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 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.

As an integrative fertility specialist, my team and I help couples through their fertility journey with treatments and suggestions for lifestyle changes so they can start a healthy family.  In addition to state of the art technology to help my patients conceive, I can help patients prepare  their body and mind to maximize the chance of a successful pregnancy. This is referred to as integrative fertility. Here are some common questions I get from my patients.

Q: What should I eat to support my fertility?

A: The general nutrition principles for preconception are the same, whether you are trying naturally or going through fertility treatments. I usually recommend that prospective parents focus their diets on whole, fresh, and natural foods. Eat a lot of colorful vegetables and fruits, ideally, if you can get them locally and seasonally. Enjoy some nuts and seeds. 

Eat less meat. If you do eat meat or dairy products, choose organic because the non-organic ones can be high in pesticides and environmental toxins. Enjoy high-quality fish and seafood, but avoid high mercury ones, such as tuna and king mackerel. Also, cut sugary, fried, processed, canned, or prepackaged foods. 

Your nutrition plan should also take your health status into account, especially factors that led you to seek fertility treatment in the first place. For example, if you have polycystic ovarian syndrome (PCOS), you may do better with a lower-carbohydrate diet. If you struggle with PCOS or other conditions that could be treated with nutrition, I recommend working with a nutritionist to customize your diet program. 

Nutrition is one of the most important building blocks, both for pregnancy and raising children. I recommend cooking at home as much as possible so you can choose the ingredients that go into your food.

Q: What fertility supplements do you recommend?

A: When I see my patients during their preconception appointments, I use labs to identify nutritional deficiencies. Based on the labs, I help them get to optimal rather than just normal levels. Your bloodwork may indicate a need for therapeutic doses to achieve healthy levels of these nutrients. Many common nutritional deficiencies can affect fertility. 

Iron deficiency is widespread among women of reproductive age, and it can affect fertility 1

Many North Americans are also deficient in vitamin D, which is important for fertility for both prospective moms and dads. A recent study found that among women seeking fertility treatments, those with healthy vitamin D levels had significantly higher live birth rates 2

Magnesium is an essential mineral for general health, hormone balance, and pregnancy 3. It is also one that is harder to get through food alone. 

Folic acid is a standard recommendation for any prenatal regimes, although I now recommend methylfolate (MTHF) instead. 

Generally, a high-quality prenatal multivitamin with methylfolate, fish oil, magnesium, and vitamin D should cover your nutritional base. Antioxidants such as vitamin C and Coenzyme Q10 have also been shown to boost fertility for both genders. However, the best answer to this question would be to work with an integrative fertility specialist to optimize your nutrition status.

Q: What are natural ways to support my hormone balance?

A: Many women struggle with hormone imbalance symptoms such as premenstrual syndrome, acne, heavy bleeding, and fibroids. 

The modern diet and lifestyle expose us to a lot of substances that act like estrogen while depleting our progesterone. The good news is that you can fix much of the hormone imbalances naturally by:

  • Managing stress – stress reduces progesterone, worsening hormone imbalance
  • Using nontoxic home and body care products that are free of parabens, phthalates, and perfumes
  • Eating organic meats to avoid pesticides and environmental contaminants
  • Eating a lot of fiber and staying regular promotes hormone balance, as constipation hinder the elimination of old hormones 
  • Filter your water with a filter that removes hormone disruptors. To learn about which ones I recommend, check out my resources page.

Q: Can we improve the quality of sperms and eggs without drugs?

A: During fertility treatments, it might look like the prospective moms do most of the work, but prospective dads can also do their part to maximize the chance of success. In other words, both partners can improve the quality of their sperms and eggs with these tips. 

  • Managing stress. Don’t forget mental health and stress management for prospective dads, especially during fertility treatments. Couples counseling and stress management practices will come in handy during this time.
  • Sleeping well is essential for hormone balance and reducing oxidative stress.
  • Avoiding hormone disruptors and toxic exposures, including at work
  • Eating a healthy diet with the rainbow color of plants to increase antioxidants
  • Drinking less coffee. Excess caffeine intake may reduce sperm quality 4.
  • Maintaining a healthy weight and exercising regularly
  • Not smoking and reducing alcohol as much as possible 
  • Making sure you consume enough zinc and folate. These nutrients are very important for the quality of both sperms and eggs, and overall pregnancy.
  • Antioxidant supplements, such as CoQ10 and lutein, may be helpful for some couples.

Oxidative stress can damage the DNA and reduce the quality of sperms and eggs 5,6. Therefore, these low oxidative stress lifestyle tips will improve the chance of having high-quality embryos.

The key to a fertility-supporting lifestyle is to build healthy habits and create a supportive network around you. If you’d like to schedule an integrative fertility consult, contact me today.


1. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Iron intake and risk of ovulatory infertility. Obstet Gynecol. 2006;108(5):1145-1152. doi:10.1097/01.AOG.0000238333.37423.ab

2. Chu J, Gallos I, Tobias A, et al. Vitamin D and assisted reproductive treatment outcome: a prospective cohort study. Reprod Health. 2019;16(1):106. doi:10.1186/s12978-019-0769-7

3. Tonick S, Muneyyirci-Delale O. Magnesium in Women’s Health and Gynecology. OJOG. 2016;06(05):325-333. doi:10.4236/ojog.2016.65041

4. Ricci E, Viganò P, Cipriani S, et al. Coffee and caffeine intake and male infertility: a systematic review. Nutr J. 2017;16(1):37. doi:10.1186/s12937-017-0257-2

5. Alahmar AT. Role of Oxidative Stress in Male Infertility: An Updated Review. J Hum Reprod Sci. 2019;12(1):4-18. doi:10.4103/jhrs.JHRS_150_18

6. Ruder EH, Hartman TJ, Goldman MB. Impact of oxidative stress on female fertility. Curr Opin Obstet Gynecol. 2009;21(3):219-222. doi:10.1097/gco.0b013e32832924ba

It is estimated that 10% of women of reproductive age are impacted by polycystic ovarian syndrome, also known as PCOS.  This condition has to do with a hormonal imbalance where high amounts of androgen and insulin can be found in the body.  Though the cause of PCOS is unknown the hormonal abnormalities can lead to metabolic and reproductive challenges.

Symptoms of PCOS include:

  • Irregular periods 
  • Increased hair growth on the face, chest, back, stomach 
  • Severe acne or oily skin
  • Weight gain
  • Thinning hair or hair loss on the head
  • Insulin resistance
  • High cholesterol and/or blood pressure

Research shows that a healthy diet and physical activity can help to manage PCOS and improve symptoms.  Eating a balanced diet that is rich with high-fiber vegetables and fruits, lean protein and anti-inflammatory foods can help to lower your blood sugar, improve your body’s use of insulin and regulate your hormone levels.  This food pyramid created by Dr. Joel Furham is a great example of food choices that will support managing PCOS:

Foods to avoid if you have PCOS are:

  • Refined carbohydrates and processed foods
  • High sugar snacks and drinks
  • Inflammatory foods such as processed red meats

In addition to eating well, getting plenty of daily physical activity (shoot for 10,000 steps!) can also help.  

If you’d like support with managing your PCOS, or if you think you may have PCOS, contact me and we can develop an integrative plan to help you return to health.

When women or couples experience challenges with fertility, they look for possible causes. While there may be medical reasons for a woman’s difficulties in getting pregnant, research has shown other factors such as stress and environmental toxins may also play a role. 

Many men and women encounter toxins in their personal care routines every day, often unaware of the impact these could have on their fertility.  Research has identified four primary areas of fertility that are impacted by toxins in personal care products. Learn more about these effects below. 

Endocrine Disruption and Reproductive Harm

The endocrine system is the body’s chemical messenger system. It is responsible for transmitting information that makes hormones. These hormones control everything from moods, growth, development, metabolism, and reproduction. 

Many cosmetics and personal care products contain synthetic byproducts such as parabens, phthalates, glycol ethers, fragrances, cyclosiloxanes, and bisphenol A (BPA).  These can act as endocrine disruptors causing interference with hormone signaling, production, and excretion. 

What’s In Your Personal Care Products?

An article by the Environmental Working Group cited women use an average of 12 products containing 168 unique ingredients every day. Men use about six products daily with 85 unique ingredients. Their study shows that some of the chemicals in personal care and cosmetic products have been linked to health problems.

The most common effects of exposure to endocrine disruptors appear to be reproductive and developmental effects. These include ovulation disorders, fibroids, disruption of thyroid function, male sexual dysfunction, low sperm count, possible link to cancer, and low birth weight in babies.

Common Toxins In Personal Care Products

  • Parabens are perhaps one of the most common toxins added to personal care products as a preservative. They can act as estrogens and disrupt hormone signaling. They have been linked to potential fertility issues in men and women, congenital disabilities, a link to breast cancer, as well as a link to more aggressive tumor growth and the formation of malignant cancers. Many moisturizers, facial cleansers, sunscreens, deodorants, shaving gels, kinds of toothpaste, cosmetics, and other personal care products contain parabens. 
  • Phthalates are commonly found in some cosmetic fragrance mixtures, nail polishes, hairsprays, after-shaves, deodorants, and other personal care products like shampoos, conditioners, and moisturizers. Phthalates have been found to cause reproductive abnormalities such as reduced testosterone and sperm quality in men and early puberty in girls.
  • Formaldehyde is a preservative commonly added to products to add to shelf life and prevent mold and bacteria growth. Nearly one in five cosmetic products contains a substance that generates formaldehyde, a known carcinogen. These products include shampoos, conditioners, bubble baths, and other personal care products, including those marketed for children. Formaldehyde and formaldehyde like chemicals are also found in hair straighteners and “smoothing” creams marketing for the BIPOC community. Exposure to formaldehyde can include risks of reduced fertility and increased risk to the fetus. 
  • Triclosan and triclocarban are chemicals found in a variety of products.  Triclosan was banned in antibacterial soaps in 2017. However, they are still found in some dish soaps, personal care products, and toothpaste. It is used in a variety of products but won’t be on the label. To avoid triclosan do not buy products listed as antibacterial. Although this might seem tempting and should make things cleaner, its all harm and no good in this situation.  Even at low levels, these chemicals have been shown to interfere with thyroid signaling and male and female sex hormone signaling leading to reproductive abnormalities. 

Unfortunately, the cosmetic industry in the United States is largely self-regulated at this time, and there is not any restriction on the use of harmful chemicals in personal care products.. In February 2020, the California Assembly reintroduced the Toxic-Free Chemicals bill under A.B. 2762 which proposes banning 12 toxic ingredients, such as mercury and formaldehyde, from the beauty and personal care products sold in California. This is the third time such a bill has been proposed, earlier iterations of the bill being blocked in April 2019 and failing in January 2020. You can read about their efforts here. 

Toxins such as those listed are readily absorbed into your skin and metabolized by your body. Because you use these products daily, the exposure to such toxins compounds over time creating a greater effect of harm on your body. 

Defend yourself against toxins

Your best defense is taking the time to educate yourself about the products you use and making changes to clean products. Although this article specifically addressed personal care products, environmental toxins are all around us. To learn more and find out how you can reduce your exposure you can find additional references and articles here on our website.

To start educating yourself about toxins in your personal care products and other purchases you make, I suggest the Environmental Working Group’s website  EWG is a non-profit, non-partisan organization dedicated to protecting human health and the environment. They also have a database created specifically for products. Some 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 harmful in terms of your health. You can enter your current products in the search in the Skin Deep Database and see how they measure up. 

Reducing or eliminating toxins in personal care products is one facet of integrative medicine we suggest to women and couples we work with at our clinic.  If you are interested in a consultation to see if integrative techniques can further support your fertility journey, contact me at Shala Salem, MD 

Health trends come and go, they can be challenging to implement long-term, or carry a high price tag that isn’t manageable for most.  But one trend for improving health that likely has staying power is mindfulness. Why?  Because it’s easy to try, free or low-cost, and it now has plenty of evidence-based research backing it.  Here are six ways that mindfulness has been shown to improve health.

Less Stress

Studies have shown that mindfulness-based stress reduction can be helpful to reduce symptoms associated with stress, anxiety, and depression. 

Heart Healthy

A regular mindfulness practice can help to lower blood pressure and has been recommended by the American Heart Association as an adjunct treatment for heart disease.

Improved Immune Function

Regular meditation may help your body heal and fight disease.  Studies have shown meditation to have a positive impact on immune response.  

Mental Focus

Meditation can reduce reactivity to stress or challenging situations, at the same time, it makes it easy to draw your attention back when distractions happen.  This is why proponents of meditation say they experience a clear, focused mind is a benefit of the practice.  

Increased Emotional Regulation and Self-Control

Mindfulness trains the practitioner to slow down and be in the present moment.  By developing the skill of self-awareness and observation, you are able to be less reactive and more in control of emotions.

Slows Cell Aging

Cell aging occurs naturally over time and can increase with stress and disease. Research has shown that meditation could help slow this process.

Now that you know some of the physical and mental benefits of mindfulness, it’s time to integrate it into your life.  Building a mindfulness practice can happen over time.  You can start small with just a few minutes of meditation each day.   Begin by sitting calmly and breathing slow with your eyes closed, for just a few minutes.  Add this into your morning routine or a time of the day that makes sense for you.  If you need more guidance, try a yoga, tai chi, or qi gong class to adopt mindfulness techniques.  Practice builds consistency, but for most people, it will take time to build your practice, so be patient with yourself.  Even 20 minutes a day can have a huge benefit on your overall well-being.  

If you want to learn more about mindfulness-based stress reduction, check out our videos page or reach out to Dr. Shala for more information.

What Is The Mediterranean Diet?

As a doctor who works with patients seeking integrative fertility support, I am often asked if there are specific foods the couple can eat to improve their chances of conception. Many of my clients have had success following The Mediterranean Diet for fertility. 

An integrative approach to health takes into account the whole person, including all aspects of lifestyle. How and what we eat plays a crucial role in the body’s ability to heal and function optimally. While nothing can guarantee a couple’s success in conception, the Mediterranean Diet is a sound way of eating that can be sustained throughout a lifetime for good health. 

What Foods Are Included?

The Mediterranean Diet has its roots in ancient times. Farmers in the area known as the Mediterranean basin commonly ate foods like sheep cheese, vegetables, olives, nuts, fresh fish, and very little meat or bread. 

To incorporate this way of eating into your lifestyle, focus on eating fresh fruits and vegetables, whole grains, legumes, nuts, healthy fats such as olive oil, moderate amounts of fish, seafood, dairy, eggs, and poultry. Red meat and simple carbohydrates are limited. You can find some resources about getting started here

Choose Fresh, Whole Foods

One of the most important things to remember is that the Mediterranean Diet features fresh, organic, minimally processed foods. When fresh foods are not available, opt for foods that have been flash-frozen to retain most of the nutrients.

A typical “western diet” full of highly processed foods is usually unfavorable to conception. Processed foods are likely to contain trans-fats, sugar, pesticides, BPA, and other ingredients that have been found to adversely affect metabolism and ovulation. 

Enjoy Your Meals

The culture of the Mediterranean is also important to mention. Imagine the pleasure of enjoying fresh, healthy meals, eating slowly, and spending time in the company and conversation with friends. This is the type of mindset you will want to have while eating. Allow yourself to taste each of the flavors on your plate and take time between bites. 

Having a slow, leisurely meal is unlike the way most of us Americans tend to eat. We are much more likely to grab a bite and eat while working or eat a take-out meal in our car while running errands.  By slowing down during mealtimes and reducing stress you begin an integrative approach to fertility.  

Benefits of The Mediterranean Diet for Fertility

Health Benefits for Women

Foods like broccoli, asparagus, brussels sprouts, and eggs are all rich in folate and B6. These minerals and vitamins have a positive relationship with the possibility of conception. Vitamin D is also essential when trying to conceive. Vitamin D helps to increase both progesterone and estrogen levels, which regulate menstrual cycles and ovulation. Dietary sources like oily fish (salmon, herring, sardines), egg yolks, and mushrooms are rich sources of Vitamin D. 

The Mediterranean Diet is high in antioxidants because of the large number of fresh vegetables and fruits recommended. This creates a healthier endometrium; or mucus membrane of the uterus, preparing it for embryo implantation.

Health Benefits for Men

Women aren’t the only ones who benefit from monitoring their eating habits while trying to conceive. Men’s dietary choices play a role in conception as well. In men, Vitamin D supports both the semen quality and semen count. It can also increase their levels of testosterone, which boosts libido. 

Stress and Vitamin and Mineral Levels

Trying to conceive or facing infertility treatments can be stressful for couples. Stress is known to deplete essential vitamins and minerals within the body, which can hinder pregnancy efforts. The B vitamins, vitamin C, vitamin E, magnesium, zinc, and iron are the most common nutrients affected by stress. 

All of these play a vital role in fertility, as well as overall wellness. Remember, part of the Mediterranean Diet is slower, more leisurely meals. So being less stressed during meals will hopefully have a ripple effect throughout your day and allow you to retain some all-important building blocks within your body. 

The Mediterranean Diet has numerous health benefits, and they reach far beyond improving fertility success. It’s never too early for men or women to adopt this lifestyle, but it is recommended to be more intentional about your choices at least three months before trying to conceive. 

If you find you need additional support with your integrative fertility journey, please reach out to us online, by phone, or through one of our offices