October was Pregnancy and Infant Awareness month. Anyone who has ever miscarried is fed the statistics about 1 in 4 pregnancies resulting in early loss. Human reproduction is so inefficient that many women conceive and don’t even know because their period just arrives. Unless you are peeing on a stick each month before your period is due you wouldn’t know that you have fallen pregnant. Mother Nature needs everything perfect for your DNA to replicate and your embryo to remain viable. Any imperfections in the chromosomes from the egg or the sperm upon fertilisation and the pregnancy may be challenged. And that’s just the start of it.
Your embryo is like Goldilocks. The environment it tries to nestle into needs to be ‘just right’. The depth of your endometrial lining needs to be 8-12mm thick around ovulation. If it’s less or more, the chance of you miscarrying goes up. The presence of fibroids, scar tissue and endometriosis can also be challenging for implantation.
You need to be making beautiful amounts of progesterone. This means your menstrual cycle needs to run smoothly. Progesterone is the hormone that holds your pregnancy in place. If you are undergoing IVF, they will give you progesterone as part of a treatment cycle, but if you are trying to conceive naturally you are probably in the hormone wilderness, and may not be aware of whether you are making enough.
You need to be good at replicating your DNA. By the time your embryo reaches 5 days old it contains over 200 cells. Folate and B12 are just two of the important nutrients needed for healthy cell division and methylation – which is just a fancy way of saying you can replicate your DNA properly. Most of you would know you need to take folate when you are trying to conceive, to help close your baby’s neural tube to prevent spina bifida. You need to be able to use that folate and B12 properly, and sometimes you don’t due to enzyme issues which can result in high homocysteine. Elevated homocysteine can affect blood flow through to baby and can cause issues later in pregnancy.
You could have blood coagulation or autoimmune issues (like coeliac or Hashimoto’s thyroiditis) that you don’t know about. In Australia, women who have had 3 or more miscarriages can be investigated for some of these underlying conditions. Your immune system needs to do some ridiculously clever things to allow implantation to occur. I would always challenge that one miscarriage is one too many, so let’s have these issues on our radar.
Your vaginal and endometrial eco-system microbiomes need to be ship-shape. Scientific research is exploding around the role of microbiomes and fertility. Pregnancy is most likely to occur when you have predominantly good bugs called lactobacilli living in the vagina and the endometrium. If you have thrush, bacterial vaginosis, or group B streptococcus just to name a few, we are going to hit some speed bumps. So many women don’t know what their microbiomes are doing and have no idea they have dysbiosis that could be raising their risk of miscarriage.
I touched on chromosomes and DNA before. Any woman who has ever been labelled with egg quality issues knows the pain and the frustration at stabbing in the dark trying to fix this unquantifiable dilemma. It’s easy with men to assess DNA integrity. This can be assessed as part of a semen analysis. The higher the percentage of DNA breakage in the head of the sperm, the greater your risk of miscarriage. Your greatest chance of addressing egg and sperm DNA issues is pre-conception care. Do everything you can to get as healthy as possible.
My patients often exclaim it is little wonder anyone ever gets pregnant! It’s a tough gig…and an even bigger slap in the face when you have probably spent a lot of your young adult life trying NOT to fall pregnant.
As a naturopath working in the fertility space, I am constantly reminded how delicate life is, as you sit across from me with all your hopes and dreams for a baby lingering in the space between us. Some days are tear-filled with you. Others are met with elation as I learn of your pregnancy.
I will never underestimate the impact of fertility treatment or the desire to have a baby on my patients. The day I lose sight of this is the day I need to hang up my naturopathic boots. Miscarriage and pregnancy loss can be deeply traumatic. It is my job to listen to your story and to try and figure out the missing piece of your puzzle. So many of you tell me that you don’t feel listened to as you walk this fertility road. My hope for you is that in my consult room, you do feel that I am in your corner and that you trust that I will keep digging in the hope that we strike baby gold. If you or someone you know has endured miscarriage, please feel free to share our newsletter with them so we can help them find that missing puzzle piece.