Infertility is becoming increasingly common throughout the developed and the developing world, with one couple in six suffering some degree of impaired fertility. Approximately 40% of this infertility is due to male factors, while 60% is related to some problem in the female, hormonal or reproductive systems.
Infertility has many causes and includes:
- Hormonal problems in the female, including lack of ovulation, polycystic ovary syndrome, luteal phase defect, premature ovarian failure, pituitary or thyroid disease and others.
- Problems with sperm production and health. Hormone deficiency in men affects sperm quality and quantity. Many chemical compounds, industrial processes and some medications, also, affect sperm production.
- Antibody formation to sperm, or inability of sperm to fertilise the egg.
- Fallopian tube obstruction (usually as a result of pelvic inflammatory disease, endometriosis, ectopic pregnancy, or previous surgery).
- Multiple other causes including toxin exposure, nutrient deficiency, obesity, caffeine excess, smoking and others.
The female reproductive system consists of a delicately balanced system, involving a number of endocrine (hormone producing) glands and reproductive organs.
This system is sensitively attuned to and affected by, a woman’s overall health, so a holistic approach to any hormonal or fertility issues is essential.
Many female menstrual and reproductive problems arise as a direct result of disturbances in hormone production, metabolism and/or elimination.
For optimal hormonal and reproductive health, women need adequate levels of luteinising hormone (LH), follicle stimulating hormone (FSH), thyroid hormone, oestrogen and progesterone, all of which need to be in the correct balance, at the correct time of the month.
Any changes in the balance of these hormones may occur due to a number of factors, including inflammation, environmental toxins, stress (including physical, emotional, psychological, and financial causes of stress), poor diet, medication and a lack of exercise.
Addressing all these factors must therefore be an integral part of any treatment strategy for all women with hormonal imbalances or infertility.
The cyclical fluctuations in sex hormones during a woman’s menstrual cycle, are the key to her reproductive health. When there is an alteration in hormone production, metabolism or elimination, these cyclical fluctuations are deranged and this in turn affects ovulation, implantation of the embryo and maintenance of an early pregnancy.
To achieve optimum fertility, it is essential that one has healthy reproductive organs as well as balanced hormones.
In Australia, the first menstrual period usually occurs between 8 and 13 years of age, and the menstrual cycle may then take 12-24 months to become regular. Despite regular menstrual periods however, it is important to note that the reproductive system takes 6-8 years to develop fully and it is not fully developed, until a woman reaches 20 years of age.
While the reproductive organs are well developed at puberty, it takes years for the hormonal system and the hypothalamic-pituitary control mechanisms to become fully operational.
Some of the causes of infertility include amenorrhea, oligomenorrhea, luteal phase defect, endometriosis, polycystic ovary syndrome, thyroid disease, hyperprolactinemia and premature ovarian failure.
Amenorrhea is the absence of a menstrual cycle during a woman’s reproductive years (for reasons other than pregnancy and breastfeeding). Causes of amenorrhea are many and varied and include hormonal failure, physical obstruction, extreme stress (including overexercising), metabolic dysfunction, pituitary tumours, hormonal imbalances and low body fat levels.
Oligomenorrhea is characterised by infrequent or very light periods and has the same causality as amenorrhea.
A luteal phase defect is a menstrual abnormality where low progesterone levels in the second half of the cycle, results in deficient development of the endometrium (the lining of the uterus). Progesterone gives the endometrial lining structure and integrity and prepares the endometrium for implantation of a fertilised egg. Failure of this endometrium to develop properly, means pregnancy cannot occur, as the embryo cannot attach to the uterine wall.
Endometriosis affects approximately 10% of reproductive aged women and is characterised by the presence of endometrial tissue outside the uterus. This condition is most often associated with pelvic pain and infertility, however, it does occur in fertile women who experience no symptoms.
Endometriosis is strongly associated with infertility and may contribute to reproductive failure in 3 main ways. Firstly, there may be poor egg development if there are endometrial deposits on the ovaries. Secondly, scar tissue and adhesions may block the fallopian tubes or interfere with the movement of the egg into the uterus. Thirdly, there is an association between endometriosis and autoimmune disease, and recurrent immune mediated miscarriage.
Polycystic ovary syndrome is characterised by ovaries containing multiple cysts, signs of elevated male hormones, infrequent or absent periods, insulin resistance, obesity and hypertension. The biochemical and endocrinological changes that occur in women with PCOS result in failure to ovulate. The elevated insulin and obesity seen in many PCOS women also has effects on ovarian function and fertility.
Elevated prolactin inhibits progesterone production and impairs fertility.
Certain nutrients are required for normal hormone production and deficiency may occur in the presence of poor diet, use of some medications, or in conditions causing poor absorption of nutrients, including gastrointestinal disease and leaky gut.
Premature ovarian failure, premature menopause and other organ disease can also adversely affect fertility.
While not all infertility is treatable, an increasing number of couples are achieving a healthy pregnancy after following a holistic management plan, using dietary and lifestyle modification, nutritional supplementation, and correction of any coexisting medical or hormonal abnormalities such as obesity and PCOS.