Episode 29: The Ins and Outs of Fertility – Part 1

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[1:38] Cassy Price: Hello, and thank you for tuning in to another episode of Supplementing Health. I’m your host, Cassy Price. Today, we are joined by Dr. Sarah Zadek, a naturopathic doctor located in Ontario with a clinical focus on women’s health, endocrinology, and fertility. Welcome, Sarah.

[1:52] Dr. Sarah Zadek: Thank you.

[1:53] Cassy Price: Before we dive into our topic of fertility for both men and women, would you mind sharing a bit about yourself and how you got started in this field?

[2:01] Dr. Sarah Zadek: Absolutely. When I started to practice women’s health, it was always something that was very near and dear to me just because I’ve grown up with quite a few gynecological issues. I have endometriosis. So getting more than just an MD’s outlook on what my treatment options were was really important to me because I knew that there was more than just having to take a birth control pill. There’s more than just surgery. This is a longer journey than that.

[2:29] That’s what got me into it as far as jumping into women’s health and the fact that a lot of women don’t know a lot about their cycles. I found a lot of my peers didn’t even know quite how to count their cycles, like how long their cycles were. So even the smallest things I found were being not discussed in the realm of women’s healthcare.

[2:55] So I started working with a group called Conceive Health here in Ontario. We’re a growing group. We’re situated within multiple different fertility clinics across Ontario, so I’m happy with the location. What we do is, it’s basically mostly preconception healthcare. That means we’re looking at your healthcare before you want to conceive for the best and healthiest pregnancy, but also just so that you can get pregnant, to begin with.

[3:24] We look at a lot of cases of infertility and trying to find the cause of that. We’re finding more and more now, which is really exciting, that what used to be labelled as unexplained infertility, we’re finding more reasons why women are infertile. There’s so much research going into explaining unexplained fertility, and that’s really neat, and I hope we get a chance to touch on some of those topics in these podcasts.

[3:50] Cassy Price: That’s super interesting. I love the scientific fields for that reason, just how much things can advance, and one thing that seems set in stone at one point can change the next day or the next week or a few years later kind of thing. Can you explain what infertility is and share some of the more common causes?

[4:12] Dr. Sarah Zadek: Sure. Infertility, they’ll have different definitions depending on who you see and which medical care you seek. In general, we’re looking at if you’ve been trying to conceive naturally for 12 months and have not been successful, we consider that to be infertility. It’s especially so, and we call it unexplained infertility, when we don’t quite know the reason why it’s happening yet. That’s why we have to go into further investigations.

[4:43] The idea of infertility, men or women who are having difficulty conceiving, and also ones who are having recurrent miscarriages, any type of pregnancy loss, or recurrent loss can also be considered into that realm because they are often either implantation issues or immune system issues. So infertility can encompass quite a lot.

[5:11] Cassy Price: I know you mentioned 12 months, but does that timeline vary depending on the age of the patient?

[5:17] Dr. Sarah Zadek: Yes, absolutely. So for women who are over the age of 35, we know that there is a bit of a clock running, and we want to address things sooner. So for women over 35, we want them to seek help, only if it’s only been six months trying and not having a successful pregnancy. At that point, we say, “Get into an OB/GYN or fertility clinic and start investigations as soon as you can.

[5:45] Cassy Price: One of the things we see, sometimes, in comedy movies or some of these spoofs is that after intercourse, they’ll get the woman to stand on her head, or they’ll talk about certain positions mattering. Is any of that grounded in reality?

[6:06] Dr. Sarah Zadek: It’s hard to say for sure. It’s not going to do any harm if you want to invert yourself. The idea is you want to have sperm in the area for as long as possible and give them a good chance. If you’re going to stand up and shake around right after, you’re probably going to have some sperm not staying in that area. 

[6:27] So the idea is, you can do that. There’s no data, I don’t think, on how effective that is. But I even tell women afterwards, just lay down – just rest. Give yourself a good 5, 10, 20 minutes if you want, and just lay down. Even just being horizontal will help to retain semen and sperm and allow it to give it that chance to swim.

[6:53] Cassy Price: Okay. Awesome. I think most of us know that nutrition has a profound impact on overall health. Can you explain how diet affects your fertility?

[7:07] Dr. Sarah Zadek: Yeah. Diet actually plays a much a bigger role than maybe some of us have realized. The idea is that definitely, there are key nutrients that we need and macronutrients that are critical for producing our hormones and for their function. We also need antioxidants to help protect the DNA of our sperm and eggs as well from oxidative stress.

[7:34] When we start looking at the diet, we also want to set you up for a healthy pregnancy. These are all things that you’re going to have to do when you’re pregnant anyway, so starting early, building that foundation can help. One of the first things I look at when it comes to macronutrients is, is a woman getting enough protein? 

[7:54] When we consume proteins, they get broken down into amino acids, and these are the building blocks and the materials necessary to make everything, including our eggs and sperm and many other tissues. Protein requirements are incredibly important, and this is even more so in patients looking to lose weight. If we’re looking to obtain a better and healthier body composition, we need protein to build muscle. The importance of protein cannot be understated there.

[8:23] Then, we have our specific nutrients that we get from foods. For example, we know that folic acid is really important for both male and female fertility, and we can find folic acid in a lot of our legumes, things like chickpeas, lentils, kidney beans. For an example, for male health, zinc is incredibly important for boosting sperm count. It’s basically a fuel for sperm and can help to improve the quality and function of sperm. So we find those in different kinds of animal meats, and pumpkin seeds, and things like that. All these nutrients from our food definitely contribute to helping everything function properly and building everything properly. 

[9:06] Then, on top of that, there are foods that can be detrimental for our health. For example, having high-sugar intake and having blood-sugar irregulation can have a really big impact on fertility, or eating lots of processed foods, as well. Anything that skews us away from being able to intake all these healthy and productive nutrients and vitamins is going to affect fertility.

There was a study done in 2018 on the Mediterranean diet on fertility. What they’re finding is that for women who had a greater adherence to a Mediterranean diet, they had a higher likelihood of achieving a clinical pregnancy and a live birth. These were women who were not obese, and who were under that age of 35.

It’s the idea of having a good balanced in healthy fats compared to the inflammatory fats, and a good diet rich in fresh fruits and vegetables, nuts and seeds, and all these whole foods – fish and lean meats. So that whole composition really puts everything into perspective as far as having a healthy and balanced diet that will support a pregnancy, that will support implantation.

[10:27] Cassy Price: You mentioned that zinc specifically helps men with their sperm count. Are there a lot of differences in the nutrients that a man would need to improve his fertility over what females need to improve their fertility and support pregnancy?

[10:42] Dr. Sarah Zadek: Yeah. There are some similarities, and there are some differences. For men, zinc is a little bit more important. Women need it too. It’s not to say that’s not important for us, but it is very important for sperm. One big difference that I find between the two sexes is iron. Usually, when we’re treating men, we really want to use iron-free multivitamins or formulas because the iron can interfere in the absorption of other nutrients. 

[11:12] Whereas for women, we usually will dose iron and specific forms of iron because most of us are low on iron, to begin with, just because we menstruate. Every month that we lose blood, we lose iron, and I’d say in my practice, it’s very rare to find a woman with normal-high levels of iron. So, that’s what’s going to make your difference.

[11:37] Cassy Price: Interesting. We know for women that their hormones play several key roles in the process of conception, from fertility right through to birth. Even though men don’t have those same hormonal cycles, are there times that they are more fertile?

[11:53] Dr. Sarah Zadek: Not necessarily. So men are always generating sperm, whereas we have all of our follicles that we’re born with. For men, though, they still have to generate sperm from the most primordial cells. It takes time for a sperm to go from that little tiny cell to a fully functioning sperm with a head, body, and tail, and to have it be able to function properly.

[12:22] The timeline is a little bit different. For women, It takes us 100 days for our little preantral follicles to be turned into a mature egg. With men, it ranges. The numbers I’ve read, average numbers are about 116 days. I read one paper that quoted 60, which I thought was a bit low, but again, you’re looking at three or four months for the development and the maturation of sperm.

[12:49] As far as fertile windows, we do know that women do have a fertile window around ovulation. For men, there’s not that same window because they’re not having cyclical releases of sperm. Instead, though, what we often recommend is if you’re looking to conceive that month, and it is a woman’s ovulation window, is to not over-ejaculate. So not having an ejaculation, say like four times a day or six times a day. We don’t want you to hold onto it and not ejaculate for a couple of days. There’s going to be a bit of balance there.

[13:32] So a lot of the recommendations are once a day or even every other day for men. I go somewhere in-between, depending on the situation and what the sperm analysis is showing, like how is the concentration, how healthy are the sperm and are they swimming properly? In general, we don’t want to overexert the production, but we also don’t want to wait too long. 

[13:59] What happens is, if a man waits too long, say he’s withholding for three or four days without ejaculating, it really changes the quality of the actual seminal fluid as well. So any type of old white blood cells, sometimes just different types of compounds can sit around for too long, and it can make semen more viscous. That viscosity is a reflection of having that debris in the semen. We don’t want anything impeding the sperm being able to swim. We want them to have clear seas, so to speak. That’s why it’s important to have that balance. We want a good, thinner seminal fluid and not to hold on to an ejaculate too long.

[14:48] Cassy Price: I’m currently reading an interesting book titled, ROAR, by Stacey Sims and Selene Yeager. In the book, they discuss the female triad and how women can better leverage their menstrual cycles in training, which got me thinking about the effects of exercise on fertility. Are there any activities that could be detrimental for women’s fertility, such as overtraining?

[15:10] Dr. Sarah Zadek: Absolutely. Yes. I think this is a really big one, too, because so much focus is put on getting women to lose weight and to be in a healthy body fat percentage for fertility. I think we need to focus on the actual body fat percentage instead of BMI. When I see women who overtrain, they usually have low body fat percentage; not all of them, but you can. 

[15:39] So there are two problems here. One is that if you dip below 20% to 19% body fat, now we’re starting to suppress hormonal function and reproduction function. We see this more often in women who are underweight, even if they’re not training. But if they have low body fat regardless, a lot of them tend to lose their periods, and they stop menstruating. The reason is because of the suppressed menstrual function when there’s not enough body fat. Your body, basically, thinks you’re almost in a starvation mode, and it doesn’t think you can handle carrying a pregnancy to term when you don’t have enough fat reserves and energy reserves on your body. That’s one example of where we can see that happening.

[16:26] But, also, when it comes to overtraining, you’re also increasing cortisol levels and stress on the body. So that doesn’t mean you have to stop doing vigorous exercise necessarily. Also, this is all very individual and specific, and it depends on that person’s individual genetic profile. Typically, when I have runners who come in, especially those who are used to running races and marathons, we tell them not to go over 60 kilometres a week in running.

[16:59] In a high-stressed person, if you have, say, someone who works downtown or in a high-profile job, I would cut this back even further because now you have someone who has been stressed all day long at work, and now they want to go stress their body with a two-hour run. I typically cut back most women to about 20 to 40 minutes of very vigorous work, and no more than 60 kilometres a week of running.

[17:26] Cassy Price: Cool. A few episodes ago, I was talking to Joy McCarthy, and we were discussing how some chemicals mimic estrogen, such as parabens, phthalates, etc. Can those also interfere with the fertility and fetal development, and do you recommend clients move away from using plastics and conventional personal care items that are laden with these toxins?

[17:52] Dr. Sarah Zadek: Yes, 100%. It’s even more so with patients with endometriosis or any type of any autoimmune condition or inflammatory conditions like fibroids or chronic cysts. And most patients, I’ll tell them to avoid these regardless, but it’s more important in those specific instances. 

[18:15] The research on BPA is growing, and it’s extremely strong. In IVF fertility clinics, we’re showing that exposure to pesticides and BPA can lead to poor outcomes. It can lead to diminished ovarian reserve and decrease egg quality. Parabens, we know have been linked to low clinical pregnancy and live birth rates. So these are things that we need to be very cautious about.

[18:47] I think a lot of us shrug it off because the half-life of these compounds is actually pretty short. BPA itself has only a half-life of 6 to 24 hours. I think phthalates, as well, only have a half-life of, on average, 12 hours. 

[19:04] Cassy Price: Oh, wow.

[19:05] Dr. Sarah Zadek: Yeah. There’s a great book out there called Death by Rubber Duck, by Bruce Lourie and Rick Smith. They’re testing the compounds in their own urine, and their exposure and the half-life is actually pretty short. But that doesn’t mean that we need to take this lightly. We can’t assume that our body is being very efficient of getting rid of these chemicals. Even when they’re in our system, during those 12 to 24 hours, it can still have an effect.

[19:29] Now, with that being said, we can’t be perfect all the time, and that’s what I love about this one book. They mention that you cannot avoid all plastics in our world. It’s just impossible. That’s okay. The idea is that we want to reduce exposure in any many ways that we can, where we do have the choice. 

[19:55] That does mean looking at your body products, everything in your medicine cabinet and what you’re putting on your body like shampoos and lotions. We want to avoid chemicals like parabens, phthalates, artificial and synthetic fragrances. All these chemicals do build-up, and you have to think about everything that we’re exposed to that the liver has to process and get rid of for us.

[20:23] There’s air pollution and different chemicals on our food. There’s our drinking water. We’re exposed to pollutants everywhere. If we can take control over some of those and maybe choose to not wear perfume or to use unscented paraben-free lotions and shampoos and soaps, then you’re doing yourself a big service. Even choosing organic foods whenever you can or when it’s possible within your budget for the week for groceries. That’s going to help as well.

[21:00] Cassy Price: Beyond diet, personal care, and all those things that you already mentioned, are there other lifestyle and environmental factors that can have an effect on fertility, which people can control for themselves?

[21:13] Dr. Sarah Zadek: Yeah. There are a couple that we tend to investigate, especially in cases of infertility, the first being overall sleep patterns. Poor sleep quality and not getting enough sleep can negatively affect your fertility. We find this a lot in shift workers. It’s really tough because if you are a shift worker, it’s not like you can just up and change your job. But it’s something that we need to be very cognizant of.

[21:40] For those who aren’t shift-workers who are maybe only getting six hours a night of sleep or less, this is something that we have to change. We have to change habits. So, going to bed earlier or changing your wakeup and bedtime routines to make sure you’re getting enough hours in. I find that a lot of people just want to stay up later to spend time with their partners, which is heartwarming and wonderful, but we also have to get enough sleep to have proper gene regulations, to solidify memories, and have proper repair in our bodies as we rest.

[22:18] The other thing that’s up and coming in our research is the microbiome and not just the microbiome of your gut, but the microbiome of the actual vaginal and uterine environment. This is really needed, and something that I’m really interested in right now is – and testing is actually new for this as well. 

[22:40] It’s called the EMMA test (Endometrial Microbiome Metagenomic Analysis), and it’s a test looking at the microbiome inside the uterus. We’re finding that certain, what we call lipopolysaccharides from bacteria, specifically gram-negative bacteria, can suppress or change our hormone function. Some studies are reporting that it can alter the receptor function of follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) in the uterus. When we have a poor Lactobacillus presence, it can also lead to failure of implantation.

[23:17] We’re seeing this more and more in IVF clinics when you’re transferring a very healthy normal euploid embryo, and it’s not implanting. That’s why now in clinics, we’re screening for antibiotic use, history of vaginal candida, which are yeast infections, and bacterial vaginosis, and looking at the different factors that can affect both cervical mucus and the PH of the whole environment.

[23:49] Cassy Price: That’s super interesting. Unfortunately, we’ve reached the end of our time for today. However, we’re going to bring you back next week for another episode to continue this conversation. Thank you so much for joining me today, Sarah, and I look forward to speaking to you again next week.

[24:04] Dr. Sarah Zadek: Wonderful. Thank you so much.

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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at marketing@aor.ca. We hope you tune in again next week to learn more about supplementing your health.

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