Practically Fertile
If you wanted to get pregnant yesterday, but you're confused and overwhelmed by all the noise on the internet, then this is the right podcast for you. Hosted by Dr. Adrienne Wei, Doctor of Acupuncture and Chinese Medicine, Fellow of the American Board of Oriental Reproductive Medicine (ABORM), functional medicine practitioner, and functional nutritionist. Here, you'll find zero fluffy, useless information or rah-rah motivation. You'll only find practical strategies and "how-tos" for identifying the root cause and amplifying your fertility by using a proven method of combining science with tradition.
Practically Fertile
Episode 1 - Fertility Basics: All the Major Hormones and a Few That You Didn't Know About
Whether you've been trying to conceive for a while or you're just starting the process, chances are, you've heard of the common female hormones such as FSH, estrogen, and progesterone. But hormone interactions are nuanced and complex. It's not as straightforward as "normal estrogen levels equal fertility." In fact, normal rarely means optimal. There are other hormones that make conception possible behind the scenes as well.
In this episode, we explore the complex interplay of several well-known hormones and a few not-so-well-known ones and their critical roles in conception. Here is what to expect:
• An overview of the major fertility hormones
• The importance of hormones acting in conjunction and what happens when they don't
• Hormones in supporting roles that are critical for fertility
• Common misconceptions about how hormones work
Follow me on instagram @dradriennewei
Website: www.adriennewei.com
Welcome to the Practically Fertile Podcast. I'm Adrienne Wee, doctor of acupuncture and Chinese medicine, functional medicine practitioner and functional nutritionist. I specialize in using an evidence-based method, blending principles of East Asian medicine and modern functional medicine to help women optimize fertility and get pregnant. I believe in a world where every woman who wants to be a mother becomes one. If you're tired of being told that you're infertile and you want to take the right steps to get pregnant naturally and quickly, this podcast is for you. Hey, fertile friend, to kick off this brand new season of our podcast, let's start from the very beginning and make sure that we have a good understanding of how our bodies work. We're going to dive into the world of fertility hormones. I know, I know you might be saying I already know all about my hormones. Yes, you might be familiar with the major players, but we're also going to talk about the hormones that are super critical for fertility, but they're never talked about and doctors don't proactively test them. And we're also going to look at your fertility from an East Asian medicine perspective. East Asian medicine is also known as traditional Chinese medicine. It is thousands of years old and still used today by billions of people in Asia. So I will use East Asian medicine and Chinese medicine interchangeably, because they're the same thing. Since my method is a blend of East meets West, you'll need to get familiar with both concepts. Anyway, I think, whether you've been trying to conceive for a while or you're just starting, or maybe you haven't even started thinking about having kids, you might be dealing with PCOS, endometriosis or your period's doing something wonky. Before you can fix something, you have to know what you're dealing with and the why. So let's get started.
Speaker 1:First, let me define what a hormone is. A hormone is a messenger. It takes the message to a specific part of your body and tells it what to do. Follicle-stimulating hormone, for example, tells your ovaries to produce follicles. Antidiuretic hormone tells your body that you're thirsty. Insulin tells your body to take up a glucose molecule to use for energy. You know that saying don't shoot the messenger. Well, same thing for our hormones. If your hormones are acting weird and not doing what they're supposed to do, it's really not their fault. They're not getting the right message. The second thing I want to say about hormones is that no hormones ever act alone. There is a certain degree of interconnectedness between all of them. This is something that's been drilled in my head by my functional medicine school teacher. She has said it so many times that it's now just automatic for me.
Speaker 1:We tend to think that, oh, my estrogen is high, my progesterone is low, let me supplement something. And not realizing that low progesterone could be caused by egg quality, that could be caused by low estrogen, that could be caused by high testosterone. So you're not really fixing the root problem by supplementing progesterone. It's not going to help you if your egg quality was the issue to begin with. What about things like melatonin? You think that taking melatonin is harmless. Well, melatonin affects insulin. It keeps the insulin low while we're sleeping. This means, if you're already having blood sugar issues, taking melatonin can mean that you wake up with high blood sugar in the morning, even if you don't have blood sugar issues. Over time, that can put you at risk for becoming insulin resistant. Anyway, I hope these two concepts make sense.
Speaker 1:Chinese medicine doesn't have the idea of hormones and because of that, the way that it looks at fertility is very different. There's less of well, this hormone is high or low, let's give you a pill. It's more about looking at how the hormone imbalance is affecting your body in all aspects of life and where that might be coming from. But, on the other hand, the thing about Chinese medicine is that it also can't tell you anything about your blood chemistry, whether you have high FSH, low AMH or high blood sugar. So that's one of the reasons why I decided to go back to school for functional medicine too, because I recognize that both systems can fill the gaps for each other. All right, so let me come off of my soapbox and let's get on with what we were going to talk about on this podcast. All right, let's think of your fertility hormones as a big bowl of soup the hormone soup and the key ingredients in this recipe are estrogen, progesterone, luteinizing hormone and follicle-stimulating hormone. These four are the heavy lifters in the fertility process.
Speaker 1:Follicle-stimulating hormone FSH. This is a hormone that stimulates the ovaries to produce follicles. A certain number of follicles will naturally die off when they're growing. That's just the way things are. So a larger number of follicles at the beginning of the cycle will increase the likelihood that one follicle will grow to a good size that's big enough to ovulate. So, especially for IVF, you want as many follicles as possible at the beginning, so you'll have more to choose from to fertilize with the sperm and make embryos, and that's what they're testing for at the beginning of the IVF cycle the antral follicle count. The higher the number of the AFC, the more likely you're going to produce many follicles and get higher quality embryos.
Speaker 1:The main problem with the FSH is that when the number is high, it actually means your ovaries are not responding to the signals. You would think that the higher the better, but this is the opposite. That's because our hormones work off of what we call a feedback loop. They rely on messages from each other to know how to act. No hormones ever work alone. Right? In this case, the ovaries are not responding, so the pituitary gland, where the FSH comes from, keeps sending more, and this is usually not a good sign. Even if your AMH is normal or if it's high, it still means that the ovaries won't be able to fully utilize the full egg reserve that's available. In clinical practice I haven't seen a case of high FSH and high AMH, because it's usually the combo of high FSH and low AMH. That typically signifies there's a problem with the ovarian reserve. But theoretically, the scenario that I described high FSH, high AMH theoretically it's possible.
Speaker 1:Okay, to make the follicles grow, you need estrogen, typically when a follicle wins the race and then sucks up all the estrogen and becomes the one the one that ovulates. Estrogen also helps with lubrication. You'll notice more watery and running cervical mucus as you get closer to ovulation. Sometimes you'll even notice a watery mucus again after you've ovulated, and that's because estrogen surges again in the luteal face after you ovulate to help with aligning and also to help sustain a pregnancy, along with the progesterone. So you might think that progesterone is the only hormone that's at play after ovulation. It's not. It is the dominant hormone, which means that there are more of them. But that doesn't mean that estrogen is not important. Once your estrogen gets to a certain level usually over 200, that will correspond to a follicle size of 16 millimeters to 18 millimeters Then the egg is considered mature. That is when the luteinizing hormone comes into play.
Speaker 1:When you have an estrogen problem meaning even though your estrogen levels rise and you ovulate, it doesn't mean the egg is at the best quality. There are many factors that influence egg quality, I know, but follicle size is one of them. Small follicles have been associated with lower progesterone levels in the luteal phase, even though you're ovulating. The follicle might need to be a little bit bigger for that specific cycle. Low estrogen could also mean that you don't see a lot of the watery stringing mucus and you might have some vaginal dryness and make intercourse painful. But if your estrogen gets to be low enough then you won't have a follicle that grows and you might skip a cycle more. So those are all the issues that come with low estrogen. Now the luteinizing hormone the levels are rising along with the rising estrogen and it surges once the egg is mature and the estrogen signals back to the pituitary gland and says hey, we have a winner.
Speaker 1:The LH surge is what your ovulation predictor kits are measuring. Depending on the type that you're using, you might notice that a line is getting darker each day as you get closer to ovulation and then it gets really dark. That's when, usually when the surge is happening. Measuring the LH to predict ovulation is probably the bane of your existence. If you're trying to get pregnant.
Speaker 1:It is notoriously hard to catch at the right time. That's because when you're peeing on the stick, the hormone is already on its way out of the body. You literally have to catch it in the act. Blood work isn't the most accurate, but it's also very impractical if you're not doing any fertility treatment. It's also very impractical if you're not doing any fertility treatment. There are fancier methods of tracking, like the Oura Ring Mira app and Neato. I have opinions about them, but that's for another podcast.
Speaker 1:If you're peeing on a stick, my advice is to pee in the afternoon. Most women up to 80% will surge at night, which means the LH won't be in your urine until hours later. If you're testing first thing in the morning, that can create frustration because you're not, because you're going to think that you're not surging when in reality you are. You just have to wait a few more hours. Problems with the LH means ovulation might not happen. A lot of PCOS patients can experience this. Your LH can be constantly high due to cysts on the ovaries, and then your body gets confused and the LH never surges. If the LH doesn't surge, then there's no ovulation, okay.
Speaker 1:Finally, the progesterone, progesterone, will rise after ovulation. That's a given fact. Progesterone does so much more, however, than what we think it does. We know that progesterone prepares the uterus and thickens the lining, but it's also preventing uterine contractions to prevent premature birth. It also acts as an immunosuppressant, which means it prevents the mother's immune system from rejecting the baby. So that's pretty cool, right.
Speaker 1:It is, however, very controversial what the progesterone level needs to be at after ovulation, and even the OBs don't really agree on this. I've seen some OBs who don't care about their progesterone level under 10, even when the woman's pregnant. That happened to one of my patients Her progesterone level was 8, and her OB did not supplement. I've also known OBs who freak out if the levels are not over 15. Some OBs don't worry too much because progesterone, like all other hormones, the secretion of the progesterone is not consistent. It's not constant. It means it's released in spurts. So that means that there might be a chance that you're testing your progesterone at a time when there isn't a lot of it being released. It being released. There's also inconsistent research data about whether or not low progesterone truly can cause problems like spotting, miscarriage, shortened luteal phase. So in this case, you really need to work with your OB on this and see what they recommend.
Speaker 1:All right, so now that we've covered the main ingredients of the soup, let's look at the supporting ingredients. If you were making soup in real life, this would be things like onion, garlic, potatoes. So these supporting hormones they don't get talked about much, but without them, the hormones that we just talked about wouldn't work, or wouldn't work properly. So remember, no hormones ever work alone. Let's get started with a hormone called gonadotropin-releasing hormone, gnrh. This is the fire that cooks the soup. Without it, the soup can't cook. Gnrh comes from the hypothalamus, which is located in the brain.
Speaker 1:Naysayers about stress affecting fertility listen up. There is something called the HPTGA axis. The five organs involved are hypothalamus, pituitary, thyroid. G stands for gonads, which are the sex organs, and A stands for adrenal gland. This is how the hormones are all interconnected. You can't think that a problem with one area isn't going to affect the other. It's like an elevator If something isn't quite right, the elevator isn't going to affect the other. It's like an elevator If something isn't quite right, the elevator isn't going to go anywhere.
Speaker 1:An easy way to understand this is the adrenal glands will produce cortisol, which is the stress hormone that many are familiar with. But the stress hormone comes based on the signals from the hypothalamus, from your brain. Your brain processes the information that you're receiving like triggers and then determines whether or not it's a threat or it's a non-threat. If your brain perceives that there is a tremendous amount of threat that you're facing, the adrenals will hyperproduce cortisol to keep you alive, fight, flight or freeze. If this cycle gets to a point where your brain determines that you're in imminent danger, the hypothalamus will prioritize survival instead of sending the GnRH Because having a period is not going to help you survive. I know you might feel differently, but having a period, having high fertility and having a baby your brain thinks that it's not high priority when it comes to survival. Hypothalamic amenorrhea gets the name from this phenomenon. The body is under so much stress the period stops altogether.
Speaker 1:The next step is testosterone. Not all bad for women, because it is actually very much involved in helping the follicle growth in the early stages. It acts as a precursor for estrogen. It's having too much testosterone that's the problem, and if you have too much testosterone in the body it actually doesn't help, because then it actually stops the follicles from growing in the later stages of development and then you might not ovulate. This is very common for PCOS, but you don't have to have PCOS to be affected by high testosterone. I recently tested the patient who doesn't have PCOS symptoms but she has high testosterone. I really believe that that could be affecting the egg quality and causing her miscarriage. The levels weren't too high, but they were high enough to have an impact, and her doctor never tested testosterone because she never showed any PCOS symptoms.
Speaker 1:Okay, next up is insulin, one of the most important hormones for fertility and often overlooked because we associate insulin with conditions like diabetes. Insulin is so important for many other processes in the body because it acts like a nutrient traffic director. It tells your body whether to use the glucose or to store fat, and how insulin impacts fertility is this. It's very much involved in the follicle recruitment and development stages. Think about it An egg is a cell, and every cell in the body will need glucose for energy in order for it to grow. Insulin helps to take the glucose to the ovaries to help with that. In fact, studies have shown that larger follicles usually have more glucose in the follicular fluid, and we know that larger follicles typically is associated with higher progesterone levels. Insulin also prevents the follicles from premature death, increasing the chance that more follicles can survive in the selection pool. So the estrogen has a chance to choose a really good one.
Speaker 1:Another important function of insulin is to stimulate the production of testosterone, and we just talked about how testosterone acts as a precursor for estrogen in the early stages of follicle development. This means any imbalance in insulin can affect the production of testosterone. When you have too much insulin, you can end up with too much testosterone. Now, to be clear, your adrenal glands also produce male hormones, which the name is androgens. Testosterone is part of the androgens, so your adrenal glands also produce these metal hormones. So it's not just insulin, but having high insulin can definitely add to the mix.
Speaker 1:Okay, finally, we have the thyroid hormone, which pretty much regulates everything in the body. I want to do an entire episode on thyroid hormones, so I'm not going to get into too much detail about it right now. But we really need to test not just the TSH, the thyroid stimulating hormone, but we need to see how the TSH is being converted and used by the body. Sluggish thyroid means sluggish anything. This is another easy way to remember how the thyroid really impacts the body.
Speaker 1:So, to wrap up, on the surface it seems really straightforward and most of you already know about the FSH, estrogen, lh and progesterone. What I hope you would walk away with from this episode is not like all of a sudden, you'll become an endocrinologist, but that you walk away from the understanding that there's a degree of interconnectedness between all the hormones and all the systems in the body that either make things run smoothly or cause problems. It's time to really look beyond just what's showing up on your blood work. That's one snapshot in time, not the complete picture, and when you understand that, then you'll actually feel better and less frustrated, because if you can find the root cause, you can find the answers as to why you are struggling to get pregnant, and then you can come up with a plan to overcome these obstacles. All right, fertile friend, these obstacles. All right, fertile friend. If you found this episode helpful, please subscribe and share it with someone who might benefit. Until next time, take care of yourself and your amazing body. You're one fertile cycle away from getting pregnant, thank you.