Secondary Infertility

It may surprise you to know that there are more than one type of infertility; and I don't mean male and female infertility. One of the lesser known types of infertility (or subfertility) is secondary infertility. This is described as the inability to conceive after birthing one (or more) children.

The causes of secondary infertility are along the same lines as primary infertility:

1. Sperm quality

2. reproductive organ damage

3. Scar tissue or complications from previous surgery/pregnancies

4. Risk factors like advanced age, obesity, and other health issues in both partners.

The reasons of secondary infertility are not all that shocking, however, when a couple decides to try to achieve pregnancy for the second, third, or fourth time, and they find themselves trying for a year or more, not attaining pregnancy can be a bit of a shock.

This is a huge benefit of charting cycles with FAM or NFP. Regardless as to how one approaches trying to conceive, knowledge of ovulation and symptoms that are (or are not) present can be a blinking red indicator of where the dysfunction lies.

Another concern for this issue is self-diagnosis. Often times I hear of couples who may have been surprised with their first pregnancy. And then a few years down the road, when it is time for baby number two they are discouraged when in the first month they do not conceive. I am in no way insinuating that secondary infertility doesn't exist, but I think it is very important that we stick within the diagnostic characteristics of the disorder at hand. 

In my opinion, secondary infertility can be just as harmful emotionally as primary infertility. To have the want and love for a baby you haven't met yet, and to month after month be disappointed is challenging enough, and then if you express sadness over secondary fertility often times the retort is that, "You already have one baby, some people don't even have that!" This goes back to that nasty old parent-guilt business that I talk about all the time. 

Below are some of my personal thoughts on the causes of secondary infertility:

1. Stress. I say this ALL the time in person, but let's say it here too! 

         If you go in to your kitchen and you see a kitchen fire, what is the first thing you are going to do? You probably wont start to fold laundry. You are going to try to put that fire out and save your house! Your body works similarly. There are natural cycles happening all over the place inside of you, and that's how its supposed to be; FSH, serotonin, insulin, TSH, even daily poops work on a schedule and cycle. So if your body perceives a greater threat, the focus will move away from those "activities of daily living" (think chores and errands) and hone in on the crisis at hand (think kitchen fire or basement flood). Managing family, friends, work, and toddler is pretty stressful. Take that natural stress and then impose upon it the rampant parent-guilt of modern culture, and stress levels easily become unmanageable. Then, on top of that, add the stresses of disappointment of not conceiving as quickly or as easily as a couple did the first time around, and you have a recipe for cortisol soup.

           To all of this I say: Chiropractic. Chiropractic is the methodology of helping the body adapt to stress. Often times people will say, "Oh, my shoulders are so tight! It's just stress though." I entirely disagree. Stress is common. Stress is everywhere and we all feel it in different ways and places and manifestations, but it's always there. However, you should be able to work with the stress in your life. When you fail to adapt, dysfunction becomes a major factor. This is most evident in people with knee pain; almost always, knee pain comes from hip or foot dysfunction. The most significant take away from that metaphor is that it is simply a metaphor; these mal-adaptations happen in our brains, in our lungs, in our visceral organs, in our nerves, and because our spinal cord is the main communication device between our brain and our cells and tissues, it plays a major part in how we adapt to stress. Long story short: get your nervous system checked.

2. LAM. Lactation Amenorrhea Method.

       This is actually a form of NFP, sort of kind of.... Basically, if a woman ecologically breastfeeds, as in, no schedule, and feeding baby whenever baby is hungry (including night time), she can and most likely will delay the return of her menses. I live in a community that has a higher than average age for first births. Some may think of this as a negative thing, but I think its pretty beautiful. We also have a higher than average single earner family rate. I also think this is beautiful. Families on the Central Coast tend to be pretty crunchy, and we have a much higher than average "prolonged breastfeeding" statistic. It is not impossible to achieve pregnancy while breastfeeding, and despite some old wives tales, it is not harmful to breastfeed throughout pregnancy. However, the return of menses is also accompanied by a shortened luteal phase. The stunted luteal phase means that while a woman may be ovulating, her body is not providing a nice soft endometrial pillow for the fertilized egg to implant upon. The luteal phase should be at least 12 days so that the egg has time to make the trip from the Fallopian tube to the uterus, implant, and begin the division processes that will lead to a viable pregnancy. If the luteal phase is too short, the egg will simply be disposed of during the period, like every other non-fertilized egg of her menstrual cycle's history.

3. Shortened luteal phase due to other circumstances.

     Unfortunately our culture is soy, and otherwise xeno-estrogen happy. Our government subsidizes the growth of soy beans, so much like wheat and corn, it is in everything. Hormonal birth control is also widely popular in our country. These are a few factors that contribute to the over all estrogen rich ecosystems that we walk around in daily. Estrogen dominance is not simply, "too much estrogen." Though, "too much estrogen" is absolutely an issue of its own. The greater issue is the amount of estrogen in relationship to the amount of progesterone in the body. For about half of the menstrual cycle, it is meant for estrogen to be the dominant hormone. Estrogen is responsible for the thickening of the endometrial lining; so it is safe to say that estrogen creates the pillow for the fertilized egg to implant upon. However progesterone is the luteal phase dominant hormone. This means that within 36 hours of ovulation, estrogen drops and progesterone starts to ramp up. Progesterone is the dominant hormone after ovulation and only when progesterone starts to wane, will the menses begin. If a woman's progesterone is low, then the woman is more likely to have a quicker onset of menses; so her period will start again quicker than if she had more progesterone. When the menses returns quicker, say, less than 12 days, the environment of her uterus becomes less friendly to conception, or rather, implantation.


In short, secondary infertility is a heartbreaking experience. The best thing you can do is be an advocate for your own health and chart your fertility. Note cervical mucus, LH spike, and how many days after ovulation your period comes. These factors alone can make a world of difference. You are not alone and you are not broken. You are not wrong for wanting another baby. Just because you have one baby doesn't mean you should be satisfied or accepting. Fertility is a natural cycle in our lives to be respected. Please don't feel selfish or arrogant for wanting another baby. And please reach out for help if you have feelings of depression and futility.

Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 2004;117:126-31.

Carbohydrate consumption and estrogen

It's been a while since we did a more keto/research filled post. So, let's hop on it!

First:
Estrogen dominance is an umbrella term for a culmination of health issues affecting not only fertility, but the whole body [1]. It is important to note that estrogen dominance doesn't necessarily mean an excess of estrogen, but potentially a lack of progesterone. This is significant because in some instances, decreasing estrogen may not be the issue. Over all, we know that elevated estrogen contributes to a gambit of health disorders, but progesterone is what holds estrogen in balance.

Next:
Previously I've shared some articles about long term benefits of a reduced carbohydrate diet. I'll openly admit that the fad aspect of the ketogenic diet makes me want to roll my eyes so hard... BUT, things gain momentum and popularity often because they yield some semblance of the desired result, so for the sake of my experiences with low carb/ketogenic eating, I'm going to stick to it as my reference point. Please feel free to look back at those articles for more generalized information.

Here's what we know:
Xenoestrogens are becoming more prevalent in our lives [2]. This often leads to the body being unable to accommodate with natural progesterone production. Think of it like a line graph.

Sometimes in the cycle, estrogen is meant to be higher. For you Marquette/NFP/FAM people, this is the proliferative phase of your cycle. After the period, estrogen is the hormone responsible for building up a nice pillow soft landing for that fertilized egg. After ovulation, estrogen is starts to wane and progesterone takes over. Again, for your Marquette/NFP/FAM people, this PHASE III!!!! 💗💗💗💗 (for non-Marquette/NFP/FAM people, this is the least likely time to conceive, so, many couples use this phase exclusively for intimate contact). NOW, the important thing to note here is that progesterone is the dominant post-luteal (post ovulatory) hormone. So, for all you postpartum mamas and daddies out there thinking "Oh my gosh! We DTD on day 234234234 (mild exaggeration of course) and peaked the next day!!!" Guess what? Our bodies are so smart that in the postpartum phase, progesterone is trying to come back on line after all that lochia and prolactin and oxytocin that usually that post-luteal phase is so short that the body doesn't have time to make that super comfy pillow before the period starts. This is also a serious concern for all estrogen dominance disorders. This is only true for breast feeding mamas. Formula or non-ecological feeding mamas tend to have an earlier return of their period, and thus, ovulation [3].

So, let's say someone, somewhere, with some authority, has told you that you are estrogen dominant, or you've been diagnosed with dysmenorrhea [4], endometriosis*, uterine fibroids [5]. The information below belongs to you.

From research presented in this post, we can gather that there is a correlation between estrogen related health disorders and thyroid health. We can also gather that there is a relationship between estrogen and liver function. The liver metabolizes fat, filters the blood, and sends cholesterol packin' for the exit.

There are two main reasons that carbohydrates can be a contributing factor to estrogen dominance.

1. Fructose, the sugar from fruit, bypasses normal sugar breakdown and is immediately taken to the liver for storage (fat). Eating WHOLE fruit, not just juice, slows this down, but it happens nonetheless [6]. Also, fast available energy is going to unavoidably increase blood sugar (that's kind of the point), thus kicking the liver into "work mode". This should be a normal and common occurrence, however, in the proportions of the standard american diet, the liver simply can't keep up, at least not on any long term basis. This taxation forces the liver to "prioritize", and depending on the body's state, different things will result, but in any case the result is not the optimization of liver function [7]. Think of it like Lucy and Ethel eating chocolates off the candy line. Recent research shows that adipose tissue (fat) can actually produce estrogen, thus further contributing to the estrogen dominance [8].

2. The other way that carbohydrate consumption influences estrogen, and to me this is the biggest shocker, is mold. MOLD. This one blew my mind. Below, under "extra fun reading" you'll find one legit article, and then several weak, or wiki articles. These are purely supporting pages that let you know the sources of the mold mentioned in the first article. These molds that are directly known as estrogen metabolites are covering most grains, beans, and corn. It's not their fault that these molds love them so much, but anything that is mass ground (wheat, barley, corn) is going to contain at minimum trace amounts of these contaminants. And we aren't saying, "oh this may be a contributing factor." Science is saying "this may be THE THING". Mold.

By consuming a sub 25g net of carbohydrates a day, you are most likely not fitting wheat, corn, or beans into your diet. Thus, potentially removing 60-80% of the contributing factors of estrogen dominance.

*Frankly, non-reputable sources highly correlate endometriosis to decreased sensitivity to estrogen receptors...but I can't find anything that is accessible to the public (there are about 17 sources on pubmed, if you have access), but I wont cite crappy research.



1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113168/
2. https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-11-S1-S8
3. http://journals.sagepub.com/doi/abs/10.1177/000992288802700804 ** if you have access to this article it is GREAT. I can't find it for free to share with you :(
4. https://link.springer.com/article/10.1007%2FBF02134006?LI=true
5.http://www.nejm.org/doi/full/10.1056/NEJMra1209993
6. http://www.health.harvard.edu/heart-health/abundance-of-fructose-not-good-for-the-liver-heart
7.http://www.sciencedirect.com/science/article/pii/0022473187902007
8.https://www.ncbi.nlm.nih.gov/pubmed/11511861

Some extra fun reading about contributing factors of estrogen dominance:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164220/
    a) https://en.wikipedia.org/wiki/Zearalenone
    b)https://en.wikipedia.org/wiki/Gibberella_zeae
    c)https://en.wikipedia.org/wiki/Fusarium_culmorum

Is losing weight a sign of health?

A good friend posed this question to me earlier this week and I was struck by what a complex question this is. I want to address it as thoroughly as possible, but before I do that I'd like to give a brief explanation of what Ketosis/the ketogenic diet is.

Ketosis is a state of being; ketogenic is the way of eating (WOE). So, you are IN Ketosis, and you adhere to a ketogenic lifestyle. The ketogenic diet is described as a composition of specific macronutrient ratios consisting of 5% carbohydrates, 75% fat, and 20% protein. Commonly this way of eating (WOE) results in a calorie deficit, however calories are not considered a priority especially in the initial stages of Ketosis. This diet is arguably the "original" primal way of eating for our species, but beyond that it has hundreds, and probably thousands of research articles on its effect on patients with epilepsy, MS, diabetes, PCOS, neurological disfunction, and over all estrogen dominance disorders (3). Now that we've discussed the diet, what is Ketosis? Ketosis, as mentioned above is a state of being. Ketosis is what happens during and after Keto-adaptation. The body prefers and will use carbohydrates from our food for energy. When the body does not observe carbohydrates coming from digestion, the body will produce ketones which will lead to gluconeogenesis in the liver. Ketones require fat breakdown to exist, so if you are overweight, Ketosis can take fat from your body. If you are not overweight it becomes necessary for the fat to come from your plate. I know that if you are not familiar with Ketosis, the first thing you might think is, "Is this like Ketoacidosis?" Short answer: No. Long answer: No, they have very very little in common. Ketoacidosis has easily 100-1000X the amount of ketones in the blood compared to Ketosis (1). Unless you have certain insulin disorders (DMII is not one :)), it is thought to be impossible to induce ketoacidosis through diet alone. Keto has been recommended for the afore mentioned disorders for almost 100 years now, however in the past 2 decades more research has been produced on the benefits of Keto and diabetes mellitus II (2).  

So, I suppose the first step in determining if weight loss is a sign of health is we must decide if weight gain is a sign of poor health. First, let's go ahead and remove some outliers; rapid unexplained weight loss or gain is not healthy, weight gain for underweight people is healthy, and weight loss for those who are overweight is healthy. Now, what determines that a person needs to lose weight? Tricky tricky! Need implies necessity, necessity implies lack of function due to weight; our bodies are complex beyond our comprehension, within this there are systems dependent on systems dependent on systems. More and more we see that subclinical deficiencies are making an impact on organ systems and maintaining health (4). I am not beyond the idea that some people's constitutions require a heavier load, however I do think that each body has it's own structural limits. Research also suggests that our organs have a limitation in the workload they can handle; for instance long term variances in blood volume is shown to damage arteries. Or, long term blood sugar variances have been shown to tax the pancreas and ultimately reduce insulin production and/or sensitivity (DMII).

What is health? This is a philosophical question. But fortunately for you this is my jam! Health is not the absence of disease. Health is a culmination of physical signs and state of mind. Health is being able to work towards physical and lifestyle goals without physical limitations. If you want to run a marathon; you should be able to train for it and complete it. If you want a new job you should be able to apply mental focus and enthusiasm to attain a new position. If your body or your mental state prevents you from making or achieving goals; this is unhealthy. Age is irrelevant; there is no age in which goals lose value or purpose. I once cared for an 89 year old woman who set the world record for running her last marathon at 84 years old (She no longer holds the record!!!)

Getting to serious business: Weight is one of the 6 vital signs. Obesity has a negative impact on physical and emotional health. The most commonly prescribed medications in the US are drugs that support hormone secreting organs (Thyroid/Pancreas/Uterus). While my previous statement is inference, Metformin, hormone-replacement therapies (HRT), and birth control pills (BCP) are directly related to this conversation. I don't think it is possible to deny the weight:health ratio, however a quick Google search of "Does BMI matter?" Will show you the controversy over determining what "over weight" means. 

Also, within the confines of defining health and word choice, there is a systemic allusion to sustainability and longevity; this inherently means that weight loss cannot be healthy (weight loss is not something you can do indefinitely, therefore it is not healthy). Weight loss should not be a lifetime pursuit. So I suppose my answer is weight loss is not a sign of health. Weight gain is not a sign of health. Equilibrium and the pursuit of affairs outside of the 6 vital signs, is a sign of health. (The last 3 statements can only be true if we remove the outliers mentioned before.) Healthful pursuits are a sign of health, but that does not necessarily mean weight loss or gain. Despite ancestral inclinations of using food to define culture and society, I would call for a transition away from this. We identify with comfort foods, and we make friends around dinner tables. What if we made friends on hiking trails? Or standing in line at the DMV? Or, let's go super modern.... What if we made friends in meetup groups? You see, that's precisely what I've done. 

I am 28 years old. My body has only recently shown signs of trouble; I am fairly healthy. I am overweight, I am anemic, and I occasionally have heart palpitations. These are all things that have existed for years. However, I noticed these things more when they began negatively impacting my life. I began to notice them when other things in my life were going poorly. I moved to a city that I hated, I was surrounded by people I didn't like, and I went from LIVING outside to being inside 23 hours a day. I went from running and riding my bike 20-30 miles a week to not exercising for 9 months. This was my form of depression. It bled into everything. I made friends with people who were depressed. I sank away and despite the extra weight, despite the anemia, and despite the heart palpitations, that is the first time I have felt in poor health. About 4 months ago I started the ketogenic diet again, I registered for a distance bike race, and I forced myself to go to meet ups where I was certain to be the newbie, and a complete stranger. My life is coming back to me. Not only have I lost weight, not only have I actually started TREATING the anemia and heart palpitations, my friends are more supportive, my community is stronger, my life is on a good path. 

Poor health cannot simply be defined as high blood pressure, weight gain, or any other dis-ease. Poor health is the systemic representation of deviation from an innate path. Our culture makes social media addiction a light joke; but we don't see each other anymore. We are more connected and less attached than ever. So, despite the irony of sharing this on a blog, I woud implore you to buy a coffee for the person behind you in line. Carry a small packet of coloring pages and a few crayons for the impatient kid in line at the DMV. When you know you'll be walking in an area with homeless people, tuck a care package in your purse. Smile, just to smile. When you see the overweight man walking down the side walk, say a little prayer that he keeps working. I encourage you to step out. If you like something, there's a pretty good chance there's a thousand people out there who like it too. Make friends! Make connections! Will these things make you lose weight? I don't know. Maybe? But more importantly they press us to the hard lines of our comfort zone. One of the most wonderful men I've ever known told me once, "Life grows in adversity." In recent months, along with my Keto diet, my outings, and my random acts of kindness, I feel refreshed. And while healthy weight and blood pressure are important, so is feeling human. I am optimistic for your healthful pursuits. Please let me know if I can help you in any way. 

Also, if you have reached out to me, I am so honored! Thank you for giving me your time. Next up: Chiropractic principles (Specific focus on the principle of Time!) 

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