Updated: Dec 28, 2020
While I was studying nutrition, one topic that peaked my interest (and later my passion) is fertility. When I began doing some research around fertility and how to optimize my chances of conception, I quickly realized how complex fertility can be. I remember getting quite nervous that my husband and I would have difficulty getting pregnant. I have had quite a few friends experience sub-fertility and I was worried that we might experience that as well.
While in nutrition, we had to do several projects based on conditions someone might experience in their lifetime. My first project centered around anovulation, or, when a female is not ovulating. I wanted to share what I learned on this topic to start the conversation about sub-fertility. From what I have seen in the past, sub-fertility has become a taboo topic. It is important to me (and hopefully to you as well) to have these conversations with others to acknowledge and hopefully understand the difficulties infertility brings. I will be continuing to share more information around infertility in men and women, along with some actionable strategies to optimize fertility.*
According to the American Pregnancy Association (2017), sub-fertility affects one out of every six couples. ONE OUT OF SIX! That means that they been trying to conceive for a full year and have been unsuccessful (if the woman is under the age of 35) or have been trying for six months if the woman is 35 or older. While the exact cause of sub-fertility can be difficult to pinpoint, there are a variety of factors that can influence fertility in both men and women. When experiencing sub-fertility, it is important to rule out any physical reasons conception is not occurring. For women, this could include damage to Fallopian tubes, ovulation disorders, endometriosis, and uterine or cervical issues. For men, they may be experiencing sperm concentration issues, sperm motility issues, varicoceles, or genetic conditions. The particular post will be an introduction to female sub-fertility due to anovulation (not ovulating). Next week's post will focus on dietary and lifestyle factors to optimize fertility.
In order to understand anovulation, it is helpful to first understand a female’s menstrual cycle. When a menstrual cycle is functioning optimally, there are five key hormones involved in the process. They are estrogen, progesterone, follicle stimulating hormone, luteinizing hormone, and gonadotropin releasing hormone. Throughout the cycle, which is typically around 28 days (but can be a bit shorter or longer), there is a rise and decrease of these various hormones. They each play an important role within the cycle, and when those hormones are out of balance, fertility will become challenging. During the first phase of a woman’s cycle, known as the follicular phase, progesterone and estrogen are fairly low. This will then signal to the pituitary gland to release follicle stimulating hormone, which in turn then stimulates the ovaries to form a follicle to prepare for ovulation. An egg is then released and travels down to the Fallopian tube where it is either fertilized by a sperm or, if not fertilized, dissolves. The follicle will then produce more estrogen to prepare the body for pregnancy, which then triggers luteinizing hormone to be released. Ovulation will only last between twelve-to-twenty-four hours and it is only during the ovulation period that a woman can become pregnant.
If a woman has an anovulatory cycle, her ovaries do not release a mature egg. There is the possibility for a woman to occasionally have an anovulatory cycle, however, if she is experiencing chronic anovulation, then this becomes a problem. Anovulation can occur when there is an insufficient level of progesterone in the body, which may lead to heavy bleeding (Timmons, 2016). Because of this bleeding, a woman will assume she is having a regular menstrual cycle. Other triggers of anovulation can be:
· Sudden changes to hormone levels
· Body weight that is too high or too low
· Extreme exercising
· Eating habits that are deficient in key macro- and micro-nutrients
· High levels of stress
With anovulation, luteinizing hormone could also be suppressed. Luteinizing hormone is what triggers ovulation to occur so it is vital that this hormone is functioning properly. This surge of luteinizing hormone occurs mid-way through a woman’s cycle. Luteinizing hormone can be suppressed by elevated levels of prolactin in the body, which can be triggered by hallucinogenic drugs, alcohol, aspartame, excess protein, antidepressant medication, headache medication, menstrual cramp medication, and breastfeeding. There are other conditions that could potentially be the cause of anovulation as well. According to the article by Hamilton-Fairley and Taylor (2003), additional conditions could be due to hypothalamic pituitary causes (where the pituitary gland is not producing enough luteinizing hormone and follicle stimulating hormone), polycystic ovarian syndrome (where there in an excess of androgen production so a dominant follicle is not produced), premature menopause, and genetic abnormalities.
If a woman wants to understand her cycle and fertility, there are several ways she can monitor it. She can utilize hand written charts, apps on her phone, a calendar, and even ovulation tests. Apps and resources that I recommend are:
· Kindara app
· MyFLO app
· Clue Period & Cycle Tracker app
· Natural Cycles fertility monitor
· https://fertilityfriday.com/ (this was one of my favorite podcasts while I was preparing for pregnancy)
Through charting and monitoring over a few months, it may become apparent that ovulation is not occuring. This could be a helpful indicator that hormones are out of balance and may need some additional support. If using an app is not something that is prefered, there are a few other ways to identify the signs and symptoms that ovulation is occurring. Orecchio and Buckley (2015) provide an outline of what to look for when a woman is ovulating:
· A lower abdominal pain on one side of the body
· A change in the viscosity of vaginal discharge, along with an increase in amount
· Basal body temperature will decrease a few days before ovulation, then increase after you have ovulated
· An increase in desire for your partner
The signs and symptoms of anovulation may not be as obvious as other conditions a person can experience. As mentioned earlier, a woman may still bleed during her cycle and interpret that bleeding as menstruation. If you are on hormonal birth control and are taking it correctly, you are not ovulating. Another sign a woman may not be ovulating, according to Gurevich (2018) is that she is having irregular periods (meaning the length varies from cycle to cycle). This highlights the importance of tracking your cycle each month. If a woman suspects that she is not ovulating, she can ask her primary care physician to run a few tests for confirmation. They can check progesterone levels, the lining of the uterus, and the presence of certain antibodies in the blood, along with even doing an ultrasound to take a look at the uterus and ovaries.
To help promote ovulation and support female fertility, a real foods diet can be a good place to start. A real foods diet, which is what we focus on in this course, can help balance hormones and set the stage for conception. Focusing on seasonal, organic, unrefined, and local foods while minimizing the amounts of refined foods is a great way boost to fertility naturally. It is also helpful to take a look at caffeine intake; alcohol, smoking, and drug use; exposure to environmental toxins; and reducing stress.
In next week's post, we will go on a deeper dive into some specific foods and nutrients to focus to optimize fertility, while also taking a look at possible lifestyle factors to adjust.
American Pregnancy Association (2017). Female Infertility. Retrieved from http://americanpregnancy.org/infertility/female-infertility/
Gurevich, R. (2018). Anovulation and Ovulatory Dysfunction: What to Know. Retrieved from https://www.verywellfamily.com/anovulation-and-ovulatory-dysfunction-1959926
Hamilton-Fairley, D. & Taylor, A. (2003). Anovulation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC192851/
Orecchio, C. & Buckley, W. (2015). How to Conceive Naturally and Have a Healthy Pregnancy After 30. New York, NY: Grand Central Life & Style Hachette Book Group.
Timmons, J. (2016). Anovulatory Cycle: When you Don’t Release an Oocyte. Retrieved from https://www.healthline.com/health/pregnancy/anovulatory-cycle#1
*The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. This information serves as general knowledge and for informational purposes only. While all content is written by a holistic nutrition coach, your specific health needs may or may not apply to the content within this website.