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What does AMH tell you about fertility?

January 28, 2019
AMH fertility, toronto naturopath, naturopathic doctor toronto, fertility naturopath

Did you know that tests exist to tell you how fertile you are?

It’s true!

Your ability to become pregnant depends on your chronological age and biological age.

Your chronological age reflects your current age, while your biological age is in reference to your ovarian reserve (the quantity of and quality of oocytes at a certain time point). Chronological age increases year after year, while biological age decreases year after year until menopause.

Fertility Testing

When women are undergoing infertility evaluation, a flurry of testing is usually done. This includes:

  • Anti-müllerian hormone (AMH)
  • Follicle stimulation hormone (FSH)

AMH and Fertility

AMH is produced by developing follicles, and serves as an indicator of ovarian function. An AMH greater than 0.8-1.0 ng/mL is suggestive of a normal ovarian reserve (the ability of your ovaries to provide eggs that are capable of being fertilized and resulting in a pregnancy).

Your AMH levels will gradually decrease after peaking at around 25. Around 5 years before menopause, AMH levels decrease below the detectable limit.

Studies have also shown that low AMH is associated with increased risk of miscarriage. Women with an AMH of 0.4% had over twice the risk of miscarriage, with the increased risk primarily associated with clinical pregnancy loss.

FSH and Fertility

FSH is a hormone produced in the pituitary and stimulates ovarian follicles to grow and develop. In some women, the pituitary secretes a lot of FSH to get the ovary to respond. This usually happens when your ovarian reserve starts to decline. When FSH is over 10mIU/mL, it’s suggestive that ovarian reserve is in decline.

Overall, AMH decreases as you age and FSH increases as you age.

Testing AMH and FSH

If you are sent for testing to better understand your fertility, most of the tests will be done on day 3 of your period (ex. 3 days after you start your period).

FSH needs to be tested on Day 3, whereas AMH remains stable during your period. It’s independent of any other hormones (ex. FSH, LH and estradiol are usually tested together). AMH is also more predictive of hyper-response and ovarian hyperstimulation syndrome risk during IVF than FSH.

Next Steps

Getting your AMH tested may sound frightening especially as it tells you about your ovarian reserve. This is something that your Naturopathic Doctor can test for you.

Moreover, if you’re worried about your chances at a successful pregnancy, working with a ND may be worthwhile as we take a look at your diet and lifestyle habits, lab work, and more!

References

Iwase, Akira et al. “Clinical Application Of Serum Anti-Müllerian Hormone As An Ovarian Reserve Marker: A Review Of Recent Studies”. Journal Of Obstetrics And Gynaecology Research, vol 44, no. 6, 2018, pp. 998-1006. Wiley, doi:10.1111/jog.13633. 

Wang, Shunping et al. “Discordant Anti-Müllerian Hormone (AMH) And Follicle Stimulating Hormone (FSH) Among Women Undergoing In Vitro Fertilization (IVF): Which One Is The Better Predictor For Live Birth?”. Journal Of Ovarian Research, vol 11, no. 1, 2018. Springer Nature, doi:10.1186/s13048-018-0430-z. Accessed 13 Jan 2019.

Zamah, A. Musa, and Mary D. Stephenson. “Antimüllerian Hormone And Miscarriage: Fifty Shades Of Gray…”. Fertility And Sterility, vol 109, no. 6, 2018, pp. 1008-1009. Elsevier BV, doi:10.1016/j.fertnstert.2018.02.140. 

Zhu, Jieru et al. “Chronological Age Vs Biological Age: A Retrospective Analysis On Age-Specific Serum Anti-Müllerian Hormone Levels For 3280 Females In Reproductive Center Clinic”. Gynecological Endocrinology, vol 34, no. 10, 2018, pp. 890-894. Informa UK Limited, doi:10.1080/09513590.2018.1462317. 

What are Uterine Fibroids?

January 7, 2019
uterine fibroids, toronto naturopath, naturopathic doctor toronto, fertility naturopath

When you think of fibroids, your brain may automatically jump to the scary C word. But fibroids are not the same as cancer.

Uterine fibroids are tumours that that come from the same tissue as the uterus. They grow at a modest rate, and are affected by hormones like estrogen and progesterone.

Uterine Fibroid Risk Factors

Some of the risk factors for uterine fibroids include:

  • Increasing age, around 40-50 years old
  • Family history of uterine fibroids
  • Getting your period before 12 year old
  • African American
  • Obesity

Types of Uterine Fibroids

Subserosal Uterine Fibroids

These fibroids project outside of the uterus. Surgical removal isn’t typically recommended and they don’t appear to impact fertility.

Submucosal Uterine Fibroids

These fibroids project within the uterus and can impact fertility in a negative way by affecting implantation rates, clinical pregnancy rates, ongoing pregnancy, miscarriage and live birth rates. Pregnancy rates may improve following surgical removal of the fibroids.

Intramural Uterine Fibroids

These fibroids are found within the myometrium (middle layer of uterine wall). They may affect fertility by negatively impacting implantation and clinical pregnancy rates.

Signs and Symptoms of Uterine Fibroids

The most common symptom is heavy, prolonged or abnormal bleeding. Unsurprisingly this can be followed by iron deficiency anemia.

You may also notice pelvic pain or pressure, although this is rare. And obstructive symptoms may present with larger fibroids.

Fertility may also be impacted depending on the type of fibroid you have.

Confirming the Presence of Uterine Fibroids

Palpation can give you an idea if you have fibroids, but you’ll need a more definitive diagnosis – preferably with imaging.

Two of the most common (and least invasive) tests are:

  • Transvaginal and transabdominal ultrasonography
  • MRI

Uterine Fibroids in Fertility

Depending on the location of your fibroid, it may decrease your fertility. Fibroids may decrease implantation and clinical pregnancy rates, based on where they present. Intramural and submucosal will affect fertility more than subserosal.

Uterine Fibroids in Pregnancy

Fibroids might remain the same size or become smaller in pregnancy. In the postpartum period, fibroids may shrink or completely disappear.

Sometimes they may have an impact on pregnancy outcomes, including an increased risk of malpresentation of your baby, increased chance of c-section, and increased risk of preterm delivery.

Treating Uterine Fibroids Naturally

Uterine fibroid treatment is dependent on the symptoms you’re experiencing.

If you’re not experiencing any symptoms, then doctors usually take a watch and wait approach. If you are experiencing symptoms, then treatment depends on your desire for fertility.

There are many drugs out there for the treatment of fibroids, and if you’re familiar with my website, I often focus on natural alternatives instead. Moreover, if you’re here because your fibroids are affecting your fertility, many of the recommended treatments wouldn’t be compatible (ex. birth control).

It’s important to note that natural therapies may not make your fibroid completely disappear. And this is one of the conditions where we’re focusing on the symptoms you’re experiencing.

Nutrition and Uterine Fibroids

One of the goals when you have fibroids is to adopt an anti-inflammatory diet. This means whole foods, fresh and organic fruits and vegetables, cold-pressed oils, oily fish, and nuts and seeds.

Sadly this leads to an avoidance of red meat, processed foods, refined carbohydrates, sugar, saturated fats, fried foods, dairy, caffeine, and alcohol.

Fibre is very important in assisting the elimination of estrogen and promoting bowel movements. Before you chug back some psyllium husk, berries and leafy greens are a great source of soluble fibre (the type of fibre that bulks up your stool). An easy way to ensure you’re getting enough fibre during the day is to start your morning off with a berry and spinach smoothie (ps. don’t forget the fat and protein!).

Lifestyle and Uterine Fibroids

Because obesity plays a role in fibroid development, it may be helpful to achieve a healthy body weight. Obviously many factors (ex. hormones) affect weight, so one of the simplest ways to start to process is to focus on nutrition.

Stored fat is often transformed into estrogen which may become stored in the body and ultimately affect hormones.

Liver Support and Uterine Fibroids

Yes, I brought up the liver because it detoxes! While we know that your liver knows how to detox. It’s important to consider that it may be burdened with outside estrogens. This may be affecting how your fibroids grow, and ultimately, this might slow down its detoxing job.

Detoxification happens in 2 steps, and if you don’t have the necessary nutrients for both, your liver may not do its best work. So what’s a person to do? Instead of tossing a pre-packaged detox into your cart, make sure you’re eating a variety of protein, getting your daily dose of B vitamins, and making broccoli (and other brassica vegetables) are you friend.

Once your liver gets these toxins out, they still need to be excreted via urine or stool. A healthy gut microbiome and frequent bowel movements will ensure that estrogen is not recirculated back into your system. But if you experience constipation (ex. less than 1 bowel movement per day) or uncomfortable digestive symptoms, then you may need some digestive support.

Nutrients and Uterine Fibroids

These vary and are based on the symptoms you may be experiencing. However, one important nutrient will be iron, especially if you’re noticing excessive menstrual bleeding (losing over 90mL of blood each cycle). Having your ferritin tested, will give your ND an idea if you should be supplementing.

Other nutrient actions that may be beneficial are anti-inflammatories, immune support, and specific antioxidants.

Herbs and Uterine Fibroids

This is another category that varies based on your symptoms and goals. We may want to consider:

  • Hormonal modulators (to improve hormonal regulation)
  • Liver tonics (to support liver detox)
  • Uterine tonics (to improve uterine tone)
  • Uterine astringents (to reduce uterine bleeding)
  • Uterine stimulants (to relieve pelvic stagnation)
  • Uterine antispasmodics (to reduce pain)

Obviously this is a huge list, and I haven’t listed off any herbs – mostly because you should be taking them under the supervision of a ND or herbalist.

Acupuncture and Uterine Fibroids

It’s no secret that I love acupuncture the most out of all my tools. This can’t be done at home, and should be done in your Naturopath’s or Acupuncturist’s office.

In the case fibroids, your ND will likely focus on ensuring the smooth flow of energy and movement of blood throughout the body. A few treatments are typically needed to see results (it’s not a one and done type of treatment).

Final Thoughts

If you’re experiencing heavy bleeding, it’s important to know that fibroids may be the reason why. Moreover, they may also interfere with your fertility.

If you’re hoping to retain your fertility and address your symptoms through a natural lens, feel free to try some of the above ways or work with a Naturopathic Doctor.

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What should men eat for fertility?

December 24, 2018
male fertility diet, toronto naturopath, naturopathic doctor toronto, fertility naturopath

Spoiler alert: Men can contribute to infertility. 

It’s not just a woman’s issue. And what you’re eating (or not eating), can affect your fertility success. Let’s dive into a couple of things that can help improve sperm parameters in men. 

Fatty Acids and Fertility

The sperm cell membrane high in fatty acids, and these acids are necessary for sperm function. The membrane is pretty important when it comes to fertilization – it helps with cell maturation, penetrating and fusing with the egg. 

The fatty acids that you need to do these jobs can’t be made by your body, so you need to either eat fish, supplement with fish oil, or eat nuts and seeds. Studies have shown that male fertility patients who have a higher intake of omega-3, have more normal sperm. A study looking at walnuts (which are a great source of omega 3s) have been related to higher sperm parameters – vitality, motility (how sperm move), and morphology (how sperm look). Another study showed that men’s fish intake was related to shorter time to pregnancy and a lower risk of infertility. 

It is important to pay attention to mercury levels in fish, and consider avoiding fish with high mercury levels as it may impact fertility. 

Soy and Fertility

Women aren’t the only ones cautious about soy. From my experience, men are pretty fearful too. When we look at the research on dietary soy and men’s health it’s pretty conflicting. While one study mentions that dietary isoflavone intake is associated with higher sperm count and motility, another says that soy intake is associated with lower sperm concentration. 

Here’s the thing, if you’re vegan or vegetarian and soy makes up a large part of your diet, aim for non-GMO and organic sources. 

Dairy & Meat and Fertility

Research on diary and sperm parameters is pretty mixed. One study looking at young men and dairy consumption showed that intake of dairy products (like milk) have been related to lower testosterone, FSH and LH levels. 

When it comes to meat, the same results exist. Some studies show that meat is unrelated to sperm parameters, some show that processed meat affects sperm counts. 

Something to consider though is your cardiovascular health. While that Double Big Mac might not do anything to your sperm, it might affect your heart health! Keep in mind that your body 

Fruits & Vegetables and Fertility

Unsurprisingly, fruits and vegetables are cornerstone of good health. But, many of them are sprayed with pesticides. One study showed that consumption of high-pesticide-residue fruits and vegetable was associated with poor sperm quality in men attending a fertility clinic. 

So what does this mean? Choose organic when eating foods off the Dirty Dozen list. 

Next Steps

Overall, the review that I read didn’t go into as much detail as the female version. However, it did mention that if you’re going to abide by a diet, then the Mediterranean Diet is a good bet. It’s high in seafood, vegetables and fruits, whole grains, etc. Basically you’re not eating processed and packaged foods.  

Changing a diet can be pretty difficult. I’m of the mind of taking it a week at a time, so if you’re introducing a new food or avoiding an old (but problematic) favourite, do it in weekly increments. 

When I was giving up gluten, cow dairy and eggs, I picked one and committed to that for a week, then gave up another, etc. When introducing new foods like salmon, commit to eating it once a week, find different ways to prepare it, etc. Changing your habits around food don’t need to be difficult. But like all things, it does take some work. 

For more information on how you can boost your fertility and improve your sperm parameters, consider working with a naturopathic doctor. If you have any questions, feel free to get in touch!

Reference

Nassan, F., Chavarro, J. and Tanrikut, C. (2018). Diet and men’s fertility: does diet affect sperm quality?. Fertility and Sterility, 110(4), pp.570-577.