Dr. Donata Girolamo, ND
Dr. Donata Girolamo, N.D. explains in this 5-part series how to build a strong foundation to improve conception rates, labour experiences, and have a healthy baby.
Stress is commonly overlooked and not considered as an obstacle to natural conception. I’ve chosen to write about it as part 1 of Foundations of Fertility, because stress is now acknowledged as being the cause for many disease processes.1 Managing stress better and initiating the relaxation response can help reverse or heal the disrupted physiology causing the infertility. You may have heard stories yourself; friends who have been trying to conceive for years and finally do so after placing their names on an adoption list, or after a vacation. I have known many patients like this. Another patient became pregnant after decreasing her hours at work. This type of anecdotal evidence has been observed for decades or longer.2
How stress affects fertility
“Sure I have stress. But how does that affect my fertility?!” I hear this all the time. The following is how the stress response affects fertility:
We perceive a stressor through our perception – eyes, ears, thoughts. (Sometimes the stressor can be physical, like a chronic dehydration). The information is sent to the amygdala, the center for emotional processing, then to a master regulator, the hypothalamus. The hypothalamus communicates through the nervous system, to the adrenal glands. The adrenal glands pump out stress hormones such as adrenaline, stimulating blood sugar. The hypothalamus also activates the HPA-axis, releasing corticotrophin-releasing hormone causing the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH travels to the adrenal glands, prompting the release of cortisol.3
Cortisol then can delay the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) surge, and suppress gonadotropin-releasing hormone ( GnRH) secretion4. GnRH is responsible for releasing LH and FSH from the pituitary. This causes disruption in ovulation and can cause anovulation.4
Cortisol can cause significant changes in thyroid hormone levels, inflammation, weight gain, suppressed immunity, depression, insulin resistance, and other degenerative diseases.5 This does not fare well for fertility! In fact, these are also many of the physical reasons behind infertility. Luckily, we have an inherent capacity to activate the antidote within ourselves: the parasympathetic nervous system. Some ways to do this is through meditation, using botanicals, acupuncture, and lifestyle modifications.
Meditation or activating the relaxation response has been found to stimulate the parasympathetic nervous system and decrease cortisol.6 Other stress markers such as heart rate and oxidative damage have also been found to decrease, along with blood sugar, and inflammation. Meditation can also improve immune function, decrease anxiety, depression, binge-eating, and emotional distress, and improve quality of life, and sense of purpose in life.7 It has also been found to elicit gene expression changes, and benefit oxidative stress and cellular damage.8 Meditation, yoga, Qi Gong, or prayer all elicit the relaxation response and are a very important part of infertility treatment.
Botanicals have an excellent capacity to regulate our stress response. For example, Rhodiola Rosea is a gentle yet powerful adaptogen that inhibits the breakdown of serotonin, promoting wellness and stamina. It has been used for centuries for issues with the nervous system, digestion and immune system.9 Historically, Dr. Tori Hudson, N.D. shares, “It was thought that rhodiola could enhance fertility, and young Siberian couples carried rhodiola roots in bouquets prior to marriage”. Currently, studies have shown rhodiola to restore ovulation in women with amenorrhea (loss of menstrual cycle) and physicians have reported cases of women who have failed to conceive using fertility drugs, becoming pregnant months after taking rhodiola.10 Rhodiola is a wonderful herb to consider for stress management especially when fertility is a concern.
It is necessary to support detoxification pathways while experiencing stress and infertility. Cortisol impairs liver detoxification, allowing the buildup of environmental and physiological toxins. This in turn will have an effect on gastrointestinal tract flora and hormonal balance. Paul Pitchford states, “the liver benefits from organic plant foods, which are rich in minerals (including magnesium), vitamins, antioxidants, and various other phytonutrients. Eating vital, unrefined plant foods initiates liver cleansing and restoration, and will act as a foundation for other more specific therapies”.11 Your naturopathic doctor may also prescribe supplementation as an effective approach to enhancing detoxification while under stress. Stay tuned for more information regarding fertility and nutrition in next month’s article.
Traditional Chinese Medicine acknowledges the subtle manifestations of stress in relation to fertility. A common TCM diagnosis for a women experiencing infertility is Heart and Liver qi stagnation. The heart is the emotional center of the body and houses the spirit. Emotional upsets can obstruct the Qi (vital force) in the heart, and have an impact on ovulation. In western terms, this is related back to the hypothalamus, which controls ovulation. Research can now verify that acupuncture does indeed initiate a parasympathetic response in the central nervous system12 and has an effect on the HPA-axis.13 The liver Qi is easily obstructed by stress, and is commonly the first organ and meridian to be effected by everyday stress. Obstruction of this meridian can cause PMS and digestive complaints, and does not become a serious problem for infertility unless it leads to stagnation, which can then influence the uterine lining. Obstructed liver qi can also cause tension in the fallopian tubes, preventing the passage of the egg, sperm or embryo. Fertility expert Jane Lyttleton acknowledges that meditation is one of the most effective means to prevent qi stagnation, along with exercise and massage14. I include an acupuncture protocol in all fertility cases. It is an effective way to target many systems at once, and impacts many health variables such as stress management, sleep, energy, hormones, and digestion.
The following is a case study: 35 yr old female came to see me with chief concern of infertility. She had been trying to conceive for 1 yr. She had 1 miscarriage during that time. She acknowledged a stressful year; her sister passed away, and she received a promotion at work. She could not ‘shut her brain off’, felt anxious, and had trouble sleeping. She noted even her dreams were work related. Her periods were regular, she had some gas, but regular bowel movements. We started with herbs to support the nervous system, a nutritional supplement for metabolic support, and weekly acupuncture. We discussed nutrition, and she began charting her basal body temperature (BBT). Her blood work showed possible subclinical hypothyroidism, and her iron stores were sub-optimal. Her BBT revealed a TCM diagnosis of “yin deficiency” and “liver fire”. We continued to support the adrenal gland with herbs and homeopathics. 3 months later she discovered she was 6 weeks pregnant! This was a straightforward example of how stress can impact the ability to conceive.
I hope you have developed an appreciation for how significantly stress can affect your fertility. A comprehensive individualized treatment plan including meditation and exercise, botanicals, detox support, and acupuncture, can effectively mitigate the effects of stress.
After graduating from the University of Toronto with an Honours Bachelor of Arts degree, Dr. Donata Girolamo then pursued her passion for holistic medicine at the Canadian College of Naturopathic Medicine in Toronto, becoming a licensed and registered Naturopathic Doctor.
Dr. Donata Girolamo maintains a private family practice with special interests in fertility and mental wellness. Her mission is to optimize your health care by combining evidence-based medicine with the art and wisdom of traditional medicine. To address your health concerns she uses acupuncture, herbs, homeopathy, nutrition and lifestyle counselling.
She maintains inspired through continuing education, and has extensive training in homeopathy, biotherapeutic drainage, auricular medicine, and medical intuition. She has additional certification in Wilson’s Temperature Syndrome, First Line Therapy; a lifestyle program for weight loss and chronic disease prevention and treatment, and Psychosomatic Energetics. Due to her interest in the link between mind, body and spirit, Dr. Girolamo has taken intensive courses in Vipassana and Mindfulness meditation, and mind-body medicine through The Benson-Henry Institute for Mind-Body medicine.
She is certified by the Board of Directors of Drugless Therapy Naturopathy and an active member of The Ontario Association of Naturopathic Doctors, the Canadian Association of Naturopathic Doctors, and the Association of Perinatal Naturopathic Doctors. She is a regular contributor to Health Wellness and Safety magazine, and has written for Canadian Health and Lifestyle. She is a guest speaker at Niagara College, teaching stress management with meditation, and is active in the community, giving health talks to groups like Run Girl Run, Happy Hearts, Niagara Pain Program, and Form Fitness. She is appearing in a fertility segment on CHCH news, and has been interviewed on 610 CKTB newstalk radio regarding menopause. Understanding and sharing the body’s wisdom is not only a passion, but her calling.
- McEwen, B. Stress, Adaptation, and Disease: Allostasis and Allostatic Load. Annals of the New York Academy of Science. 2006;840. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1998.tb09546.x/abstract;jsessionid=dd3040686bac53aaa41b62768cf40946.f04t01?deniedaccesscustomisedmessage=&userisauthenticated=false. Accessed April 17, 2015.
- Sandler, B. Emotional Stress and Infertility. Journal of Psychosomatic Research. 1968;12(1):51–59. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1998.tb09546.x/abstract;jsessionid=dd3040686bac53aaa41b62768cf40946.f04t01?deniedaccesscustomisedmessage=&userisauthenticated=false. Accessed April 17, 2015.
- Understanding the stress response – Harvard Health. Harvard Health. Available at: http://www.health.harvard.edu/staying-healthy/understanding-the-stress-response. Accessed April 17, 2015.
- Berga, SL, Daniels, TL, Giles, DE. Women with functional hypothalamic amenorrhea but not other forms of anovulation display amplified cortisol concentrations. Fertility and Sterility. 1997;67(6):1024–1030. Available at: http://www.fertstert.org/article/s0015-0282(97)81434-3/abstract. Accessed April 17, 2015.
- Friedman, M. Thyroid and Parathyroid Metabolism Disorders. In Fundamentals of Naturopathic Endocrinology.Vol 67.; 1997: 93–112.
- Dusek, JA, Benson, H. Mind-Body Medicine: A Model of the Comparative Clinical Impact of the Acute Stress and Relaxation Responses. Minn med. 2009;67(6):47–50. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2724877/. Accessed April 17, 2015.
- Greeson, JM. Mindfulness Research Update: 2008. Complement Health Pract Rev. 2009;67(6):10–18. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2679512/. Accessed April 17, 2015.
- Duseck, JA, Otu, HH, Wohlhueter, AL. Genomic Counter-Stress Changes Induced by the Relaxation Response. PLOS ONE: 2008. Available at: http://journals.plos.org/plosone/article?id=10.1371%2fjournal.pone.0002576. Accessed April 17, 2015.
- Van Dierman, D, Marsten, A, Bravo, J, Carrupt, PA, Hostettmann, K. Monoamine oxidase inhibition by Rhodiola rosea L. roots. Journal of Ethnopharmacology. 2009;67(6):397–401. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19168123. Accessed April 17, 2015.
- Hudson, T. Dr. Tori Hudson, N.D. » Rhodiola: Stress, Fatigue, Memory, Mood, Reproductive Health. Available at: http://drtorihudson.com/articles/rhodiola-stress-fatigue-memory-mood-reproductive-health-help-with-these-and-so-much-more/. Accessed April 17, 2015.
- Pitchford, P. Healing with whole foods: Asian traditions and modern nutrition. Third. Berkeley, CA: North Atlantic Books; 2002:39.
- Li, Q-Q, Shi, G-X, Xu, Q, Wang, J, Liu, C-Z, Wang, L-P. Acupuncture Effect and Central Autonomic Regulation. Evid Based Compliment Alternat Med. 2013. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3677642/. Accessed April 20, 2015.
- Acupuncture Points & the Pituitary Gland. LIVESTRONGCOM. Available at: http://www.livestrong.com/article/536102-acupuncture-points-the-pituitary-gland/. Accessed April 20, 2015.
- Lyttleton, J. Treatment of infertility with Chinese medicine. Third. Edinburgh: Churchill Livingstone; 2004:350-351.