Functional fertility: optimizing your fertility holistically

Olivia Neely specializes in functional fertility. Read on for a crash course about what functional fertility is, why our conventional medical system is not set up to provide this support, and how to tell if following this approach could be for you.

You can find the original version of this post here.

What is functional fertility?

My personal definition of functional fertility goes something like this:

Functional fertility is a systems-based approach to optimize both female and male fertility by addressing nutritional, lifestyle, and psychological components that correct root-cause imbalances in order to prevent or drastically reduce infertility. Functional fertility has long-lasting benefits for the entire family unit beginning in the prenatal period and extending through to adulthood in the offspring impacting the health of generations to come.

If you are not familiar with the idea of practicing in a “functional” way, I encourage you to read my blog here. In brief, “functional” medicine is a medical approach that treats health problems or prevents them by addressing the body as an interconnected unit.

This is a very different model than the standard model of care, especially in the U.S., where our allopathic care model takes a “pill for an ill” approach that addresses one part of the body at a time. You go to the gynecologist to help with your period problems, the dermatologist for acne, and a therapist for anxiety, yet none of these experts talk to one another. If they did, they might see how they could work together to accomplish relief of all of these symptoms for you, but this doesn’t happen.

Here in the United States we have amazing emergency resources. If I am ever in an emergency situation (a car accident, a broken bone, GI bleed, etc.), I would be incredibly thankful to be under this type of medical care. However, this focus on emergency care and the “pill for an ill” model does not offer much in terms of preventive or wellness care, especially for women.

This leaves otherwise healthy individuals with a lack of answers to common underlying symptoms that are impacting their overall quality of life such as:

• Fatigue
• Infertility
• Anxiety
• Sleep issues
• Hormone imbalances like thyroid disorder or PCOS
• Skin irritations like eczema or psoriasis or acne
• GI issues like bloating, constipation, diarrhea
• Metabolic disorders like high blood sugars, diabetes, hypertension

Why is this approach so needed?

How many of you can relate to this picture?

This meme provides more than just a quick chuckle. It illustrates how our allopathic model of care is woefully lacking in the ability to see beyond the standard model of treatment and connect with the person in front of them:

The doctor has limited time to talk with you in a rushed (and usually late) visit.

The decision is made to run a standard lab panel, and then tell you that everything looks “normal” even though you are feeling terrible.

You exit the appointment still needing answers.

How disconcerting and frustrating!

The root of the problem here is that the allopathic model of care simply is not built to be able to provide the kind of care that many of us need.

Conventional “in network” doctors generally must see 20+ patients daily due to the way the US reimbursement system is structured, and this has led to a median visit length of 15.7 minutes per patient with an average 1-5 minutes spent on 6 topics (1).

While this certainly is not enough time to get to the underlying issues behind anyone’s health problems, I’d like to make it clear that this is not their fault. Our conventional GPs, OBGYNs, endocrinologists, and other MDs are all highly trained, brilliant individuals. But when they work within our conventional health system, it’s nearly impossible to practice a more comprehensive model of care.

Infertility when everything is “normal”

This is exactly the kind of system failure I am seeing surrounding the ever growing rates of infertility. 1 in 8 US couples has trouble getting pregnant or sustaining a pregnancy. Globally, infertility affects an estimated 15% of couples (2).

After trying to conceive for several months, many couples are sent home from the doctor with the following advice:

“Nothing seems wrong. Your labs are normal! You are financially ready for a baby and in great shape. Go home, have sex for a year, then come back and we will look into fertility treatments then.”

Let’s take a closer look at this scenario:

• Your labs are normal. “Normal” lab ranges are very different from “optimal” lab ranges. In fact, the values that define what puts you in the “normal” range are based on the average of the entire population: sick, old, chain smokers, couch potatoes, morbidly obese, and chronically ill. So your “normal” blood glucose is based on what is normal for the entire population, sick folks included. A 1999 study in Denmark showed that women with a high but still “normal” A1C (a blood glucose marker) were half as likely to get pregnant over a six month period as women in a low normal A1C (3). In addition, many generic lab tests are prescribed without consideration of timing. For female hormone testing, timing is everything – our hormones fluctuate on a monthly cycle, and if labs are taken at the wrong time they will not give an accurate portrayal of our reproductive system’s health.
• Sending mixed signals. The nervous system can be in one of two modes: the sympathetic (stress) mode or the parasympathetic (repair) mode. Many couples that are early in their family formation journeys are also very busy in other areas of life: high-pressure careers, abundant social lives, and more. This creates stress – both conscious and unconscious – and too much stress results in sympathetic dominance, which means your body is stuck in a chronic “fight-flight-or freeze” mode. When the body perceives this stress it sends hormonal messages to both female and male reproductive organs via the hypothalamic-pituitary-gonadal axis (4) that it’s not a good time to think about growing another human. Women’s bodies are particularly sensitive to stress, whether it comes from career pressure or going to too many Barry’s Bootcamp classes each week. So as much as you may want to get pregnant, your body may be sending the exact opposite signal to your reproductive system!
• Suboptimal terrain: Did you know the prenatal microbiome may play a role not only in fetal development but also in the predisposition to diseases that may develop in adulthood (5)?  Stress, birth control, alcohol, NSAIDs, and environmental toxins all damage the gut microbiome and deplete the very vitamins and minerals needed to support conception. A year is a long time to do some incredible improvements on your gut health, yet many couples are never made aware of the impact this can have on the health of their future family.

These are just several areas that impact our fertility that a couple can be actively working to improve while they wait to hit the 12 month mark of TTC (trying to conceive), which is the point at which an infertility diagnosis can be made under the standard approach. Unfortunately, as mentioned above, most couples are advised to revisit their doctors upon hitting the year-mark without said doctors taking a closer look at lifestyle factors that could be inhibiting conception.

The standard approach to fertility

Once an official infertility diagnosis is made, most conventional doctors will revert straight to medical intervention, more often than not with a hyper focus on the women’s reproductive system (even though 1 in 3 infertility cases are caused my male reproductive issues (2), many of which can be improved with dietary and lifestyle practices!).

With so much female fertility technology available like Clomid, intrauterine insemination (IUI), and in vitro fertilization (IVF), it’s easy for many to jump right to these as solutions.

For many doctors in the standard (allopathic) model of care it doesn’t make sense to dive deep into areas like hormone balance, gut health, thyroid support, and stress management. Addressing root causes for infertility such as a short luteal phase, low progesterone, PCOS, hypothyroidism, autoimmune disease, poor sleep hygiene, and gut dysbiosis is often overshadowed by the ease that a quick Clomid prescription or IUI attempt can bring.

A single round of IVF generally costs upward of $10,000, sometimes sitting in the $15,000 range. Many employers are beginning to cover this as a benefit for their employees, but for women who do not have this coverage, IVF can be a hefty investment.

If you wanted a baby yesterday and have the health coverage or personal savings to pay for these procedures, taking the standard approach may work for you. But, if you aren’t ready to commit to invasive procedures and lofty medical bills, it’s important to know that you have other options.

A functional approach to fertility

None of the solutions above address the underlying root-causes of impaired fertility, which can be many and take a little bit of digging. For couples who want to address underlying root causes behind trouble conceiving – and are also comfortable that addressing these issues and seeing changes can take upwards of 6-12 months – a functional approach may be a better fit.

Much like general preventative care, we can make changes now to optimize our future fertility. We know that a full cycle of egg development takes 4 months, and several cycles are sometimes needed to prepare our bodies for conception if we have recently been on hormonal birth control or are trying to re-balance our body from a condition like PCOS.

This in mind, I generally recommend women start to prepare their bodies 6-12 months before they even start trying to conceive; it takes many of us at least a full egg cycle to optimize our fertility if we are starting from a place of imbalance. During this time, I have found it helpful to follow an approach of the “three pillars of functional fertility” –

• Pillar 1: The Non-Negotiables. During this time, we explore how to rebuild your foundation. This takes a look at you holistically: digestion, sleep, stress, and more. If other aspects of your health are struggling, even the most expensive fertility treatments and prenatal supplements may prove to be futile efforts.
• Pillar 2: Depleted to Repleted. After we’ve established a solid foundation to build from, Depleted to Repleted dives into finding the best nutrients and movement to balance your hormones, directly support egg and sperm quality, and encourage egg maturation. If you’re someone who is doing everything by the book and still not where you want to be, you may be reading the wrong book. During this step we will take a personalized approach to identifying which lifestyle choices are best for you to get your body to a place where it is ready to conceive.
• Pillar 3: Fertile Grounds. In this final pillar we put your foundation to the test. Your body is capable of incredible healing, do you believe in that possibility? Finally understand what it takes to give your body permission to thrive.

Who is functional fertility for?

In short, everyone! Let’s take a close look at this.

• If you are having difficulty TTC. PCOS is the number one reason for female infertility, however, standard lab tests are not always helpful in detecting this imbalance and it is only one possible root-cause imbalance that could be going on. With help from appropriate hormone testing, increasing antioxidant rich foods, and supplementation, together we can rewrite your fertility story.
• If you are trying to conceive through IVF or IUI. The above strategies taken in functional fertility like minimizing toxin exposure, implementing dietary changes, and adding targeted supplements will help support our bodies for IVF and IUI journeys by helping our body produce higher quality eggs.
• Those experiencing recurrent miscarriage. Improving egg and sperm quality, assessing thyroid health and immune function, and assessing progesterone levels through appropriately-timed testing are all strategies for avoiding a miscarriage. In fact, studies have shown that women who have Hashimoto’s Thyroiditis (an autoimmune thyroid disorder which is severely under-diagnosed in women) may be able to reduce miscarriage rates by 50% when thyroid antibodies are lowered through dietary changes and an added treatment of Levothyroxine which stops the antibody attack on the thyroid (7).
• Everyone else. Improving egg quality is helpful for all of us, even women without any existing fertility concerns. Young, healthy women with normal egg counts and no existing hormonal imbalances will still usually have a significant proportion of abnormal eggs that are ovulated throughout our reproductive years. If our bodies ovulate these abnormal eggs for several months in a row, this can decrease the chances of conceiving. Making sure our bodies are optimally balanced will in turn enhance our new egg quality and help accelerate future conception efforts.

Citations

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254573/

(2) Manaker, L. (n.d.). Introduction. In Fueling Male Fertility (p. 2)

(3) Fett, R. (n.d.). The Egg Quality Diet. In It Starts With The Egg (p. 207)

(4) https://www.ncbi.nlm.nih.gov/pubmed/15723162

(5) https://www.ncbi.nlm.nih.gov/pubmed/30544936

(6) Fett, R. (n.d.). The Egg Quality Diet. In It Starts With The Egg (p. 112)

(7) Fett, R. (n.d.). The Egg Quality Diet. In It Starts With The Egg (p. 22)

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