To want a child and struggle to be able to conceive or carry to term is perhaps among the most heartbreaking trials would-be parents encounter. And it’s a struggle that is becoming more common as infertility rates rise in North America.
A fertility story
Ees (42) and Sally (38) are struggling with fertility. On the surface, this couple is the all-around embodiment of health: free from chronic disease and unhealthy habits, careful about the foods they eat and the chemicals they expose themselves to, and long-time participants in regular exercise routines. Nevertheless, they have tried to get pregnant for two years without success.
“We tried [to conceive] naturally at first,” says Sally, but when after almost a year it didn’t happen, “we talked about our options.” Sally is a nurse educator and understood that for her, in her late thirties, time was not on her side. They engaged a fertility clinic and—despite no mention of it from the clinicians there—each also engaged holistic healthcare providers. For Sally that meant regular acupuncture, and for Ees, consultation with a functional medicine doctor—a practitioner who specializes in addressing the underlying cause of disease and works together with the patient to create lifestyle practices for optimizing health.
They did everything “right”: exercised, chose organic food, got quality sleep, eliminated toxins, abstained from drugs and alcohol, and included other lifestyle changes to promote fertility. They also did a number of rounds of Intra-Uterine Insemination (IUI) where the male’s sperm is “concentrated” and then placed inside the female’s uterus. In Sally’s case she was also given artificial hormones.
After three rounds of IUI without success, they did their first round of In Vitro Fertilization (IVF) in which eggs are collected and fertilized with a man’s sperm in a laboratory. Only one was ultimately found to be viable and they forged ahead with a single embryo, placing their hope in the singularity of it all that it might just work.
It did not.
A sad and stressful time
It was a sad and stressful time. They had done everything “right” and yet they still weren’t pregnant. Both Ees and Sally are from modest upbringings and Sally’s work is primarily in communities that serve addicts, chronically homeless, and otherwise disenfranchised individuals. She said she felt “conflicted” using all those resources, including financial (IVF cost them approximately $25,000 CAD for their first round), to try and get pregnant. It felt like a very “middle class struggle” compared to what she witnessed within the other realms of her life.
Ees and Sally aren’t alone. Up to 16 percent of couples in Canada and the U.S. are unable to conceive a child without intervention and are struggling to find an answer.
Sperm : seeds of change
Sperm quality and quantity is changing. In 2005, in the largest study ever done on male fertility, featuring 26,000 participants, French researchers found that sperm counts had fallen by one third in a 16 year period. Furthermore, the study showed a nearly two percent annual decrease, taking the average sperm count from 74 million per millilitre of semen to about 50 million. These decreasing tendencies are validated by an even more recent meta-analysis of all relevant studies on male sperm count done between 1997 and 2011 on men from North America, Europe, Australia, and New Zealand. The results showed a 52.4 percent decline in sperm concentration and a 59.3 percent decline in total sperm count.
The quality of sperm may also be deteriorating. The World Health Organization (WHO) has officially changed their definition of “normal” from greater than 60 percent healthy, undeformed sperm in a man’s ejaculate in 1980, to its current definition of “normal” as just four percent healthy, undeformed sperm; a dramatic redefinition in less than 40 years. Yet, despite these dire-sounding numbers, other researchers are quick to point out that the process of evaluating sperm quality has never really been standardized. Thus, the WHO numbers may be somewhat or even very skewed by variations in how different studies characterize normal sperm.
What is normal sperm?
After all, what is normal sperm? The rather unscientific and unsatisfying answer boils down to something akin to: good sperm is as good sperm does. In other words, if the woman who receives the sperm gets pregnant with a healthy fetus, the sperm must be “normal enough”. And therein lies the crux of the male fertility issue: if the sperm doesn’t get the woman pregnant, who bears the shortcoming? If she ends up pregnant but the fetus isn’t healthy, how can we ever know where the problem originated? Implicit in the definition of healthy sperm is the ability to get a woman pregnant, and when we reverse engineer a healthy pregnancy sometimes it turns out the sperm in question aren't the actual sperm at all. Further to this, according to the WHO, it is difficult just to get fathers to donate sperm to help answer these questions. And, whatever normal sperm is, it only takes one of them, among millions, to make a baby.
Nevertheless, every expert I spoke with in the fertility field had no doubt that male infertility was a growing problem and saw some aspect of the male infertility issue routinely in their practice. And while it just takes one lucky sperm to create an embryo, more sperm of good quality increases pregnancy likelihood and rates and may even decrease the incidence of miscarriage in viable pregnancies.
“Sperm is a great baseline indicator of what is going on in the environment,” says Dr. Spence Pentland, a doctor of Traditional Chinese Medicine (TCM) with a specialty in fertility, founder of the Yinstill Reproductive Wellness Clinic, and author of Being Fertile. While many fertility clinics focus largely on women, he works with both partners, focusing on lifestyle changes to improve fertility.
“Sperm are sensitive to environmental toxins,” he says. In a comprehensive study on specific environmental toxins and their effects on couples trying to get pregnant, researchers followed 500 couples for 12 months as they attempted to conceive, measuring their blood for the presence of 63 common organic pollutants. The results suggested that greater exposures to certain environmental toxins correlate with time to pregnancy. In women, the greatest associations were with persistent organic pollutants (POPs) including polychlorinated biphenyls (PCBs) and perfluorinated compounds. In men, an up to 29 percent reduction in successful impregnation was associated with an even greater number of POPs, including seven different PCBs—used in plasticizers, some dyes, and numerous industrial applications—and one pesticide, DDE. The results suggest that the male’s role is every bit as threatened as the woman’s, and perhaps even more sensitive to current exposures.
Thyroid, environmental toxins, and fertility
Many men and women will never even think about fertility unless they struggle with conception. Yet, fertility is an indicator of health. Or, as Pentland asserts, “To be fertile is to be in as balanced a state as a human can be.”
Women have insight into their fertility health available to them their entire reproductive lives by way of their menstrual cycle. Geraldine Matus, midwife and founder of Justisse Healthworks for Women and the Justisse Method of fertility planning, believes the menstrual cycle is “a window into a woman’s endocrine system” which she describes as the second most vital system after the central nervous system. “If the endocrine system isn’t working, you aren’t working.”
At the heart of the endocrine system is the thyroid. It’s the “sentinel gland for the environment,” says Dr. Bethany Hays, MD, who has spent 34 years as an obstetrician, founded the True North holistic healthcare practice, and serves on the board of the Institute for Functional Medicine. Hays’ extraordinary career has included much more than just delivering babies. She lost her own thyroid to cancer between her first and second pregnancy, driving her to become an expert on the relationship between the thyroid, environmental stressors, and fertility. “There are thyroid receptors in every cell of the body,” she says.
The thyroid, responsible for energy production and metabolism of all cells, including those of the brain, works closely with the adrenals on issues related to hormones, energy use and conservation, and the stress response. The thyroid is particularly sensitive to environmental stress. If the adrenals are under chronic stress—from daily life, diet, or environmental toxins—they will tell the thyroid to slow down to help keep from over-drawing the adrenal bank account. Numerous environmental toxins directly affect the thyroid as well including most of the POPs (PERC, dioxins, PCBs, chemical flame retardants, PFOAs), heavy metals, pesticides, plastics, soy, and fluoride.
Autoimmune hypothyroidism
All of these stressors can lead to autoimmune hypothyroidism which is responsible for the vast majority of all thyroid problems in North America. Hypothyroidism can result in fatigue, weight gain, thinning hair, digestive problems, constipation, hormonal issues, miscarriage, and, after conception, has been linked to issues of the developing brain such as developmental delays, ADHD, and autism. It is also a cause of infertility. “The machinery has to be very carefully balanced to create sperm and ova. Having thyroid levels far enough out of the range that it is supposed to be adds to the problems of getting those things to happen and in the right order,” says Hays.
“I think Mother Nature’s approach is that if life is too stressful there is no need to be making babies.” She asserts that if one is able to reduce their stress, including environmental toxin exposures, then the thyroid will work better and that can return a person to a state of fertility. “If they don’t, they may get pregnant, but will they stay pregnant, does the baby’s brain form normally?” She says that to really address the issues of thyroid, we need to “go upstream” and focus on treating the causes rather than the symptoms.
Or, as Geraldine Matus says, “As soon as our reproductive health declines, our whole life health declines.” In this way she reports a dramatic degradation in women’s health over the 30 years of her practice. “WiFi, stress, dietary pollution…what are the stressors on the camel’s back that breaks a person? One person will say it is high fructose corn syrup and another lead in water.” Ultimately, she believes the root of it lies in epigenetics: how the environment causes our genetics to respond.
We’re born this way
Women are born with a lifetime supply of eggs—the total number decided for her when she is still a fetus, somewhere between 16-22 weeks old. At that time the female ovary likely contains roughly 6 million immature egg cells (oocytes). By puberty that number is 100,000 to 400,000, and at menopause only about 1,000 remain. With each menstrual cycle, hundreds of oocytes are lost and one matures into an egg, which finds its way into the fallopian tube, thus beginning ovulation. That egg actually started its journey 12 to 16 weeks before ovulation and received additional blood flow, nutrition, and oxygen. All told, the egg is one of the longest lived cells in the body, which explains why it is so vulnerable to damage and why age impacts women’s fertility so significantly.
Men produce around 1,500 sperm per second, and the supply of sperm is continually replenished throughout adulthood. The process of sperm developing from undifferentiated cells into mature sacks containing the unique information that will make up half of a baby’s genetic material (called spermatogenesis) is risky. It takes approximately 70 days and multiple splittings for a sperm to mature, providing many opportunities for genetic mutation, and the process is sensitive to environmental factors (alcohol consumption, tight underwear, exposure to toxins, heat, and, perhaps, electromagnetic fields). And while age may not be a determining factor for a man’s sperm viability, it does impact fertility and the future health of the child, as older fathers are linked to higher miscarriage rates and higher rates of birth defects and disease, including schizophrenia, autism, and a reduction in quantifiable intelligence.
The journey of the egg and the sperm that meet to become an embryo begins long before ovulation or ejaculation. It begins even before the parents-to-be are in the womb themselves. In fact, current epigenetic research suggests that the journey of a child’s health started generations before their conception.
Epigenetics: Before the womb
Defining the intricacies of human development as either DNA-based or environmental-impact-based—“nature vs nurture”—has been the prevalent way many of us—scientists included—have looked through the lens of development. Genetics and the environment, while both equally important, exist in very separate categories. With epigenetics, however, we are beginning to understand how influences once considered environmental, and presumed strictly ephemeral, are able to cause inheritable changes.
We have long understood how certain traits are passed down through generations by inheritable DNA sequences that might control things such as grandpa’s red hair, great-grandma’s dimples, or your child’s skin colour. Now scientists are researching how environmental influences—including diet, chemical exposures, and severe emotional stress—can extend beyond the womb to alter genetic material. Without changing the fundamental DNA, the expression of genes is altered in such a way (turned on, off, up, or down) that these genetic changes become inheritable. Studies show that even what might have been considered lifestyle or emotional events can have far-reaching effects on generations to come by flipping those on-and-off switches in the genes, thus changing the genetic road map in the offspring and descendants.
Environmental exposure and epigenetics
It has long been common sense for a mother to avoid alcohol and other toxins while pregnant, but evidence is now indicating that males also bear great responsibility, even prior to mating, that can produce physical and behavioural changes in the offspring. Alcoholic fathers are more likely to have children with hyperactivity and reduced cognitive ability. Fathers who smoke are more likely to have children who are obese. Exposure to certain endocrine disruptors can also have epigenetic effects on future progeny. For example, the fungicide Vinclozolin—used on the oilseed rape and other fruits and vegetables and considered “not acutely toxic”—has been shown to cause serious problems if the father is exposed during critical periods of his own development. In rat studies of this fungicide, male fetuses exposed late in their development have sons with an increased risk of tumors, kidney disease, immune system abnormalities, and infertility for at least four subsequent generations though the male line.
The Överkalix study looked at an isolated community in Sweden from 1890 to 1995. It found that circumstances such as poor food supply could affect the propensity for obesity and diabetes, and even the mortality rate in their grandchildren. The study also evidenced risks singularly passed along sex lines. For instance, if a father started smoking early in his life it increased the chances of obesity in the son but not the daughter. A grandfather’s food availability during the slow growth period of 8 to 12 years old was associated with negative effects in grandsons but not granddaughters. Similarly, a newer Australian study showed that sons (but not daughters) of obese fathers were at greater risk of developing obesity, metabolic disorders, and diabetes, when eating the same foods as males whose fathers weren’t obese.
Genetic gifts for your descendants
For those on the receiving end of some of the less-than-perfect behaviours of our forefathers, epigenetics may seem like a bum deal (and it certainly is!). But, as knowledge is power, we now have the opportunity to change things for the better in the preconception period that has the potential to positively impact our own descendants. Recovering fertility would be a sign that our good work is beginning to pay off. And it's never too late: every positive health change your child takes up has the chance to improve things for his or her children, grandchildren, and beyond.
“The best gift you give your child may be before you conceive,” says Dr. Spence Pentland. This is particularly true for men who, because of the rapid turnover of sperm, are able to influence their overall sperm health much more quickly than women can recover their fertility health. “Starting to be a good parent begins before conception,” he coaches his clients. “Even if you are going through IVF, your life force is in the egg, the optimal function of the mitochondria that produces the egg, the proficiency of the DNA replicating has everything to do with epigenetics and what you did long before [conception].”
Start by taking care of yourself
There is a growing body of evidence to suggest that factors once considered extraneous to fertility are actually essential. Proper nutrition, maintaining a healthy weight, avoiding excessive alcohol consumption, limiting caffeine consumption, partaking of acupuncture and the use of certain Chinese herbs, recovering from (or avoiding) long term use of hormonal birth control, and detoxifying (or avoiding) many of the everyday toxins associated with the endocrine system, can all help increase fertility. Pentland promotes these tangible action items that people can do while also pointing out the less tangible: namely, nurturing the spirit. As anybody who has been through fertility treatments knows, it is extraordinarily stressful. Pentland reminds both partners to take the opportunity to develop practices of self-growth and of service.
Right now, Ees and Sally are still hoping there will be good news in their future. They have undergone a second round of IVF and have one frozen embryo awaiting its shot at life.
The Green Mama’s best-shot-at-fertility suggestions
First, assess your overall health. Are there signs that your body may be under too much strain, physical or emotional, to conceive? If so, trust your instincts and consult with a healthcare provider to help get your body ready for the work of growing and nurturing a baby.
Go organic
Especially with all animal products and oils (many toxins, especially those that mess with hormones, concentrate in fats). This is important for both parents as research has found that men who eat more conventional meat and dairy are more likely to have poorer semen samples. It is believed that this reduction of semen quality is a result of the high concentration of xenoestrogens (chemicals that behave like estrogen and can have feminizing effects on the body) in conventional meat and dairy. Also look for organic alternatives to the “Dirty Dozen” most contaminated fruits and vegetables to ensure that what you’re putting in your body is free from GMOs, pesticides, herbicides, and other harmful chemicals.
Devour nutrient-dense foods
Packed with vitamins A, B, C, D, and E, iodine, zinc, iron, magnesium, folate, essential fatty acids, and antioxidants, nutrient-dense foods include organic, pastured eggs, butter, grass-fed meats and organ meats, mama-and-baby-safe seafood (with low mercury and toxin levels), beans prepared at home (not from a can), and richly coloured (and organic) vegetables such as kale and spinach, cabbages and broccoli, pumpkins, beets, and squash. Sunflower seeds, flax seeds, raw pumpkin seeds, sesame seeds, almonds, walnuts, olives, garlic, bee pollen, and lentils are all great for fertility. Bone broth from the highest quality animal sources provides gelatin and minerals to the body in preparation for the work of growing a baby.
Embrace whole foods
The less processed the better. Whole milk is better than skimmed. Broth made from bones is better than cubes. A bit of wild-caught salmon is better than fish sticks. Eat whole grains and soak or sprout the grains when possible.
Drink whole milk
If you consume dairy, eat whole-fat dairy products such as cheese, ice cream, or milk. Reduced-fat dairy foods are linked to an increase in infertility. In the largest study of diet and fertility ever done, Dr. Jorge Chavarro from the Harvard School of Public Health examined 18,555 married, premenopausal women between the ages of 24 and 42 with no history of infertility and found a correlation between low-fat dairy consumption and infertility. This study further showed that by changing dietary habits, women with infertility caused by irregular or absent ovulations reduced their risk of infertility by 80 percent. Interestingly, skim milk has been found to have even higher concentrations of xenoestrogens than whole milk.
Favour fish
Or take a fish oil supplement. Fish and seafood can be great for growing brains, and for preventing depression. Unfortunately, it can also be high in some pretty awful toxins like mercury and PCBs, which can bioaccumulate in the fish. Larger and older fish, such as tuna, king mackerel, tilefish, swordfish, and shark tend to have the highest concentration of mercury and should largely be avoided. (Many of these fish are dangerously overfished as well.) Methylmercury is stored in measurable amounts in our tissues, including our breasts and brains. It can cross through the placenta into the fetus. Growing babies and young children are especially vulnerable to the effects of mercury because it can interfere with the rapidly developing brain to cause neuron degeneration and even long-term cognitive impairment. The other toxins to worry about, PCBs, a type of persistent organic pollutant (POP), stay in the environment and the fatty tissue of animals and people for a long time and have been linked to immune, reproductive, endocrine, nervous system problems, and infertility.
Despite these contaminants, and their known neurological downsides, research indicates that eating fish during pregnancy positively impacts children’s brains. Don’t avoid seafood and fish, just eat it wisely—avoid bottom feeders, longer-lived seafood, and farmed salmon—and/or buy a high quality fish oil supplement that’s been tested to be free of mercury and PCB contamination.
Swig the highest quality water
Avoid unfiltered tap water and water bottled in plastic. Get a great water filter that removes chlorine byproducts, fluoride, hormones, and pesticides. All of these things can be found in both tap and many bottled waters.
Eschew sugar and carbs
The Chavarro study on diet and fertility said that women whose diets had the highest glycemic load—think foods that immediately enter the bloodstream as sugar—were 92 percent more likely to have ovulatory infertility than those whose diets had the lowest glycemic load. So, avoid refined sugars in the form of such things as sodas, sports drinks, and even pasteurized juices, all of which pack a mean punch to blood sugar levels. As well, avoid refined carbohydrates such as white flour foods and treats.
Refuse trans fats
In another study, doctors found that for every two percent increase in the consumption of trans fats there was an associated 73 percent increased risk for ovulatory infertility. Trans fats hide in poor quality or partially hydrogenated oils, shortening, and margarine. That means watching out for fried foods (which are almost always fried in partially hydrogenated oils) including fish and chips, french fries, donuts, potato chips, and all those other lovely, greasy favourites.
Steer clear of soy
As a person who used to eat a lot of soy, I’m sorry to report that soy—especially soy milks and tofu—are full of phytoestrogens that are best avoided by all people, especially women and men trying to get pregnant, and children. The phytoestrogens in soy have been shown to negatively affect reproduction and endocrine function and can contribute to thyroid problems. As well, soy can reduce the assimilation of minerals such as calcium, magnesium, copper, and iron, and interfere with the body’s absorption of vitamin B12, D, and protein. Soy also contains high levels of aluminum, a known neurotoxin. Men who eat or drink soy are more likely to have lower sperm counts: the equivalent of one cup of soy milk per day is associated with 50% lower sperm count than that of men who didn’t eat soy, according to a 2008 study at the Harvard Public School of Health. The issues of soy in developing organ systems are so well-documented now that a number of countries discourage soy formula for infants.
Cut out caffeine
Caffeine was shown to increase the time to conception in otherwise fertile women. Women who reported drinking over 300 mg/day of caffeine had a 27 percent lower chance of conceiving for each cycle, according to a study by Hatch and Bracken. As well, too much caffeine can disrupt the body’s ability to effectively use magnesium, potassium, and calcium, which are particularly important when growing a baby.
Spurn plasticizers
Known to negatively impact the endocrine system and hormones, be wary of plastic wrap, plastic food storage containers, canned foods, and anything bought in plastic. Remember that acidic and fatty foods absorb more of the plasticizers.
Manage your microbiome
Keep the bacteria, parasites, viruses, and other microbes that make up the ecosystem of your digestive tract healthy by avoiding antibiotics unless absolutely necessary, getting rid of all those household sources of antibacterial exposure, and eating more fermented foods.
Enhance your sleep
Sleep is one of the only ways to build up the adrenal system, which helps with all those fertility and growth hormones. It’s not just quantity of sleep that’s important. Not enough darkness (8 solid hours a night) is linked with reduced fertility. Dim the lights and avoid the sleep-and-hormone-disrupting blue lights from phones, computer screens, and CFL light bulbs around bedtime and during the night.
Take a stab at acupuncture
Acupuncture has been proven to help with many health conditions from chronic pain to compromised fertility. A 2016 study done by the British Homerton University Hospital found that using acupuncture on women undergoing IVF doubled their chances of conceiving: 46.2 percent of the treatment group conceived versus only 21.7 of the women in the IVF-only group.
Have fun
Injecting yourself with hormones, using computer apps to track ovulation, scheduling intercourse, and all the regular visits to the clinic demanded by fertility treatment is certainly not fun. And that doesn’t even account for the mood swings caused by the artificial hormones, the disappointment and sadness with each failed attempt or pregnancy loss, and the endless pressure. But trying to get pregnant should be the fun part. Learning to create time for one’s self-growth as Dr. Pentland recommends, or finding ways to bring laughter and play into a relationship can only help. If nothing else, all of this is good training for parenting, which is full of ups and downs.
Keep the big picture in mind
I grew up in a family where not one of my three siblings and I share the same set of genetics. And I couldn’t love any of them more if they looked like me. This doesn’t diminish a person’s desire to have their own genetic children, or the experience of pregnancy and birthing a child, both of which I have done and loved. It’s just a reminder that love comes in all sorts of different packages.
