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Can Sleep Deprivation Affect Fertility?

April 22, 2020
fertility sleep naturopathic doctor toronto

As many of us are practicing physical distancing and working from home, it’s a great time to focus on sleep – especially if you’re hoping to become pregnant in the near future! This is because sleep deprivation can affect fertility – no matter if you’re a man or a woman.

Sleep deprivation happens when there’s a decrease in your total amount of sleep over a certain period of time, or when there’s a shortage of sleep per night. It can also happen during shift work or from jet-lag.

Sleep deprivation can contribute to many adverse health conditions (ex. high blood pressure, depression and anxiety disorders, glucose dysregulation, etc.). Studies in humans who experienced a shorter duration of sleep experienced with high cases of mortality. Unfortunately in animal studies, long-term sleep deprivation lead to death!

Today I’m going to tell you how your sleep routine might be impacting your fertility and what you can start to do to get back on track!

Female Fertility and Sleep

In women, sleep affects many reproductive hormones.

TSH and Sleep

With respect to the thyroid, thyroid stimulating hormone (TSH) has a significant increase in women experiencing acute sleep deprivation. This can lead to anovulation, amenorrhea (no period), and recurrent miscarriages.

Prolactin and Sleep

Prolactin is a hormone that plays a role in reproduction, and in the postpartum, it stimulates milk production (for chest or breastfeeding). In sleep deprivation, prolactin levels may increase causing hyperprolactinemia which is associated with anovulation, PCOS, and endometriosis.

Estrogen and Sleep

Estrogen, specifically estradiol, is needed for the development and maintenance of female sex characteristics. In sleep deprivation, estradiol increases and is associated with poorer sleep quality.

Melatonin and Sleep

Interestingly enough, melatonin is a hormone and is quite important when it comes to fertility! Melatonin is secreted at night, basically telling your body that it’s time to go to sleep. As the night progresses and it turns into morning, melatonin production decreases until it’s shut off completely.

With fertility, melatonin enhances reproductive function by syncing your sexual behaviour with the appropriate season and timing for mating and conception.

When you’re ovulating, melatonin protects your eggs from stress. But if your melatonin level is low, it’s associated with stress which can ultimately impact the quality of your eggs.

If you’re undergoing IVF, taking melatonin may actually help improve your outcomes – like the number of eggs retrieved, egg quality and maturation, and fertilization rate. This is also seen in women with PCOS. Before placing melatonin in an online shopping cart, consult with your ND to determine if melatonin as a supplement is right for you.

Shift Work and Female Fertility

In women working shift work, studies showed an increased odds of abnormal menstrual cycles and infertility was also seen – however no early spontaneous pregnancy loss was noted. Nevertheless, a study looking at female flight attendants (when work coincided with sleep), there was an increased risk of first-trimester miscarriages.

Male Fertility and Sleep

Sleep deprivation in men can affect their sexual behaviour (even if they had previously excellent sexual behaviour). It specifically affects the time to initiate sex as well as a decreased rate of penetration and ejaculation.

Testosterone and Sleep

Sleep deprivation can lead to increased stress levels which can contribute to lower testosterone production in males. Moreover, low testosterone may cause men to feel tired during the day, find it difficult to concentrate and focus on tasks.

In a rat study, sleep deprivation also led to lower testosterone production. Sleep deprivation also affected rat’s sperm too! Sperm motility, which is the ability of the sperm to move properly, was also significantly reduced.

Simple Sleep Tips

Fertility Sleep National Sleep Foundation Sleep Duration Recommendations

Around 39% of people who responded to the National Sleep Foundation’s survey reported getting less than 7 hours of sleep on weeknights! Because many of us are currently working from home, improving our sleep habits may be possible. Here are a couple of tips to help get you started:

  1. Stick to a schedule. Ideally you want to be going to bed and waking up around the same time each day including weekends. Aim for at least 8 hours per night.
  2. Avoid a few things right before bed like coffee, alcohol, smoking and large meals.
  3. Avoid exercising late into the night, ideally you should not exercise any later than 2-3 hours before bed.
  4. Aim to designate your bedroom for sleep and sex. If it happens to be your makeshift office right now, consider setting a bed-time alarm so you’re able to put everything away at a consistent time. This way, you can stick to your sleep schedule.
  5. Let’s face it, most of us are using some type of device before bed. If you have the option, consider turning on night mode, reducing the amount of blue light that you’re being exposed to.
  6. Your bedroom should also be dark and cool – which means that those cute, fuzzy pj’s may not be the best option for sleep.
  7. In the mornings, expose yourself to bright light! I like to open the blinds once I make my way to my living-room office (it gives me a great view of my tree ad neighbourhood birds). Or you can even consider a sunrise alarm, where you’re woken up to gradual to bright sunlight in the morning.

These are all great options to start with before considering supplements like melatonin – which undoubtedly can be helpful, but fixing your routine is foundational.

If you have any tried and true sleep tips that have worked for you, please share them below!

Reference

Lateef, O., & Akintubosun, M. (2020). Sleep and Reproductive Health. Journal Of Circadian Rhythms18(1). doi: 10.5334/jcr.190

Walker, M. (2017). Why We Sleep: Unlocking the Power of Sleep and Dreams (1st ed.). Scribner.

Exercise During Pregnancy

April 10, 2020
exercise pregnancy naturopathic doctor toronto

Now that you’re pregnant, you’re probably wondering about exercise during pregnancy. I’m summarizing the Canadian guidelines for physical activity throughout pregnancy set by the SOGC.

By exercising during pregnancy, you’re positively affecting your and your baby’s health. If you don’t have any contraindications to pregnancy (which are posted below), now is the time to start doing something. Especially if you were previously inactive and/or considered overweight or obese.

How much and what type?

Ideally you should aim for about 150 mins of moderate-intensity activity over the week (think: 30 minutes, 5 days a week).

If you’ve been previously inactive, you may want to begin gradually at a lower intensity, and increase the duration and intensity as your body gets used to it.

Aerobic and resistance training, with a pinch of yoga are great options. And in terms of improving health outcomes for you and your baby, you should aim to do all of them within the week.

Some activities do carry a higher risk and are considered contraindicated during pregnancy – like scuba diving, any activities with physical contact, danger of falling, and non-stationary cycling. Avoiding high-heat activities like hot yoga – as it may cause dehydration.

What the F is DRA?

DRA, known as diastasis rectus abdominus, may occur in some people. Essentially, your abdominal muscles may begin to separate. If you’re noticing that this has happened, book a visit with your pelvic floor physiotherapist to see what you can do. This means that you may also want to avoid ab strengthening exercises for the time being.

One of my colleagues filmed a video about DRA a few years ago. Check it out if you’d like more info

What about the first trimester?

Studies show that exercise in the first trimester doesn’t increase the odds of miscarriage or congenital anomalies. In fact, not exercising during the first trimester increased the odds of pregnancy complications like gestational diabetes, gestational hypertension, excessive gestational weight gain and depressive symptoms.

Let’s keep it real though, most people are exhausted in their first trimester – so the idea of anything besides walking is absolutely not appealing. But, if your energy hasn’t taken a nose dive, or if you’ve reached the point in your second trimester where you feel like you can start your routine again – let’s get to it!

Should ALL pregnant people exercise?

Exercising during pregnancy can provide many health benefits, but there are women who shouldn’t engage in strenuous exercise as its contraindicated. Keep in mind, this doesn’t mean they’re not allowed to move and continue their activities of daily living.

Absolute contraindications to exercise include:

  • Ruptured membranes
  • Premature labour
  • Unexplained or persistent vaginal bleeding
  • Placenta previa after 28 weeks
  • Preeclampsia
  • Incompetent cervix
  • Intrauterine growth restriction
  • High-order multiple pregnancy – like triplets
  • Uncontrolled type 1 diabetes
  • Uncontrolled hypertension
  • Uncontrolled thyroid disease
  • Other serious cardiovascular, respiratory or systemic disorder

Relative contraindications to exercise include:

  • Recurrent pregnancy loss
  • Gestational hypertension
  • A history of spontaneous preterm birth
  • Mild/moderate cardiovascular or respiratory disease
  • Symptomatic anemia
  • Malnutrition
  • Eating disorder
  • Twin pregnancy after week 28
  • Other significant medical conditions

Obviously, if you fall into any of these categories you’ll want to check in with your OB/Gyn or Midwife to see about your specific health situation – especially if you fall into the ‘relative’ category. You’ll want to figure out the advantages and disadvantages of exercise with your care provider before you start to exercise.

Tell me about KEGELS

During pregnancy, you may start noticing some urinary incontinence – perhaps some leaking will occur when you’re running, jumping, and laughing. Although this is common, it’s not considered normal. Many books or other professionals will tell you to start doing kegels. Do NOT do this. Instead, visit a pelvic floor physiotherapist so they can assess your pelvic floor. The reason being is that your pelvic floor may be “tight” yet weak (hence the leaking), and doing kegels can cause your pelvic floor to become tighter, not stronger. However, sometimes kegels can be helpful – but it’s super important to get a professional assessment before starting these.

Never heard of kegels before? Check out this video filmed by one of my colleagues!

Final Thoughts

Exercise during pregnancy is a great thing if you don’t have any of the above absolute/relative contraindications – but always speak to your care provider if you have any questions.

If you’ve been a bit sedentary in the first trimester (that’s okay, pregnancy is tiring!), start slow with low intensity and shorter durations and increase as you go.

If you happen to notice any abdominal separation or even leaking while jumping/running/laughing, be sure to book an appointment with a pelvic floor physiotherapist. I’m writing this post during the COVID-19 pandemic and a lot of health care practitioners have transitioned to virtual visits, so there’s still an opportunity to see a pelvic floor physiotherapist or naturopathic doctor if you have the ability to do so.

References

Mottola, M., Davenport, M., Ruchat, S., Davies, G., Poitras, V., & Gray, C. et al. (2018). No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy. Journal Of Obstetrics And Gynaecology Canada40(11), 1528-1537. doi: 10.1016/j.jogc.2018.07.001

The Effects of PCOS on your Long-Term Health

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April 15, 2020
PCOS long-term health naturopathic doctor toronto

While I’m at home practicing social/physical distancing, I thought it would be an opportune time to catch up on the literal stack of studies I’ve printed out over the last year or two – many of them being about PCOS (polycystic ovary syndrome).

Today I’m going to summarize an article that came out in 2018, which discusses the effects of PCOS on your long-term health.

A quick recap: PCOS is the most common hormonal disorder in reproductive-aged women. To be diagnosed, you need at least 2 of the 3 following criteria:

  1. Delayed ovulation or irregular menstrual cycles (oligomenorrhea)
  2. High androgenic hormones like testosterone
  3. Polycystic ovaries on ultrasound

If you’re in the perimenopausal and menopausal time period, you can still be diagnosed with PCOS if you’ve experienced a history of irregular periods and high male hormone levels (which may have resulted in male-pattern hair growth or hair loss) in your reproductive years.

Because PCOS is associated with many other conditions like diabetes and metabolic syndrome, the study suggests that we should also be spending time decreasing the risk of future symptoms in addition to treating the symptoms you may be currently experiencing.

Type 2 Diabetes and PCOS

Women with PCOS often have a higher risk of developing impaired glucose tolerance – which essentially means that your body isn’t able to process glucose (aka. sugar) as effectively as it should, thereby leading to higher blood sugar levels.

This finding was seen in women who’s PCOS was diagnosed based on total testosterone levels and a history of irregular menstrual cycles.

In women over the age of 40, those with a ‘normal’ weight still had increased odds of developing diabetes, compared to ‘normal’ weight women without PCOS.

Overall during the reproductive years, the risk of impaired glucose tolerance is increased. Whereas the risk of diabetes is increased during perimenopause and menopause. This means that if you’ve been diagnosed with PCOS, you should be monitoring your fasting blood glucose and fasting insulin every 1-3 years to assess your risk of eventually developing diabetes.

Dyslipidemia and PCOS

Dyslipidemia is a fancy word for abnormal amount of lipids (fats) in your blood. In people with PCOS, this is seen in those who are overweight/obese, and may happen when they’re younger and can persist past menopause. So, this would likely also result in screening every couple of years to assess risk.

Overweight, Obesity and PCOS

Obesity is super common in women with PCOS, and they often express their difficulties in losing weight. Most evidence demonstrates that women with PCOS continue to be overweight/obese as they age compared to women without PCOS. Specifically, obesity is higher in white women compared to Asian women.

Metabolic Syndrome and PCOS

Metabolic syndrome is a collection of five health conditions:

  • Insulin resistance
  • High blood pressure
  • High fatty acids in your blood
  • Low HDL cholesterol (aka. the ‘good’ cholesterol)
  • Visceral obesity (aka. a waist circumference of more than 35 inches in women)

Because PCOS can encompass many of these conditions, it’s worth it for us to pay attention to these conditions from a preventative mindset and screen frequently.

Pregnancy Complications and PCOS

Check out a post I wrote about how PCOS can affect your pregnancy. I cover miscarriage, gestational diabetes, pregnancy-induced hypertension, and more.

Depression, Anxiety, and PCOS

Although there isn’t any great research looking at depression and anxiety in PCOS women over 40 years old, there is an increased incidence of depression and anxiety in younger women with PCOS.

Final Thoughts

If you have PCOS, it’s important to address your condition now, but to also think of things preventatively. Because insulin resistance and diabetes is so prominent – you may want to discuss the benefit of annual blood work to assess your risk. These two conditions can also lead to obesity and metabolic syndrome, making it exceptionally important to be aware of.

If you’re pregnant, please check out my pregnancy and PCOS blog post to get an idea of what you should be aware of as you approach the second and third trimester.

Blood tests you should *also* be looking at yearly:

  • Fasting insulin
  • Fasting glucose
  • Fasting lipids

Although these aren’t blood tests, consider getting your blood pressure checked often as well as measuring your waist circumference. If you’re pregnant, your waist circumference will change – so keep that in mind.

References

Cooney, L., & Dokras, A. (2018). Beyond fertility: polycystic ovary syndrome and long-term health. Fertility And Sterility110(5), 794-809. doi: 10.1016/j.fertnstert.2018.08.021