnant...

Fats are the basic building blocks of your cell membranes. These fatty membranes surround every cell (including your eggs) and act as the border patrol allowing the right balance of hormones to enter your cells.  Healthy cell walls mean a healthy hormone balance. Unhealthy fats make your cell walls rigid, making it hard for hormones to get into your cells.

Studies show that low fat diets can decrease ovulation.  That’s because fats are a structural component for hormones and hormone-like substances.  In fact, cholesterol is converted to all hormones, including progesterone, estrogen, testosterone, cortisol, DHEA, and vitamin D.

Fat soluble vitamins such as vitamins A, D, E, K are found in the fat so when you eat low fat, you lose vital fertility nutrients.

Fat provide fuel for mitochondria and produce less damaging free radicals than sugar or carbohydrates.

Proteins

You need protein to build bones, muscles, skin, and cells.  Because your body can't store protein the way you can store carbohydrates and fat, you need to get enough protein every day.

Proteins are broken down into their component amino acids, the building blocks of new proteins. They are like Legos, coming in different shapes, sizes, and types that help construct the different structures our bodies (and the embryo) need.  It's a perfect economy, with the amino acids being recycled into new proteins on a supply-and-demand basis.

Studies have shown adequate, high quality protein can...

  • improve egg quality so that embryo quality doubles

  • doubles pregnancy rate

  • decrease miscarriage rate by half

IVF patients who switched to a low-carbohydrate, high-protein diet and then underwent another IVF cycle increased their blastocyst formation rate from 19% to 45% and their clinical pregnancy rate from 17% to 83% (study)

Inadequate high quality proteins can decrease frequency of menstrual periods
      
While choosing the right foods to eat when trying to get pregnant is important, pay attention to food that can cause harm.

Here are some foods to avoid when trying to get pregnant:

Sugar

One of the key mechanisms by which sugar causes premature aging, thus reducing egg quality and fertility is through mitochondrial dysfunction.

When your body burns sugar (as opposed to fat) for its primary fuel, more free radicals are produced that damage the mitochondria, cell membrane, and proteins. 

Researchers found that perceived age using facial photographs increased nearly half a year per 1 mmol/L increase in glucose level in non-diabetic people.  In other words, the higher your glucose levels, the older you'll tend to look. If the glucose is damaging your skin cells to age you more quickly outwardly, how do you think it would affect you internally - specifically your eggs?

When blood sugar levels are consistently high as is the case when eating a lot of sugar in a high carb and high sugar diet, sugar binds to protein unpredictably forming advanced glycation endproducts (AGEs).  

AGEs are linked to DNA damage in the eggs, lower fertilization rates, poor follicular and embryonic development and lower pregnancy rates regardless of age.  

Eggs need to be plump with a soft outer shell of proteins so that sperm can easily penetrate it. Hardening of the outer shell from the cross linking of the AGEs to the shell’s proteins makes it very difficult for the sperm to penetrate it.   

The good news is old glycated collagen (which causes wrinkles and shriveled hard eggs) will eventually be eliminated. It will be recycled and reused for new collagen formation. But this time you need to make sure you are not bombarding your cells with S-U-G-A-R!

Dairy.jpg

Dairy

Dairy is one of the most confusing food groups because so many people rely on drinking milk daily to get their calcium.

Unfortunately industrial milk and dairy products are loaded with hormones, antibiotics, toxins.

Dairy products are the single largest source of dietary estrogen for humans.  Researchers estimate that 60-70% of our food-sourced estrogen comes from milk, yogurt, ice cream, cheese, and other dairy products.  

Too much foreign estrogen-mimicking chemicals called phthalates disrupts normal hormonal balance and fertility. In women, phthalates are linked to poor egg health and early pregnancy loss.

There is simply no reason to drink cow’s milk.  

Get your calcium from other food sources e.g. dark, leafy greens, sardines, broccoli, almonds, sprouted seeds

Bottom line:  Your fertility can be improved with mindful practices to improve your overall health, regardless of your age or diagnosis.

Show me how to improve my fertility naturally with daily email tips

Can Folic Acid Increase Fertility?

If you’re trying to get pregnant in your late 30s or 40s, supplementing with folic acid is important to prevent birth defects in your future baby.  However, most people are unaware that it's also essential for optimal fertility and improving your chances of conceiving.

How can folic acid increase fertility?  Although associated primarily with the prevention of congenital malformations, adequate levels of folate is critical for healthy reproductive function such as improving egg quality, implantation, and reducing the risk of miscarriage.

Unfortunately, most women are taking the inferior form of this nutrient in their supplements.  Find out how to increase your folate for optimal fertility and a healthy baby. Knowing your genetic risk for folate deficiency may also guide you as you’re trying to conceive.

Why is Folate Important for Fertility?

Vitamin B9 or folate is important in all aspects of pregnancy from pre-conception onwards.

Some of B9’s important functions are:

Read More

Let them see your sweat stains...

Despite poor critical reviews, "Venom" was actually quite entertaining.  Not sure what that says about my taste in movies...

My kids and I enjoyed the unexpected sense of humor.  And I love me a Tom Hardy anything.   Unfortunately, his British accent was Americanized.  Sigh...

Read More

This kind of man is a dead man walking

One of my favorite relationship experts, Dr. Pat Allen, advises that unless your man is bleeding out or vomiting his guts out, don't ask him how he feels.  He can figure it out on his own without you mothering him.  

As women, we know how men become whiny man-children when it comes to the littlest thing - like a cold.  Not sayin' that's your man, but in general.

Read More