This series of articles is looking at fertility and how naturopathic medicine can help improve it if you are having difficulty conceiving. Over the last few weeks, I have talked a lot about hormones and their relationship to infertility; last week we discussed the role of thyroid hormone and this week I will explain the significant role that stress and another important hormone – the stress hormone cortisol – play in fertility.
If you missed any of the previous articles in this series and would like to catch up you can find them here:
We all know what it is like to be stressed.
Stress is anything that the brain and body perceive as being stressful and can be caused by many things – physical, environmental or emotional. A physical stress can be caused by pain or missing a meal. Environmental stressors can include being too hot or too cold and emotional stress can be caused by a disagreement with a spouse or friend, or a confrontation with your boss. One major source of extreme emotional stress is the inability to conceive and/or frequent miscarriages and it’s a frustrating (and often upsetting) paradox that this stress can be the one thing that prevents you getting pregnant. It’s not uncommon to hear about a friend or family member that was working hard to get pregnant and, once they decided to stop trying or started the adoption process, they were able to conceive naturally, often without any assisted reproductive technologies. I want to explain why this is and give you some tips to prevent the wear and tear of stress on your body, and improve your fertility.
What Does Stress do to Fertility?
One of the main reasons stress inhibits conception seems to have its roots in an evolutionary mechanism. As a species, if we were too stressed, it meant it was not a safe time to bring an infant into the world because of famine or lack of shelter or attack from wild animals. The problem is that now the stressors we are under are very different than they were 100, 500 or even 1000 years ago but we still respond to stress in exactly the same way we did hundreds of years ago – we produce cortisol as part of the ‘flight or fight mechanism’ that prepares us to face down, or run away from, danger.
Stress and Fertility
The reason stress can affect both male and female fertility is rooted in our hormones. Our sex hormones (estrogen, progesterone for women and testosterone for men) and our main stress hormone (cortisol) are all made from cholesterol. Cholesterol is, in fact, the backbone of all our steroid hormones.
There are two main pathways that these hormones can take from the cholesterol molecule. One creates testosterone and estrogen while the other creates progesterone and then cortisol. When males are stressed, the emphasis on hormone production is shunted away from testosterone and towards making cortisol. When females are stressed, their hormone production is shunted from progesterone and towards cortisol. Simply put, when men are stressed their testosterone drops and when women are stressed their progesterone drops.
For optimal fertility men need healthy testosterone levels in order to produce plenty of healthy sperm – strong, linear swimmers with a good morphology vital for making the long journey from the testes to the female fallopian tube.
For women, progesterone levels are needed primarily for keeping the uterine lining in place for a fertilized egg to implant into. Low levels of progesterone lead to a short luteal phase which may not give enough time after ovulation for a fertilized egg to solidly root into the uterine lining. If progesterone levels are not high enough or they drop too quickly then this will trigger the uterine lining to shed causing the onset of a menstrual period. Low progesterone levels can also cause a miscarriage in the early part of a pregnancy; it takes 10 weeks for a placenta to be up and running and one of the many jobs of the placenta is to produce progesterone. This means that, until the tenth week, women are relying on the corpus luteum (or shell of the egg) in the ovary to produce adequate amounts of progesterone to maintain the pregnancy. If the woman has been under acute or chronic stress her body prioritizes cortisol production over progesterone and, as a result, her blood levels of progesterone drop.
How Do You Test Your Cortisol Levels?
Cortisol levels have a circadian rhythm and should be high in the morning and low in the evening so the best way to check cortisol levels is by doing a 24-hour salivary cortisol test. This is a spit test, not a blood test – blood tests are primarily used to check for adrenal pathologies such as Addison’s (low cortisol) and Cushing’s (too much cortisol). By testing your cortisol over 24 hours you can tell not only your over all levels but also that the levels are ideal for the time of day. Once you know this you can be specific about the type of supplementation needed.
In addition to checking cortisol we can also check levels of testosterone (men) and progesterone levels (women). Both of these can be done with a blood test. For males, you want to test blood drawn in the morning for both free and total testosterone. For women you want to do a ‘pooled progesterone test’ – a single draw of progesterone will not give you enough data to know if your progesterone level are high enough for fertility purposes so you need to draw blood on 3 different days starting after ovulation. It is the sum of these 3 draws that will give you an accurate progesterone value.
Tackling Stress and Infertility – Taking Care of the Adrenals
Cortisol is produced by the adrenals, tiny little glands that live on top of the kidneys and produce many hormones, of which cortisol is the predominant one. The adrenal glands play a key role in fertility, and yet their role in the conventional medical model is overlooked. The bottom line is this:
Supporting your adrenal glands supports your fertility.
Unfortunately, there are no quick fixes for the adrenal glands. The state of our adrenal glands is the sum of many years of stress, poor diet and lifestyle and it may take many months to restore them to optimal health. However, that doesn’t mean that making changes now won’t have an immediate effect on your health and fertility.
Promoting adrenal health, whether you have too much or too little cortisol, is the same approach. The main treatment difference will be in the choice of botanicals and whether you need support reducing high cortisol. Here are my top diet and lifestyle tips to improve your adrenal health and your fertility.
Diet plays a major role in promoting fertility and most women who are trying to conceive are already eliminating caffeine and alcohol, and working on eating a healthier diet. Eating a diet that puts less “stress” on the adrenal glands reduces elevated cortisol and helps maintain healthy levels of the reproductive hormones needed for fertility, for both men and women.
The main hormone produced by the adrenal glands is cortisol whose main job is to regulate blood glucose levels (our blood sugar). When our blood sugar levels drop too low this is considered a “stressor” on the body causing the brain to trigger the adrenal glands to produce more cortisol. Cortisol then tries to rectify the situation by putting more glucose into the blood, primarily from stores in the liver. So one way to reduce this extra production of cortisol is to avoid that blood sugar dip by eating 3 meals (and possibly 1 or 2 snacks) every day, this will help regulate your blood sugar levels by avoiding dramatic peaks and troughs. A slow steady rise and decline of blood glucose is less stressful on the adrenal glands and the pancreas which produces insulin to shuttle the glucose from the blood and into the cell so try to avoid meals that are high in sugar and refined carbohydrates and that contain healthy fat, fiber and protein as this will give you a steady rise in glucose after a meal instead of a sharp spike.
This is primarily about stress management. We all have stress but it is learning techniques to deal with that stress that is key. One of the best ways to reduce excess cortisol is through exhalation. The yogis have it correct when they say it is all about the breath. Spending some quiet time alone on a daily basis and focusing on slow steady breaths can do wonders for getting rid of excess cortisol. In addition aerobic exercise is also important for decreasing cortisol. This is one of the reasons we feel so much better after exercise. Some people learn meditation or study other relaxation techniques such as restorative yoga, Tai Qi, Qi gong or Bio-feedback. I recommend trying different techniques to determine which one is best for you.
Referred to as good sleep hygiene, this means trying to get an average of 8 hours of sleep every night with the first 1-2 hours occurring before midnight when cortisol levels start to climb. If you stay up too late you will find it harder to fall asleep because of cortisol’s circadian rhythm. Cortisol levels should be at their highest in the morning and lowest in the evening; if we go to bed closer to 10 pm then we are following the normal hormonal rhythm of the body and good sleep cycles reduce stress on the body.
There are standard vitamins that are good for supporting the adrenal glands and balancing cortisol levels.
Note: Some botanical formulas & herbs are best prescribed once you know what your cortisol levels are. Consult with your naturopathic doctor for specific advice.
1000mg twice a day
Vitamin B Complex
1 capsule a day
Take in the morning and with food as vitamin B complex can make you nauseous if taken on an empty stomach or with not enough food.
Vitamin B5 as Pantethine
500mg twice a day
Vitamin B6 as Pyrodixine
250mg a day
30mg twice a day
2 capsules at bedtime if cortisol is elevated at night
Withania/Ashwaganda (an adaptogen that is good for balancing cortisol)
1-2g a day
Licorice (helps raise cortisol levels)
1-2g a day
Only use under the care of a physician since this plant can cause elevated blood pressure.
Rhodiola (an adrenal herb that is traditionally used as a fertility herb in some parts of the world)
200-600mg a day
For many women, adding progesterone supplementation after ovulation may be necessary. I prefer to get bio-identical progesterone from a compounded pharmacy.
Note: I recommend you talk to your physician about this if your progesterone levels are low. You can also support progesterone levels through some simple dietary changes.
Trying to get pregnant can be one of the most stressful events for many couples and often, people do not realize just how much stress they are under. Stress, whether acute or chronic, is a significant factor when it comes to fertility health. As a culture, we all experience various forms of stress on a daily basis; however it is our ability to recover and heal from it that makes a difference to the wear and tear on the adrenal glands and reproductive hormones. There are many tools a couple can use to help minimize the effect of stress on their bodies and increase their chances of conceiving. To find out more, or to schedule an appointment, use the book online tool above.
Join me next time as I conclude my fertility series by discussing lab testing for those planning to get pregnant or who have been struggling with infertility.