What the experts say

Interview with Dr. Kristin Maloney, ND

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Q: In your experience, why do you believe so many couples are currently facing fertility challenges? What advice do you have for these couples? 

A: I think the answer is multi-faceted.  The main challenges however, that I see are: stress and advancing maternal age.  I am currently working with a couple who have quite a lot of stress and told me that previous doctors have assured them that stress does not interfere with fertility (eye roll… sigh)  There are studies that show that this in fact is not true. High levels of stress can lead to “allostatic overload”, meaning a change in stability of physiological systems affecting fertility.  In one study, they observed ovarian atrophy in response to stress in rats. Additional studies have confirmed that stress inhibits the HPG axis (hypothalmus – pituitary- gonadal axis).  

Here are some references to check out, if you’re interested:

Berga SL. Reprod Endocrinology Sure Tech 1996. Lippencott-Raven , Philadelphia: 1061-76
McEwen BS. J Psychiatry Neurosci:30:315-8

Sanders KA, Bruce NW. Hum Reprod 1999,14:1656-1662

People today are living such high paced lifestyles and are failing to nurture themselves properly, on all levels (mind, body, and spirit).  The majority of women I see are coming to me in their late 30’s or early 40’s and are both nutritionally starved and adrenally “exhausted”.  They have spent their 20’s and 30’s getting their university education and then their 30’s slipped away from them, while working their way up the “ladder” in the workplace.  And now… they want to get pregnant.  Believe me, I am all in favour of university education and desirable occupations for women, I have done so myself.  The flip side though is how do we as women, continue to “do it all” and still conserve our vitality and fertile energy into our 40’s?  The truth is that advancing maternal age is a challenge when it comes to fertility.  Women over 40 have a 33% chance of miscarriage, decline in total number of eggs and decline in the percentage of genetically normal eggs compared to women under 40.  

As a naturopathic doctor I treat the individual not the diagnosis, so all of my treatment plans are customised to the patient in front of me.  I may use some of the same nutraceuticals or botanicals from one case to another but no two treatment plans look exactly alike.  That being said, adrenal support is high on my list for all my patients because stress is such a big factor in our lives today and does have a real impact on fertility.  I prefer to use tinctures instead of pills because I believe the body can absorb the herbs better in this form.  One of my favourite adrenal formulas is some combination of: schizandra, eleuthero, ashwaganda and a little liquorice root.  Nourishing the adrenal glands can help to recharge the system and impact the dynamic interplay of the other key hormonal players: the pituitary and gonads (and can’t forget the thyroid too). They are all connected and when one system is out of balance, it affects the others as well.  In addition to adrenal support, I spend a lot of time counselling my patients on lifestyle choices and help them to carve out time throughout their day for self care. 

2) Q: Do you find preparing for pregnancy important and why?

A: YES!! Preparing for pregnancy is essential in my opinion.  I like to compare it to building a house.. Would you ever build a house without first making the blueprints and LOTS of planning? Finding the right building materials, etc? Preconception planning is analogous to preparing the blueprints and laying the foundation.  Preconception care ensures that the couple is taking the ideal quantities of nutrients for proper development of egg and sperm.  Sperm and egg development takes about 4 months, so couples have adequate time to make improvements! I put every couple on a preconception detox for four months, to get their bodies in an optimal state for those fresh eggs and sperm to do their job! Both egg and sperm (particularly sperm) are very sensitive to ROS (reactive oxygen species) and free radical (toxin) exposures- this could be from both environmental sources as well as from the foods that we consume.  The free radicals can impair sperm count, motility and most importantly morphology.  This is why it is SO important to eat a clean organic diet, with NO sugar, NO alcohol, NO processed foods during this critical period.  This includes a clean environment, with non-toxic cleaning products, no pesticides, etc. Clean, filtered water is also imperative to minimise the toxic burden.  Strict avoidance of endocrine disrupting compounds (like plastic water bottles) is crucial. During this four month detox, I will also give the couple nutrients that are needed (for sperm health and/or egg quality) depending on what they present with and what is necessary for their individualised fertility plan.  This usually is a combination of nutraceuticals, herbs, and homeopathy.   I think in reality, preconception care is the cornerstone for preventative care.  Starting with a healthy environment for a baby to grow in, and ensuring healthy adults! 

3) Q: For a woman who wishes to get pregnant, what key vitamins or minerals do you wish to see in her diet? 

A: There is an increased nutritional need for most vitamins/minerals during gestation.  Some medical conditions can create an increased need for some women to need specific nutrients.  We must keep in mind that lifestyle factors can also cause nutrient depletion. 

I always recommend a top shelf prenatal vitamin, and my favourites in this category must contain folate NOT folic acid.  Most women do not know their MTHFR status, so best to either test for it prior (ideally) or make sure that they are taking folate and not folic acid.  The MTHFR defect is a huge topic and one that I have been delving deeply into but for the purpose of this question, I would recommend that readers go to my colleague, Dr Ben Lynch’s website: http://mthfr.net/recurrent-miscarriage-mthfr/2016/11/01/  to find out more about this common genetic defect.  

Back to the question now- 

The prenatal vitamin should cover most of the bases but some women also need need extra B12, Iron, and zinc.  Prenatal vitamins are associated with better birth outcomes, compared to folic acid and iron alone.  Taking prenatal vitamins is also associated with better: birth rate, pregnancy outcomes (decreased rate of stillborn, miscarriage, neonatal death.)  B12 deficiency has been associated with menstrual cycle dysfunction, recurrent miscarriages and infertility.  Also for protection from oxidative damage, vitamins A,C,E, zinc and selenium are important to have on board.  Free radicals can have negative effect on oocyte maturation, fertilisation embryo development, and pregnancy. A low antioxidant level has been found in women with infertility. In addition to the high quality prenatal vitamin, I recommend ALL women take an omega 3 fatty acid supplement.  Vitamin D and probiotics are also essential.  

Now those are the specific nutrients in supplement form (I do believe that diet alone is not adequate these days to ensure that the woman has all her needs met nutritionally).  I do emphasise that my clients eat a whole foods, organic diet, with adequate protein and no trans fats.  The key is to “eat the rainbow”, making sure to get as many different colours on your plate at each meal with provide the most vitamin-rich meal.

I have been living in Greece for the past 6 years, and have become accustomed to the traditional mediterranean diet.  I think this diet is wonderful for many reasons but particularly for fertility.  There are studies that have been conducted that demonstrate the “greatest adherence to the mediterranean diet, showed the lowest difficulty getting pregnant in 2154 Spanish women aged 20-45 years old.” 

Toledo E et al. Fertil Steril. 2011 Nov;96(5):1149-53

And another study from the Netherlands, consisting of 161 couples undergoing IVF/ICI demonstrated that mediterranean diet adherence increased the probability of pregnancy (odds ratio 1.4). It was also associated with high folate and B6 in red blood cells and follicular fluid.   

There is no need to get overly complicated about diet, in my opinion.  Just cut out the bad stuff (processed foods, sugar, trans fats) and load up on the good stuff (organic veggies, particularly greens, and fruits, legumes, high quality organic meats and fish, limited dairy).  

4) Q: Can you share a unique or odd fertility tip that our viewers might not have heard before?

A: I can’t think of something really odd at the moment but a really simple piece of advice that I give to all my clients is to chart their cycle.  By charting your cycle, you will become in tune with your body and begin to understand so much more about your hormonal fluctuations, and when (and if) you ovulate.  You will become more acquainted with your “fertile fluid” throughout the month and combining these things will direct you to the most fertile days of the month.  I found this to be an invaluable tool for me when I was trying to conceive.  I had actually used this method years prior as “birth control”, as it gave me such a great awareness of my cycle and which days to abstain from intercourse so as to not get pregnant- so it has a dual purpose!  I won’t go into the details of how to chart your cycle because there is so much information available online as well as handy charts that you can easily print out.  I am a book lover so I have had a copy of “Taking Charge of Your Infertility” by Toni Weschler for many years.  You can check out her website as well, to learn about this method and begin charting your cycle: http://www.tcoyf.com

For those of you wishing to contact me for a consultation, I am located in Athens, Greece but I also am available for Skype calls as well.  My email is: drkmaloney@gmail.com 

 

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