Functional Fertility:
Basics and Beyond for Preconception

Whether trying to conceive naturally or going through advanced reproductive options, there are lifestyle, nutritional, nutraceutical and botanical interventions to support optimal fertility. We need balanced hormone communication and low levels of inflammation for a woman’s body to create and nourish new life.

By Blair Cuneo, PA-C

Basics:

Some quality Zzzs…

Good sleep hygiene is important for our general restoration, healing and detoxification. Our daily circadian rhythm should be an appropriate balance of our stress hormone, cortisol, and our restorative hormone, melatonin. Related to healthy menstrual cycles, chronic low overnight melatonin impacts hormone signaling between the brain and ovaries. Hormones necessary for conception include luteinizing hormone (LH), estrogen and progesterone. Production of these hormones is decreased in chronic low melatonin levels.

 

Melatonin is an important antioxidant in the follicular fluid ovarian eggs are swimming in. It acts as a strong scavenger of free radicals, protecting egg cells from cellular damage. Melatonin is also anti-inflammatory, turning down cranky messengers like NF-KB and turning up calming ones like IL-4 and IL-10. Studies with IVF patients taking even 3mg of melatonin nightly days 5 until mid-cycle showed a 4-fold increase in follicular melatonin, which resulted in decreased oxidative damage of these eggs and higher pregnancy rates.

 

Regular sleep is key for fertility. Aim for 8 hours nightly and turn off screens at least one hour before bedtime. This is to address not only the blue light impact on wakefulness, but also to limit the cognitive and psychological stimulation from texting and scrolling through feeds, for example. Use the later hours in the day to turn your attention inward and cultivate, rather than demand, sleep. Consider breathing exercises, calming herbal teas including chamomile and lemon balm, gratitude journaling and yoga nidra.

With all things, give yourself grace and start your fertility journey from a place of fullness. Know that you are enough!

- Blair Cuneo

Step away from the chicken fried biscuit…

When examining your nutrient intake, if you need a template to guide changes, I recommend the Mediterranean food plan. It has shown to improve markers of fertility for females and males.  Its major principles include:

  1. Emphasis on fruits and vegetables, providing great phytonutrient and antioxidant diversity
  2. Higher content of omega 3 fatty acids, which are anti-inflammatory, support cell membranes and improve blood viscosity which ensures good blood flow to the uterus
  3. Mediterranean foods are rich in B6 and folate – fertility boosting nutrients!
  4. Dietary fiber from vegetables and grains – keeps bowels moving regularly to support healthy detox to mobilize toxins and hormone metabolites like high estrogen, high cortisol.

Beyond:

How’s my thyroid doing?

Low thyroid function affects fertility. Around 1/3 of women experiencing subfertility have thyroid disease. The ovaries and egg cells have receptors for thyroid hormone. Thyroid testing includes TSH, free T4, free T3. TSH levels <3 are associated with better ovarian reserve. It’s important to also consider antibodies to the thyroid. Even in a patient with normal thyroid levels, presence of thyroid antibodies is correlated to increased rates of miscarriage and pregnancy-related complications.

 

What’s my Vitamin D level?

Vitamin D deficiency is linked to a number of reproductive issues including gestational diabetes, endometriosis and PCOS. Vitamin D levels >30ng/mL are associated with greater rates of pregnancy. This is likely due to higher levels of anti-mullerian hormone (AMH) when vitamin D is sufficient. The more AMH, the more eggs in the ovarian reserve, the more changes for successful pregnancy. Vitamin D is also involved in helping create endometrial docking sites to help an embryo attach and hold on tight!

 

What’s my iron status?

Iron deficiency is common in subfertility. Iron’s job is to deliver oxygen to tissues throughout the body, including the uterus and ovaries. Chronic oxygen deprivation can take a toll on egg quality and result in anovulation. Adequate iron levels build a nice, fluffy endometrium…a cozy place for an embryo to attach.

 

Am I inflamed, you ask?

A balanced immune system is important in order to conceive and carry pregnancy to term. One’s general level of inflammation can be assessed with the blood test, hs-CRP. Contributors to systemic inflammation include gum disease, food sensitivities, insulin resistance and imbalances in gut microbiome. Nutrients and botanicals to help reduce inflammation include omega 3s (fish oil) and curcumin. Additional testing is available to further investigate these areas of potential inflammation if needed.

Help your cup “run-eth” over

With all things, give yourself grace and start your fertility journey from a place of fullness. Know that you are enough! By integrating supports to reduce inflammation and balance communication, your internal supports will overflow to support the life of another. Fill your body with adequate sleep, nutrients, love, support and confidence! Involve a trusted health care provider if you need additional support and guidance along the way.

 

I’d like to thank Kalea Wattles, ND and the Institute of Functional Medicine for their educational support and offerings to help write this article.

Blair Cuneo, PA-C, is a Physician Assistant and Functional Medicine provider, certified through the NCCPA and the Institute of Functional Medicine. Before joining the Raleigh-based functional medicine practice, Carolina Total Wellness, she provided Family Practice and Urgent Care services in the Triangle for a decade. She has a B.S. in Radiologic Science from The University of North Carolina at Chapel Hill and a M.S. in Physician Assistant Studies from East Carolina University.
At Carolina Total Wellness she works with patients ages 3 years and older, especially enjoying when she is able to care for multiple members of a family. This partnership in the family dynamic emphasizes open communication, knowledge sharing and cultivation of individual and family strategies to create paths to wellness.

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