Endometriosis is said to affect 1 in 10 women during their reproductive years. Perhaps you are one of them. Effects of endometriosis can include painful periods, painful ovulation, pain during and after sexual intercourse, heavy menstrual bleeding, chronic pelvic pain, fatigue, and infertility. [R] This impacts your physical well-being and can impact your emotional health as well.  

 

What is Endometriosis

 

Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus. The condition induces a chronic inflammatory reaction that may result in scar tissue.  [R

Symptoms

 

Endometriosis symptoms can include pain before and during periods, pain in between periods, pain during or after sex, pain when urinating or having a bowel movement (often during monthly periods), difficulty achieving pregnancy, and cysts of endometriosis on the ovaries called endometriomas, also sometimes called chocolate cysts.  [R] Other symptoms may include heavy bleeding during menstruation and fatigue. [R[  Some of the symptoms have been “normalized” to be associated with menstruation in general, and therefore, there seems to be an average delay of seven years between the onset of symptoms and a woman seeking treatment. [R

Cause

 

There is no known cause of endometriosis, but it appears to be related to complex interactions of immunologic, hormonal, environmental, and genetic factors. [R]  Women have a higher risk of developing endometriosis if their mother and/or sister(s) are also affected. Gynecological factors such as age when the menstrual period starts, prolonged menstrual flow, and short cycle interval may be possible risk factors. [R] There is some evidence environmental factors such as exposures to toxins such as dioxin (an environmental pollutant) and PCBs can correlate to endometriosis symptoms. [R]

Treatment

 

While there is currently no cure for endometriosis, there are treatments available. Pain medications may alleviate discomfort symptoms, although they do not address other symptoms such as heavy bleeding, fatigue, or infertility. Birth control pills may also be an option in reducing pain symptoms, though this is not an option for treatment if you are trying to conceive. Additionally, some women may not want to be on a hormone-based medication for an extended period of time. Doctors may also recommend surgery such as laparoscopy to remove endometriosis tissue or a hysterectomy depending on the severity of symptoms [R]

 

Treatment options are considered in relation to the patient’s age, desire for children, the severity of symptoms, and the endometriosis stage and should be discussed with your provider. 

How Does Endometriosis Affect Fertility

 

Having a diagnosis of endometriosis does not automatically mean a woman will experience infertility; some women can achieve pregnancy without difficulty. Women who have endometriosis may experience difficulty in achieving pregnancy.  Studies show endometriosis is the cause of up to 50% of infertility cases. [R] The excess tissue growth may cause adhesions, scarred fallopian tubes, or inflammation of the pelvic structures. 

 

Because endometriosis may be caused by an excess of estrogen in the system, some women may also experience altered immune system functioning, changes in the eggs’ hormonal environment, impaired implantation of a pregnancy, and altered egg quality as a result of the hormonal imbalance. [R]

 

Endometriosis and IVF

 

Assisted reproductive technology is the first line of treatment in patients who experience infertility due to endometriosis. [R]  Studies seem to indicate that treatment’s success depends on individual patient factors play the most crucial role in the outcome. Treatment choice depends on the patient’s age, duration of infertility, disease level of progression, and childbearing wish. [R]

Integrative medicine may also provide support with pain management and stress during the IVF process for all patients, not just those with endometriosis. Yoga and acupuncture are two ways patients can manage pain and stress levels. A clean diet and lifestyle also promote healthier estrogen levels, which may support efforts in alleviating some symptoms of endometriosis.  If you seek support around Integrative Fertility Medicine practices as part of your journey, you can contact our clinic for an appointment. 

You’ve probably heard of BPA when shopping for things like water bottles, food storage containers, and even in your cosmetics like lipsticks, eye and face makeup, and nail lacquers. But do you know what it is and how it affects your health?

 

BPA, or Bisphenol A, was initially developed to be used as an estrogen-like compound for the pharmaceutical industry.  BPA was later used to manufacture plastics, and the plastic industry exploded in the 1950s. The chemical was presumed to be safe by the Environmental Protection Agency in the 1970s, with few animal studies in doses not relevant to humans.  BPA leaches out of plastics long after it is produced, and there are no requirements for companies to prove its safety. 

BPA and Health

BPA is an endocrine disruptor, meaning it mimics or interferes with the body’s endocrine system. Even in low amounts, exposure can alter the body’s endocrine system and lead to health concerns such as breast and other cancers, reproductive problems, obesity, heart disease, and behavioral changes. 

 

BPA has been shown to decrease egg quality and a reduced ability of an embryo’s successful implantation in women. Some research has demonstrated infertile women have higher BPA levels. Elevated BPA seems to adversely affect estradiol levels, the number of eggs produced, egg quality, fertilization rates, and embryo quality. Increased levels of BPA may decrease the success rate of IVF treatments. [R]

 

Multiple studies have correlated BPA exposure with a reduction in various characteristics of sperm quality. Sperm concentration, total sperm count, and morphology were a few of the traits affected [R] Researchers found that BPA can affect sperm integrity even at low levels. 

Steps to Reduce BPA in Your Life

 

  • Ditch the Plastics. At the store, you will commonly see the claim “BPA-free” on products, but that doesn’t necessarily mean it’s safe. When BPA became a customer concern companies started exploring the idea of using other Bisphenols, like BPS, as a substitute in order to place the label BPA-free on the label as a marketing tool.  It is much cheaper for a company to replace the chemical in question with another chemical rather than safely reformulate it. While there are fewer studies on replacement bisphenols, evidence shows very similar side effects in those exposed to BPA. Other things to look for and avoid in plastics are PolyCarbonates (“PC”) or recycling code #7, as these may contain BPA. 

 

Seek alternatives such as glass or stainless steel water bottles, glass food storage containers, or natural food wraps such as beeswax for bringing lunches on-the-go. 

 

  • Choose Fresh or Frozen Over Canned.  Fresh, organic, locally grown, in-season produce is best when available. Otherwise, choose fruits and vegetables that have been flash-frozen to protect as many of their benefits. Canned fruits and vegetables may be at risk of exposure to BPA, which is often found inside the can linings. 

 

  • Practice Clean Beauty. A database of safe cosmetics and body care products can be found on Skin Deep, provided by the Environmental Working Group.  EWG is a non-profit, non-partisan organization dedicated to protecting human health and the environment. Some of the health and personal care products contained in the database are EWG Verified, meaning the products are free from harmful chemicals, provide full transparency in labeling, and follow good manufacturing practices. Other products rated on a scale from 1 to 10 indicating least to most damaging in terms of your health. BPA is one of the many toxins EWG screens. 

 

  • Limit Your Exposure to Receipts.  Paper such as sales receipts, plane, and concert tickets all have a BPA coating that gives them that smooth texture.  If your employment causes you to come in contact with a large volume of receipts, it’s essential to protect yourself from BPA exposure. You may ask to work with gloves and, if this is not an option, be sure to wash your hands often. If you are a consumer, you can limit your exposure by asking for an emailed receipt whenever possible, declining receipts you don’t need (this will help the environment too!), or by handling the receipt as little as possible and washing your hands with soap and water as soon as you are able. 

 

  • Avoid Use of Hand Sanitizers. Hand washing is always preferred to hand-sanitizer. However, due to COVID-19 and flu season around the corner, hand-sanitizer seems to be everywhere. When soap and water isn’t an option, use it, but know that hand sanitizer can increase absorption of BPA after touching receipts into your body of 10-100X! That’s an alarming percentage; stick to soap and water as a best practice. 

 

Reducing or eliminating toxins, such as BPA, is an easy step you can take at home to begin steps to a cleaner lifestyle. There are many other components to integrative medicine that can impact fertility that I suggest to patients.  You can learn more from my eBook, download it today.

The holidays are typically a time for gatherings with family members, spending time with those you love, and celebrating family traditions. For couples struggling with infertility, the holidays and spending time with family may not hold the same joy and excitement as years past. During the holidays, couples struggling with infertility may get asked questions they don’t have answers to or don’t want to discuss with others.  This can bring about feelings of shame, guilt, inadequacy or a sense of loss. 

 

Oftentimes, family members have the best of intentions, not realizing how a couple experiencing infertility may be struggling in that moment.  It is common for couples to feel pressure from family members about their infertility journey, conceiving, and upholding family traditions. Couples who are experiencing infertility may get asked questions like “when are you going to have children” or “how are fertility treatments going?” Family members may try to place blame on one partner for not having a child, or struggling to have one. The couple may feel attacked, ashamed they are not “performing” or meeting their families expectations.  Feelings of guilt, loneliness, and sadness may increase and compound difficult emotions that are already present during a fertility journey. 

 

There are a few ways a couple can prepare when attending the holidays with family. The important thing is to build a support system amongst each other so they know how to reply to the family, and when it’s a good time to leave the holiday gathering or not attend at all.  

 

  1. Couples can gauge whether it’s mentally and emotionally healthy for them to attend these holiday gatherings.  It’s important they remember that it is not worth their mental and emotional wellness attending holiday gatherings that may cause anxiety, feelings of guilt and shame or place more pressure on them.
  2. Next, the couple can create clear boundaries to assist them with how much information they will share about their infertility journey with their family members.  They can determine certain details that they will choose not to share.  The couple can discuss what their responses will be depending on who asks questions.
  3. The couple can communicate clearly by letting family members know their infertility journey is not up for discussion. The couple can let the family know what is up for discussion and what is not. 
  4. Couples can let family members know to keep their story private.
  5. The couple can create a sign or gesture they will make to one another when it’s time for them to leave or when someone needs to go assist the other.  

 

Couples struggling with infertility may experience change in their family dynamics, especially during the holidays. Their feelings can take over making it difficult to communicate what they need or want from others.  

 

Couples may feel that family members are intrusive, or invading their space and privacy with inappropriate questions.  The couple can simply say no to the gatherings that they do not want to be a part of or to those being intrusive and invading their space.

 

Self-care is important for couples experiencing infertility.  They need to be able to recharge and rest when needed. A couple should create a plan around self-care they can establish, if needed, after attending a gathering that leaves them emotionally and mentally drained. For example, a night home alone watching movies, a hike, a walk to breathe some fresh air, visiting family or friends that are supportive or simply creating new family traditions that bring them peace and joy.

 

Struggling with infertility is challenging and the holidays may make things feel more intense. Finding effective communication, boundaries, and a self-care plan can help couples to maintain their emotional wellbeing through the holiday season.  

Exercise may already be a part of your everyday lifestyle. Most adults need both aerobic activity and strength training for overall health. The CDC recommends 150 minutes each week of cardiovascular exercise. That can be broken into smaller blocks of time, including anything from brisk walking to running and muscle-strengthening activities two or more times per week [R] But do the guidelines change if you are trying to conceive?  How does exercise impact your fertility?

Benefits of Exercise

 

There are many benefits of exercise, including weight management, blood sugar and insulin levels, improvement of mental health and mood, reduction of cancer risk, improved sleep, and improved sexual health, among others. [R] All of these facets can impact fertility in both men and women. 

Couples who are overweight may encounter more difficulties when trying to conceive. Women with a higher BMI may experience menstrual dysfunction and anovulation, placing them at risk for lowered conception rates or infertility.  [R] Increased weight in men has been associated with a lower testosterone level, poorer sperm quality, and reduced fertility as compared to men of average weight. [R] Exercise helps to increase metabolism, or how many calories you burn in a day. When combined with healthy eating, individuals may experience weight loss and lowered BMI, improving the chances of conception. 

Exercise can reduce the glucose in your blood and make you more sensitive to insulin. Insulin resistance affects ovulation, fertilization, and embryo implantation, causing first trimester miscarriages and infertility. [R

Stress hormones such as cortisol have been shown to play a role in the length of time needed for a couple to conceive successfully. [R] Cortisol also plays a role in your libido. It may sound like common sense, but having a low desire can affect your conception if you aren’t having sex within your ovulation window. Regular cardiovascular exercise was found to mitigate the health impact of psychological stress. [R

Exercise can help to mitigate the risk of certain cancers. This is particularly true of cancers which have increased risk related to BMI, insulin sensitivity, and increased estrogen levels. [R] According to the summary of the research cited, even recreational exercise levels showed benefits in reducing colorectal and breast cancer risks. 

Adequate sleep is necessary for maintaining optimal health. Irregular sleep patterns might adversely affect the hormone secretion impacting ovulatory cycles. The hormone disruption could additionally contribute to “insulin resistance and glucose intolerance potentially contributing to infertility and early pregnancy loss, particularly among women with PCOS.” [R] Exercise appears to have a positive correlation to sleep, especially in middle-aged and older adults. Regular exercise was found to have moderate and strong positive effects on overall sleep quality. In contrast, chronic exercise appeared to increase the total sleep time and sleep efficiency to some degree. [R

Finally, it appears exercise has a relationship to sexual health, including increased sexual drive, sexual activity, and sexual satisfaction. Obesity and inactivity have some relationship to sexual dysfunction, and in males, a high BMI can correlate to erectile dysfunction. [R] Among both men and women, moderate amounts of exercise appeared to stimulate sexual interest and behavior. [R] However, too much activity was associated with a decrease in testosterone, and other male hormones, which may decrease sexual desire [R]. Libido in men is dependent both on testosterone levels and on psychological factors

 

Exercise and Fertility

 

While it can be acknowledged that physical activity benefits overall health and well-being, does exercise specifically relate to fertility health? 

Lack of exercise or inadequate amounts of physical activity may result in health complications such as increased BMI, increased insulin resistance, and higher amounts of cortisol and estrogen in the bloodstream could affect poorer ovulation, fertilization rates, and embryo implantation. [R]  In males, lack of exercise and higher BMI has been linked to a lower testosterone level, poor sperm quality, and reduced fertility compared to men of normal weight. [R

When individuals begin exercising “too much,” it can also be counterproductive to fertility efforts as well. Studies done on both male and female athletes have shown that endurance training, such has long-distance running, has been linked to altering fertility. [R, R]  In some females vigorous exercise for extended periods can be linked with anovulation which can affect fertility. [R]. 

There appears to be an “upper limit” of exercise, especially when working with individuals who are elite athletes. In such cases, they may benefit from working closely with their medical professionals and trainers to develop a customized plan to ensure their well-being and fertility during conception efforts and pregnancy. [R[

The yoga asanas also help to strengthen the body and improve blood flow to the reproductive organs. Some research has shown improved blood flow and circulation as it relates to a higher abdominal temperature that may correlate to enhanced fertility. 

Physical activity such as yoga, pilates, and barre may be particularly helpful for fertility as the asanas, or physical poses, can bring a calming energy to the pelvis, stimulate the endocrine system and restore hormonal balance where needed. This applies to men as well as women.   [R]  Choosing yoga poses that target specific trigger points may help to regulate monthly cycles, improve libido, rebalance thyroid function, stabilize blood sugar, and support fertility health. To help support hormone balance, you might select poses such as fish pose, sun salutations, garland pose, mariachi’s pose, and the bound angle pose. Illustrations of these can be found here

Women who are physically active prior to receiving IVF or ICSI appear to benefit from physical activity and demonstrate higher success rates compared to women who are physically inactive. [R]  However, depending on your personal health history, your doctor may recommend you decrease your exercise levels. 

Integrative fertility may be a choice for you if you would like to combine natural and modern therapies in your fertility journey. If you are interested in a consultation to see if integrative techniques can further support your fertility journey, contact me for more information.

As a healthcare provider, it can be challenging to share everything that I’d like a patient to know about their fertility during one office visit.  A visit with a fertility specialist will typically include gathering medical history, explaining procedures, setings expectation for patients, and answer their questions.  Often, I wish I had more time during a visit to talk through all of the ways a patient can optimize their health for fertility.   This is what inspired me to write an eBook, Jumpstart Your Fertility – A Guide to Enhancing Your Fertility at Home.

I’m thrilled to announce that after many months of hard work, I’ve poured my integrative fertility knowledge into one FREE resource.  This eBook is packed with easy, everyday tips to improve your fertility at home.

Click here to get free access to my eBook!

Infertility can affect as many as one in eight couples trying to conceive. While many people tend to believe infertility is “a woman’s problem,” male infertility is a factor in roughly one-third of all infertility cases (25% in combination with female infertility factors and 8% as a singular factor). [R]  Male infertility can be categorized as endocrine or systemic causes, testicular defects in spermatogenesis, sperm transport disorders, and idiopathic male infertility. [R]. Treatment is often available, and many couples are able to conceive after receiving a medical intervention. 

 

Types of Male Infertility

Endocrine or Systemic Causes

 

Endocrine or systemic causes make up about 2 – 5% of male infertility cases. They refer to dysfunction of the hypothalamic-pituitary-gonadal axis, and like most hormonal pathways within the body, are sensitive to disruption and can be indicative of other disorders. [R] Excess estrogen appears to have an adverse effect on the balance of the HPG axis. 

 

While some estrogen and estradiol are necessary for male biological function and reproduction, excess estrogen appears to be damaging to the balance of the HPG axis and could be a contributing factor to male infertility. As in women, excess estrogen in the body can be produced as a result of obesity, stress, or environmental factors [R, R, R]. 

 

Testicular Defects in Spermatogenesis

 

Some more common disorders that affect the testicles include trauma, torsion, cancer, epididymitis, and hypogonadism.  Infection and inflammation of the reproductive tract are significant causes of male factor infertility.

 

Depending on the nature of the trauma, it is possible scar tissue may result within the testicular tissue leading to reduced to halted sperm production.  Trauma did not appear to be a major cause affecting spermatogenesis, as early repair of any trauma seemed to preserve normal functionality. [R]  Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. Adequate sperm needed for fertilization can be produced from one testicle, While medical intervention may be possible to repair and preserve the damaged testicle, the effects of testicular torsion on fertility remain unclear. [R

 

If the testicular defect is a result of cancer, chemotherapy treatment could have an adverse effect on sperm production and fertility, so patients may wish to speak to their treatment provider about sperm banking before treatment begins. [R].   The epididymis is part of the male reproductive tract where spermatozoa acquire motility and the ability to fertilize the egg. When this area becomes damaged, usually through inflammation or infection such as a urinary tract infection or sexually transmitted disease, it can cause harm to the maturing sperm. 

 

Male hypogonadism is a condition where the body does not produce enough testosterone and other hormones needed for masculine growth and development during puberty or enough sperm or both. The condition may be acquired or congenital. 

Sperm Transport Disorders

 

In order for fertilization to occur, sperm must successfully reach the female egg. If there are difficulties in the sperm reaching the egg, it could be a potential cause of infertility. Sperm transport disorders account for 5% of male infertility cases. [R

 

Causes of sperm transport issues may be congenital, surgical, or acquired through infection or disease. Congenital causes may include the absence of the vas deferens, incomplete development of the sperm ducts, or lack of the seminal vesicles which store sperm. Surgical intervention might be a vasectomy. Infection or disease-related causes of sperm transport disorders could be a result of a sexually transmitted disease which has led to scarring. 

 

Idiopathic Male Infertility

 

Idiopathic male infertility, or IMI, affects approximately 10 – 15% of males in their prime reproductive age. [R] Men presenting with idiopathic infertility have no obvious history of fertility problems and both physical examination and endocrine laboratory testing are normal. However, semen analysis as routinely performed reveals sperm abnormalities that come alone or in combination. 

 

Testing for Male Infertility

 

When seeking support for male infertility, the initial evaluation typically focuses on detecting the small percentage of causes that can be treated to restore normal fertility. The remainder of the evaluation of male infertility is focused on determining which couples with male factor infertility might benefit from assisted reproductive technologies (ART). [R] A medical history, physical examination, and semen analysis are usually common. While additional components of the exam may go on to include endocrine testing, imaging of the glands and ducts, and genetic tests. [R]

 

Can Male Infertility Be Treated?

 

In cases where male infertility is related to hormonal imbalance, such as endocrine dysfunction or hypogonadism, sperm production or motility may be increased through the use of certain medical treatment. Usually, the focus is increasing testosterone production, increasing follicle-stimulating hormone (FSH) levels, and normalizing the testosterone to estrogen ratio. [R]

 

Depending on the nature of the testicular defect, surgery, hormonal intervention, or sperm banking may be an appropriate intervention for fertility. 

Sperm transport disorders may be resolved through surgery, as in the case of reversing a vasectomy, or through the use of IVF procedures. 

 

ART did not seem to be as successful with male infertility related to sperm DNA damage such as caused by cases of damage to the epididymis [R]

 

If you’d like to schedule a consultation for male fertility testing contact Pacific Reproductive Center today. 

You may associate pregnancy with the idea of “eating for two” and craving unusual foods as the baby grows. This may be a popular adage, but keep in mind the best source of health for you and your developing baby is a nutrient-rich diet. While it’s possible to obtain adequate amounts of vitamins and minerals from eating a variety of fruits, vegetables, and lean proteins, many people do not. Legumes are rich in  protein, iron, folate, and calcium. Dark, leafy greens contain ample amounts of vitamin C, vitamin K, vitamin A, calcium, iron, folate, and potassium. Berries are high in antioxidants, while foods like salmon provide fatty acids for brain health.  If these foods aren’t staples in our diet, you may consider supplementation.

 

Taking prenatal vitamins in preparation of your pregnancy is like an insurance plan. The eggs that are ovulated start on their development journey about three months prior to the cycle. Before you begin trying to conceive, you may want to speak with your doctor about the best prenatal supplement for you.  Prenatal vitamins are recommended if you are not using birth control methods to prevent pregnancy, just in the event a pregnancy occurs you will want to ensure optimal nutrients are available for the fetus’s development. 

What to Look for In a Prenatal Vitamin

 

A good prenatal should have various vitamins and minerals to support the health of the mother and the baby. While supplements vary in their ingredients, key items to look for include 

 

  • Vitamin A with the majority as beta carotene – extremely important for fetal vision development and immune function

 

  • Vitamin B12 – important for maintaining the health of the nervous system

 

  • Choline – supports the development of the baby’s brain and neural tube

 

  • Iron – needed to make hemoglobin, a substance in red blood cells that transports oxygen throughout your body

 

  • Methylfolate (instead of folic acid) – decreases the risk of preterm birth and congenital heart disease

 

  • Calcium – necessary for skeletal formation and growth as well as muscle, heart, and nerve development
  • Magnesium – enables the growth of strong bones and teeth in the baby and also supports the mother by reducing blood pressure levels and reducing the risk of premature contractions

 

  • Selenium supports thyroid hormone metabolism, DNA synthesis and acts as an antioxidant protecting cells from damage and infection

 

  • Zinc – needed for cell division and tissue growth during baby’s development

 

  • Iodine – maintains normal thyroid function for both mother and baby

 

  • Biotinrequired for the metabolism of glucose and amino acids and is essential in liver, skin, and nervous system healthy

 

Your doctor will be able to assist you in choosing the right dosage for you, as they will take into account your health, current diet, and any concerns that may warrant additional supplementation. 

 

Many prenatal vitamins also contain Vitamin D and/or DHA. Sufficient levels of vitamin D help ensure proper calcium absorption. DHA, or Docosahexaenoic acid, is an omega-3 fatty acid essential for brain development during pregnancy.  While these two ingredients are beneficial, most supplements do not contain adequate amounts.  You will want to consult with your doctor to determine if you need an additional supplement. 

What to Avoid in Your Prenatal Vitamins

 

A good rule of thumb when choosing supplements is to look for those as natural as possible. Avoid those that have food colorings or dyes which are unnecessary and petrochemicals, hydrocarbon derivatives, and coal tar. These may act as endocrine disrupting chemicals and affect fertility along with having adverse effects on the immune system. 

 

Other ingredients in supplements you’ll want to avoid are hydrogenated oils like soybean, canola, and rapeseed.  These are sometimes added to supplements to preserve shelf life and save costs. The hydrogenated oils are considered trans fats and have been shown to cause health concerns such as heart disease, stroke, diabetes, and possibly infertility. 

 

Folic acid is added to some brands of prenatal supplements. You may be aware folate is important for prenatal health and the baby’s growth and development, but folic acid is the synthetic form of folate. The body has a more difficult time breaking down the folic acid (the synthetic version of the vitamin), and unmetabolized folic acid (UMFA) can build up in the blood and cause health concerns. It’s recommended instead to seek out supplements which provide methylfolate as a source of folate.  

 

Your doctor will be able to recommend brands that are appropriate for you as they take into consideration your health history and nutritional needs. If you are local to the southern California area, I see patients in my offices in Los Angeles, Orange, and Riverside Counties where I offer comprehensive integrative fertility treatments. You can contact us for an appointment here.

Taking initiative around your health when you want to become a parent is a responsible choice.  It’s wise to mind your health and set a good foundation for the little one you are helping to create. The list of what to eat and what not to eat during pre-pregnancy and while expecting can be overwhelming, but it doesn’t have to be. 

Why Does Organic Matter?

 

Choosing organic foods can limit your exposure to pesticides, which can act as endocrine disruptors and carcinogens within the body. Higher levels of pesticides can also be linked to lower pregnancy rates and/or lower birth weights. 

 

Conventionally grown produce is sprayed with multiple types of pesticides many of which have been implicated in causing things like cancer and influencing infertility.   In 2017 The EARTH (environment and reproductive health study) showed eating higher pesticide residue vegetables and fruits was associated with lower rates of pregnancy and live birth following infertility treatment. These findings were consistent with prior animal studies displaying a similar result.  

What is the Dirty Dozen and Clean 15?

 

A simple guideline to follow is using what’s called the “Dirty Dozen” and “Clean 15” lists. Every year the Environmental Working Group releases Dirty Dozen and Clean Fifteen guides. In 2020 EWG analyzed 47 items and compiled their list. 

 

The dirty dozen were the top 12 fruits and vegetables with the highest pesticide content in the analysis. 

  1. Strawberry – rich in antioxidants
  2. Spinach – packed with iron, folate, and zinc
  3. Kale – high in iron, folate, calcium, and manganese 
  4. Nectarines – rich in selenium and vitamin C
  5. Apples –  high in vitamin C and fiber
  6. Grapes – packed with vitamins C and K and rich in antioxidants
  7. Peaches – rich in selenium and vitamin C
  8. Cherries – excellent source of vitamin C, zinc, calcium, iron, magnesium and vitamin B6.
  9. Pears – high in vitamin C and fiber
  10. Tomatoes – an excellent source of lycopene
  11. Celery – high in anti-inflammatories and fiber
  12. Potatoes – sweet potatoes are high in vitamin C, zinc, calcium, iron, magnesium and vitamin B6 as well as antioxidants
  13. Hot peppers ( an extra item on the list this year)  – rich in vitamins A, B, C, and E and some studies suggest capsaicin acts as an antioxidant to protect your cells and helps tamp down inflammation

 

The “Clean 15” conversely had the lowest levels of pesticides. ⁠

  1. Avocado – great source of vitamin E, antioxidants, and monounsaturated fats
  2. Sweet corn – contains folic acid, zeaxanthin, and pathogenic acid
  3. Pineapple – high in bromelain, an anti-inflammatory and anti-coagulation
  4. Onions – high in sulfur which helps promote the antioxidant glutathione
  5. Papaya – contains folate, vitamin A, magnesium, copper, and pantothenic acid
  6. Sweet peas frozen – rich in magnesium, potassium, and calcium
  7. Eggplant – high in fiber, potassium, vitamin C, vitamin B-6, and antioxidants
  8. Asparagus – rich in folate 
  9. Cauliflower – high in vitamins C, K, B6, and folate
  10. Cantaloupe – an excellent source of beta carotene, vitamin C, and folate
  11. Broccoli – rich in iron and folate
  12. Mushrooms – source of vitamin D
  13. Cabbage – an excellent source of beta carotene, vitamin E, and folic acid
  14. Honeydew melon – contains a high amount of vitamin C
  15. Kiwi – rich in vitamin C and folate

 

Don’t misunderstand that the Clean 15 is free from pesticide use. Why is the Clean 15 somewhat “safer” then? It’s because many, although not all, of these fruits and vegetables have a layer of protection in the outer layer of their skin. Others, such as cabbage and asparagus, contain naturally occurring enzymes that help to protect against pests and therefore require fewer pesticides to protect them during commercial growing. 

How to Make Organic Food More Affordable

 

Many of my patients have expressed concern about the increased cost of shopping organic.  One thing I would like to stress is not to let the list prevent you from adding a variety of vegetables and fruits to your diet. There are ways you can cut costs without cutting out these important sources of nutrients from your diet. 

 

  • Visit farmers’ markets or get to know local farms or farmers  Many farms do not have the organic label but do in fact use organic practices.  

 

  • Buy seasonal produce as its typically less expensive when in-season.

 

  • Look for frozen organic fruits and vegetables.  Frozen produce tends to be lower in cost but still high in nutrients because they are flash-frozen. 

 

  • Look for store brand organic produce or budget-friendly stores. Certain stores are known to be more expensive (Whole Foods, for example)  or more affordable (such as Aldi or Trader Joes). While in the stores shop the sales and look for in-season produce. When you purchase out of season, that will typically mean a higher price tag because of the cost in transportation to get the items to your local market.

 

  • Stick to basics. You will do better with your grocery budget purchasing organic, whole foods instead of splurging on organic snack chips, organic cookies, and so on. These items tend to be expensive, and even though they may be organic, they tend to have unnecessary sugars and ingredients that should be enjoyed on rare occasions.  Remember, we are looking to nourish the body with food. It’s best to learn to satisfy your sweet tooth with fruits (one of my favorites is fresh organic berries tossed with some high-quality balsamic vinegar for about 10 minutes to draw out the extra sweetness and then served with organic, full-fat, grass-fed Greek yogurt or coconut milk or nut milk of you are dairy-free and a small amount of farm-fresh honey. Be sure to choose yogurt that is free of added sugars.)

Remember each little step to reduce your exposure, is a step in the right direction. Check out the Dirty Dozen and Clean fifteen on www.ewg.org for more information. If you would like additional support around your own fertility journey and how integrative medicine might support you, contact me. 

The journey through infertility can be filled with stress, anxiety, sadness, frustration, and loneliness. I have heard from couples that they feel like their bodies are broken or aren’t good enough because of their fertility struggles or have tried to find ways to detach themselves from the disappointments of unsuccessful attempts at trying to conceive on their own. Yoga is an excellent tool to facilitate calm and help support patients on their fertility journey. The practice of yoga may allow people to reconnect to themselves, to each other, and to find a sense of community.  

 

Many women who are experiencing infertility feel stress and disconnectedness from their body. Yoga is a way to reduce stress and rebuild the mind-body connection.  Our emotions don’t just exist in our minds, we can also carry them with us in our bodies.  This can show up as muscle tension, physical pain, digestive issues, or fatigue.  You helps you to avoid holding un-processed emotion in your body. 

Asanas Allow Reconnection and Physical Benefits

 

Researchers have found our minds may cope with difficult emotions by disconnecting from a sense of self-awareness and body-awareness. A goal of healing and wholeness becomes reconnecting with your body in a safe, comfortable, healthy way. Yoga is excellent at filling this need. The physical poses, or asanas, in yoga, allow you to connect to your body through movement and breath. 

 

The yoga asanas also help to strengthen the body and improve blood flow to the reproductive organs. Some research has shown improved blood flow and circulation as it relates to a higher abdominal temperature that may correlate to enhanced fertility. 

 

Some asanas particularly helpful for fertility include those that are hip openers, such as lunges, butterfly pose, and the reclining bound angle pose, and those that bring calming energy to the pelvis such as the legs up the wall pose, the seated forward bend, and the standing forward bend. 

 

Similarly, some yoga poses are also beneficial for stimulating the endocrine system and restoring hormonal balance where needed. This applies to men as well as women. Choosing yoga poses that target specific trigger points may help to regulate monthly cycles, improve libido, rebalance thyroid function, stabilize blood sugar, and support fertility health. To help support hormone balance, you might select poses such as fish pose, sun salutations, garland pose, mariachi’s pose, and the bound angle pose. Illustrations of these can be found here

Yogic Breathing and Stress 

 

Yoga’s role in stress reduction is well documented. Yoga is a multidimensional system that includes physical poses, breathing, and meditation. Yogic breathing is also known as pranayama and translates from the Sanskrit ‘to control life force.’ Essentially, this refers to breathing in certain patterns that require you to inhale and exhale in ways that draw greater awareness to your breath. There are many different types of pranayama, and each has a specific role, such as restoring balance or focusing energy. 

 

Deep breathing allows us to reduce stress and manage body functions like blood pressure, immune health, and concentration.  Ujjayi breath is probably the most common type of pranayama used in foundational yoga classes and helps to bring focus to your mind and breath. This is also used to calm your mind during meditative practices. 

Yoga as a Sense of Community

 

While yoga can be practiced on your own, you may benefit from practicing in a class setting where you can connect with a supportive community of others sharing similar experiences. You may choose to seek out classes designed for restorative or gentle hatha yoga, as these would be most supportive of the asanas, breathwork, and meditations supporting stress release.  Sometimes knowing you are not alone in your journey is helpful, While your experiences are unique to you, connecting with others who may be sharing a common story.  

 

Research has shown that women who practice emotion-focused coping skills, such as reducing stress, may experience improved results when participating in fertility treatments. Sometimes the problem itself cannot be immediately resolved the way we want; instead, we need to examine the way we respond to the situation. Having resources such as yoga, breathing, and mediation available for stress reduction may be valuable. 

 

Resources for incorporating yoga and meditation into your habits can be found on my website along with this beginner’s yoga sequence. I encourage you to find a non-toxic yoga mat, made from biodegradable natural tree rubber, manufactured with zero waste and no harmful plasticizers. Manduka mats are free of toxic chemicals, dyes, and phthalates. If you would like to read more about the impact of environmental toxins on fertility, an article can be found here on the blog. 

 

Integrative fertility may be a choice for you if you would like to combine natural and modern therapies in your fertility journey. If you are interested in a consultation to see if integrative techniques can further support your fertility journey, contact me at Shala Salem, MD.

 

 

Losing a pregnancy or child is one of the most painful experiences a person can go through in life.  Pregnancy loss is often followed by a period of grief where a range of emotions can be felt, including guilt, anger, or even depression.

If you or someone you know has experienced the loss of a child, know that you are not alone.  Here are some statistics that show how common loss is:

  • 1 in 4 mothers report experiencing perinatal loss, however, the number may be as high as 50%  (Jaffe& Diamond, 2011)  
  • Approximately 24,000  mothers will experience a stillborn, or  loss after 20 weeks gestation. 
  • According to the CDC,  an additional 23,000 mothers  a year will experience infant loss during the first 28 days of their child’s life (MacDorman &Gregory, 2015).  

There are no  clear steps on how to navigate a loss, as each woman’s journey to healing is unique. Losing a child brings about difficult feelings and there is no right or wrong way to grieve. There is no typical time period that it takes, it’s different for every family. It’s important to allow yourself or anyone who is experiencing a loss time to feel the loss and go through the grieving process.  Often family members will grieve in different ways and it’s important to honor each person’s way of grieving, without judgement or expectation.  

Moving forward after the loss of a child can feel impossible. Often mothers and partners may feel stuck with no end in sight to their pain.   Couples should be supported in their choices to start trying for a baby again, or choosing to take some time before trying. Some couples may want to try to conceive soon after their loss.  For them, it may be a way of helping them ease the pain or shorten the grief period.  While other couples may choose not to try. 

Regardless of how the couple processes their loss, it’s important to acknowledge that some form of support is necessary to facilitate healing.  Most people will find comfort in getting support to cope with the emotions that accompany the grieving process.  Support can come in many forms.  It may be seeking help from a mental health professional, a support group, a spiritual community or a trusted friend.  Professional help is a proven way to work through the emotions that come with pregnancy loss.  For those that are hesitant to get professional help, it’s recommended they talk to someone in their life and find comfort in sharing what they are experiencing.

Here are some examples of those you can turn to for help and support after a loss

  • A close friend
  • Partner/ spouse
  • Family member
  • Spiritual leader
  • Counselor 
  • Psychologist 
  • Therapist 
  • Support Groups

It is common for mothers to blame themselves for the loss.  They may experience feelings of guilt and shame for not doing things that could have “prevented” the loss from happening.  These feelings may cause the mother or family member to retreat, isolate, and not seek support from others around them.  This will likely intensify the feelings of loss and grief, by spending time alone without support it may be more difficult to process your pain or find comfort.  

Seeking help and sharing your pain is not easy to do.  But the path toward healing includes working through your emotions and learning to process your grief in a healthy way.  For some people, family, cultural norms, or your beliefs may prevent you from asking for help. However, seeking help is the best step you can take in coping with your loss and grief.  Speaking to someone about your emotions may help in making sense of the loss and having your feelings validated.  Support during this time will help lessen the feelings of guilt and help to comfort you.  Remembering that you do not have to face the loss alone allows you to open up to receive support.

When working through loss and grief it is so important to prioritize self care.  Taking care of your body is as important as taking care of your mental and emotional health.   A healthy body can help promote balanced emotions and a healthy mind. Taking care of yourself does not mean that you are forgetting about the loss of your child.  You are healing yourself and the memory of your child will always live within your heart. 

Here are some examples to support your self care:

  • Eating a healthy, nutrient-dense diet
  • Exercising
  • Going for a walk outside
  • Meditation 
  • Yoga
  • Getting enough sleep

For those supporting a family member or loved one who has experienced loss there are many ways that you can help.  Here are a few tips:

  • Arrange for a meal delivery 
  • Refer to them as parents (acknowledge them on Mother’s Day and Father’s day)
  • Ask them if they want to tell you their story
  • Be present sit with them and listen 
  • Ask them what you can do to be helpful or to help them heal
  • If they have living children ask if you can help babysit or take them on an outing.
  • When they feel ready, join them in one of their favorite activities

Looking for help may be challenging when you may not know where to begin.

Here’s a list of resources:

This October, reach out to a mother or family that has experienced loss. Ask how you can support them in their healing. If you personally find yourself grieving the loss of your child, please know that you are not alone in this journey. Help is available all around you and you will heal on your own time.