Infertility is a rapidly increasing global health challenge for millions of couples worldwide.
At least one in six people experience infertility at one stage of life, according to the World Health Organization (WHO).
While fertility therapy, like ovulation induction, intrauterine insemination (IUI) and in vitro fertilisation (IVF), has revolutionised reproductive medicine and enabled millions of families to get pregnant, health professionals are starting to understand that infertility is not just a result of the health of the reproductive organs.
As such, they are developing an interest in functional medicine, which is an evidence-based approach to understanding and addressing diseases and dysfunctions that can contribute to the root causes of infertility.
A complex process
Traditionally, infertility has often been viewed primarily as a problem involving the ovaries, uterus, fallopian tubes and/or sperm.
However, reproduction is a complex biological process that depends on the coordinated functioning of multiple body systems.
Hormones must be balanced, nutrient levels must be adequate, inflammation must be controlled and metabolic health must be optimised.
Even subtle disturbances in thyroid function, insulin regulation, immune activity or environmental toxin exposure may affect fertility.
Functional medicine approaches infertility by asking a broader question: “Why is the body struggling to conceive?”
This shift in perspective allows healthcare practitioners to investigate potential contributing factors that may otherwise go unnoticed during routine fertility evaluations.
Common areas assessed in a functional medicine fertility evaluation include:
- Hormonal health
- Thyroid function
- Blood sugar regulation
- Nutritional status
- Gut and microbiome health
- Chronic inflammation
- Environmental toxin exposure
- Stress and sleep quality
- Metabolic health and body composition.
By identifying and correcting imbalances in these areas, fertility outcomes may improve, while also supporting long-term health.
Hormones
Hormonal balance is key to female reproductive health and has a significant impact on ovulation, implantation and pregnancy.
Common causes of infertility include polyendocrine metabolic ovarian syndrome (PMOS, previously known as polycystic ovary syndrome or PCOS), thyroid disorders and hormonal imbalances.
PMOS affects 8% to 13% of women, and is one of the leading causes of ovulatory infertility.
It is also associated with irregular periods, weight gain and insulin resistance.
A functional medicine approach with dietary changes, exercise and stress management can help fertility – even a small weight loss (5-10% of body weight) can have a positive effect.
Hormonal signalling is affected by thyroid dysfunction, where even a mild dysfunction can in- terfere with reproductive activity.
Fertility experts typically suggest optimising thyroid function before pregnancy and monitoring it during pregnancy to minimise the risk of infertility and complications.
Egg quality is better when you have good cellular health.
As women age, fertility drops because their eggs are less abundant and less fertile.
Eggs depend on the mitochondria in cells for energy, growth and fertilisation.
Good nutrition can promote mitochondrial health and protect eggs from oxidative stress.
A balanced, healthy diet with good fruits, vegetables, healthy fats and proteins allows for the antioxidants that you need, as well as nutrients like coenzyme Q10 (CoQ10), folate, vitamin B12, magnesium and vitamin D, which are required for reproductive health.
Smoking, excessive alcohol, sleep deprivation and chronic stress can lead to oxidative damage and fertility deterioration.
These are the problems that need to be addressed in functional medicine fertility programmes.
Inflammation
Inflammation is the body’s response to injury and infection, but chronic low-grade inflammation is linked to infertility.
It can affect ovulation, egg quality, implantation and hormonal balance.
Endometriosis, obesity and metabolic syndrome tend to increase inflammation, and it is crucial to have an anti-inflammatory lifestyle for fertility.
Vegetables, fruits, legumes, nuts, olive oil and fatty fish are important for reproductive outcomes.
Foods that are ultra-processed, refined sugars, trans fats and excessive alcohol consumption are inflammatory.
Regular physical activity increases insulin sensitivity and cardiovascular (heart) health, thereby leading to better reproductive function.
Gut health
Gut health is important for fertility because it impacts hormonal status, immune system function, nutrient absorption and inflammation.
The gut microbiome, which is composed of trillions of microorganisms, is fundamental for health.
Imbalances in the microbiome can lead to chronic inflammation and hormonal illness.
In fertility evaluations, functional medicine practitioners can assess digestive health.
It is possible to improve gut health through increased dietary fibre, more fermented foods, better nutritional quality and treatment of any digestive disorders.
Good gut health promotes good nutrient absorption, which is critical for reproductive health.
Environmental toxins
Today’s lifestyle puts humans in contact with a world of toxic chemicals that disrupt hormonal function and fertility.
Endocrine-disrupting chemicals in plastics, pesticides, industrial products and other toxic chemicals in agricultural products can mimic or block natural hormones.
Chemicals like bisphenol A (BPA), phthalates and some agricultural chemicals have been connected to reproductive health problems.
Even though avoidance is not an easy thing to do, it is a good idea to reduce exposure.
For example, use glass or stainless steel containers and not plastic while cooking food, buy fresh food, filter your water and minimise chemical exposure at home.
Tobacco and excessive alcohol are associated with low fertility and should be limited.
Nutrition
Nutrition is a primary factor affecting fertility.
A Mediterranean diet, which emphasises vegetables, fruits, whole grains and healthy fats is linked to better fertility as it is good for hormones and metabolic health.
Pregnant women should take folate, iron, vitamin D, omega-3 fatty acids and choline in sufficient quantities.
For men, zinc, selenium, CoQ10 and antioxidants are key for sperm health.
Healthcare professionals need to tailor nutritional advice to supplement requirements.
Stress and sleep
Today’s lifestyle places enormous physical and mental demands on the body and mind.
Chronic stress and lack of sleep are becoming more common and may contribute to reproductive dysfunction.
Stress triggers hormonal pathways, including cortisol and the hypothalamic-pituitary-adrenal axis.
Long-term activation of these systems could affect reproductive hormone signalling, fertility, ovulation, libido and fertility.
It is just as important to get enough quality sleep.
The body is responsible for hormones involved in metabolism, immunity, tissue repair and reproduction during sleep.
Sleep quality has been associated with hormonal disturbances, insulin resistance, obesity and low fertility.
Functional medicine supports stress management techniques, mindfulness, exercise, counselling and healthy sleep behaviour.
The male factor
Male factors account for 40%-50% of infertility cases, therefore, both partners should be evaluated for health reasons.
Healthy sperm production is important for male fertility, including sperm count, motility, morphology and DNA (deoxyribonucleic acid) integrity.
Factors that may adversely affect sperm health include obesity, smoking, excessive alcohol, toxins, stress, poor sleep and nutritional deficiency.
Functional medicine treats male infertility through consideration of overall health.
Hormonal evaluation is important as testosterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin and others affect sperm health.
Imbalances can interfere with sperm development.
Oxidative stress also plays a significant role as sperm are susceptible to oxidative damage.
Antioxidants can protect sperm health, with nutrients such as zinc, selenium, vitamin C, vitamin E, CoQ10, omega-3 fatty acids and L-carnitine being beneficial.
Maintaining a healthy weight is essential as excess fat disrupts hormone balance and decreases testosterone levels.
Diet and exercise, especially when resulting in weight loss, can improve sperm quality.
Integrated approach
Functional medicine is not a substitute for evidence-based reproductive medicine.
Rather, it is a complementary approach to the bigger health issues that affect fertility.
Couples who have infertility need to check for any structural, hormonal, genetic or reproductive diseases, and get proper treatment.
Assisted reproductive technologies are still required in many cases.
But better nutrition, control of inflammation, improved metabolic health, decrease in environmental toxin exposure and stress management may also enhance fertility outcomes and the chances of pregnancy.
As science is becoming more educated on reproductive health, fertility is no longer just an issue of reproductive function, but also one of the whole body’s health.
Through a functional medicine approach to dysfunction and the body’s own capacity for balance, a patient-centred approach can be developed to help couples have children.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
