It Takes Two... And a Uterus: The Ultimate Guide to Understanding and Enhancing Your Fertility

By Dr. Sarah Zadek

An evidence-based guide to optimizing egg, sperm and uterine health for improving the odds of a healthy pregnancy (whether naturally or with advanced reproductive technologies such as IVF), no matter your gender, sexual orientation, or relationship status. This witty and easy-to-follow guide addresses key factors in fertility such as your: genetics, gut and vaginal microbiomes, diet, physical activity, sleep, stress, and exposure to environmental toxins.

Understand the science behind fertility, how to troubleshoot "unexplained infertility," PCOS, endometriosis, and the challenges with conceiving in your 30s and 40s. Learn how to track ovulation, when to have sex (or inseminate), and which supplements may help along the way.

• Language: English
• Publisher: Tellwell Talent
• Release date: Feb 28, 2023
• ISBN: 9780228884194

Dr. Sarah Zadek

Dr. Sarah Zadek ND, is a writer and licensed Naturopathic Doctor in Ontario, with an honours degree in biological sciences and a Doctor of Naturopathy degree. Sarah currently practices at Conceive Health at TRIO Fertility in Toronto, an integrative clinical model that supports collaboration between naturopaths and medical practitioners. When she's not working or spending time with her husband and daughter, Sarah loves getting lost in a good book or going for a run with her dog Maple.

Book preview

It Takes Two... And a Uterus

The Ultimate Guide to Understanding and Enhancing Your Fertility

Dr. Sarah Zadek

It Takes Two… And a Uterus

Copyright © 2023 by Dr. Sarah Zadek

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author, except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law.

The information contained in this book is provided for educational purposes only. It is not meant to replace professional medical advice, diagnosis, or treatment. Any attempt to diagnose and treat a medical condition should be done under the direction of a healthcare provider or physician. For any medical conditions, each individual is recommended to consult with a healthcare provider before using any information, idea, or products discussed. Neither the author nor the publisher shall be liable or responsible for any loss or adverse effects allegedly arising from any information or suggestion in this book. While every effort has been made to ensure the accuracy of the information presented, neither the authors nor the publisher assumes any responsibility for errors. References are provided for information purposes and do not constitute endorsement of any websites or other sources. Readers should be aware that the information in the book may change.

Tellwell Talent

www.tellwell.ca

ISBN

978-0-2288-8418-7 (Hardcover)

978-0-2288-8417-0 (Paperback)

978-0-2288-8419-4 (eBook)

Dedication

This book is dedicated to my amazing and supportive husband Aaron, my daughter Martha, and anyone out there who hopes to start or add to their family.

Table of Contents

Introduction

Chapter 1 The Quest for Conception

Chapter 2 Mighty Mitochondria: Egg and Embryo Energy Packs

Chapter 3 Inside the Pocket of Your Genes: Genetics and Fertility

Chapter 4 Find My Cycle: The Ovulation Shakedown

Chapter 5 Microbiomes: Who’s Living in your (Pre-Pregnancy) Uterus?

Chapter 6 Rock that Body: Body Composition and Fertility

Chapter 7 Diet Riot: Food for Follicles (Eggs) and Sperm

Chapter 8 Let’s Get Physical!

Chapter 9 Go the F to Sleep

Chapter 10 Hot off the Stress: Modifying Your Mindset

Chapter 11 Lifestyle Saboteurs: How Getting Your Fix Affects Fertility

Chapter 12 Everyday Mini-Toxins: Save Your Gonads and the Planet at the Same Time

Chapter 13 Sex and Orgasms!

Chapter 14 Super Swimmers: Making Spectacular Sperm

Chapter 15 Advanced Reproductive Technologies (ART)

Chapter 16 Supplemental Helpers for Improving Egg, Sperm, and Embryo Quality

Chapter 17 Supplemental Helpers for Uteruses

Chapter 18 Overthrow Your Endo: Trying to Conceive after Being Diagnosed with Endometriosis

Chapter 19 You Can’t Cyst with Us! Trying to Conceive after Being Diagnosed with Polycystic Ovarian Syndrome (PCOS)

Afterword

References

Glossary of Fertility Acronyms and Terms

Acknowledgements

About the Author

Introduction

Welcome to your all-in-one fertility guide!

Whether you picked up this book or it was a gift, you’ve taken a positive step towards enhancing your reproductive success and overall health—assuming you actually read it. My goal is to get you comfy and cozy with your reproductive system and the art and science of making a baby! The art is the delicious food you can eat and glorious orgasms that help you get pregnant. The science is the hundreds of biological processes that go into making a new human being.

No matter what your situation, gender, sexual orientation, or relationship status, this book provides insight into how you, a partner, or a surrogate can improve the odds of becoming pregnant. As the title suggests, conceiving and making a healthy baby requires a healthy and viable egg, a healthy, motile sperm cell, and a uterus for the resulting embryo to grow in. Since the majority of humans have either testicles or ovaries and not both, it takes two people (and sometimes three if you need a surrogate uterus) to make a baby. Although I have a sperm health section of this book (see Chapter 14), you’ll find that I’ve included information for people with testicles throughout many chapters and sections, not just in that single chapter. I highly encourage you to read this book from start to finish as it tells the story of reproduction and fertility challenges and how to address each one.

Within these pages I’ll discuss the foundational health factors that go into improving sperm and egg quality and uterine health. I also address which supplements may be helpful for increasing reproductive odds and review your reproductive options if you’re not taking the old penis-ejaculating-into-vagina route.

As a licensed and practicing naturopathic doctor, I’ve spent almost a decade focused on hormonal health, including its links to diet, digestion, sleep, inflammation, autoimmunity, and oxidative stress. I’m also fortunate to be part of the Conceive Health family, a fertility-focused naturopathic clinic integrated within a medical fertility clinic setting (TRIO Fertility, Canada’s largest in-house fertility clinic team). It’s undeniable that these two forms of healthcare are complementary, working together for more successful fertility outcomes.

Not only do I work with Conceive Health, but I’ve also put my own care in their hands! (After all, when you know too much, it’s often better to have someone else take care of you and narrow down your treatment plan.) I was diagnosed with endometriosis in my early thirties after experiencing blinding pain throughout my cycle, and heavy, long periods. My OB/GYN was good, but I wanted more expert eyes on my case. I knew where to go. Knowing that I was ready to try to conceive soon, I saw one of the reproductive endocrinologists (also called an REI, or a fertility medical doctor) at TRIO Fertility. I knew immediately that I was in the right place. He referred me to an OB/GYN surgeon who would later do an incredible job removing my lesions and adhesions. All the while a naturopathic doctor at Conceive Health took care of my naturopathic treatment plan, helping me suppress the shit out of those lesions and prevent them from coming back.

I’ve experienced the highs and lows of a fertility journey, and I feel lucky to now parent an adorable and imaginative daughter. My goal as a fertility-focused naturopath is to inspire and guide you along your fertility journey. This path may be short and easy for some, but it can be long, stressful, and tiresome for others. Be patient and kind with yourself.

If you’re ready, let’s get started!

Chapter 1

The Quest for Conception

Bringing a live baby into the world is an incredible capability of humans, but a more impressive miracle starts about nine months before that. The number of steps and processes that must occur (or not occur) for conception to happen and for a fetus to grow is almost unbelievable.

Of the millions of sperm introduced into the vagina, roughly 5%–10% are actually normal. One in those 5%–10% has to then blindly travel—relying only on the fluid they’re swimming in and the changes in physical conditions around it—to make it all the way from the vagina, up the cervix, into the uterus, then up the correct fallopian tube to meet an egg that we hope is healthy and ready. That sperm then must have a healthy head so it can fuse with and break into that egg. Once inside, both cells need to merge their DNA, creating the DNA of a new living creature.

But they’re not done yet.

That egg needs enough energy to sustain this transaction and the five-to-six-day journey to the uterus.

So now you have an embryo (yay!). That embryo has to undergo cell division, cleaving that single zygote cell into sixteen cells. Each of those cells is compacted and forms different layers while hoping that the lining of the uterus is ready for it. That uterine lining also has to make changes to create a receptive landing pad. It sends out signals and changes the layout of the ground to make sure the embryo can attach properly. And don’t forget about the timing: it must be done within the proper implantation window. If that embryo is off by even a day, the uterine lining crew may have already packed up their tools and left.

That’s when a symphony of messages is sent back and forth between the two. Adhesion molecules anchor the embryo while other immune factors make sure that the embryo is facing the right direction. The immune system within the uterus has to allow all of this to happen and not reject this strange little hybrid cell mass as a threat. New blood vessels must form to support the lifeline of the implanted embryo, and the whole thing has to not only survive but keep dividing, growing, and changing form. We literally take two single cells—one each from two completely different human beings—and spark the creation of a brand-new brain, skeleton, heart, digestive tract. There’s your miracle! You have sex or have sperm (or an embryo if you’re undergoing in vitro fertilization) introduced into a uterus and start the creation of a new human life.

Sure, some people can have sex one time and become pregnant right away. That happens. People also win the lottery. It’s not impossible, and we all know someone that’s happened to (the pregnancy part, maybe not winning the lottery). But it doesn’t happen that quickly for many people, and it’s important to be prepared for that possibility.

Keep in mind that getting a Big Fat Positive (BFP) is a benchmark. It’s a freaking exciting and euphoric benchmark, but so much more has to happen before you can hold your baby. You actually have to grow it, and it has to develop properly over the course of the following thirty-eight weeks or so. Preconception healthcare prepares your body for a healthier pregnancy and birth. These changes also set the stage for your future baby’s health.

Your offspring are more likely to have less health risks in childhood and beyond if both a healthy sperm and egg are contributed. It is also important that the person carrying the baby during pregnancy provides a healthy home that is rich in nutrients for growth and development. In order to do that, the goal is to be in a healthy state as early as possible. You are the creator of the parts that will make up your baby. If you are in an unhealthy, inflammatory state full of cellular and DNA damage that is flooded with problematic microbes and bacteria, that is the source material you’ll use to create your little human. Why not give them the best opportunity? Why not use your healthiest building blocks?

We know that genetics play an influential role in health outcomes, but those are just the instructions. It’s up to you to decide how you want your body to follow those instructions. Our dietary and lifestyle choices have a significant impact on our current and future health. Not only does this affect the quality of eggs or sperm we produce, it also affects pregnancy and that baby’s health as they grow throughout childhood and even well into adulthood.¹ For example, maternal gut health in preconception and pregnancy can determine how well that future infant’s immune system will work after they are born and potentially for the rest of their life.² Wow.

While there is no guarantee of a pregnancy on any given cycle, there are several things you can do now to prep your body and create a more favourable environment for conceiving and growing a baby. Although some people can get pregnant their first cycle trying, that isn’t the norm. There’s only about a 30% chance of conceiving in an average healthy cycle, so it’s not uncommon for it to take three, four or more months of trying before becoming pregnant.

If you have been unsuccessful in becoming pregnant or have been diagnosed with unexplained infertility (which is basically when your doctor can’t figure out why you’re not getting pregnant—I know, frustrating!), understanding genetics, microbiome health, and environmental factors can help improve your odds or shed light on the unexplained part of your infertility.

An embryo receives half of its DNA from the egg, half from the sperm, and almost all of its initial energy comes from the egg. This makes it critical for reproductive cells to have adequate essential nutrients for their best health and function. Both sperm and eggs should be supported with optimal diet and lifestyle choices, including any necessary supplements, for the best chances of a healthy and successful conception.

It takes about eighty days for sperm to mature and be ready to launch, and about one hundred days for an egg to go from a premature follicle in the ovary to a fully mature egg that is ready for ovulation. This is your window, your opportunity. The goal is to have a positive influence on these cohorts of follicles and sperm.

During this time of development, the follicles in an ovary and the sperm growing in the testicles are extremely vulnerable to DNA damage from exposure to toxins, inflammation, infections, and nutrient deficiencies. This means egg and sperm health can be greatly impacted before they are even released during ovulation or ejaculation, respectively. This is the window we need to take advantage of to increase the health of your eggs and sperm, which increases the odds of a viable and healthy egg and embryo. We call this window the 100 days of preconception health.

Although we place a lot of importance on ovarian and uterine health, sperm health directly relates to overall health as well. If sperm aren’t functional or there are breaks in DNA or abnormal head or tail shapes, it’s less likely it will make it to the egg, let alone fertilize it. If a poor-quality sperm actual succeeds in fertilizing an egg, any mutations or abnormal DNA can be passed onto the offspring and continue to be passed on for generations. Therefore, planning for a healthy pregnancy must include both partners (or known donor[s]).

This isn’t meant to scare you, but to empower you.

There are many things we can do for our health that affect our eggs and sperm. The following chapters will walk you through these processes and show you why we care so much about eating right and getting enough sleep. I also reveal why artificial fragrances, pesticides, and other chemicals are damaging even though you might feel fine, and why it helps if you orgasm during sex.

Yup—I’m going to teach you how orgasms can help you become pregnant!

I’ll talk about specific challenges to getting pregnant, such as if you have hormonal disorders like endometriosis or polycystic ovary syndrome (PCOS) or if you’re older and are worried about egg quality or reserve.

This book is your preconception fertility friend. It’s your companion when you’re trying to conceive (TTC), but it will also help you optimize your health. After all, reproductive health and aging health are inextricably linked. The information provided can guide you to make positive choices for a healthy conception and less risky pregnancy, but it also supports your optimal health so you can enjoy each milestone with your family.

Chapter 2

Mighty Mitochondria: Egg and Embryo Energy Packs

When trying to get pregnant, having good quality eggs will enhance your odds. After all, a good quality egg helps make a good quality embryo. The egg’s DNA makes up half of the embryo’s genetic material, and if merged with a poorer quality sperm, a healthy egg has the ability to repair some damaged sperm DNA. The egg is also responsible for providing the majority of cellular energy to the embryo for those earliest days of development. Therefore, a good quality egg needs to have healthy, intact DNA and chromosomes, and enough energy to sustain the initial stages of embryo growth.

Younger eggs, such as those ovulated in a person’s twenties, are typically better quality because our younger cells have greater energy-producing capabilities and are more efficient at repairing damage. These cellular processes become less precise and efficient as we age, and the ovaries age much sooner than we’d like, affecting egg quality as early as our mid-thirties. To the ovaries, these are the last years before retirement. Egg quality starts to dip between the ages of thirty-five and thirty-seven, and by thirty-eight, those eggs are fighting major biological challenges including having less energy, being prone to more DNA damage, and having problems replicating and repairing DNA.

Eggscellent development

Sperm and eggs (oocytes) are each individual cells. At birth, the ovaries contain all of the premature oocyte cells they will ever contain for the lifetime of that person. Each premature oocyte is nestled within a follicle made of layers of cells. These follicle cells are responsible for receiving hormone signals and nutrients to help its oocyte grow and mature when the time is right.

These oocytes remain asleep during childhood until the hormone surges of puberty wake them up and prompt them to develop. But post-puberty oocytes are vulnerable to environmental factors such as chemicals, nutrients (or lack thereof), and hormones, which influence their overall quality and ability to grow.

A cohort of follicles in each of the ovaries is recruited to grow during every menstrual cycle. This is referred to as your antral follicle count (AFC), which is ideally about 8–10 follicles per cycle regardless if you’re TTC naturally or with advanced reproductive technologies (ART) like in vitro fertilization (IVF). Keep in mind that your AFC can fluctuate from cycle to cycle, and it’s possible to have one ovary vastly outperform the other in follicle count.

These follicles are supplied with follicle stimulating hormone (FSH), which comes from the little pituitary gland under your brain. Additionally, follicular cells produce estrogen to assist in their growth and maturation. Estrogen and FSH act like a miracle grow to the bed of flowers that are your ovaries, hoping that one of those seeds (follicles) will sprout and grow. The follicle that grows and responds best to these hormones is the chosen one, a.k.a. the dominant follicle which will become the ovulated egg that cycle. A mature, dominant follicle will have grown from 1mm diameter to about 18–24mm. When that happens, all the other follicles in that cohort are broken down and discarded.

Keep in mind that your AFC decreases with age. This means that your ovarian reserve, or the pool of follicles you’re trying to grow, will begin to shrink in your mid- to late thirties and beyond. This is not a major problem if the egg you’re able to grow is a quality one. This is something I review with my clients who are undergoing IVF. Yes, you want a greater amount of follicles for a greater chance at having at least one of them pan out for you, but quantity isn’t everything. You only need one good egg to make an embryo and a baby. Remember: quality over quantity. This is something that those with polycystic ovary syndrome (PCOS) can also relate to. The AFC for someone with PCOS can be as high as 30–40 or even more, but even with a large cohort lingering in the ovaries, the hormone dysregulation in PCOS prevents them from growing and maturing. Egg quality matters.

Follicle and egg quality have other important functions too. After the egg has been released