In your quest for conception you have most likely come across the word ‘inflammation’, so what is it? Inflammation is an essential process in the body. It helps us repair damaged tissues and is important for immune protection. In response to stress, which may take the form of injury, illness, an unhealthy diet, sleep deprivation, or other physiological stress or emotional stress, the body’s immune system responds by releasing various chemical regulators to restore the normal environment, or ‘homeostasis’. These chemical regulators may be released from the white blood cells of the body which communicate with other cells and tissues.
Some of these chemical messengers are small proteins called cytokines which can be measured and therefore used to quantify the severity of the inflammation or the activation of the immune system. Delving into our immune system is incredibly complex though so measuring one protein will not provide you with the entire picture. We have spent a lot of time in clincial research understanding these processes of inflammation and oxidative stress and we love translating this knowledge into practice!
Inflammation, and the resolution of inflammation, is usually a tightly regulated process and controlled inflammation is essential for the process of embryo implantation.
While acute inflammation is a normal, healthy response to short-term stress or injury, chronic low-grade inflammation is implicated in several diseases such as cardiovascular disease, diabetes and most importantly infertility .
The cause of higher than normal levels of inflammation is multifactorial. These include a diet missing key micronutrients, carrying excess body fat, hormone imbalances, infections, stress, imablances in exercise and being sedentary.
What is Oxidative Stress?
With increased inflammation, oxidative stress is also elevated. This is also true for increased oxidative stress promoting inflammation, so it is a bit of the chicken and egg scenario.
Oxidative stress is happening within the body all the time. Reactive oxygen species that cause oxidative stress are necessary for many biological processes but just as the name suggests, these reactive oxygen species are unstable. If their levels rise too much, or there is a reduction in the defence systems used to combat reactive oxygen species (eg. antioxidants), they cause considerable damage to DNA and cell membranes, leading to cell death. Inflammation and oxidative stress are inextricably linked.
The main source of reactive oxygen species are mitochondria, a little organelle that sits within most cells. As oxygen is broken down (metabolised) to produce energy, electrons can escape from the energy production chain and these transform oxygen from a stable molecule to one that loses some electrons to become unstable. If your mitochondria are not functioning properly this will generate considerably more reactive oxygen species, leading to greater oxidative stress.
While most reactive oxygen species are produced from processes in the body, they can also come from outside sources including smoke, pollutants, tobacco, certain drugs and radiation.
Electromagnetic fields from mobile phones, laptops, and other electric devices have been shown to increase the production of reactive oxygen species with negative consequences for both male and female reproductive health (Santini, Cordone et al. 2018).
What Conditions are Associated with Elevated Infammation and Oxidative Stress?
Inflammation and oxidative stress underlie the pathology of many conditions including metabolic syndrome, cardiovascular disease, rheumatoid arthritis, diabetes, neurological conditions and importantly our reproductive health.
Unexplained Infertility: Over 70% of females with unexplained infertility have high levels of inflammation and oxidative stress . Antioxidant levels that protect against oxidative stress are lower in females with unexplained infertility (Alam, Khan et al. 2020). Total antioxidant capacity of follicular fluid is lower in infertile women while DNA oxidative damage was dramatically higher than those found in fertile women (Espino, Macedo et al. 2019).
PCOS: Women with PCOS show chronic low-grade inflammation, characterized by increased circulating levels of inflammatory proteins, which leads to insulin resistance. Levels of oxidative stress are also increased in PCOS (Mohammadi 2019). Our defences against oxidative stress include circulating levels of antioxidants (Vitamin C and E) and other antioxidant enzymes. These defences are lower in women with PCOS (Fatima, Amin et al. 2019).
Endometriosis: For 20% of people seeking fertility treatment it is the sole reason they require assisted reproductive technologies. Endometriosis is an estrogen driven inflammatory condition and women with endometriosis have elevated levels of inflammation and circulating immune toxins (such as lipopolysaccharide). Oxidaitve stress and inflammation are associated with the progression of endometriosis (Yun, Chon et al. 2016).
Recurrent Pregnancy Loss: Levels of inflammatory proteins and circulating immune toxins (such as lipopolysaccharide) are higher in women with recurrent pregnancy loss (Tersigni, D'Ippolito et al. 2018).
Male Factor: Increases in circulating markers of inflammation and oxidative stress play a significant role in male infertility (Haervig, Kierkegaard et al. 2018). It is estimated that oxidative stress may be present in about 56 million males presenting with infertility (Dutta, Majzoub et al. 2019). Inflammation and oxidative stress underlie sperm damage, which has been implicated in recurrent pregnancy loss .
How Can I Dampen Inflammation and Oxidative Stress?
The good news is that there are strategies you can adopt to dampen inflammation and oxidative stress! This then translates to enhanced fertility, and increased pregnancy success.
Diets rich in antioxidant whole foods that nurture your gut diversity can dampen inflammatory markers by more than 50%. Exercise is also a powerful anti-inflammatory and this in part is attributed to the beneficial changes at the level of the gut microbiota.
Understanding the cellular processes of inflammation and oxidative stress, and how to address these enables us to tailor evidenced based support for better outcomes.
Take a listen to us on the Beat Infertility Podcast if you would like to find out more.
Alam, F., T. A. Khan, R. Ali, F. Tariq and R. Rehman (2020). "SIRTI and cortisol in unexplained infertile females; a cross sectional study, in Karachi Pakistan." Taiwan J Obstet Gynecol 59(2): 189-194.
Dutta, S., A. Majzoub and A. Agarwal (2019). "Oxidative stress and sperm function: A systematic review on evaluation and management." Arab J Urol 17(2): 87-97.
Espino, J., M. Macedo, G. Lozano, A. Ortiz, C. Rodriguez, A. B. Rodriguez and I. Bejarano (2019). "Impact of Melatonin Supplementation in Women with Unexplained Infertility Undergoing Fertility Treatment." Antioxidants (Basel) 8(9).
Fatima, Q., S. Amin, I. A. Kawa, H. Jeelani, S. Manzoor, S. M. Rizvi and F. Rashid (2019). "Evaluation of antioxidant defense markers in relation to hormonal and insulin parameters in women with polycystic ovary syndrome (PCOS): A case-control study." Diabetes Metab Syndr 13(3): 1957-1961.
Haervig, K. K., L. Kierkegaard, R. Lund, H. Bruunsgaard, M. Osler and L. Schmidt (2018). "Is male factor infertility associated with midlife low-grade inflammation? A population based study." Hum Fertil (Camb) 21(2): 146-154.
Mohammadi, M. (2019). "Oxidative Stress and Polycystic Ovary Syndrome: A Brief Review." Int J Prev Med 10: 86.
Santini, S. J., V. Cordone, S. Falone, M. Mijit, C. Tatone, F. Amicarelli and G. Di Emidio (2018). "Role of Mitochondria in the Oxidative Stress Induced by Electromagnetic Fields: Focus on Reproductive Systems." Oxid Med Cell Longev 2018: 5076271.
Tersigni, C., S. D'Ippolito, F. Di Nicuolo, R. Marana, V. Valenza, V. Masciullo, F. Scaldaferri, F. Malatacca, C. de Waure, A. Gasbarrini, G. Scambia and N. Di Simone (2018). "Recurrent pregnancy loss is associated to leaky gut: a novel pathogenic model of endometrium inflammation?" J Transl Med 16(1): 102.
Yun, B. H., S. J. Chon, Y. S. Choi, S. Cho, B. S. Lee and S. K. Seo (2016). "Pathophysiology of Endometriosis: Role of High Mobility Group Box-1 and Toll-Like Receptor 4 Developing Inflammation in Endometrium." PLoS One 11(2): e0148165.
Guest blog by Kristen Jones an APACE accredited Embryologist and Founder of “I Like My Eggs Fertilised“.
We are excited to collaborate with the fabulous Kristen from @ilikemyeggsfertilised. Kristen is an Accredited embryologist and has teamed up with our Accredited Exercise Physiologist and Accredited Dietitian to discuss what DNA fragmentation is and steps you can take to reduce it for better quality sperm!
What is Sperm DNA Fragmentation
DNA is essentially the genetic instruction book for how we grow and function that is contained in every living cell. Breaks, or fragmentation, of the DNA will affect how the cell functions. A small amount of DNA damage is always present but when this damage is high, fertility can be impacted.
If your sperm viability is low (<50%), then it is likely that you have high DNA fragmentation rates. Even with a normal semen analysis, 15% of men can have high levels of DNA damage to the sperm. Read on to find out more about DNA fragementation and importantly steps you can take to reduce this for better fertility outcomes.
What Causes Fragmentation?
Fragmentation of the Sperm DNA may occur while sperm are stored in the epididymis of the testes. Some causes may be short term illness, injury, lifestyle factors or chemical exposures, but sometimes, no cause is identified.
Semen quality and DNA fragmentation are likely to vary somewhat, but when sustained, it is associated with reduced natural conception and increased chance of miscarriage. While infertile men possess substantially more DNA damage (Zini et al., 2008), a semen analysis may show normal parameters when high levels of DNA fragmentation are present (Robinson et al., 2012).
How is Fertilisation Impacted?
Fertilisation rate in IVF may, or may not, be impacted by higher levels of DNA fragmentation. While some studies show a negative correlation between the integrity of DNA in ejaculated sperm and fertilisation rates (Bronet et al., 2011), sperm with DNA damage can fertilise oocytes successfully (Alvarez Sedo et al., 2017). Despite successful fertilisation that may give rise to good grade embryos, these may fail to implant or result in early pregnancy loss (Robinson et al, 2012). Indeed, male factors do contribute to early pregnancy loss.
With ICSI, sperm with high DNA damage are more likely to fertilise than with conventional IVF, but miscarriage can still occur (Robinson et al, 2012).
Is Embryo Development Affected?
A study by Alvarez Sedo et al. (2017) found that while fertilisation was not affected by high DNA fragmentation, there was a negative correlation with blastulation rate. They found that high levels of DNA damage promote embryonic arrest and induce activation of apoptosis, or cell death and observed a much high pregnancy rate in patients with low DNA damage.
The affect of DNA fragmentation may be more severe in older patients as oocyte quality is strongly associated with age and the ability of an egg to repair sperm DNA damage may decline in older eggs (Robinson et al., 2012).
Pregnancy Rates and Loss
While the chance of getting pregnant can be lower in couples with high DNA fragmentation going through IVF and ICSI treatment (Bronet et al, 2011; Zhao et al, 2014), for those that do have a positive pregnancy test, sperm damage may also increase early pregnancy loss.
While some studies suggest no increase in recurrent pregnancy loss (Bronet et al, 2011, Coughlan et al. 2014, Gat et al, 2017), others report significantly higher risk of pregnancy loss with IVF and ICSI (Haddock et al, 2020, Rivas-Maynou et al., 2012, Zhao et al, 2014, Zini et al., 2008).
Pooled data from 13 studies has found that "male partners of women with a history of recurrent pregnancy loss have a significantly higher rate of sperm DNA fragmentation compared to the partners of fertile control women" (McQueen et al, 2019).
While Bronet et al (2012) and Gat et al (2017) did not find a correlation between sperm DNA fragmentation and chromosomal abnormalities in embryos, the majority of studies show that high levels of oxidative stress and inflammation are related to sperm damage and increased pregnancy loss (Kamkar et al, 2018).
What Strategies are Proven to Reduce DNA Fragmentation?
1. Keep Them Cool
One common cause of high DNA fragmentation may be anatomical. If veins near the testicles are enlarged as with a varicocole, temperature of the testicles may be too high, impacting sperm health. This is found in 35% of patients with male infertility and can be surgically repaired (Kim, 2018).
Keeping testicles cool is a good idea in general. Avoid having a laptop on your lap, wearing tight clothing like cycling shorts for prolonged periods and choose cotton boxers over briefs. Also avoid high temperature environments such as saunas.
2. Boost Your Antioxidant Defenses
Exercise has been shown to improve sperm quality and DNA integrity by reducing markers of inflammation and oxidative stress (Maleki et al, 2017). Even if male factor fertility issues are not the primary reason you are undergoing IVF, ensuring your sperm are in tip-top shape will help you to maximize your chances. If you have not exercised regularly before and are planning to undergo IVF, the right exercise prescription will benefit your sperm health.
Twelve weeks of structured jogging sessions (70-85% VO2max 3 x week) in infertile males significantly reduces inflammation, boosts antioxidant capacity, reduces sperm DNA fragmentation (Maleki & Tartibian, 2017). These benefits are also seen in slightly overweight males (average body mass index >25) undertaking aerobic exercise (Hajizadeh et al, 2013). Six months of moderate exercise in males with low sperm counts with or without DNA fragmentation increased live birth rates by over 90% (Hajizadeh et al, 2017). Now that's an impressive outcome!
Progressive resistance (strength) training over a period of 12 and 24 weeks has also been shown to improve sperm quality and pregnancy rates (Hajizadeh et al, 2018). The mechanisms for this relate to the reduction in inflammation, boost in antioxidant defences and increase in circulating testosterone concentration that comes with strength training. In males taking part in structured resistance training, the chance of live birth increased 2 to 15 times.
Getting the balance of exercise right though is important. In high level triathletes (VO2max 70 ml/kg/min) with 5 years racing history and training, semen parameters were at the lower end of the ‘normal’ reference range set by the World Health Organization (ranges used in laboratories to determine sperm quality), and DNA fragmentation was high (Vaamonde et al., 2017). This supports similar studies that suggest that high volumes and intensities of endurance training may have negative effects on sperm quality (Hajizadeh et al., 2013; Vaamonde et al., 2017).
You can take a listen to us on the Beat Infertility Podcast to find out more about exercise and sperm health. Seeing an Accredited Exercise Physiologist will ensure you get the right exercise prescription to optimise your sperm health.
3. Nourish Your Sperm
A healthy diet correlates with better quality sperm parameters, and lower DNA fragmentation. (Skoracka et al, 2020). Inflammation and oxidative stress contribute to DNA fragmentation but these can be modulated by your diet. A diet that focuses on reducing refined sugars, saturated fats and animal proteins, and includes fruits, vegetables, nuts, whole grains, fish, and healthy oils will reduce inflammation.
Saturated fats and sugar lead to disruption of our gut microbiome causing dysbiosis which promotes inflammation (Guevara-Cruz, 2019). Eating to nurture the diversity of your gut microbiota reduces inflammation and immune toxic compounds such as lipopolysaccharide (LPS) that damage sperm DNA (Pearce et al, 2019).
While it may be tempting to reach for an antioxidant supplement we first recommend a comprehensive dietary analysis to identify what micronutrients you are missing out on so that if you do require a supplement, it is specifically targeted for a better outcome. Only 17% of ingredients found in male fertility supplements have published evidence showing a positive effect on semen parameters (Kuchakulla et al, 2020). Consult with an Accredited Dietitian so you get to look at your diet as a whole and establish the best strategy for optimising sperm health so you are not throwing your money down the drain!
If you are after evidenced based, clincial dietetic guidance to reduce sperm DNA fragmentation join our next Fertile Gut Masterclass starting January 2021!
4. Time to Quit?
Cigarette smoking negatively affects fertility, compromising nearly every system involved in the reproductive process. Heavy smoking, and heavy drinking, significantly increase sperm DNA fragmentation (Boeri et al, 2019). Knowing that the quality of sperm at the time of conception can have a lasting impact on the future health of your unborn child, seek support by contacting quitline or check out quit.org.au for some great resources to help you on your journey to better sperm health.
You Can Make a Difference!
If you have undergone a DNA fragmentation test and have levels that are high, there are steps you can take to improve the health of your sperm. Your lifestyle impacts sperm health and sometimes changes required may be small, but translate to improved fertility and chance of conception.
Ensure you access evidenced based services so the strategies you are adopting will have you on the path to reducing DNA fragmentation.
Optimising sperm health should be top of the priority list for a successful pregnancy. Dad’s health at the time of conception influences the health of your future children. Even if male factor fertility issues are not the primary reason you are undergoing IVF, ensuring your sperm are in tip-top shape will help you to maximise your chances of pregnancy success.
There is no doubt that our gut microbiota, the populations of mainly bacteria, have an impact upon our ability to get and stay pregnant. We talk so much about our gut microbiota, but now it is time to find out more about another important ecosystem in our body: our reproductive tract microbiota.
The Vaginal and Uterine Microbiota
A healthy vaginal microbiome is associated with an increased chance of conceiving and successful pregnancy. So what does a healthy vaginal microbiome look like?
The microbiota of a healthy, non-pregnant woman contains a variety of Lactobacillus species. These bacteria are thought to provide a healthy supportive environment that is conducive to conception.
The Lactobacillus bacteria produce lactic acid to maintain the pH of their environment and they dominate the microbiota of the vagina protecting it from harmful intruders. Lactobacillus love to use glycogen for energy and once they metabolise glycogen to glucose and maltose it is then further broken down to lactic acid. Lactic acid decreases the pH of the vagina to around 3.8-4.4 which creates a protective environment against the growth of pathogenic bacteria. This is one way that the body prepares for the impending pregnancy. Lactobacillus are very important in maintaining the pH of the vagina and consequently its microenvironment.
Some of the main bacteria in the vagina are L. crispatus, L. gasseri, L. iners and L. jensenii. Other bacteria that could cause a problem in the vagina if Lactobacillus are overrun include Gardenella, Atopobium, Mobiluncus, Prevotella, Streptococcus and Ureaplasm (just to name a few). The good news is that with a healthy level of Lactobacillus, these bacteria remain almost inactive or dormant.
Unlike the gut microbiome where diversity is key, in the vagina you want to have the genus Lactobacillus dominating. Lactobacillus know their job and are very protective of their environment. If Lactobacillus are threatened, they have the ability to promote antimicrobial defences which would kill other microbes that don’t belong. They are great at protecting and defending their territory.
Our Reproductive Tract Microbiota Impacts Pregnancy Success
Contraception, ovarian stimulation and hormone manipulation can have an effect on the health of the vaginal microbiome. These mostly decrease the number and types of Lactobacillus species in the vaginal microbiome and can cause an increase in bacteria such as Escherichia coli and Gardnerella both of which can be detrimental to the conception process as they cause infection.
There is a link between the success of assisted reproductive treatments and the health of the vaginal microbiota . Lower abundance of Lactobacillus, and higher abundance of pathogens Gardnerella and Prevotella are identified in women that do not fall pregnant following IVF, compared to those that have pregnancy success .
In 130 women undergoing IVF at a Danish Clinic, an abnormal vaginal microbiota was found in 28% of women. ‘Abnormal’ was categroised by the presence of high levels of Gardnerella vaginalis and/or Atopobium vaginae. Following IVF, women with a normal vaginal microbiota had a pregnancy rate of 35% while those with an abnormal microbiota had rates of only 9% . Almost half (45%) of women experiencing repeated implantation failure have a non-Lactobacillus dominant endometrial microbiota  .
Early and late miscarriages have also been linked to the composition of the vaginal microflora. A lower abundance of Lactobacillus , and an increasing presence of Mollicutes have been found in the vaginal microflora of women experiencing preterm premature rupture of membranes . Microbial disturbances such as bacterial vaginosis have also been associated with preterm birth .
Our reproductive tract microbiomes impact the chance of conception, and healthy pregnancy progression so nurturing this is important for positive pregnancy outcomes.
What’s the Gut- Reproductive Tract Connection?
While our gut and reproductive organs may seem far apart, what happens in our gut can influence what goes on in our reproductive organ ecosystem. Bacteria have been shown to ascend from the rectum to the vagina and diet which manipulates the gut microbiota can be an effective treatment strategy for bacterial vaginosis .
Composition dynamics of the vaginal microbiome are influenced by changing levels of sex hormones which can be regulated by our gut. The health of our immune system, psychological stress, antibiotics and smoking all play a role in shaping the diversity of our gut microbiota but these are also linked to the health of our vaginal microbiota .
The gut and female reproductive tract are in constant communication with each other via microbial metabolites, our immune system and our circulatory system .
Studies exploring the gut microbiome and vaginal microbiome in the same population are few, but those in women with endometriosis show that where gut dysbiosis exists, vaginal dysbiosis is present . reduced . Nurturing our gut health is connected to the health of our reproductive tract. Compounds that increase the diversity of our gut microbiota have been shown to boost Lactobacillus abundance in the vaginal microbiota.
Want to get your Microbiota on track for conception. Come and see us for evidenced based strategies to optimise your chance of pregnancy success!
Book a free 10 min phone call to find out if you could benefit from our expertise.
1. Fu, M., et al., Alterations in Vaginal Microbiota and Associated Metabolome in Women with Recurrent Implantation Failure. mBio, 2020. 11(3).
2. Kong, Y., et al., The Disordered Vaginal Microbiota Is a Potential Indicator for a Higher Failure of in vitro Fertilization. Front Med (Lausanne), 2020. 7: p. 217.
3. Haahr, T., et al., Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Hum Reprod, 2016. 31(4): p. 795-803.
4. Kadogami, D., Y. Nakaoka, and Y. Morimoto, Use of a vaginal probiotic suppository and antibiotics to influence the composition of the endometrial microbiota. Reprod Biol, 2020. 20(3): p. 307-314.
5. Verstraelen, H. and A.C. Senok, Vaginal lactobacilli, probiotics, and IVF. Reprod Biomed Online, 2005. 11(6): p. 674-5.
6. Paramel Jayaprakash, T., et al., High Diversity and Variability in the Vaginal Microbiome in Women following Preterm Premature Rupture of Membranes (PPROM): A Prospective Cohort Study. PLoS One, 2016. 11(11): p. e0166794.
7. McGregor, J.A., et al., Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol, 1994. 170(4): p. 1048-59; discussion 1059-60.
8. Neggers, Y.H., et al., Dietary intake of selected nutrients affects bacterial vaginosis in women. J Nutr, 2007. 137(9): p. 2128-33.
9. Moosa, Y., et al., Determinants of Vaginal Microbiota Composition. Front Cell Infect Microbiol, 2020. 10: p. 467.
10. Amabebe, E. and D.O.C. Anumba, Female Gut and Genital Tract Microbiota-Induced Crosstalk and Differential Effects of Short-Chain Fatty Acids on Immune Sequelae. Front Immunol, 2020. 11: p. 2184.
11. Ata, B., et al., The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls. Scientific Reports, 2019. 9(1): p. 2204.
12. Hong, X., et al., Association between polycystic ovary syndrome and the vaginal microbiome: A case-control study. Clin Endocrinol (Oxf), 2020. 93(1): p. 52-60.
Fertility Week is wrapping up for 2020! This year's theme is age. If you are a female heading north of 35 years you no doubt have heard that age is a factor that impacts fertility. As we age the production of high quality eggs (oocytes) reduces. While we can’t do much about our chronological age, let’s take a look at what underlying mechanisms impact egg quality with age and an effective strategy that may reduce the impact of ageing on fertility.
Age and Oocyte Quality
As our oocytes divide, the chromosomes inside segregate but with age there are more errors in this process. An oocyte with an incorrect number of chromosomes is a condition known as aneuploidy. In most cases this oocyte if fertilised will not lead to an ongoing pregnancy. We are beginning to understand more about the mechanisms that contribute to this aneuploidy.
Mitochondria are little bean shaped organelles are found in almost every cell. They are involved in energy production and important players in the ageing process.
As we learn more about these little energy factories (our mitochondria), it appears that the health of your mitochondria is a great indicator of the success of fertilisation and embryo development.
The decline in egg quality with ageing has been related to mitochondria. The ability of mitochondria to produce energy is crucial during the development of eggs (oocytes) and to allow for normal embryo growth and development.
In aged oocytes, metabolic activity and energy production are reduced. This may in turn impair processes such as cell division, embryo development and implantation.
Telomeres are essentially little caps on the end of our DNA that protect our chromosomes. While Each time our cells copy themselves, telomeres get a little shorter.
While telomeres shorten as we age, they can also shorten in response to stress, smoking, lack of exercise, daily alcohol consumption and a poor diet. Inflammation and oxidative stress are key processes that have been shown to shorten telomeres.
Telomere length in cumulus cells at the time of oocyte collection is predictive of highly competent oocytes and good-quality embryos. In women that experience IVF failure or recurrent miscarriage (Mania et al, 2014), or aneuploid embryos (Treff et al, 2011), oocyte telomeres have been found to be shorter.
During cell division, an internal cell skeleton (spindle) has the job of keeping chromosomes in place for accurate segregation. With advancing maternal age nearly 80% of oocytes have some abnormalities in spindle formation. The proteins in the cell that help ensure correct spindle formation change with age.
This process requires lots of energy. If our mitochondria are low in number or are not functioning well, it is likely that spindle formation will be impacted.
So What Can I Do?
There are strategies that we know that may slow down cellular ageing. In this post we are going to talk about the incredible benefits of exercise to put the brakes on ageing, and in some cases even turn back time.
Exercise opposes the detrimental effects of ageing. It enhances insulin sensitivity, reduces inflammation, dampens reactive oxygen species, and improves efficiency of our mitochondria.
Engaging in regular activity has also been shown to improve the activity of an enzyme that protects our telomeres, and in some cases may even increase telomere length! With the close connection between oocyte quality and telomere length who wouldn’t want to lengthen their telomeres for optimal fertility.
With discussions of age and fertility you may have heard of AMH. Anti-Mullerian Hormone or AMH is secreted from cells within antral follicles and has been used as a marker of ovarian reserve. While it may be useful in predicting pregnancy rates in older females, AMH does not appear to predict pregnancy rates in women <36 years.
Women who exercise more than two times per week have higher AMH levels than women not exercising (Maslow et al 2019). Another study supports the benefits of exercise on AMH levels, where women that are physically active have higher levels of AMH compared to inactive women. The increase in AMH levels was irrespective of age (Kiranmayee et al., 2017).
Exercise can also improve how your oocyte spindles function, chromosomes align and healthy cell division. In a mouse model of ageing, exercise improves both ovarian follicle reserve and oocyte quality (Faraci et al., 2018). Exercise maintained normal mitochondrial distribution and improved spindle and chromosome alignment. This means that in the mature oocyte, the chromosomes were organised properly inside the cell.
The Next Steps
Seek out the ideal exercise prescription for you. Your medical background, fertility journey to date and previous activity will all influence what type of exercise and how much is right to optimise your fertility!
Welcome to Mental Health Week! There is a close connection between our mental wellbeing and our physical health. Acute stress can be beneficial for us physically, heightening our brain function, boosting our immune system and helping us to build resilience.
On the other hand, chronic stress may have negative consequences for our health and wellbeing, and this includes our fertility.
The stress that comes with infertility and undergoing assisted reproductive treatment can be equivalent to that of someone dealing with cancer or heart disease (Domar et al, 1993). Yep - infertility takes a real toll on us.
Read on for our top three strategies to manage your mental health when dealing with infertility.
Be Proactive in Seeking Support
You may be a seasoned infertility warrior or new to the world of fertility treatments, but this tip applies equally – seek professional psychological support. The majority of fertility clinics in Australia recognise the importance of maintaining or enhancing mental wellbeing during the fertility journey and provide access to this support during treatment cycles.
As an integral component of optimising fertility we have our fertility Psychologist, Alisha Polsen at The IVF Project.
When going through treatment it is a case of when you may experience mental health impacts rather than if you will experience them. Some level of stress and / or anxiety was reported by 72% of couples undergoing IVF.
Pre-empt that the process may bring challenges and employ constructive coping strategies, before you find that your health is suffering. A Psychologist with expertise in fertility will help:
Not only will you keep your mental health on track but interventions designed to reduce psychological distress may increase pregnancy rates. Out of 10 interventions where pregnancy rate was measured, getting support from a Psychologist doubled the chance of pregnancy (Frederiksen et al, 2015).
Reducing stress by learning the tools of mindfulness from a Psychologist has been shown to benefit mental health, helping with emotional regulation and reducing passive-avoidance coping strategies. A bonus is better sleep quality too which benefits fertility.
Food For Your Mood
Certain foods and key nutrients can lift your mood. Have you ever eaten lots of processed foods and sugar and felt really blah? Well, there is a science to explain how food can influence your mood.
Our gut talks to our brain so keeping our gut bacteria fuelled with prebiotic foods is a great step to boosting out mental wellbeing. Getting microbiota accessible carbohydrates and key gut loving nutrients into your diet has been shown to improve brain health and reduce depression (Dingeo et al., 2020).
Certain strains of bacteria have been shown to reduced anxiety- and depression-like behaviour and the gut microbiome can shape how our brain functions, even altering neurotransmitter production.
An imbalance, or dysbiosis, of the populations living in the gut can impact our brain and our behaviour. Nurturing our gut microbiome for enhanced diversity can provide many benefits for your mental wellbeing.
What we eat can promote a diverse microbiota for better mental health. Looking to build resilience? Want to reduce the anxiety and stress around trying to conceive? Optimal nutrition to fuel your gut diversity will help build resilience and reduce anxiety, while boosting your fertility!
The right exercise prescription can increase your resilience, reduce depression and anxiety, help manage your mood and help you sleep instead of worrying about all the things that could keep you up at night. All of these benefits are great for you – but also for your assisted reproductive treatment!
Engaging in regular exercise has been shown to increase your ability to bounce back from a stressful situation and to limit how much stress you experience. This is so important for riding the rollercoaster of fertility treatments. If I did not have the opportunity to exercise during my treatment there is no way I would have been able to handle multiple cycles and pick myself up after a negative pregnancy test. Exercise was such an important tool to manage the stresses of all the poking and prodding and waiting, and to ensure quality eggs and uterine receptivity.
Exercise is also a powerful antidepressant, thanks in part to increases in brain derived neurotrophic factor (BDNF) that is released with exercise. Getting the right balance of aerobic and strength training will also improve the diversity of our gut friends for optimal mental health and fertility outcomes. Exercise can increase the proportion of beneficial bacteria living in our gut, increasing the incredible short chain fatty acids that promote health and fertility.
When comparing the gut microbiome of women who did not meet the guidelines for minimum physical activity and those that exercised at least 3 hours per week, women that exercised had a greater abundance of health-promoting bacterial species, including Faecalibacterium prausnitzii, Roseburia hominis and Akkermansia muciniphila (Bressa et al., 2017).
Have you moved your body today?
Investing in Your Mental Health is an Investment in Your Fertility
Your mental health is just as important as your physical health. If you are dealing with infertility, make a plan to access the best support so you can have the best outcomes!
Bressa, C. et al (2017) PLoS One. Differences in gut microbiota profile between women with active lifestyle and sedentary women. 10;12(2).
Dingeo, G. et al (2020) Food Func. Phytochemicals as modifiers of gut microbial communities. Ahead of Print.
Domar, A. et al (1993) J Psychosom Obstet Gynaecol. The psychological impact of infertility: a comparison with patients with other medical conditions. 14 Suppl:45-52.
Frederiksen, Y. et al (2015) BMJ Open. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. 5:e006592.
Did you join us at the FREE Beat Infertility Summit? If not- the good news is you can still register to attend the Summit here and have access to replays of over 60 informative talks from fertility experts across the globe.
At the Summit we shared how essential your gut health is for fertility. Nurturing a health gut is one of the key steps we use with our clients for pregnancy success.
Start with the Best Baby Making Ingredients
The single best predictor of a healthy embryo, that leads to pregnancy, is starting with a healthy egg and sperm. We can’t turn back time to be younger, but there are things we can do that are scientifically proven to benefit egg and sperm quality, AND create a receptive endometrium for implantation.
We want our sperm to have great motility, morphology, for there to be enough of it (quantity) and for it to have low levels of DNA fragmentation or damage.
We need our oocyte (egg) to look good and have functioning mitochondria inside so it has the ability to mature.
We want a receptive uterus with good blood flow, ideal lining thickness and an immune response that is just right for implantation, not too much and not too little.
Improving these ingredients in the baby making process does not start with your reproductive organs. It starts in your gut!
Let’s explore the Gut-Fertility Connection, so you know how to leverage it for pregnancy success.
Meet Your Microbiota
We have over 2kg of microorganisms or microbiota living in our gut (these are mainly bacteria). These microbiota produce essential vitamins, regulate our immune system, influence our metabolism, alter hormone levels, our muscle strength and even our mood.
When our gut microbiota breakdown microbiota accessible carbohydrates, they produce these amazing short chain fatty acids. These short chain fatty acids are potent anti-inflammatory molecules. They enhance the barrier function of the gut cells and protect against pathogenic or bad bacteria.
They can also regulate metabolism by influencing hormones involved in food intake and insulin secretion.
Our gut microbiota are required to activate beneficial polyphenol compounds found in plant based foods and to ensure our immune system stays in check.
Feeding Your Microbiota
Feeding your gut microbiota is important and they love specific types of fibre – this makes them thrive! If they miss out on specific fibres, even intermittently, they can begin to breakdown the mucus layer of the gut as a food source.
When the mucus layer of the gut is damaged, inflammation is increased and this ultimately damages eggs and sperm.
Diet is the most potent modulator of your gut microbes. Nurturing them promotes greater diversity and the release of beneficial compounds that influence almost every process in your body. What you eat matters!
In many conditions affecting fertility, the gut requires some additional love. The diversity of the gut microbes is negatively impacted in PCOS, endometriosis, male factor infertility and unexplained infertility. There are higher levels of bad bacteria in the gut and low levels of beneficial bacteria that we need for optimal fertility.
How do we improve the diversity of out gut microbes to optimise our chance of pregnancy? By feeding our microbes the food they need to thrive!
What’s On My Plate?
If you are wondering how to nurture your gut for optimal fertility, we would love you to join us in our first ever Fertile Gut Masterclass! Cut out the dietary noise and fast track your fertility by optimising your gut health. Over three weeks you will learn how to eat to nourish your gut for conception and beyond. This course delivers over $1200 value for the cost of less than one Consultation! What's that?! Yes- it's true BUT only for this first round offering!
Not only will this course improve your chance of conception with fertility treatment, but you may also improve your chance of natural pregnancy! The health of Mum and Dad to be at the time of conception influences the health of your future child so what better way to give your child the best start in life. If you want to give yourself the best chance of pregnancy success then this course is for you! Find out more about our Fertile Gut Masterclass Modules so you can create a fertile gut.
There is a lot going on around the globe right now. We are in the midst of dealing with the emotional rollercoaster that is infertility as treatment cycles are postponed and the time frames for commencing treatment with COVID-19 restrictions remain uncertain.
As we near the end of endometriosis awareness month, I wanted to provide some hope. Endometriosis is a condition where tissue of the endometrium is found outside the uterus. Twenty to 50% of women dealing with infertility have endometriosis . For 20% of people seeking fertility treatment, endometriosis is the sole reason they require additional support to achieve pregnancy. Know that if you have endometriosis (my hand is up!), you are certainly not alone.
While you wait, there are steps you can take to optimise your treatment outcome and chance of natural conception. While not all women with endometriosis have trouble getting pregnant, let’s look at how endometriosis affects fertility, and five steps you can take to give yourself the best chance of pregnancy success!
Infertility with Endometriosis
Oxidative stress and inflammation are elevated in women with endometriosis [2, 3], and these overactive immune processes impact fertility. The increased oxidative stress and inflammation change the structure of eggs in women with endometriosis, making them less likely to mature once collected . The endometrium is also different, which reduces embryo implantation and pregnancy progression. The good news? There are ways to dampen oxidative stress and inflammation!
Changes in anatomy may also impact how likely egg and sperm are to get together. Over 30% of women with endometriosis may present with adhesions, which is a type of scar tissue . Adhesions may cause structural changes that restrict the passage of eggs and sperm, making conception difficult. These adhesions are associated with increased pain, impacting quality of life  but there are positive ways to manage, and even reduce this pain.
While fertility treatments for endometriosis may involve interventions like laparoscopic surgery, here are some steps you can take now to improve your chance of pregnancy success.
Tips to Improve your Fertility with Endometriosis
One of the best anti-inflammatories going around, exercise can play an important role in the management of endometriosis. Exercise ramps up anti-inflammatory and anti-oxidant defences to reduce inflammation. This improves the health of our energy producing mitochondria, hormone regulation and other pathways that promote better quality eggs.
Exercise is also a powerful n effective tool for managing pain. Pain and depression are higher in women with endometriosis , but incorporating regular physical activity into your day can be a great way to improve quality of life and fertility!
2. Strength Train
Most people think of exercise as aerobic activities, such as walking or swimming, but don’t forget to strength train.
Strength training promotes the production of anti-inflammatory proteins and can limit the loss of muscle and strength that comes with chronic exposure to high levels of inflammation.
Getting strong is also a great way to boost energy levels to combat fatigue, and you can strength train from the comfort of your lounge room.
3. Nourish Your Body
A diet rich in different coloured fruits and vegetables, wholegrains and oily fish has been linked to a lower risk of developing endometriosis . On the flip side, diets high in trans fats, which often come from processed foods, and low in anti-inflammatory Omega-3 fats may increase the risk of endometriosis .
If you have endometriosis, the good news is that diet is an incredible way to reduce inflammation and manage the condition. One strategy that may suit your medical history is to adopt a Mediterranean style of eating. This typically means:
Eating a Mediterranean Diet is effective for fertility as it changes what happens in your gut to optimise egg quality. See our next tip to find out more!
4. Improve Your Gut Health
We have over 2kg of bacteria living in our gut. They influence how we get our nutrients from food, our mood, muscle strength and our fertility. In endometriosis, the growth of endometrial lesions outside of the uterus is driven by oestrogen, and our resident gut microbiota (the collection of bacteria and other microorgamisms in our gut) play a role in regulating these levels.
Endometriosis is associated with an imbalance in gut microbiota. Women with endometriosis have lower concentrations of beneficial Lactobacilli bacteria, and higher levels of potentially pathogenic bacteria  that increase inflammation. You can promote a healthy balance of bacteria in your gut by eating a diet rich prebiotic fibre.
Prebiotics act as a food source for beneficial gut bacteria. When you don’t get enough prebiotic fibre in your diet, your bacteria start to digest your gut lining for food, which promotes more inflammation. Eat a wide variety of fruits, vegetables and wholegrains each day to optimise your gut health for fertility. It can be hard knowing where to start and that’s where a specialist Dietitian can help!
5. Get to Bed
Sleep is probably the single most important thing we can do to ensure physiological and mental health. Without sleep, our immune system is not as effective at fighting off viruses, our sex drive reduces, and our pain threshold increases. Research shows that sleep quality is reduced in endometriosis . Missing out on sleep can reduce our pain threshold, and promote inflammation which we know is not great for fertility.
Just as we adopt healthy habits around moving each day and making positive choices around what we eat, consciously adopt strategies that can improve your sleep. Stick to a usual bedtime and wake up schedule, avoid exposure to screens for an hour before bed and try a mindfulness app just as you get into bed to bring on sleep quicker. Once you are exercising regularly this has the benefit of enhancing sleep quality too!
Empower yourself to take charge of your fertility! If you would like extra support in getting started we are here to help. Make sure you are following us on Instagram at @DrKitic and @fertilegut for tips and strategies for improving your preconception health!
Factors affecting fertility include poor quality eggs and sperm, weight, sleep, metabolic elements, hormone balance and environmental exposures.
Did you know that these are all influenced by what is happening in your gut?
Our gut is the most important immune organ in our body. It is home to over 2kg of microbes that regulate lots of processes in the body. They talk to our brain, our muscles and can influence egg and sperm quality.
The genetic material of our gut microbiome is more than 100 times ours so our complexity is not because we are human, but more likely because of the component of us that isn’t human.
Having lots of different, beneficial populations living in our gut is associated with positive benefits for health and fertility. In contrast, when the populations in the gut are not as diverse or are out of balance, there are negative consequences for health and fertility. Read on to find out how our gut microbiota can be nurtured to enhance your fertility.
Why Does our Gut Matter?
Imbalances in our gut microbiota that lead to dysbiosis are associated with:
What is the Role of our Gut Microbiota?
Our microbiota play a key role in extracting nutrients and energy from food, they influence how well our immune system works, they can protect us against bad bacteria and viruses and they can influence the strength of our gut barrier. A healthy, diverse gut microbiota is essential for a functional gut and fertility.
Diversity Dampens Inflammation
A diverse microbiota will ensure our immune system is working properly. Poor gut health is associated with an increase in microbiota that promote inflammation in the gut, which can then enter our bloodstream, impacting egg and sperm quality.
Inflammation, and the resolution of inflammation, is usually a tightly regulated process if you gut is in good health. Controlled inflammation is essential for the repair of tissues, immune protection and even the process of implantation.
While acute inflammation is a normal, healthy response to short-term stress or injury, chronic low-grade inflammation promotes infertility.
Low diversity in your gut microbiota drives inflammation, which is not good news for fertility. Inflammation damages your gut lining and can lead to elevated levels of inflammation in your circulation. This then can cause damage to your developing eggs and sperm.
Reducing inflammation is a proven strategy for enhancing your fertility. If your lifestyle nurtures a diverse microbiota you will keep inflammation in check and optimise your egg and sperm health.
Extract More Antioxidants and Energy
We started to understand more about our gut microbiota in 2006 when Jeffery Gordon (the father of the microbiome) demonstrated that the gut microbiota could control weight. He transferred the gut microbiota from obese mice to lean mice. The lean mice then put on body weight and increased fat mass despite consuming less food!
In humans, differences in microbiota composition and diversity are observed between obese and lean individuals, showing that the gut microbiota plays a role. If you have been on antibiotics, this strips out your gut bacteria. With the changes in your gut populations you may have noticed that your health is not as optimal as it usually is or that you have put on weight despite a similar diet. Improving the diversity of your gut microbiota can help get you back on track.
With a diverse gut microbiota we are able to activate polyphenols and other antioxidant compounds in the food we eat. Having a diverse, fertile gut means you may extract more essential nutrients from your food for optimising egg and sperm development.
Boost Mental Health
There are lines of communication between our gut and our brain. Over 16 years ago a study in mice showed that when mice were exposed to stress, the magnitude of their physiological response was dependent upon their gut microbiota.
Certain strains of bacteria have been shown to reduced anxiety- and depression-like behaviour and the gut microbiome can shape how our brain functions, even altering neurotransmitter production.
Anxiety and depression are common in women and men dealing with infertility. An imbalance, or dysbiosis, of the populations living in the gut can impact our brain and our behaviour. Nurturing our gut microbiome for enhanced diversity can provide many benefits for your mental wellbeing.
Have you head the term “Food and Mood” or “Move for Your Mood”? What we eat and how we move our bodies are key regulators of promoting a diverse microbiota for better mental health. Looking to build resilience? Want to reduce the anxiety and stress around trying to conceive? Optimal nutrition to fuel your gut diversity and the ideal exercise prescription are essential tools for pregnancy success.
Reduce Toxin Exposure
Our fertility can be affected by certain chemicals. For example, exposure to Bisphenol A or BPA reduces egg and sperm quality and may account for 20% of unexplained infertility.
BPA can be rapidly broken down in the gastrointestinal tract by certain microbes. If you are lacking these microbes, or their populations are small, your absorption of BPA will be greater, leading to more endocrine disruption.
Having a diverse gut microbiota appears to be protective against certain chemicals that damage fertility. Greater gut diversity means less absorption of these harmful chemicals.
Ways to Nurture your Microbiota
In working with our clients for pregnancy success we have a focus on proven strategies that will improve gut diversity as it is central to fertility.
Shaping a fertile gut microbiota depends on the availability of microbiota-accessible carbohydrates that are found in dietary fibre. Prebiotics are an important type of fibre. They are nondigestible, fermentable foods and you may already eat them every day. Prebiotic fibre has distinct physical and chemical properties which interact with the microbiota of your gut to benefit fertility.
Our microbiota thrives on prebiotic fibre and one of the reasons why, is that it enables them to make the short-chain fatty acid butyrate.
Butyrate is incredibly potent at dampening inflammation, strengthening the gut barrier, regulating metabolism, optimising brain health and regulating immune function. The mechanisms of action of butyrate are incredibly beneficial for fertility as they dampen processes we know compromise egg and sperm quality and the progression of a healthy pregnancy.
Getting a variety of fibre in your day is a promising strategy for weight management, reducing the risk of metabolic disease and improving your reproductive health!
Keep up the intake of fresh, wholefoods that are packed with prebiotic fibre. If you can't seem to get enough variety in your day, you are trying to conceive, or you just can't get organised for a veggie laden meal, then top up your diet with the proven mix of prebiotic fibres and Omega-3 in Fertile Gut.
Want to Improve Your Gut Health for Pregnancy Success?
Get in touch with us to find out more about how we can enhance your preconception health. Find out if we are the right support for you by booking in a FREE 10 min phone call with us.
Investing in developing the best quality eggs and sperm will give you the best chance of success and we are here to help!
Male infertility is the main reason around 40% of couples seek fertility treatment. In assessing male fertility, semen analysis is the most important test. While this visit to the 'specimen collection room' is unavoidable, this initial assessment does not necessarily capture your potential for pregnancy.
Routine semen analysis will count the number of sperm and check their shape (morphology) and movement (motility), there is one thing it does not measure: DNA fragmentation.
Today I want to share with you what DNA fragmentation is, why it matters and what you can do about it!
What is Sperm DNA Fragmentation?
DNA is essentially the genetic instruction book for how we grow and function that is contained in every living cell. Breaks, or fragmentation, of the DNA will affect how the cell functions. A small amount of DNA damage is always present but when this damage is high, fertility is reduced.
If your viability is low (<50%), then it is likely that you have high DNA fragmentation rates . Even with a normal semen analysis, 15% of men can have high levels of DNA damage to the sperm.
DNA fragmentation is a major factor in unexplained infertility.
Does Sperm DNA Fragmentation Reduce Our Chance of Pregnancy?
High levels of sperm DNA fragmentation:
While semen analysis may be normal and you may have good fertilisation of your collected eggs, if you have multiple transfers that don’t implant or recurrent early pregnancy loss, DNA fragmentation may be a factor.
When a sperm with DNA damage fertilises an egg, the egg has to invest energy trying to repair the damaged DNA. If there is lots of DNA damage, the embryo won’t have enough energy to develop normally. This leads to an inability to implant or to develop further once an embryo has implanted.
In an ideal situation you want your embryo spending time growing and developing, not repairing itself from the outset!
What Causes Sperm DNA Fragmentation?
Inflammation and oxidative stress are drivers of DNA fragmentation. Inflammation and oxidative stress are elevated with poor diet, insufficient or very high levels of physical activity, stress, sleep deprivation, alcohol and chemical exposure (just to name a few).
How Can I Lower Sperm DNA Fragmentation?
One of the most potent ways to reduce sperm DNA fragmentation is by exercising regularly at optimal intensities with enough recovery.
Infertile men completing a progressive structured running program over 24 weeks had significantly reduced levels of sperm DNA fragmentation. Inflammation and oxidative stress were also significantly lower but best of all these men had a significant increase in pregnancy rate when compared to a non-exercising control group .
Structured resistance training also significantly lowers DNA fragmentation .
Where Do I Begin?
If you are exercising regularly you may want to check in with an Accredited Exercise Physiologist that your current routine is supporting optimal sperm health. The intensity, frequency and duration of your exercise sessions in combination with your strength training can be optimised for creating healthy sperm.
If you have yet to get moving, make sure you get expert advice from and an Accredited Exercise Physiologist so you can ensure you get the best prescription that is tailored for your individual needs and for making your sperm the best it can be!
Sperm takes ~72 days to be produced so changes you make now will produce healthier, happier sperm in as little as 12 weeks. It's time to get moving!
1. Samplaski, M.K., et al., The relationship between sperm viability and DNA fragmentation rates. Reprod Biol Endocrinol, 2015. 13: p. 42.
2. Maleki, B.H. and B. Tartibian, High-Intensity Exercise Training for Improving Reproductive Function in Infertile Patients: A Randomized Controlled Trial. J Obstet Gynaecol Can, 2017. 39(7): p. 545-558.
3. Hajizadeh Maleki, B. and B. Tartibian, Resistance exercise modulates male factor infertility through anti-inflammatory and antioxidative mechanisms in infertile men: A RCT. Life Sci, 2018. 203: p. 150-160.
I hear of so many people removing gluten from their diet in a bid to improve their fertility and get pregnant. There is a lot of misinformation out there so here is a wrap of gluten and fertility to get informed about the decisions you make!
What is Gluten?
Gluten is essentially the ‘glue’ that holds cereal grains together. It is a protein found in wheat, rye, barley, oats and anything derived from these gluten containing grains such as malt. Gluten is a common additive to many foods (sometimes as a thickener or colour) so you may find it in ice cream, lollies, processed meats, yoghurt and salad dressings.
For those diagnosed with Coeliac Disease, eating gluten disrupts the gastrointestinal tract and damages intestinal cells, stressing the immune system and reducing the absorption of nutrients. Untreated Coeliac Disease is a cause of ‘unexplained’ infertility but the number of women with undiagnosed Coeliac Disease is low. In a recent Canadian study, only 1.2% of women with unexplained infertility were diagnosed with Coeliac Disease following routine screening (1). If you are a Coeliac then removing gluten from your diet will improve your fertility. If you are not a Coeliac, there is no scientific evidence to support that eating gluten free will improve your chance of pregnancy.
It can be exhausting reading food labels to determine if a product is gluten free but for anyone diagnosed with Coeliac Disease, a strict gluten free diet is the only management strategy we currently have. There is hope that hookworms may help but expect any alternative treatment to be at least a decade away. As a Coeliac myself I am hopeful that one day I can eat some gluten containing goodies!
Is it Gluten or FODMAPS?
Some people who are not diagnosed with Coeliac Disease experience symptoms such as abdominal pain, diarrhoea, bloating and excessive wind and fatigue that they attribute to eating gluten or wheat. This has been termed ‘Non-Coeliac Gluten Sensitivity’ and emerging research in this field suggests that it is not gluten that contributes to these symptoms but rather the FODMAP content of the diet (2).
FODMAPs are short chain carbohydrates that may be poorly absorbed in the gastrointestinal tract. FODMAPs include fructose (when in excess of glucose), fructans, galacto-oligosaccharides, lactose and polyols (eg. sorbitol and mannitol) – hence the acronym! Some of our work in healthy athletes has shown that reducing dietary FODMAPs can reduce gastrointestinal symptoms (3) so it may not be gluten that is the culprit if you are experiencing gastrointestinal distress. If you think you need to remove gluten from your diet make sure you find the cause of your symptoms with a proper medical diagnosis prior to gluten removal.
Is Eating Gluten Free Healthier?
Somehow ‘gluten free’ has become synonymous with ‘healthy’, but is eating gluten free actually healthier? If processed foods are removed from your diet and you eat more whole foods when eating gluten free, then generally this will be associated with a reduction in dietary intake of sugars and saturated fats (including trans fats) which would be beneficial to health and fertility.
But, there may be some other dietary changes associated with removing gluten that are not so great for health, especially if you reduce your intake of grains. Removing gluten from your diet by cutting out bread, pasta and cereal may significantly reduce your dietary intake of fibre (which has neagtive consequences for creating a Fertile Friendly Microbiota) and carbohydrate. Carbohydrates are a really important component of a balanced, healthy diet and importantly wholegrain intake has been associated with improved outcomes for fertility treatment (4).
Gluten containing grains are often substituted for carbohydrate rich but protein poor ingredients such as maize starch, white rice ﬂour, potato starch or tapioca starch in gluten free alternatives. This means that your protein intake could be reduced, which may impair fertility.
A study that investigated the nutritional value of over 3000 gluten free and non-gluten products in 10 categories of food showed that relative to non-gluten free foods, gluten free products had consistently lower average protein content (5). When you consider that gluten free products often substitute ingredients with low fibre and protein alternatives, and that gluten free products may contain more sugar and fat to improve taste, eating gluten free is not necessarily a healthier option.
Does Gluten Influence Thyroid Function?
There is a partial genetic overlap between Coeliac Disease and autoimmune diseases. If you have Coeliac Disease, you are four times more likely to have an autoimmune thyroid disease. If you have been diagnosed with hypothyroidism you should immediately undergo clinical investigations for Coeliac Disease. A first step in this process is screening for blood levels of antibodies to gluten. If you have removed gluten from your diet before any investigations you will need to start eating gluten again for a period greater than one month so you can receive an accurate diagnosis.
While there is a link between Coeliac Disease and an increased prevalence of autoimmune thyroid disease, there is no evidence to support a link between eating gluten and an increased risk of thyroid issues. Indeed, even in people with Coeliac Disease that is undiagnosed, the duration of exposure to gluten is unrelated to the risk for autoimmune disease. To date, there is no scientific evidence to support removing gluten from the diet as a treatment strategy for thyroid disorders (unless of course you are a Coeliac). Hypothyroidism and Coeliac Disease are associated with reductions in egg quality and infertility (6,7) so getting a proper diagnosis is paramount.
While removing gluten may not be the answer, diet can influence thyroid function and resulting metabolism. Dietary protein intake has been linked to thyroid function in a number of animal studies, with low protein diets reducing thyroid function, increasing abdominal obesity and impairing glucose regulation (8). Ensuring adequate protein in the diet has potential to improve thyroid function and adequate protein intake is essential for muscle building too.
Some foods such as broccoli, cabbage, cauliflower, brussel sprouts, turnips, walnuts, almonds and soy may limit iodine availability, although this is only if consumed in large amounts. Cooked cruciferous vegetables in moderate amounts pose minimal risk for thyroid health (9) and given the other micronutrients they contain, their intake along with adequate iodine will form part of a balanced diet.
What's Your Gut Feeling?
The immune stimulating potential of gluten may be related to your gut microbiota. The HLA-DQ9 gene is the most commonly linked to Coeliac Disease yet some people carrying the gene do not have Coeliac Disease. Could the resident bacteria in your gut influence your propensity to develop Coeliac Disease or Non-Coeliac Gluten Sensitivity?
A study using mice looked at the impact of the gut microbiome on the response to gluten (10). Three groups of mice with three different microbiomes (different populations of bacteria and yeast in the gut) were exposed to gluten for two weeks. Mice with no microbiome (germ free) and mice with a microbiome that contained a number of disease causing species developed an adverse response to gluten, while mice with a healthy microbiome (free of disease causing pathogens) did not have an adverse response. There may be value in ensuring your microbiome is in top shape!
Historically, a gluten free diet has been associated with sub-optimal intake of protein, fiber, B vitamins, and iron alongside increased fat and sugar intake (11). In combination with possible micronutrient deficiency, removing gluten may have other adverse consequences. In healthy adults adhering to a gluten free diet for one month, numbers of healthy gut bacteria decreased while numbers of unhealthy bacteria increased. Rather than removing gluten from your diet, if not medically necessary, a focus on pre-biotic foods and eating a variety of fresh whole foods is sure to confer more benefit. Are you getting enough prebiotic foods in your day?
1. Gunn, B., Murphy, K.E., andGreenblatt, E.M. (2017). Unexplained Infertility and Undiagnosed Celiac Disease: Study of a Multiethnic Canadian Population. J Obstet Gynaecol Can.
2. Biesiekierski, J.R., Peters, S.L., Newnham, E.D., Rosella, O., Muir, J.G., andGibson, P.R. (2013). No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 145(2): 320-8 e1-3.
3. Lis, D.M., Stellingwerff, T., Kitic, C.M., Fell, J.W., and Ahuja, K.D.K. (2018). Low FODMAP: A Preliminary Strategy to Reduce Gastrointestinal Distress in Athletes. Med Sci Sports Exerc 50(1): 116-123.
4. Gaskins, A.J., Chiu, Y.H., Williams, P.L., Keller, M.G., Toth, T.L., Hauser, R., Chavarro, J.E., andTeam, E.S. (2016). Maternal whole grain intake and outcomes of in vitro fertilization. Fertil Steril 105(6): 1503-1510 e4.
5. Wu, J.H., Neal, B., Trevena, H., Crino, M., Stuart-Smith, W., Faulkner-Hogg, K., Yu Louie, J.C., andDunford, E. (2015). Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia. Br J Nutr 114(3): 448-54.
6. Meng, L., Rijntjes, E., Swarts, H., Bunschoten, A., van der Stelt, I., Keijer, J., andTeerds, K. (2016). Dietary-Induced Chronic Hypothyroidism Negatively Affects Rat Follicular Development and Ovulation Rate and Is Associated with Oxidative Stress. Biol Reprod 94(4): 90.
7. Tersigni, C., Castellani, R., de Waure, C., Fattorossi, A., De Spirito, M., Gasbarrini, A., Scambia, G., andDi Simone, N. (2014). Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update 20(4): 582-93.
8. Palkowska-Gozdzik, E., Lachowicz, K., andRosolowska-Huszcz, D. (2017). Effects of Dietary Protein on Thyroid Axis Activity. Nutrients 10(1).
9. Felker, P., Bunch, R., andLeung, A.M. (2016). Concentrations of thiocyanate and goitrin in human plasma, their precursor concentrations in brassica vegetables, and associated potential risk for hypothyroidism. Nutr Rev 74(4): 248-58.
10. Caminero, A., Galipeau, H.J., McCarville, J.L., Johnston, C.W., Bernier, S.P., Russell, A.K., Jury, J., Herran, A.R., Casqueiro, J., Tye-Din, J.A., Surette, M.G., Magarvey, N.A., Schuppan, D., andVerdu, E.F. (2016). Duodenal Bacteria From Patients With Celiac Disease and Healthy Subjects Distinctly Affect Gluten Breakdown and Immunogenicity. Gastroenterology 151(4): 670-83.
11. Theethira, T.G., Dennis, M., andLeffler, D.A. (2014). Nutritional consequences of celiac disease and the gluten-free diet. Expert Rev Gastroenterol Hepatol 8(2): 123-9.