infertility

Treating Infertility with Specialized Pelvic Therapy: A Natural Approach That Works

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In a 10-year study of 1392 infertile women, manual physical therapy yielded high pregnancy rates for women in three categories of hormonal infertility. Subsets of participants showed success for women with endometriosis, polycystic ovarian syndrome (PCOS), and high FSH (follicle-stimulating hormone).
The therapy was originally designed to treat pain due to the adhesions that form when the body heals. Adhesions tend to remain in the body, acting like an internal glue after healing has occurred. Adhesions can act like tiny straitjackets, causing pain or dysfunction – including infertility.

Endometriosis adhesions

Endometriosis, Infertility and Adhesions

Endometriosis is considered both a mechanical and a hormonal condition, with adhesions frequently accompanying endometrial implants. The therapy is designed to decrease the cross-linking, the tiny but powerful white attachments shown in the drawing. In the 10-year study, 43% (128/299) of the women diagnosed infertile with endometriosis became pregnant after receiving the therapy. This rate compares well to surgical success rates, but without the costs or risks of surgery.

PCOS and Infertility

In the study, 54% (15/28) of women diagnosed infertile with polycystic ovarian syndrome (PCOS) achieved pregnancy after therapy. While this is a smaller subset, this rate is encouraging; it is much higher than the 22% to 33% pregnancy rates achieved after surgeries cited in the study. In surgery for PCOS, the physician will either drill holes in the ovary or remove a wedge-shaped portion of the organ. One reason for the low pregnancy rates after PCOS surgery may be the new adhesions that form as the body heals from the surgery.

High FSH Infertility

pregnancy rates for women with high FSHOne of the biggest surprises in the ten-year study was in women who were diagnosed hormonally infertile due to high FSH (follicle-stimulating hormone). As a woman approaches menopause, her ovaries demand more and more FSH to stimulate egg growth in older follicles. Measured early in the menstrual cycle, most physicians feel a woman’s FSH levels should be at or below 10 mIU/mL. When a woman’s FSH is above 10, she is considered unlikely to conceive. At FSH of 25, the woman is generally considered to be menopausal.

In the 10-year 2015 study, a surprising 39% (48/122) of women diagnosed subfertile or infertile due to high FSH became pregnant after receiving the therapy; 43 of the pregnancies were natural, and five were by follow-up IVF.

“The data with these women has been absolutely remarkable” said Belinda Wurn, director for Clear Passage Physical Therapy. “Before this study, nothing in medicine has been shown to improve FSH and fertility naturally. Until now, none of us imagined that a manual therapy could have such profound effects, without surgery or drugs.”

The therapy (Clear Passage Approach™) is available at a dozen locations in the U.S. and the United Kingdom. Treatment consists of 20 hours of hands-on care described as “feeling like a deep, site-specific massage.” The therapy is often given 4 hours a day for 5 days. For more information, visit clearpassage.com.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Feature image: Tulia Colombia Torres Hurtado Pixabay

This article was published originally on August 15, 2017. 

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Recovering From Medically Induced Chronic Illness

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Unexplained or Medically Induced Chronic Illness?

“Unexplained.”  That’s what doctors say about chronic illness. Conventional medicine says, ‘learn to live with it.’ Rather than offer a true treatment or cure for these debilitating conditions, they suppress the immune system and offer more drugs for depression and anxiety – none of which are effective. I’m here to tell you that common wisdom is wrong. I know, because my own lucky story proves we can heal from chronic illness. Pharmaceutical insults created my disabling illnesses  – Chronic Fatigue, Fibromyalgia, estrogen dominance, adrenal fatigue, POTS, Graves’ Disease, Hashimoto’s, Bell’s Palsy, infertility and more. I share my journey to offer hope. The doctors were wrong. I have recovered and am once again, healthy.

Early Clues and Pharmaceutical Insults

My childhood had some clues – things I now know predict chronic illness. My lymph glands swelled when I was otherwise healthy. Mosquito bites turned into angry 3” welts. Childhood bunions and hyper-mobile joints suggested leaky gut. All these issues correlate with chronic illness and, seen in hindsight, hint at the difficulties that awaited me in adulthood.

My immune system may have been awry from the start, but pharmaceuticals tipped the scale toward chronic illness. As a teen, I took birth control pills for heavy periods and cramps. When vague symptoms appeared in my early twenties, I asked about pill side effects. The gynecologist laughed at the idea, but I trusted my gut and finally stopped the pill. I felt better in some ways but developed new symptoms.  Sleep became difficult. I was hypersensitive to noise and light and struggled with unquenchable thirst.  The doctor suggested my extreme thirst stemmed from hot weather and salty foods. This explanation didn’t add up to me, but I was young and so was the internet. I had no resources to connect the dots. Today, I recognize that 10 years of hormonal birth control created nutrient deficiencies (folic acid, vitamins B2, B6, B12, C, and E, along with magnesium, selenium and zinc) while also raising my risk for future autoimmune disease.

Recurrent UTIs, Fluoroquinolones, and New Onset Graves’ Disease

A few years later, recurrent urinary tract infections led to many doses of the fluoroquinolone antibiotic, Cipro. Cipro now carries a black box warning and is known to induce mitochondrial damage. My mid twenties also brought pre and post-menstrual spotting and bleeding for 10 days each month. Doctors did nothing for my hormonal imbalance but diagnosed Graves’ disease (hyperthyroidism). Everything about me sped up. Food went right through my system. I was moody. My mind was manic at times. I was unable to rest and yet physically exhausted from a constantly racing heart.

The doctor said Graves’ disease was easy – just destroy the thyroid and take hormone replacement pills for the rest of my life. I didn’t have a medical degree, but this treatment (RAI, radiation to kill the thyroid) just didn’t make sense. Graves’ disease is not thyroid disease. It is autoimmune dysfunction, where antibodies overstimulate a helpless thyroid.

As I studied my options, I learned that RAI could exacerbate autoimmune illness and many patients feel worse after treatment. It was surprising to find that the US was the only Western country to recommend RAI for women of childbearing age. Armed with this knowledge, I declined RAI and opted for medication. The endocrinologist mocked my decision. I was in my 20s and standing up to him was hard, but it marked a turning point and spurred me to take responsibility for my own health, rather than blindly trusting doctors. Recent reports suggest RAI treatment increases future cancer risks. My Graves’ disease eventually stabilized on medication, although I never felt really well. I pushed for answers for my continued illness, but doctors refused to test my sex or adrenal hormones.

IVF and More Damage to My Health

Things turned south again when I was unable to conceive. The supposed best fertility clinic in Washington, DC could not find a cause for my infertility. I’ll save that story for another day, but the short version involved a few years of torment and four failed IVF attempts. The fertility drugs and the stress worsened my overall health considerably.

Our last try at pregnancy was with a specialist who practiced functional medicine. Labs and charting uncovered a clear progesterone imbalance, and also explained my spotting. This simple diagnosis was completely missed by the conventional fertility clinic. A brief trial of progesterone cream resulted in two naturally conceived, healthy pregnancies. Isn’t it remarkable that several years and over $100,000 failed to produce a baby with IVF and $20 of progesterone cream on my wrist did the trick? This could be a cautionary tale about profit motive in modern medicine, but that, too, is a topic for another day.

Years of Conventional Medicine: Thyroid Damage, Autonomic Dysfunction, and Profound Fatigue

I weaned off thyroid medications and felt fairly well after my babies, but my system took a big hit when life brought an international relocation. The move was intensely stressful and my health sunk after we landed half a world away. I had no energy, gained weight, and lived in a fog. The tropical heat and humidity of Southeast Asia felt like a personalized form of torture.

Perhaps the stress of our move left me vulnerable to the reappearance of autoimmune and adrenal dysfunction, as my next diagnosis was Hashimoto’s Disease and adrenal fatigue. Doctors ordered functional medicine tests (hair, organic acids, stool, saliva cortisol and hormones) that identified nutrient imbalances, but their treatment ideas fell short. Despite replacement hormones and supplements by the handful, I remained very sick, with profound exhaustion, brain fog, sleep disruption, pain, and terribly imbalanced sex hormones.

Taking Matters Into My Own Hands

If setbacks have a bright side, it is in the drive to get better. I started studying when my doctors ran out of ideas to treat my illness. Fibromyalgia was the best description of my pain, but I knew conventional medicine offered no help for this condition. I dug into the topic and found the work of Dr. John C. Lowe, who used T3 thyroid hormone for fibromyalgia, and Paul Robinson, creator of CT3M, the circadian method for using T3. CT3M and high daily dose of progesterone cream improved my quality of life in the short term. Near daily bleeding eventually regulated back into a normal cycle and my adrenal function improved greatly.

Postural Orthostatic Tachycardia Syndrome (POTS) was the next bump, bringing a very high heart rate, very low blood pressure, heat intolerance, and extreme sweating on the lightest activity. By this time, I didn’t even ask the doctor for help. My research pointed to salt and potassium, and so I drank the adrenal cocktail and salt water daily. POTS symptoms vanished quickly with this easy strategy, as did the nocturnal polyuria that plagued me for many years.

I steadied after this time. I was not well but functional, despite some major life stressors, including another international move and a child’s health crisis. Even though I managed the daily basics, things like house guests, travel, or anything physically taxing required several days to a week of recuperation.

The Next Step: Addressing Nutrient Deficiencies

The next step in my recovery came thanks to a B12 protocol that includes co-factor nutrients, developed by Dr. Gregory Russell-Jones. Addressing the deficiencies connected to B12 helped and things progressed well until I had a disastrous reaction after eating mussels, which I hoped would raise iron levels. I vomited for hours and stayed in bed for days. I kept up the B12 protocol, but just couldn’t recover. Largely bedridden, and napping 4 hours at a stretch, I got up in the evening only to drive to a restaurant dinner, too exhausted to prepare food or deal with dishes.

Debilitating exhaustion lasted for a month, and then two, with no relief. It was an awful time, but hitting rock bottom proved a blessing in disguise, as desperation turned me back to research. Slowly, I pushed through brain fog and started to review studies on chronic fatigue and fibromyalgia. This led me to a promising Italian study using thiamine for these conditions.

Studying thiamine, it seemed plausible that the allergic reaction to mussels drained my B1 reserves, making it impossible to recover. Inspired by the research, I started on plain B1 at very high doses. To my surprise, I felt better right away. The first dose boosted my energy and mental clarity.

I continued to learn about B1’s benefits, thanks to this website and the text by Drs. Marrs and Lonsdale.  Two weeks went by and thiamine HCL seemed less effective, so I switched to lipothiamine and allithiamine, the forms recommended in Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition. WOW. What a difference! Virtually overnight, my gears began to turn, and I felt better with each new day. In a single month, I went from bedridden to functioning well 2 out of every 3 days. I had ideas, I had energy, and I could DO things. The setback days were mild and disappeared entirely after 2 months on thiamine.

At the 2 month mark, I had to travel for a family emergency. My pre-thiamine self would have needed at least a week of rest following this kind of trip, and I expected pain and fatigue as I stepped off the plane. But to my great surprise, I felt well! I remember walking through the airport late that evening and thinking it felt amazing to stretch my legs. Maybe that sounds like an ordinary feeling, but years of chronic fatigue and fibromyalgia conditioned my body to stop, to sit, whenever possible. It was entirely novel to FEEL GOOD while moving! The next day came and I did not collapse, I did not require days to recover and was able to carry on like a normal person. It was a remarkable change in an unbelievably short time.

Recovery From Conventional Medicine’s Ills Came Down to Thiamine

Getting better feels miraculous, but it’s not. The real credit for my recovery goes to experts like Dr. Marrs and Dr. Lonsdale who spread the word about thiamine. Despite years of illness and dead ends, I believed I could heal and I kept trying. Tenacity eventually paid off when posts on this site helped connect the dots between my symptoms and thiamine deficiency. More than anything, my recovery is a story of tremendous luck, as I finally landed upon the single nutrient my body needed most.

The difference between my “before thiamine” and “after thiamine” self is beyond what I can describe.  Birth control, Cipro, and Lupron created nutrient imbalances and damaged my mitochondria, leading to multiple forms of chronic illness in the years between my 20s and 40s. Replacing thiamine made recovery possible by providing the fuel my damaged cells so badly needed. At this writing, I am 7 months into high dose thiamine and continue to improve. I have not experienced any form of setback, regardless the stressors. My energy feels close to normal, the pain is resolving, and brain fog is a thing of the past. My sense of humor, creativity and mental functioning are all on the upswing. I owe thanks to the real scientists who dare to challenge wrong-headed ideas of conventional medicine, and who provide hope for these so-called hopeless conditions. My wish is that this story will do the same for someone else.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Infertility Faux Pas: 5 Things Not to Say to Someone Struggling to Conceive

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Infertility is really, really hard. It’s harder than I’ve ever even admitted to myself. It’s also deeply personal. Reminders of your infertility are everywhere. I’m not just talking about all of the babies at the employee picnic or the pregnant women at the grocery store or the mailbox full of baby announcements and shower invitations. I’m talking about insidious little reminders like this ad that Aldi posted on Twitter.

Aldi Tweet

“Dear Aldi, you are opening a giant, fluorescently lit discount grocery store. You are not having a baby,” is what I was thinking when I read this tweet. (After clicking the link, it turns out that Aldi is starting to carry a line of baby products so I can see how the people in charge of marketing would think this advertisement is clever. Even so, it still feels a little like- “oh, even a grocery store can have a baby… but not me!”)

Infertility affects millions of women— over 6 million in the United States alone. It is so common that I’m sure you know at least one person affected by it. Yet as common as it is, people still say the strangest things when they find out you are struggling to conceive. So if you would like to be a more sensitive person to those you know (or may not even realize you know) that are dealing with fertility issues, here are some things not to say.

“You just need to relax and then it will happen.”

I cannot count how many well-meaning people have told me this. I also cannot count the ways I tried to “relax” in order to get pregnant. I got massages and acupuncture and did so many yoga classes I became a yoga teacher. I meditated. I feng shui-ed my house. I talked to my belly. I went on vacation. I thought about getting pregnant. I stopped thinking about getting pregnant. And guess what? None of those things make you pregnant. You cannot relax your way into pregnancy any more than you can relax your way into making it rain. If it’s not going to rain, it’s not going to rain.

Why this is unhelpful: You are essentially blaming me for my infertility when you say this. Infertile women (and most women for that matter) are already blaming ourselves for so many things that are really out of our control. Please stop blaming us for this, too. Also, studies show that moderate stress does not affect fertility.

What to say instead: Wow, that must be really hard. I’m here to listen if you ever want to talk about it.

“I know so many people who started the adoption process and then got pregnant.”

Good for you! Good for them! Do I really need to explain why this is so ridiculous? Okay, I will. Adoption is not a cure for pregnancy. I could see how this would be confusing to some people because it can be an alternate way to grow your family when you can’t grow them in your body. However, it is not a magic pill that tricks your body into getting pregnant. Most people who say this think that you are just too focused on getting pregnant and that starting the adoption process will distract you and therefore make you pregnant. This false logic is closely tied to the “relax and it will happen” (see above). It is akin to telling Michael Phelps that his body will swim faster if he just takes up knitting.

Why this is unhelpful: The only people that should start the adoption process are the people who are ready and excited to adopt. Adoption is not a placebo for pregnancy.

What to say instead: Wow, that must be really hard. I’m here to listen if you ever want to talk about it.

“Why don’t you just adopt a (twelve-year-old/ handicapped kid/ kid with cancer)? I would totally do that.”

The people who have said these things to me are invariably the people who had zero problems conceiving their 2-5 perfectly healthy children. Let me tell you something about coming to the decision to adopt a child. It is a very hard thing for many people. Especially when you have dreamed of having a child that looks like you and your partner. Especially when you have imagined what it must be like to feel your baby move inside you, a very part of you.

When you don’t actually have to make that decision, you can imagine you are the type of person that would adopt any and every desperate child in the world no matter the circumstance. Your heart is just that big. You can imagine that you would be the Mother Teresa of adoptive parents. And you can sit with your perfectly healthy, instantly conceived child in your lap while having fantasies about what kind of person you are. BUT when you actually start the adoption process, the fantasy stops. Because you literally have to write down what you are willing to deal with and what you would rather not deal with. Which means you have to say, “hey, you know what, I don’t really want to adopt a kid with cancer because going through the adoption process and becoming a parent is already hard enough.” Remember above where I said we infertile women are already blaming ourselves enough? Cue the crashing waves of guilt for wanting a healthy baby when there are so many other children that need homes. Does anyone ever blame a pregnant woman for wanting a healthy baby?

Why this is unhelpful: The adoption process is challenging, exhausting, and often extremely expensive. Judging anyone’s decision about when and how they proceed with this process (especially if you have no experience with adoption) isn’t just ridiculous. It’s cruel.

What to say instead: Wow, that must be really hard. I’m here to listen if you ever want to talk about it.

“I’m pregnant! April Fools!”

Since the United States treats pregnancy like a disability anyway, this could be a little like saying “I’m in a wheelchair! Just kidding!” Okay, maybe that’s a stretch, but it’s a weird thing to joke about. And it’s a thoughtless thing to joke about.

Also, according to the CDC, nearly half of all pregnancies are unintended. I would imagine an unintended pregnancy is very stressful, too.

Why this is unhelpful: Not only are you poking those of us who are infertile but you’re likely causing anxiety for half of your pregnant friends as well.

What to say instead: Nothing. Have you ever heard a good April fool’s joke?

“Happy Mother’s Day.”

I don’t think I am one to take things personally when it’s not warranted. Maybe I used to but as I mentioned above, I’m very relaxed now (lots of yoga classes… seriously, tons). However, this one stings. It just does. For the past couple of years, I’ve been lucky enough to spend Mother’s Day with two of the best mothers out there, my mom and my sister. During the course of the day, sales clerks, servers, and other people we encountered would say to each of us, “Happy Mother’s Day!” Sure, these lovely folks got it right for two out of three. Yet for me, each time felt sort of like a tiny little dagger into my infertile little heart.

Why this is unhelpful: It’s not really unhelpful. It’s well-meaning. But it still hurts those who aren’t mothers yet desperately want to be.

What to say instead: I don’t know. Keep being nice to people for sure. The world is too hard not to. Maybe try a genuine, “I hope you’re having a really nice day” rather than a robotic “Happy Mother’s Day!” to every woman that comes through your check-out line.

I did leave one thing off the list. Never, ever, ever comment when a woman is buying a pregnancy test. There is no right thing to say here. Not “oooh how exciting!” Not “uh-oh, good news or bad news?” Not “you must be celebrating tonight!” Remember when I said above how many people were dealing with fertility issues and also how half of all pregnancies are unplanned? More times than not, pregnancy tests are bringing tough news. Don’t comment on these at all.

I’m sure if you have dealt with fertility issues you could add others to this list. What have people said to you that made things harder? Was there anything anyone told you that was helpful?

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was published originally in June 2016.

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Improving Male and Female Fertility with Vitamin D

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Vitamin D is essential to a healthy life, at any stage, yet its effectiveness is often overlooked by practitioners treating parents who are trying to conceive. The overwhelming majority of infertility cases are treated with drugs or surgical procedures, and are successful less than 50 percent.

Supplementation presents a simple, safe, inexpensive, and potentially effective approach to preparing for fruitful conception. In this article, I address vitamin D’s role in reproduction, evidence supporting the positive effect of this nutrient on fertility, and how to become vitamin D healthy parents.

Vitamin D’s Role in Reproduction

The human reproductive system comprises billions of cells. Every cell in the female and male reproductive systems contains genetic codes as well as a receptor to receive vitamin D.
Vitamin D is actually a steroid hormone produced by our body. We manufacture vitamin D when we take a quality vitamin D3 supplement, expose our skin to optimal sun light, or consume lots of fatty fish or vitamin D3-fortified foods.

Cells in the female reproductive system (including the ovaries, fallopian tubes, uterus, placenta, and decidua) are replete with vitamin D receptors. The male reproductive system cells (including the testes, prostate, and urethra) also are abundant with vitamin D receptors.

When we have ample amounts of activated vitamin D, it binds with its receptor to regulate genes in our reproductive system. For example, activated vitamin D in the female reproductive system controls the genes involved in estrogen production. Vitamin D also regulates several genes during the process of embryo implantation.

Conversely, when the reproductive system lacks activated vitamin D, genes essential to conception are not expressed. Hence, the chances of achieving successful conception are diminished.

Both Mom and Dad Need Vitamin D for Fertility

For many couples, getting pregnant and carrying a pregnancy to term present daunting challenges. But few understand how vitamin D plays a role in fertility of both biological parents. Scientific research indicates that the significant prevalence of vitamin D deficiency correlates to the incidences of infertility cases in women and men:

  • Researchers in Milan, Italy conducted a study of 335 women who were candidates for in vitro fertilization (IVF). Published in the August 14, 2014 issue of The Journal of Clinical Endocrinology & Metabolism, the study demonstrated that the women with vitamin D levels of more than 30 ng/mL (75 nmol/L) enjoyed the highest chance of pregnancy. The researchers concluded vitamin D is an emerging factor influencing female fertility and IVF outcome.
  • Greek researchers recently examined 30 years of scientific literature on the role of vitamin D in human reproduction. The accumulated evidence suggests that vitamin D is significantly involved in the reproductive system of both genders. Regarding fertility, the researchers noted that vitamin D status is associated with semen quality and sperm count, motility, and morphology. Moreover, they concluded that there also is a positive effect of vitamin D supplementation on testosterone concentrations and fertility outcomes. The review was published in a 2013 issue of the International Journal of Clinical Practice.
  • An Australian fertility specialist, Anne Clark, M.D., presented findings to the 2008 Fertility Society of Australia Conference that demonstrated the role of low vitamin D in men. More than one-third of the 794 men who underwent a vitamin D blood serum test were determined to be deficient in vitamin D (as well as folate). Among the couples where the male completed supplementation treatment for nutritional deficiencies, more than one-half conceived naturally or with minimal treatment.

How to Become Vitamin D Healthy Parents

In today’s modern indoor living, the most effective source of vitamin D3 (cholecalciferol) is an oil-based soft gel or liquid supplement. Vitamin D3 supplements are available over the counter in retail and online stores. Beware of vitamin D prescriptions as most contain vitamin D2 (ergocalciferol) that is much less effective than vitamin D3.

The amount of vitamin D3 depends upon your vitamin D level, derived from a simple blood test called 25(OH)D. Assume you are vitamin D deficient (most people are) and get your blood tested by your healthcare practitioner.

Based on the results of your test, supplement daily with vitamin D3 to safely increase your blood levels. A number of vitamin D experts believe a healthy vitamin D range is at least 50 to 80 ng/mL (125 to 200 nmol/L).

Repeat the test in three to six months. Increase or maintain your daily D3 dose in response to your current level. Getting within range will take time (at least months) but rest assured that you will be gaining vitamin D wellness that should increase your chances of getting pregnant.

Vitamin D’s benefits do not end with fertility! Stay tuned for my next Hormones Matter article “Maternal Vitamin D: Pregnancy and Beyond.”

Editor’s Note: Susan Rex Ryan is an award-winning author who is dedicated to vitamin D awareness. Her extensive collection of health articles can be found on Hormones Matter as well as on her vitamin D blog at smilinsuepubs.com. Follow Sue on FB “Susan Rex Ryan” and Twitter @vitD3sue.

Hormones Matter does not provide medical advice, diagnosis or treatment.

Copyright © 2014 by Smilin Sue Publishing, LLC
All rights reserved.

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Thyroid Hormone T3 Protects Ovaries from Chemo and Other Damage

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Women who undergo chemotherapy for any cancer often face infertility due to premature ovarian failure. The chemo drugs themselves deplete ovarian follicles and granulosa cells gradually leading to what is called chemotherapy induced amenorrhea (CIA). The only strategy currently available to maintain a modicum of fertility is oocyte or embryo cytopreservation, extracting and freezing the eggs alone or fertilized for later use. While encouraging, this is not an option for many women, especially younger women.

Researchers in Italy may have identified another method for preserving fertility post chemotherapy. They hypothesized that if they could protect the granulosa cells, those cells that control follicle (egg) maturation and hormone production, from chemotherapy induced apoptosis (cell death), then perhaps fertility could be protected post chemotherapy. Through a series of experiments, they found that the thyroid hormone, triiodothyronine or T3 prevented chemo induced cell death via multiple mechanisms.

Study Details – T3 and Ovarian Granulosa Cell Survival

Ovarian cells from female rats were extracted and cultured in media that contained the chemotherapeutic drug paclitaxel (PTX) alone, plus vehicle or PTX plus T3. Post extraction and pre-exposure, the cells were evaluated to ensure the extraction process did not alter normal steroidogenic pathways and to confirm the presence of all the appropriate thyroid hormone machinery. Next, a series of tests were conducted to measure cell cycle activity with the different exposures. The researchers found that T3 prevented PTX induced cell death and allowed these cells to cycle normally. T3 blocked critical factors actively involved in PTX related cell death.

What This Means

Thyroid hormones regulate each of the fundamental processes associated with cell proliferation, differentiation and cell death in virtually all tissues. That they would be involved in preventing cell death relative to chemotherapy is not surprising. That the thyroid hormone machinery is present in ovarian granulosa cells is also not surprising. What is surprising is that we are have only recently begun to look towards these endogenous ligands and hormones systems as therapeutic options for disease.

T3 is a proliferative hormone, known for initiating and maintaining growth processes in tissues. In hepatocytes, the liver cells, T3 protects against apoptosis via both genomic and non-genomic mechanisms. In the pancreas, T3 promotes survival of the beta-cells in diabetic induced apopotosis.  In the heart, thyroid hormones regulate rhythm and other processes. We see diminished T3 in cases of multiple sclerosis and other axon degenerating diseases. Researchers have shown that when T3 is added back, the disease state shifts from one of progressive demyelination towards a pattern of remyelination, regrowth and ultimately healing. Since at least 13% of diabetics also have hypothyroid conditions, where pancreatic beta cells are destroyed and peripheral neuropathies are common, T3 could be a viable treatment option here as well. It would protect not only pancreatic health but heal the peripheral neuropathy and perhaps even control the progression of the associated heart disease.

T3 and Common Women’s Health Conditions

Where disorders of reproduction are concerned, the role of T3 is less clear. In the present study, we see evidence that T3 exerts a protective and pro-survival effect on the granulosa cells. Should we expect, given its pro-survival role in other tissues that T3 would be involved in regulating cell survival in the non-beneficial tissues as well, such as fibroids, endometriotic and adenomyotic growths, and ovarian and other cysts? Since T3 is functionally pro-survival would this mean that the abnormal tissue growth seen in common women’s health conditions is linked to too much T3? Maybe not.

With polycystic ovarian syndrome (PCOS) correcting hypothyroidism was associated with a regression of ovarian cysts and a reduction of androgenic hormones, suggesting other hormones are also involved in tissue growth. This makes sense. Hormones operate in systems. It is never as simple as one hormone > one function or set of functions. The cells involved in reproductive tissues come in many forms, have many functions and are bathed in a veritable cocktail of many different hormones and other ligands, each controlling a myriad of processes.

From the research thus far, T3 prevents cell death in dying tissues. It is not clear whether it would initiate the same pro-survival mechanisms in non-dying or proliferating tissues. It is also not clear how T3 interacts in the presence of other hormones and other signals. What is clear is that many women suffer from hypothyroidism and also suffer from a slew of reproductive conditions that involve aberrant tissue growth. How the two are connected ought to be investigated more thoroughly.

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This post was published previously on Hormones Matter in March 2014. 

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Escaping Endometriosis: Hell to Happiness

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It all started at the age of 13. I went from a tall, lanky tom-boy, to a young frightened teenage girl who was having her first surgery, a laparoscopy, to determine if I had endometriosis. I didn’t know what the word meant; I only knew I wanted it to go away. I was confirmed to have endometriosis and given laser treatment to burn off the lesions, scar tissue and cysts that were forming on my right ovary. I had started my period a few months earlier, and with each cycle my problems began and intensified. At the time of my diagnosis, I had Stage IV endometriosis. Little did I know that this was only the beginning of a long and hellish life-altering journey over the next 2.5 to 3 decades.

One in ten women have endometriosis, but despite that, this disease is not well recognized. I had become a statistic that most people don’t understand, and even fewer have patience for. Looking back, I felt like I fell into a rabbit hole with no way out. My teenage years were awkward to say the least. After being diagnosed with endometriosis, I was placed on birth control pills for several years and not allowed to have a period. The pain wasn’t as bad, but my acne, anxiety, mood swings, concentration, and other complaints continued with full force. I hated my teenage years and basically everything about my life. Pictures were not allowed to happen.

Dealing With Infertility

During my early twenties, I got married and decided I wanted to have a family. I went off the pill and dealt with the acne, pain, constipation, mood swings, and depression as best I could. My marriage was far from good, and I mistakenly thought having a child would fix everything, or at least make me feel semi-whole. But, I was infertile.

For over five years I tried to get pregnant, without success. To say I felt less than a woman is an understatement. It was just one more thing I couldn’t do. Between 1980 and 2005, I consulted numerous specialists and followed their protocols, bought thousands of herbal/natural products, gave up one thing after another, and went to the extreme of cosmetic surgery in an effort to help myself with my acne and skin. Yet, with each passing year, I continued to yo-yo up and down, and my ability to bounce back with each down swing became increasingly harder. I was left infertile, feeling ugly and alone, and felt completely helpless and hopeless.

Anxiety, Depression, and Suicidal Thoughts

In 1997, after going through a very stressful and painful divorce, my endometriosis became uncontrollable. The all-encompassing and incapacitating pain of my condition, as well as the severe cystic acne, uncontrollable bleeding, and low self-esteem sent me spiraling into the depths of depression and anxiety. I thought to myself, “Is the rest of my life going to be like this? This is hell! I can’t continue to live like this. How will I ever escape from this nightmare?” My list and severity of symptoms were increasing despite trying many different protocols and consulting with a myriad of practitioners across all specialties. My acne went from my face to traveling down my neck onto my chest and my back, making the upper half of me raw and ugly looking. I tried dermabrasion, laser resurfacing treatment, Retin-A, Witch hazel, topical acne creams, internal acne remedies, all without success.

Worsening Symptoms of Endometriosis

Towards the end of my divorce, I started bleeding more and more. Each cycle lasted longer, became heavier, and the cramping intensity increased. My time in between my periods became less and less. I was put on birth control pills again to try and stop my bleeding. After a couple of months we increased the pills to two a day in the hopes of slowing down the bleeding. But, after six months, I was still bleeding heavily, anemic, exhausted, and severely depressed. The pain I dealt with on a constant basis felt like knives cutting me from the inside out. The panic attacks started shortly thereafter.

I went through four different procedures in the hopes of slowing down my bleeding: another laparoscopy, two endometrial ablations, and a D&C. These did work for a short period of time, but then within weeks, my bleeding would start again. Suddenly, I had a whole new list of things to deal with. On top of everything else, my legs started blistering, my hair started falling out, I didn’t have the strength to get out of bed, and I couldn’t stop crying or feel any joy with life. I absolutely wanted it all to end. Then came the hot flashes. I was consumed by hopelessness and despair. I was alone, without support, and ready to quit.

The doctors I went to for help gave me one excuse after another as to why things were going the way they were going. I was told “I was allergic to the sun”, and “everything was in my head and I needed to see a shrink.” One didn’t know what was wrong with me but he would give me more drugs in the hopes that it will help, at least with my depression and panic attacks.

Finally, I went to my gynecologist. When I told my doctor what was going on with me, he tested my hormones and found that being on the pill caused the majority of estrogen to be gone from my body. My hormones were completely screwed up. So, that day, he decided to take me off birth control pills so my body could ‘correct’ itself. I went from being a suicidal, crying, pimply mess to an enraged, homicidal crazy woman…and in the space of about three days.

The Beginning of the End

I HATED men, and HATED doctors even more. And then one day, while working, I broke. I had a nervous breakdown. I was immediately put on leave, and told to see the state psychiatrist (I worked for state government at the time). It was at this point, I knew I had to help myself.

My Healing Journey Begins

It was during this time in my life I decided to become a doctor. I didn’t want to be a medical doctor because frankly, they didn’t help me and it felt at times made me worse. I wanted to help heal people. So, I chose to become a Doctor of Chiropractic. This one decision led me to discover another side of medicine I had never heard of before…functional medicine.

Functional medicine teaches that each body system is inter-related. One system or organ has an effect on all systems in our bodies. And, when our systems fall out of balance, we are no longer able to adapt and overcome physical, physiological, emotional, mental, or spiritual stressors. The principles of healing our bodies using functional medicine involve several areas that are often neglected by traditional medicine. We need to cultivate a mindset for healing and transformation, and establish a nourishing lifestyle and optimal nutrition. We also need to minimize the toxic burden on the body by eliminating as many environmental and physiological stressors as possible, and at the same time maximize the detoxification pathways. We need to reduce stress, and break destructive patterns that create a stress response.

I applied the principles of functional medicine to correctly identify and remove the physiological stressors that were blocking my health. In order to determine where the breakdown was occurring I utilized specialized salivary testing that most medical doctors don’t even know about. I also checked my detoxification status, methylation, HPA Axis dysfunction, and much more. I learned how important our gut health and brain health were in relation to our hormones, and worked on correctly the real problem. And I succeeded.

I have learned that the magic bullet, “quick fix” protocols do not work. This is not ‘take a pill’ to ease one symptom, this is a process that allows for your body to heal all symptoms. Just focusing on one aspect of your health and your body is the wrong way to determine and correct where the breakdown is occurring. Understanding, accepting, and working with your body as a whole is the way to healing. It requires time, active participation, and the right type of health professionals to guide you through the process. My new understanding of health and healing have changed my life.

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Endometriosis, Recurrent Pregnancy Loss and Autoimmune Disease

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“When there is breakdown in the mother’s immune system … it is more than likely that the embryo will have a problem protecting itself from the maternal immune system” – something so simple and yet often overlooked. According to Dr. Jeffrey Braverman, a leading reproductive immunologist, both maternal and paternal autoimmune disease and general immune system dysfunction play prominently in infertility and recurrent pregnancy loss, and yet, very rarely are these conditions considered against that backdrop.

Maternal Immune Function, Infertility and Recurrent Pregnancy Loss

In the moms, his research team has identified a cluster on autoimmune haplotypes or genetic fingerprints associated with infertility and recurrent miscarriage that include several patterns of HLA genes associated with common autoimmune diseases. HLA genes code for the human leukocyte antigens called major histocompatibility complexes, the immune cell molecules that guide the activity of our immune reactions. The HLA haplotypes or patterns Dr. Braverman’s group found associated with recurrent pregnancy loss include those for: Hashimoto’s disease, lupus, multiple sclerosis, antiphospholipid syndrome, Sjogren’s syndrome, scleroderma and autoimmune hepatitis.

Frequently, the moms also have endometriosis and sometimes even asymptomatic endometriosis, or what he calls, silent endometriosis. While the connection between symptomatic endometriosis and infertility is clear, the notion that endometrial implants are present but causing no symptoms except infertility is a novel one. Research in rodent models of endometriosis suggests that the neither presence nor size of endometrial implants necessarily confers pain. Rather, it is the location of the growth and more specifically, whether the endometrial  implants contain nerve fibers that determine whether there is pain. Dr. Braverman’s discovery of a silent endometriosis may support that finding.

More importantly, Dr. Braverman contends the autoimmune nature of endometriosis and specifically, the intra-abdominal inflammatory cytokines and the over-production of mitochondrial reactive oxygen species (ROS), may act to deactivate sperm and must be corrected before pregnancy will take place.

“The autoimmune nature of endometriosis can affect egg quality by elevating the intra-abdominal levels of inflammatory cytokines that the ovaries are directly exposed to. This causes a condition known as oxidative stress and raises the level of a “toxic” chemical called ROS (reactive oxygen species) that the eggs are exposed to. (This can be treated to improve egg quality). In fact in IUI cycles or in patients trying to conceive on their own, these same ROS molecules can essentially deactivate the sperm sometimes requiring IVF even when there are no signs of tubal blockage.”

More often than not, the women who seek treatment with Dr. Braverman have been seen by other reproductive specialists who disregarded the immune dysfunction as contributing to infertility or recurrent pregnancy loss. Thyroid function, in particular, plays a large role in maternal and embryo health and is one of the most commonly disregarded culprits of infertility and recurrent pregnancy loss. As thyroid receptors are located on the follicle and thyroid antibodies have been identified in the follicular fluid, especially with PCOS, small perturbations in thyroid concentrations will affect the growth, quality of the follicles and one’s overall ability to conceive. Additionally, since thyroid hormones directly impact mitochondrial functioning and dysfunction or ROS production, it makes sense that identifying and treating thyroid disease would be imperative for healthy pregnancy.

Thyroid Disease and Recurrent Pregnancy Loss

Identifying and correcting immune dysfunction is critical to promote conception and pregnancy. Commonly, this involves a specific set of supplements targeted towards the patient’s particular type of immune dysfunction.

Supplements for Infertility and Recurrent Pregnancy Loss

Paternal Health: Dad’s Role in Recurrent Miscarriage

More often than not, dad’s health is ignored once conception takes place. It is believed that once a woman becomes pregnant, dad’s contribution is no longer important and the remainder of the pregnancy is solely her responsibility. Not so, says Dr. Braverman. Dad’s health, dad’s immune system health and compatibility with mom’s immune system are large contributors to whether the pregnancy is sustained or miscarried. Dad’s immune function determines sperm morphology or shape. Even slightly askew sperm have difficulty with motility and mobility, egg penetration and/or can contain fragmented DNA, which will then evoke miscarriage. Moreover, chemicals in the seminal fluid interact with the mom’s immune system and determine whether she will tolerate the growing embryo. Dad’s health is critical to mom’s ability to get pregnant and stay pregnant.

Paternal Contributions to Infertility and Recurrent Pregnancy Loss

 

What to Do Now

If you or yours are having issues with infertility, consider correcting maternal and paternal health issues first, in advance of attempting to conceive. Reproductive immunologists and other more functional medical specialist may be able to help.

Please note, Hormones Matter has no association with Dr. Braverman’s practice. We simply appreciate his approach.

This article was published previously on Hormones Matter in July of 2014.

 

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Assisted Reproductive Technologies, Birth Defects and Epigenetics

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Assisted reproductive technologies (ART) have grown in popularity and success over the recent decade. According to the CDC, in 2011 there were 61,610 babies born via ART, representing 1% of the US newborn population, nearly doubling ART use in just one decade. ART can be a blessing for the nearly 6% of US couples struggling with fertility issues. In the 30 years since ART began, there have been over 3.5 million children conceived using ART, many of whom are now adults of reproductive age. One wonders, what long-term, transgenerational effects might exist from ART; will those conceived via an assisted reproductive technology, also require reproductive assistance? Are the rates of cancer, especially reproductive cancers and hormone dependent cancers known to be epigenetic in nature, increased? Each of these questions remains to be addressed fully, but here is what is known so far.

The Basics – What is ART?

Assisted reproductive technologies refer to the techniques used to bring sperm and egg together in order to achieve pregnancy. The methods of assisted reproductive technologies include: in vitro fertilization – embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), and frozen embryo transfer (FET). By far the most common is IVF- ET with fully 99% of couples using this method of assisted reproductive technology. IVF begins with intense hormone treatment to stimulate maternal oocyte production. Those eggs are removed and fertilized with the donor or partner’s sperm.  In most cases, eggs and sperm are placed in a petri dish and allowed to mix freely. In some cases, additional manipulation is required and the sperm is injected into the egg. This is called intracytoplasmic sperm injection or ICSI. IVF plus ICSI appears to account for a large subset of the birth defects associated with IVF.

Early Indicators of Birth Defects with Assisted Reproductive Technologies

A 2007 study of California couples found that children conceived using ART, especially those conceived with ICSI, had a 35% increase in risk for birth defects compared to those conceived naturally. Most common among them were eye abnormalities, heart defects and malformations of the genitourinary tract. Other studies have linked ART to an increased risk major structural malformations of the heart, cleft lip and palate, esophogeal atresia (the esophogus dead-ends in a pouch rather than into the stomach where it should be) and anorecto atresia – (a malformed anal opening).

Among the few studies addressing birth defects and developmental anomalies post infancy, a Chinese study found an increase in observed birth defects in ART males as time progressed, compared to females and compared to those observed at birth. In fact the rate of observed birth defects doubled over the course of the 3 years. Similarly, a study looking at one year olds conceived via ART found a doubling of the rate of multiple major birth defects including chromosomal and musculoskeletal defects.

Long Term Consequences of ART

Studies looking at longer-term difficulties, whether health or developmentally related are few and have had mixed results, always ending with the caveat that it is unclear whether the assisted reproductive technology or the original infertility itself was to blame for the defect. There does seem to be a near doubling of the risk of some rare cancers children conceived via ART, but again the data sets are small and the risk of theses cancers in general is low.

A more recent study compared cardiac function between children and young adults conceived naturally versus those conceived with ART. What they found was striking. The apparently healthy individuals with no visible malformations who were conceived by ART had significant decreases in cardiac and pulmonary functioning by a number of parameters. There was marked vascular dysfunction of the systemic and pulmonary circulation, to which the authors of the study suggest may lead to premature cardiac morbidity at a rate similar to rates seen in type 1 diabetes.

ART and Imprinting Errors

A number of ART epigenetic studies published have assessed the risk or rate of what are called imprinting errors. Imprinting errors occur when genes are incorrectly silenced. A individual normally gets one active imprinted gene, either from mom or dad. When errors occur, they may get two active or two inactive copies. Children born from assisted reproductive technologies have an increased risk of imprinting errors compared to the rest of the population. The common conditions that arise include:

As with the some of the other birth defects observed with ART, those using ICSI – the forcible injection of the sperm into the egg, seem to proffer higher risks and seem to affect males more than females (or perhaps, as is the case with most research, it is the male offspring that are studied more frequently). Of note, the combination of ICSI and environmental endocrine disrupting chemical exposures is linked to trends in demasculization and potential sterility.

Epigenetics and Assisted Reproductive Technologies

Thus far the notion of epigenetic changes in children conceived via assisted reproductive technologies has been limited to research on the aforementioned imprinting errors, also called epimutations. Research on the broader consequences ART, particularly in general health and reproductive health is lacking. The exposure to hyper hormonal states common in many assisted reproductive technologies has the possibility of disrupting critical hormone pathways across the lifespan of the offspring and may impact his/her reproductive health in subtle, and not so subtle, ways. Some effects may not appear until much later in life and certainly there is the possibility of transgenerational changes as those observed with DES, dexamethasone and other hormone exposures during embryonic and fetal development. Additionally, as evidenced by the study on cardiac-pulmonary function, it is conceivable that many of the epigenetic effects will be functional in nature versus more obvious structural malformations. However, because ART bypasses the natural buffers in human reproduction that might have otherwise selected out for specific traits, it is difficult to disentangle native ‘deficits’ – those of the mom and dad – versus those directly linked to the procedure itself. Only time will tell what the effects of ART are on the health and functioning of subsequent generations.

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