Improving Egg Quality & Ovarian Resposiveness

Although, in this blog I am focusing on ways to support egg quality & ovary responsive to hormone signals; I would like to emphasize that the health of the male partner & therefore his sperm quality is equally important. As I mentioned in my previous blog post titled "Am I Too Old To Have A Baby,"in men and women who are 40 & over, oxidative stress is a major consideration & antioxidants a must. To read this blog please click here.

 For instance when the sperm penetrates the egg, the egg will use it's own resources to to repair any damage & oxidative stress to the sperm first & then use what is left to repair any oxidative damage to itself. So the healthier the sperm the less demand this places on the eggs own resources.

Medical Tests That Assess Ovarian Reserve & Responsiveness

Follicle Stimulating Hormone [FSH]

This blood test should be performed on day 2 or 3 of the menstrual cycle.
It is not a particularly sensitive marker as it will only be elevated in cases where their is severe depletion.

Anti-Mullerian Hormone [AMH]

This has become knowm as the "egg timer test" & has only been available for a few years.
AMH is a protein hormone secreted by the immature cells of the ovarian follicles in response to stimulation by FSH. This blood test should be performed on day 3 of the menstrual cycle & is thought to provide an estimation of the number of early growing follicles. Low ovary reserve maybe indicated with an AMH less than 10pmol/L.

However, egg quality & ovarian responsive is more important than the number of eggs in reserve. If the ovaries response to hormone signals improves then the AMH levels will also be seen to increase.

Studies on women undergoing IVF treatment have shown that regardless of the women's age, AMH was predictive of the number of eggs retrieved but was not predictive of pregnancy rates & outcomes.

Antrial Follicle Count

This investigations the most accurate assessment of ovarian reserve.
It involves a trans vaginal ultrasound in which the mature antral follicles are counted.


Nutrients That Improve Poor Egg Quality And Ovarian Responsiveness

The nutrients I am about to mention will need to be taken for 4 months to have the effect of improving egg quality as this is the time that it takes for the egg to ripen & mature. Also, please note that there are many other nutrients & factors that effect fertility & what I am about to share here relates specifically to supporting egg quality & ovarian responsiveness or for women who are 40 & over.

Coenzyme Q10
This directly improves the energy production within the cells & so improves egg quality & longevity
For fertility you will need to take 200mg twice daily.

Vitamin C
Vitamin C is a powerful antioxidant & immune support. The ovaries are known to be a site of vitamin C accumulation & vitamin C aids the growth & repair of ovary follicles.
The dose is between 2-4 grams daily, ie 1 or 2 grams taken twice daily.

Vitamin E
Vitamin is another powerful antioxidant & so protects the egg from damage & also promotes hormone balance. It improves the integrity of the mucus membrane linings of the fallopian tubes & uterus lining [endometrium].
The dose is 500 i/u twice daily

Vitamin D
On the outside of the female egg there are vitamin D receptor sites & these determine what signals will be released to aid the sperm in finding the egg. Approximately 20 sperm find their way to the egg, but only one gets to penetrate the egg & vitamin D is probably the most important component in that process.

Vitamin D also aids implantation of the embryo & can normalize ovarian response to FSH.

You will need to get your vitamin D levels checked & supplement if needed, for conception & fertility you want to aim for your Vitamin D stores to be 120 mmols in winter & 150 mmols in summer.

Arginine
This is an amino acid [amino acids are the building blocks of proteins] which has been shown to be effective in improving egg quality & it is best used in poor responders to IVF treatment. It can improve the number of mature follicles, improve ovarian response, aid implantation & improve pregnancy rates.

As a supplement it is in a powder form & will need to be prescribed by a naturopath or nutritionist.

Another amino acid called Inositol has also been shown to have a similar effect as arginine, which emphasis the importance of quality protein in the diet for conception & fertility & this is why I do not recommend following a vegan or strict vegetarian diet for my fertility clients & I encourage them to at least include some fish in their diet.

Understanding Your Menstrual Cycle

Your menstrual cycle is the result of the cyclic changes that occur in your body due to the fluctuations in the levels of various hormones. A normal cycle is generally around 27-32 days long and can vary from woman to woman, or cycle to cycle. The length of the cycle is measured from the first day of bleeding (spotting doesn’t count), which is called day 1, to the first day of bleeding of the next menstrual period.

Your cycle is composed of the following 4 phases:

Menses: This is your period (from the first day of bleeding] and a normal period would last 3-5 days.In a healthy cycle there should be no pain, flooding or clotting & the blood should be bright & start & stop cleanly [no spotting].

Follicular phase: The follicular phase, or the pre-ovulatory phase, extends from the beginning of the cycle to ovulation. During this phase, the ovarian follicles (which eventually give rise to the egg which is expelled at ovulation) develop and mature, and your body prepares for ovulation. Between 10-20 follicles begin to develop, but usually only one will become dominant, ripen & release the egg [ovum] at ovulation.

While the follicles are developing, they produce & release increasing levels of oestrogen which stimulates the growth of the lining of the uterus, known as the endometrium. Increasing oestrogen levels also support the production of increasing amounts of ‘fertile mucous’ & cause the cervix to soften & open to allow in the sperm.

The follicular phase should be no less than 13 days or greater than 16 days & for optimal fertility ideally between 13-15 days.

Ovulation:  AS oestrogen levels continue to rise this triggers the release of luteinising hormone [LH] & follicle stimulating hormone[FSH], triggering the release of the egg [ovulation]. Ideally for optimal fertility ovulation should occur between day 13-14, day 15-16 is suboptimal. If ovulation occurs from day 17 onwards & the egg is fertilized there is a high risk of miscarriage occurring.

 

Luteal phase: This is the post-ovulatory phase, the time from ovulation until the end of the cycle, and is generally 14 days long. The length of this phase is fairly constant for most women & variations are more likely to occur in the follicular phase. The luteal phase should be no less than 13 days with no spotting, pain or PMS symptoms. Less than 10 days would be an infertile cycle.

In the post-ovulatory/luteal phase of the cycle, the corpus luteum (the remains of the ovarian follicle) starts to secrete increasing amounts of progesterone, which causes:

1. The lining of the uterus to continue thickening & ensure it is fully supplied with blood and nutrients so that it is ready for the egg

2. The body’s temperature at rest (basal body temperature, or BBT) to rise after ovulation (measurable with a BBT thermometer)   

3. The cervical mucus to lessen and thicken and become ‘infertile’  

4. The ovary to stop releasing eggs

Progesterone is also the dominant hormone during pregnancy should conception occur

If pregnancy doesn’t occur, the corpus luteum shrivels up and stops producing hormones, the uterine lining breaks down and, with blood, leaves the uterus during menstruation.

 The Fertility Window

Studies show that there is essentially a 6-day window of fertility, ending with the day of ovulation. The most fertile day is generally a day or two before ovulation, with the chance of conception highest in the presence of the most fertile type of cervical mucus. According to the World Health Organization the probability of pregnancy is greatest (66.7%) on the day of peak mucus but decreases to 8.9% three days after the peak mucus day.Although the egg is viable for (at most) 24 hours after ovulation, sperm can live in the woman’s reproductive tract for approximately 3 days, which means intercourse 3 or more days before, and up to the day of ovulation, could result in pregnancy. Studies suggest that conception on the day after ovulation rarely occurs.

 Achieving Hormonal Balance 

The causes of hormonal balance are multi-factorial, therefore any form of treatment has the best chance of success if the following are assessed & addressed: 

·      Good nutrition & lifestyle habits

·       Liver function & detoxification pathways

·      Pituitary gland function

·      Ovarian function

·      Thyroid function

·      Adrenal & nervous system support/ stress management

Sympto-Thermal Charting 

This is a chart that enables temperature, mucus & symptomatic changes [ie. pain, mood changes, breast tenderness & bowel changes] to be plotted & tracked daily. It provides a visual of important cyclic patterns that occur each month, which is not possible by simply jotting things in a diary or calendar.

This is an indispensable tool for assessing hormone balance &/or developing your awareness of optimal timing for conception attempts for those wishing to conceive.

Menstrual & Fertility Wellbeing Workshop

For those of you living in Melbourne, Australia, Katherine & Kate warmly invite you to our Menstrual & Fertility Wellbeing workshop - a sacred space for you to heal & connect with your inner feminine wisdom.

This foundational workshop will provide you with a greater understanding & connection to your menstrual cycle as well as self-care tools & knowledge to help you achieve greater emotional & hormonal balance & enhanced fertility


DO YOU:

• Dread your period each month because they are so painful or your emotions go crazy?
• Suffer from heavy periods, fibroids, PCOS or endometriosis
• Feel you are constantly giving out to others, and neglect to take time out for your own self nourishment?
• Feel like you have lost connection with your deep feminine self & cycles?
• Want to conceive & bring a baby into this world & would like to discover how to boost your fertility

IF SO:
We would love you to join us at our workshop, where we will teach you empowering self care practices & tools to heal & reconnect with your menstrual cycle, how to nourish your female energy, increase your fertility & nurture the relationship to your self.

WHEN:
Saturday 18th & 25th May 2013 [this is a 2 day workshop held over two consecutive Saturdays]

But hurry, to save $170.00 with our Super Early Bird ticket on sale now, offer expires at 12MN on Saturday 27th April.
We currently have 6 cherished space still available.

For more details & to register for the workshop please visit  Click Here

Am I Too Old?

"Do you think I am too old to have a baby?" or "do you think I stand a chance of getting pregnant & having a baby?" These are the questions I am frequently asked by women who are trying to conceive & are in their late 30's to mid 40's. Unfortunately, this is a question where there really is no definitive answer as each couples situation is very individual. Therefore, this question can really only be answered in retrospect after both prospective parents have done everything possible to support conception & a healthy pregnancy & baby.

Statistically, in women it appears that optimal fertility is before the age of 30 - 31 years & that fertility then gradually decreases with an acceleration towards the age of 40 years old. For instance, at age 40 a women's fertility is approximately a 1/4 of what it was when she was 30 years old.

Our current understanding around female reproduction is that a women is born with all her eggs [approximately 1/2 million] & then with the onset of her menstrual cycle, she will lose between 20-30 follicles with each cycle & eventually run out of eggs. However, recent studies on female rats are questioning, is it that women are running out of eggs or is it that her eggs are becoming less responsive to hormone signals? Certainly, we know that at around 10 years before a women goes through menopause her ovaries go through a process called "oopause" in which her ovaries become less responsive to hormone changes in her body & less responsive to sperm.

The Good News!

So what does all this mean for the mature women trying to conceive? Can a women who is forty plus conceive naturally? Yes absolutely, women have always had babies in their early 40's long before IVF & other artificial reproductive technologies [ART] were around. What is different today is that women are often trying to conceive their first child in their late 30's & early 40's as opposed to conceiving their 5th or 6th child.

In fact for women over 42 years they have a higher chance of conceiving naturally than they do through IVF [this does not include other ART procedures such as ICSI or egg donation].

The good news is there is a lot you can do to improve your egg quality & responsiveness. In terms of your ability to conceive & have a baby, the quality & responsiveness of your eggs & ovaries is far more important than the number of eggs you have.

Free Mini Taster Menstrual & Fertility Wellbeing Workshop

Firstly, I would like to say a big thank you to everyone that took the time to the complete the survey questionnaire I sent out in January, regarding a two day workshop on "Menstrual & Fertility Wellbeing." Kate [who will be co-facilitating this workshop with me] & I really appreciate you taking the time to do this as it has helped us immensely to plan the workshop & find out what you would most want to gain from attending the workshop.

Consequently, I am excited to announce that the overall response from the survey was very positive. Therefore, Kate & I will be running this two day workshop together over two consecutive Saturdays on May 18th & 25th.

For more details & to register for the workshop please Click Here

Free Mini Menstrual & Fertility Wellbeing 'Taster' Workshop

Saturday 2nd March

3.20pm-4.00pm

Kate & I will be presenting the above taster workshop at the New Energy Festival, Doncaster, Melbourne.
Also, Kate & I have a stand at the festival if you would like to meet us, have a chat & find out more about our work.

For more information on the New Energy Festival & to purchase your entrance ticket please
 Click Here

It would be lovely to see you at the festival if you are able to come along.

Menstrual & Fertile Blessings,

Male Factor Fertility & Creating A Healthy Baby

In this blog I am turning the spotlight on the guys & taking a look at male fertility & sperm health. For the women reading this you may need to approach your man on this subject sensitively; as culturally & emotionally being a "super stud" & having the ability to father a child goes to the core of a man's sense of masculinity & therefore his self-worth. This stems back to before the mid-fifties & prior to research on semen sample investigation; when if a couple were having difficulty conceiving the focus & medical investigation was directed at he women. The 'problem' was thought to be with her & if a man was able to have an erection & ejaculate it was assumed that he was fertile.

In my own personal experience when my husband's sperm analysis showed that he did not have any sperm in his semen, he was totally convinced that the laboratory had made an error which caused his sperm to vanish from the sample. He did not budge from this stance until six months later when he finally agreed to undergo another sperm analysis, which came back with the same result.Often the information needs to come from someone else other than you, so if your partner is willing to read the following article it could be a good starting point.

To the guys about to read this article I would like to thank you for taking the time to do so & for your willingness & openness.

Modern research has revealed that when couples are having difficulty conceiving at least 40% of the reason relates to male factors [egg & womb being the other reason] & some studies have indicated that as much as 75% of infertility may be due to the male.

The good news is that in the majority of cases natural therapies can significantly improve the quality of sperm parameters. For instance in a study of 51 infertile men  who were treated with the herb Tribulus for 3 months, their ejaculate volume, sperm count & motility [movement] improved significantly. Their sperm shape & appearance normalized. In addition 31 pregnancies were recorded amongst their partners within 12 months of commencing Tribulus. It is important to realize that at least a 100 days of specific targeted treatment is required for improvement to occur because it takes this amount of time for new sperm to generate and mature

Secondary Infertility & The Struggle For Another Child

Secondary infertility is defined as when a couple who have one or more biological children are unable to conceive another child after trying for 12 months or more. Also, that their current child or children were conceived naturally without the intervention of reproductive technology or fertility drugs.

It is estimated that approximately 10-17% of all couples experience either primary or secondary infertility or sub-fertility at some stage during their fertile years. Around 40% of primary or secondary infertility is related to male factors, 30% to ovulation dysfunction & 20% to female reproductive conditions such as blocked fallopian tubes, fibroids & endometriosis. Frequently both male & female factors are involved. Approximately 10% of cases are diagnosed as unexplained infertility.

Often the assumption is that if you have easily concieved a child you will have no problem with subsequent conception attempts. However, this is not always the case as the body can change and new health issues can arise & sperm & egg quality can decline

The Emotional Aspect Of Secondary Infertility
Firstly, if you are experiencing difficulties in having more children, I just want to acknowledge that any feelings you may have of anger, loss, grief, jealousy, resentment, isolation or despair are just as valid as they are for a women who has not been able to conceive at all. However, you may receive less support & understanding as often the message is 'be grateful for the child or children you already have."

Frequently, the women I see with secondary infertility issues say something like "don't get me wrong I am very grateful for the child I have & I know I am lucky but........" This is because they have somehow been made to feel guilty about their desire to have another child when others struggle to have one at all. It's okay to long for another child, you are not being selfish & it is natural to feel the loss & pain of being unable to conceive another child. Very often too there is a strong desire to provide a sibling for your child, especially if you experienced close relationships with your sibling[s] when growing up.

Causes Of Secondary Infertility
The causes of secondary infertility are exactly the same as those of primary infertility. Therefore, what I will focus on in this article are the factors that I commonly see change after the birth of a child that can create a state of sub-fertility: