Hippocrates stated that all disease begins in the gut. This example demonstrates how an undiagnosed gastrointestinal condition can impact on fertility and how the holistic naturopathic approach uncovered the underlying cause of repeated early pregnancy loss.
A 29 year old female presented with fertility concerns. She and her partner had been attempting to conceive for over 12 months. During this time, she had fallen pregnant twice, however she suffered early pregnancy loss both times. Her GP had referred her for standard bloods, serum sex hormone testing, and a pelvic ultrasound. No abnormalities had been detected aside from low iron. Her partner’s sperm count and morphology were also normal. Her GP recommended continuing to try, with a referral to a specialist fertility clinic for further investigation if she experienced another miscarriage or failed to conceive again within six months. The patient was understandably very distressed about her pregnancy losses and wanted to do everything possible to improve her chances of a successful pregnancy. Her cycle was regular, she was ovulating each month (as confirmed by basal body temperature charting and ovulation test kits), and she had no major menstrual symptoms aside from mild premenstrual syndrome (PMS). This PMS was worsened by the emotional stress of hoping to conceive and being terrified of another miscarriage each month. She had no diagnosed health conditions. She did suffer from constant bloating, abdominal discomfort, and diarrhoea on and off for the past two years. She also experienced frequent mouth ulcers, migraines every two to three months, and was somewhat underweight with a body mass index (BMI) of 18. She was taking an over-the-counter multivitamin, plus folic acid and iodine.
Initial recommendations
Recommended to cease trying to conceive for at least three months, to conduct further investigations and implement preconception care (use of barrier contraception, to avoid impacting hormones).
Recommended a fertility support diet, rich in healthy fats and antioxidants.
Referred for further tests that had not previously been checked by her GP including comprehensive stool analysis, coeliac antibodies, serum vitamin D, homocysteine, methylenetetrahydrofolate reductase (MTHFR) gene testing, and anti-mullerian hormone (AMH).
Test results showed positive coeliac antibodies, and low vitamin D. All other results were normal. Untreated coeliac disease is associated with reduced conception rates, increased risk of repeated miscarriage, and adverse pregnancy outcomes including stillbirth, premature birth, and low birth weight. This may be due to immunological dysfunction compromising placental development and function, or causing coagulation abnormalities which affects placental and foetal microvascular function. Nutrient deficiencies caused by coeliac-induced malabsorption may also play a role.[1]
Further medical testing and endoscopy had confirmed the diagnosis of coeliac disease. The patient was feeling a little stressed about the diagnosis, but also hopeful that treating it would improve her chances of a healthy pregnancy. After discussion, she agreed to wait another three months before attempting to conceive again, to implement a gut healing program.
Prescription
Implement a strict gluten-free diet. Provided resources, dietary plan, and recipes to assist, including anti-inflammatory and gut repairing foods daily, such as bone broth, turmeric, ginger, garlic, chamomile tea, and fermented foods such as kefir, kimchi, and sauerkraut.
Avoid inflammatory foods such as alcohol, processed meats, trans fats, fried foods, excessive sugar, and artificial additives.
Outcome
The patient conceived within two months of ceasing contraception. She had no major complications during pregnancy and delivered a healthy baby girl at full term.
Clinical Reflections
When treating infertility, our first response is to treat the reproductive system and hormones. However, as this case demonstrates, chronic low-grade inflammation and micronutrient deficiencies can significantly impair the chances of successful conception and pregnancy outcomes. As our wise forefather taught us, the gut is the seat of health and should not be overlooked, even in seemingly unrelated conditions such as infertility.
References
Freeman HJ. Reproductive changes associated with celiac disease. WJG. 2010;16(46):5810. doi: 10.3748/wjg.v16.i46.5810
A case study by T. Valencius