Secondary Infertility

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Secondary infertility is the inability to become pregnant or to carry a baby to term after previously giving birth to a baby. Secondary infertility shares many of the same causes of primary infertility. Secondary infertility can be surprising and stressful.  There are no exact figures available for rates of Secondary Infertility but depending on who you speak to range from 30-60% of couples presenting to fertility clinics.  The immune system is inextricably linked with fertility issues but more so with secondary infertility. Supporting the immune function should be prioritised during the pre-conception and conception period.

Avoid adrenaline

Negative lifestyle choices have a deleterious effect on the immune function.   Prolonged exposure to stress exacerbates the immune system which in turn can disrupt the delicate female and male hormonal orchestra.  Physiologically, excess caffeine consumption induces the production of the stress hormone adrenaline.   Excess adrenaline switches off all non-essential life processes and can inhibit conception.  High levels of circulating adrenaline interferes with the intrauterine environment, egg quality and male sperm production.   It depletes the body of many essential nutrients required for conception such as vitamin C, B and magnesium.  Drinking caffeine and sugar laden caffeinated drinks increase the production of adrenaline.  Women in particular tend to be more sensitive to caffeine and caffeinated products.  Aim to avoid or reduce coffee while trying to conceive and eliminate caffeinated sugary drinks

Focus on sleep.

Sleep deprivation and exhaustion are are hard on the body.  Good quality sleep is very restorative and essential for conception.  Couples trying for a second baby may have a young child who doesn't sleep well.  This can be exhausting. The sleeplessness of life with a small child is hard.  In order to support the immune system and reduce stress, getting sufficient sleep should be a priority for couples trying to conceive.

Egg quality.

Timing conception is very important.  The average age a woman has her 1st baby is now 32 years old.  Trying for the second baby tends to occur some years later. What happens during the intervening years may lead to a decrease in egg quantity and quality.  A woman is born with her full complement of eggs.  While she cannot do anything about the amount of eggs remaining in her ovaries, she can support the development of those egg follicles as they mature. An immature egg called an oocyte takes 3-4 months to mature within the follicle before finally being released during ovulation.  The environment that this egg is immersed in influences the health and quality of the egg.  Egg quality has now become a primary focus in infertility.  Changes to diet and lifestyle during this time frame may make a difference to the health and quality of the egg follicles giving you a higher chance of conception.  Improving diet and nutrient intake is paramount to enhancing increased circulation of nutrient-rich blood to the ovaries to support egg quality. 

Iron

Low levels of egg storage in the ovaries is an increasing issue.  This tends to be more prevalent with ageing.  A simple blood test called AMH which measures a hormone involved in estimating the ovarian reserve can provide a rough estimate of the remaining eggs stored.  This is an area which is receiving much attention.  Iron is a mineral involved in the production of red blood cells.  Studies have shown that lack of iron can cause anovulation which means a woman doesn’t ovulate as the egg may be in poor health.  When blood does not receive sufficient iron, anemia occurs.  Since it is the job of the red blood cells to deliver oxygen to the ovaries which stores the eggs, insufficient oxygen and iron may weaken stores and eggs become less viable.   Animal products contain more bio available iron called haem-iron which is readily used by the body.  Best sources include, lambs liver, red meat, fish.  Vegetarians and vegans may need to keep a constant check on their iron levels to support conception.

 Nutrients and co-factors.

Fertility solutions are big business and medical intervention is very expensive.  1 in 5 Irish couples now experience fertility issues on their road to conception.  The reasons are multi factorial and can be male or female or both.  One thing all couples going through this difficulty have in common is that they need to look at their lifestyle behaviours. Food and nutrients and their impact on fertility outcomes has now emerged as one of the major players in achieving a pregnancy. Vitamins and minerals are known as micronutrients.  They play a crucial role in the functioning of the body.  They are often referred to as co-factors as they are essential to all life processes.  Their role in conception and pre-conception is vital.  Without sufficient B vitamins the body will struggle to make energy.  A lack of amino acids will impoverish protein synthesis and may hamper hormonal and sperm production.   Females may be deficient in certain nutrients post 1st pregnancy and these deficits would need to be corrected in order to conceive again.  

While the female body is the vessel to carry and nourish the developing foetus.  The role of the male in conception is of equal importance.  There is a steep increase in males presenting with fertility issues.  The focus on sperm quality and the genetics of this raw material is comprehensive and responds best to dietary intervention and adopting positive lifestyle behaviours. The new area of science termed ‘epigenetics’, is now considered one of the most informative sources when shaping a healthy environment to conceive. Epigenetics simply means that our DNA is not static but in a constant state of flux and change. Genes are being switched on and off in the presence of certain environmental factors and nutrients. This is truly apparent when we see damaged sperm in the male. This is referred to as DNA fragmentation, whereby the sperm may not be formed properly. It is relatively easy to treat as new sperm is generated in the body in approximately 74 days. There are no treatments available pharmaceutical or otherwise to treat this condition.  Positive lifestyle changes need to be adopted.   Diet and nutrients are the most effect way to influence sperm quality.  Dietary changes do improve sperm quality. Choose foods high in anti-oxidants. Consume brightly coloured fruit and vegetables which are packed full of antioxidants. Beetroot, berries, orange and red vegetables are particularly good.

Alcohol

Possibly the biggest anti-nutrient consumed is alcohol. Alcohol is detrimental to both sperm health and female eggs.  In excess it can create havoc on the very delicate female hormone orchestra. Alcohol causes cellular damage to the body and increases oxidation and free radical production. Male sperm is particularly affected by the amount of alcohol consumed. Alcohol is rapidly converted to glucose in the blood.  Excess circulating glucose damages sperm cells and causes weight gain. Furthermore, alcohol destroys a vital B vitamin called folate in the body — this vitamin is necessary for healthy DNA replication in sperm.  Rich sources of folate include, lambs liver, green vegetables, avocado and green lentils.

Mid abdominal fat

Being overweight decreases the chances of conception in both the male and the female. Weight gain- during or after the first pregnancy may make it more difficult to conceive a 2nd baby. Body mass index (BMI) is the tool used to determine over-weight.  It is not necessarily a good indicator as to what is happening internally.  A better measure is to measure mid abdominal fat. Fat around the middle is known as 'white fat' white fat cells around the ovaries, uterus and male reproductive areas can wreak havoc with these reproductive organs.  These fat cells disrupt the functioning of the sex glands and interfere with hormonal harmony.  To reduce tummy fat, reduce processed carbohydrates and aim to eliminate all sugars and foods containing processed fats.  Replace with good quality protein and bulk up on vegetables.

Trans-fats

Male and female hormones are made up of fats.  Fats are hugely important raw materials that are components of both the sperm and all sex hormones.  Cell membranes are made from the various fats and sugars consumed in the diet. A diet high in sugar and processed fats known as trans-fats interfere with the delicate signalling that occurs on these membranes.  There is no safe limit for trans-fats in the diet.  These are artificial fats made from margarine or re-heating polyunsaturated fats.  Aim to eliminate donuts, white bread, certain pizza, chips, deep fried foods, pastries, biscuits and cakes unless they are made from butter.

Essential fats

The body can make fats from all food groups especially sugar and excess carbohydrates.  There is an exception to this rule.  It cannot make omega 3 fat.  Omega 3 must be consumed from dietary sources.  The body needs a constant steady supply of this fat.  Sperm in particular need plenty of omega 3 in the reduced form of DHA to support mobility and motility.  Similarly EPA the other reduced form of omega 3 is involved in female hormone signalling and hormonal balancing.   The best sources of omega 3 are mackerel, sardines, anchovies, salmon and trout.  It is advisable to avoid tuna in the pre-conceptual period and during the pregnancy as it contains high levels of mercury. 

Mineral deficiencies

Zinc is an essential nutrient in fertility.  Men need zinc for sperm health and the immune function.  Women also need zinc at this time for many regulatory process to happen.  Zinc in involved in blood glucose control and keeping a healthy insulin response.  Zinc is a powerful anti-oxidant which is involved in clearing debris from the cells. Alcohol interferes with zinc’s absorption and assimilation.  Zinc is abundant in fish in particular shellfish and oysters, it is also found in pumpkin seeds, nuts and meat.  Selenium is a mineral which is involved in reproductive health and normal thyroid function.  Males in particular depend on a good supply of selenium for optimal reproductive health.    In certain areas and parts of the world it is lacking in the soil.  The best sources of selenium are brazil nuts, fish and potatoes fortified with selenium.  

Epigenetics and sperm DNA

While the female body is the vessel to carry and nourish the developing foetus.  The role of the male in conception is of equal importance.  There is a steep increase in males presenting with fertility issues.  The focus on sperm quality and the genetics of this raw material is comprehensive and responds best to dietary intervention and adopting positive lifestyle behaviours. The new area of science termed ‘epigenetics’, is now considered one of the most informative sources when shaping a healthy environment to conceive. Epigenetics simply means that our DNA is not static but in a constant state of flux and change. Genes are being switched on and off in the presence of certain environmental factors and nutrients. This is truly apparent when we see damaged sperm in the male. This is referred to as DNA fragmentation, whereby the sperm may not be formed properly. It is relatively easy to treat as new sperm is generated in the body in approximately 74 days. There are no treatments available pharmaceutical or otherwise to treat this condition.  Positive lifestyle changes need to be adopted.   Diet and nutrients are the most effect way to influence sperm quality.  Dietary changes do improve sperm quality. Choose foods high in anti-oxidants. Consume brightly coloured fruit and vegetables which are packed full of antioxidants. Beetroot, berries, orange and red vegetables are particularly good.

Gaye Godkin, Health Nutritionist, MPH Nutrition (Hons) DipNT cNLP