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.

Chiropractic and Birth

For the sake of this post we will only discuss pelvic floor and mechanistic views of the pelvis for labor and delivery. There is A LOT more at hand, but this is the best entry point for what will later prove to be a pretty complex relationship.

Round Ligaments
These are best described as the ropes that tether the top of a hot air balloon. Before conception, these ligaments sort of hang off the top of uterus like arms. The fibers of the round ligament actually descend so far as the labia majora (external female genitalia). As the uterus expands to accommodate the growing baby, the round ligaments look like the ropes that go over the top of the hot air balloon keeping it on the ground.

This balloon is tethered, and look how roomy it is! This is what we want the uterus to look like. If a woman has a traumatic pelvic trauma like falling off of a bike, falling off of a horse, even some hard falls when she was a baby, these ligaments can have different tensions. This would lead to something like this:

This is an exaggeration, but our goal is to give baby as much room as possible to flip and flop and wiggle around all they want until the time comes to get serious. Then, when it's time to get serious we want baby to engage and exit with as much ease as possible, for mama and baby.

Sacrotuberous ligament
This ligament deserves a regal entry. This dude is the unsung hero of all pregnancy. So, the sacrotuberous ligament makes a lot of things work: it attaches the spine to the leg (sacrum to biceps femoris, aka major player of the hamstrings), it protects the pudendal nerve (responsible for muscle tone in the perineum--wowzas!!), contains branches of the gluteal artery, Similarly to the round ligaments, if a woman has pelvic trauma, this ligament can lose it's flexibility, thus preventing the pelvis from opening properly during labor.

Sacrospinous ligament
The fibers of the sacrospinous ligament are integrated into the sacrotuberous ligament, but this job of this ligament is to essentially create the greater and lesser sciatic foramen. If you have ever been pregnant, and developed sciatic-like nerve pain...this ligament could be a contributing factor. Again, this ligament, as it is so closely related to the sacrotuberous ligament is going to have heavy influence on the pudendal nerve, which is the nerve that helps determine the muscle tone in the perineum; if the perineum is taut, you are more likely to have perineal tearing and postpartum incontinence [1]

Abdominal muscles
The abdominal muscles are an accessory in birth. While the myometrium of the uterus is responsible for the actual contraction, the abdominal muscles are there for backup and extra "oomph". Guess where the insertion of 2/3 of the abdominal muscles are? Either directly on the vertebrae in your spine, or on the tissue that is attached to those vertebrae,

Pelvic girdle
The Pelvic girdle consists of muscles, bones, and ligaments of the pelvis that ideally open symmetrically to allow baby to exit. Pelvic girdle pain is exceptionally common in the last trimester and up to 16 weeks postpartum. Many of the muscles in this area are innervated by the pudendal nerve. Previously we said that the pudendal nerve was closely related to the sacrotuberous ligament, and that between the round ligament, the sacrotuberous ligament, and the abdominal muscles, the attachment sites for all of these are either on the spine or directly to the bones of the pelvis.

So what does Chiropractic have to do with any of this?
Chiropractors who specialize in pregnancy should know how to address all of these ligaments and bones. Our pelvis is responsible for keeping us moving. Think of it in terms of survival; our arms are held on by a flimsy articulation and 4 main muscles. You can lose an arm and still get away from the lion chasing you.Your legs are held on by one solid ball in socket articulation; in our body this is the most stable a joint can get and still move. Beyond that, there are at least 5 ligaments and 4 muscle groups (multiple muscles working together) to keep your leg on; because you need the leg to escape the lion. So then amplify that by a million, when we incorporate a mother's protective reflex, and you begin to realize the significance of this hammock that we make while pregnant.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279110/

Ferocious Love

Today is not really about chiropractic, keto, or fertility. I guess my last post wasn't either. But today is sort of about my culmination of topics that is fed by my, "Why". Why does all this matter? Do these things even belong in the same sentence? Well, first, a story.

In 2009 I started working for a family in Santa Maria. I hadn't changed a diaper in over 10 years. I'd never worked with a kid with cerebral palsy. But here I was, killing it (sarcasm). I worked for a family with three children. A set of twins and one younger child. The twins' birth had been complicated and as a product, one of the kiddos had a fairly advanced Cerebral Palsy (CP) diagnosis. I was coming in about 6 months after his feeding tube had been removed; I think he was around 7 years old. When I met him, he was vibrant, intelligent, and really in to Batman. While he couldn't walk unassisted, his original prognosis was that he would never talk or eat. One time the mother told me that a doctor consulted her soon after the twins' birth and suggested that the twin with CP go to a home for children "like him." Her response is officially the topic of the day: "Not my boy."

This woman worked a full time 3rd shift job so that she could accompany her son to school when the school provided aid would unavoidably fail to show up. She worked full time in a separate business built for him to get the therapies needed to make him mobile. She lost friends, received criticism from family, and sacrificed promotions at work to make sure that her son was advancing. Her drive and passion throughout the past 14 years is, "He has to be able to survive without me."

So this week, as we barrel towards the Mother's Day weekend, I'd like to celebrate a certain mother demographic, the "Ferocious" Mother.

The ferocious mother is the mother that once she leaves the room, everyone's eyes widen and they exhale for the first time since she walked in. The ferocious mother smiles and rocks on her heels, laying in wait, as she anticipates the fallout. And once the first brick falls, she springs to action like a lioness towards her babies, keeping them safe and slaying people blocking the path towards her children's success. The ferocious mother succeeds when her children accomplish what doctors, family, experts, and sometimes even the children themselves, think can't be done. The ferocious mother is silent and pleasant, until the first glance of a furrowed brow from a baby. Then the ferocious mother becomes a wolf on the hunt.

As most of you know I am not a mother. I hope to become one, sooner rather than later, but as it stands, I don't know what it feels like to love something as fiercely as a mother loves a child. And it is also worth noting that ferociousness is not inherent. The mother that I am talking about is made through desperation. Some mothers are not this type of mothers, and guess what? That's ok!!!!!!  I don't suspect I'll be this type of mother; maybe that's why I have so much respect for these women that fight so hard for their babies.

I love ferocious mothers because a ferocious mother raised me. I was a little girl with a loving father and an absent mother. My grandmother saw that I needed ferocious love and she took me and protected me until her dying day. She pushed me, often to the detriment of our own relationship, towards success and away from the habits and traits that broke my own family apart. I'll never forget her wagging finger as she told my step-father that no stranger would be taking her granddaughter away in a car. I'll never forget the subtle dinner conversations that said, "When you go to college..." And even though she passed away before I started Chiropractic school, she knew I was going. She, in her 60's was waiting for me at midnight after marching band competitions. She threatened me, not with failure, but with mediocrity because to fail meant that I'd tried.

I met a woman recently, with two boys. She thinks that she hurt my feelings. She thinks she was mean. But I must say, with absolute adolation, that she simply let me know that she loves her children ferociously, and she wont let anyone stand in the way of her children's success. So to you, sweet, fiery woman, Happy Mother's day.

Building strong children AND repairing broken men

It takes a village right? It takes a village to raise a baby? It takes a village to build a community and it takes a unified voice to change the world. While changing the world is inevitable or impossible depending on your definition, my goal is to make sure my circles of mamas are empowered to make the decisions that work FOR them. My goal is to help women meet those goals by making sure their spine is unsubluxated and providing them information on what might be best for them. This is a big task! Most women you talk to have some aspect of their labor that was taken from them: something they didn't like: something that in the moment didn't seem like a big deal, but afterwards became a big deal. Fortunately, there are several organizations and individuals out there that agree with my goal and are also working to help women make the best labor and birth decisions for themselves.

Previously I've discussed the Chiropractic principle of time. Thank the forces that be, because it is unlikely a woman wakes up not pregnant and goes to bed that night having delivered a baby. We have time! Elephants have a 3 year gestation period.... Suddenly 40 weeks doesn't sound so bad does it? We have discussed subluxation within the complexity of time, but if time is a component of subluxation, why would a baby need to be adjusted? They are squishy, and tiny, and new, and markedly not very ossified. 

Well, I'd like you to welcome Andra Allcorn to the stage. She is in the village and she is one of the hardest working people I know. Below, Andra tackles the question, "If time is a component of subluxation, why would a baby need to be adjusted?". In my opinion the piece is articulate, emotional, and speaks a truth of that unified voice mentioned above. 

Time is a funny thing. I’ve been told time doesn’t exist – it’s a man-made construct. But so much of our understanding as human beings is centered around time. But if time is a component of subluxation, why would a baby need to be adjusted?

 

Depending on your beliefs surrounding when life begins, a human life can begin 40(ish) weeks prior to birth. That’s 280(ish) days that the little human is growing and changing at a rapid pace. From 2 microscopic cells to a 7(ish) lbbaby at birth, those 40(ish) weeks that momma is pregnant they are constantly growing and changing. Depending on the pregnancy, there can be many other influencing factors that could inhibit optimal cell growth and development, such as diet, or medications. In addition to those factors, the birth process can be a lengthy, stressful transition from inside the mother’s womb to the outside world. Most often you hear pregnant mommas say their one wish is for a healthy baby with 10 fingers and 10 toes. But if the means to connect your baby to their Innate Intelligence hours or weeks after coming into this world, wouldn’t you want to take advantage of that?

A mere 16 days after conception, the primitive beginnings of your nervous system start to form. Around 7 weeks, your brain, the command center of you starts to form. With the beginning of the central nervous system forming, the skeletal structure protecting the brain and spinal cord start to develop as well. Around 4 months, the baby is lengthening and strengthening those bones. During the 40(ish) week gestation period, your beautiful baby develops and builds more than 200 bones! They grow and grow and grow until they are ready to enter into the world as tiny little babies.

 

Through the transition from womb to real world, the baby’s skeleton is squeezing and twisting through the 4.3(ish)-inch-wide birth canal in a process so beautifully designed it can only be called miraculous. Adjusting to the real world after this transition can be just that, a transition. From the birthing process to learning to walk, the spine takes on a lot of force from the beginning. Specific chiropractic adjustments for infants, babies, and toddlers are gentle adjustments, using no more than the pressure you would put on your eyeball. The aim is to align the vertebrae of the spine so as to remove interference within the nervous system so that your little bundle of joy has the Innate Intelligence of their body flowing to every cell in their being. Vitalistic chiropractors focus on how the body functions, and provide adjustments that remove interference from day zero. 

                                     

Since we can’t deny that the progression of time is inevitable, just like death and taxes, wouldn’t it be wonderful to have all babies checked and adjusted, if necessary? As they continue to grow and develop into kidlets, tweens, teens, and beyond, having a nervous system free of interference will continue to serve them as they grow and grow and grow for the next 20+ years.