Stony Ground

Infertility is increasing dramatically (1-3), so much so that one in six couples today are unable to conceive in the old-fashioned way. It has been guesstimated that approximately 1/3 of these cases are due to female factors, 1/3 to male factors and 1/3 to a combination of male and female factors (4), which seems fair. There is a residue of about 10% of cases where the cause is unknown.

Falling reproductive rates are probably good for the planet, but they can be a tragedy for those directly involved. There is no single remedy and for some, adoption will remain the only option. In most cases, however, there are potential answers which can be tailored to individual couples, depending on the specific factors underlying their inability to conceive.

Causes of infertility include genetic problems (relatively rare), environmental toxins (important in some groups), and the inter-connected life-style factors of diet, exercise and body shape, which have become the most common cause of infertility today.

The modern, ultra-processed diet creates malnutrition, and is the prime cause of degenerative disease and early death the world over (5). It is also very clearly linked to reduced fertility. Malnourished sheep, cows, pigs, pets and poultry all experience reduced fertility. Why would human animals be any different?

The evidence that we are an increasingly malnourished species is overwhelming.

Tides of degenerative disease are rising in every country that has transitioned from traditional to ultra-processed foods. As a direct result we are simultaneously experiencing chronic inflammatory stress, Type B malnutrition, dysbiosis and insulin resistance (6), and we are becoming fatter and more diabetic. All these factors degrade fertility in both sexes.

Our dietary / metabolic problems have contributed to a dizzying fall in sperm counts. According to an extensive meta-analysis covering 185 studies, including over 40,000 men from developed countries, sperm counts (the main factor determining the quality of semen) fell nearly 60% in the four decades between 1973 and 2011 (7).

Testosterone levels have fallen in parallel (8), reflecting environmental factors and governmental advice to switch to low fat diets which appears, typically, to have made things worse … (9, 10). Male fertility, libido and masculinity are all in decline … [See former post ‘Sexx Laws’].

We have company in the dog-house, because canine sperm counts are crashing too (11). Man’s best friends are also experiencing more testicular cancer (12, 13), just as men are (14). This is to be expected. Dogs share our homes, our lifestyles, often our diet – and hence proneness to disease (15).

If a dog and its owner are exercised regularly, health and life expectancy for both increases (16, 17). Conversely, overweight and inactive dogs usually belong to overweight and inactive people. This is why diabetic and infertile dogs tend to have diabetic and infertile owners (18), and both die younger (19, 20).

Better not let sleeping dogs or humans lie. Regular exercise is better for health and fertility, probably in all species. And then there is the matter of chow.

A diet rich in ultra-processed foods is clearly associated with reduced fertility in men (21-25) and in women (26-28). In contrast, a Mediterranean diet makes everything, including sperm counts, sperm quality and pregnancy outcomes, better (29-34).

Improvements in diet and exercise, and therefore body shape, may be even more important in women.

Studies have repeatedly shown that a higher body mass index and low-activity lifestyles increase the risk of female infertility (ie 35-37). Obesity generates chronic inflammatory stress and insulin resistance, which are closely coupled, and which promote hyperandrogenism and hyperestrogenism (38-40). These metabolic and endocrine imbalances cause anovulation and reduced endometrial receptivity, and therefore infertility.

If, despite these problems a fertilized egg does implant and proceed to a successful pregnancy, the abnormalities in maternal hormones are passed to the fetus which will acquire insulin resistance, an increased risk of obesity, unhealthy food preferences and generally poor health in later life (41, 42). Maternal obesity, Type B malnutrition and probably chronic inflammatory stress are all implicated in this fetal mal-programming, and the modern diet achieves this trifecta effortlessly.

Polycystic Ovary Syndrome (PCOS), which corelates with obesity, insulin resistance and diabetes, is particularly negative for fertility (43-48). PCOS-related infertility can in many cases be successfully treated (49), but the fact that it affects up to 1 in 7 of women of child-bearing age (28, 50) is a sad testimony to the deeply unhealthy life-styles of the 21^st century.

Eat better, take more exercise and lose weight is the old familiar mantra. However, it is possible to do more by addressing chronic inflammation and dysbiosis directly. This is relevant even for older women; recent research showed the existence of quiescent egg cell precursors in adult ovaries that can potentially develop into a mature oocyte and give rise to fertilizable eggs (51), IF immunological and metabolic (and therefore nutritional) problems can be resolved.

We could start with plant oils, the omega 6:3 ratio, and bad medicine.

IntraLipid is a ‘fertility treatment’ still offered by some doctors to treat recurrent pregnancy loss. This unappealing blend of soya bean oil, egg yolk, glycerin and water is given intravenously in an attempt to stop the mother’s innate immune system from killing the fetus. The balance of evidence indicates that it has no effect (52-54), nor would I expect it to.

Soybean oil is the single one ingredient in the diet that has increased the most in the last 100 years (55). It constitutes almost 2/3 of all edible vegetable oil consumption in the USA and most developed nations (56) and is found in the majority of ultra-processed foods (55, 56). If there is one thing we are not short of it is soy oil, and the omega 6 fatty acids it contains.

A high omega 6:3 ratio confers pro-inflammatory stress (ie 57, 58). This immediately tips the balance against fertility, because successful pregnancy depends on a climate of immunological tolerance and therefore low inflammation. There is a strong case for improving the 6:3 ratio before attempting conception and pregnancy (59-61); and data from the Braverman Clinics show that a lower omega 6:3 ratio is indeed associated with better pregnancy outcomes (62).

Ditch the IntraLipid, switch to oily fish.

We could continue with plant fibers, and the microbiome.

Prebiotic plant fibers have a key role in maintaining a gram +ve dominant, anti-inflammatory microbiome in the large bowel. These fibers have been largely removed from ultra-processed foods, resulting in a gram-ve dominant, pro-inflammatory microbiome. This impacts on the colon and is deeply implicated in both IBS and IBD, but it is also involved in pregnancy.

In 2012, Australian scientists Kelton Tremellen and Karma Pearce proposed a connection between dysbiosis and PCOS (63). Studies subsequently confirmed this (64-69); and showed that prebiotic fibers could rectify dysbiosis, reduce LPS (and therefore inflammation and insulin resistance) (70), improve PCOS in pre-clinical models (71) and promote successful pregnancies in infertile women with and without PCOS (72, 73).

Prebiotics appear to be important in sperm formation also (74), so fiber is not just for women. But there’s more to the microbiome …

There are increasingly well-characterised bacterial communities in the ovaries (75) and testes (76, 77), and preliminary evidence indicates that these affect fertility too. Prebiotic fibers do not reach these tissues, but by shifting the gut microbiome they may be able to modify the gonadal communities indirectly, possibly via microbial translocation (ie 78-80). Translocation generally produces negative results, but positive outcomes are conceivable. No pun intended.

Finally, and always, there are the mitochondria. Mitochondrial function is crucial in egg fertilization, implant and development, but is impaired by inflammation (81) and malnutrition (82). Men have mitochondria too, and recent work shows that chronic stress and high cortisol levels reduce sperm numbers and motility via mitochondrial disruption (83).

An omega 3 / lipophile polyphenol combination is therefore a good idea for men as well as women, combined with a broad-spectrum micro- and phytonutrient replacement program. It may be helpful in some cases to add Q10 (84) and melatonin (85). Melatonin in particular appears to confer significant long-term health benefits (86), and is best taken as a buccal patch. If stressed, add a pinch of validated saffron extract (87, 88).

In my experience this kind of combinatorial nutritional approach, which alleviates inflammatory stress, dysbiosis, Type B Malnutrition and stress, works well. It is safe, inexpensive and non-invasive, does not require lab tests or doctor visits, and provides multiple health benefits to parents as well as their offspring. Many previously infertile couples who used it have gone on to produce healthy and precocious babies (89).

Few things sound as sweet as the patter of Little Feat (90).

Next week: How to acquire good taste. (Hint: It’s a cookbook).

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