Functional Medicine and Fertility

Story by Rebecca Roberts / December 7, 2021

By Dr. Cici Carter MD

Functional medicine is a practice of medicine that has been around for decades, with aspects of this practice being used for centuries. It’s a whole body systems approach to wellness with restoring the function of our health using the 4 pillars of lifestyle change. Those lifestyle pillars are nutrition, exercise, sleep, and stress management (use of supplements are included under nutrition for my purposes). It’s also known as root cause medicine. With specialty lab testing to identify the dysfunctional parts of our physiology, we use these 4 pillars to restore our body back to it’s normal physiologic state (as much as possible). As it pertains to fertility, the opportunities to use functional medicine are plentiful. We’ll walk through some examples of common injuries that cause physiological damage. Keep in mind that these are just examples and are meant to give you an idea about how this is all connected. The processes discussed are much more complex than what is presented here.

Stress and Inflammation
When considering a woman’s menstrual cycle, there are a particular set of hormones involved to achieve physiological balance throughout the 28-day cycle. The dominant drivers of this cycle are estrogen and progesterone. These hormones need precision in timing, amount, and ratio to one another to result in ovulation and sustained pregnancy. When we have stress or inflammation, our body produces more of the stress hormone called cortisol. Cortisol is our survival hormone and is responsible for orchestrating our physiology to help keep us alive. When we’re chronically stressed, cortisol becomes dominant and pulls resources away from making estrogen and progesterone appropriately disrupting our normal reproductive cycle. This contributes to difficulty conceiving and/or maintaining a pregnancy should it occur.

Oxidative Stress
What is it? We hear this term, but can’t always put our finger on it. Oxidative stress results from an imbalance between reactive oxygen species (ROS) and antioxidants (too much ROS) that then leads to tissue damage. Many things contribute to this: too many calories, inflammation, heavy metals, toxins, and nutritional deficiencies are some factors. What it leads to is a long list as well, mostly pertaining to mitochondrial dysfunction and infertility. Mitochondria are our powerhouse organelles and play a vital role in our daily physiology. They are responsible for our energy production and producing antioxidants to combat ROS, but in terms of fertility, our mitochondrial DNA is vital for egg health. If we don’t have healthy eggs, maintenance of a healthy pregnancy becomes very challenging.
In men’s health, oxidative stress has been implicated in a phenomenon called sperm DNA fragmentation (SDF), which can lead to dysfunction of the zygote (egg + sperm). SDF has been linked in contributing to recurrent first trimester miscarriages.

Insulin Resistance and Hyperinsulinemia
Insulin is intended to be the key to unlock the door of our cells for glucose (sugar) to go in. It’s secreted from the pancreas in response to glucose loads in our bloodstream. Insulin resistance is characterized by high levels of insulin circulating (hyperinsulinemia), but no longer fitting in the lock to open the door for glucose. Unfortunately, all cells are not created equally, meaning some cells/organs are more sensitive than others to this circulating insulin. More particularly, the ovaries are highly sensitive to insulin. In states of high insulin, the ovaries are stimulated to make more testosterone throwing off the hormonal balance resulting in menstrual irregularities and PCOS as examples.

Catabolic Physiology
This phenomenon can also be called our “breakdown” physiology. Here we have the return of cortisol. Cortisol is a breakdown hormone. When we’re in fight or flight, cortisol is responsible for finding fuel to aid our escape and one fuel source is our gut lining (there’s others, but we’ll focus on this for right now). This breakdown of the gut lining can lead to something called leaky gut syndrome. Where we once had a lining that was very selective and only permeable to certain things, now allows larger and more foriegn molecules to enter our bloodstream. This leads to chronic inflammation and activation of certain genes that can lead to autoimmunity and certainly just dysfunctional signaling pathways. In this state, reproduction is not seen as an essential process and thus gets downregulated.

Next Steps
We need to address these underlying issues. Through discovery of how your experiences impact your health, evaluation of your unique physiology through lab testing, we can create a personalized program to see a return to normal physiology including your reproductive states (in many cases). I consider this pathway as “going back to the basics”; where we focus on what we eat, incorporate more mindfulness, movement, and sleep hygiene that isn’t just going to positively affect one area of our lives, but ideally all of it. Our body was meticulously created with sophisticated systems in place, let’s find a way to restore this beautiful creation and live our lives to the fullest!

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