Recurrent Miscarriage & InfertilityHow to Prevent Pregnancy Loss and Recurrent Miscarriages
Part Two: The Functional Medicine Approach to
Identifying the Underlying Causes
The Functional Medicine Approach to Identifying the Underlying Causes
In Part I of this series, we discussed the use of a standard evaluation of recurrent miscarriage and pregnancy loss to determine risk factors to deter future losses. In cases where a standard evaluation is unrevealing, a Functional Medicine Evaluation may help to determine underlying causes that are not identified in a standard one. This approach attempts to determine the root cause of imbalance WITHIN your physiology, i.e. looking at different body systems to uncover what other internal factors could lead to infertility and pregnancy loss.
What Is A Functional Medicine Evaluation?
A Functional Medicine Evaluation looks at the body as an interconnected whole, investigating a variety of mechanisms that could be lead to infertility, pregnancy loss and repeated miscarriage. A typical Functional Medicine Evaluation assesses the following six mechanisms of imbalance:
- Hormone Imbalance: There is a very complicated interaction between the brain and our ovaries that is critical to achieving a healthy conception and pregnancy. The communication between the brain and endocrine organs that make up the female hormonal system (thyroid, adrenal, pancreas and ovary) can sometimes be broken. If ONE hormonal system is impaired, then the others will be affected as well. For example, if the adrenal gland (which controls stress hormones or the “fight or flight” response) is overworked or no longer responding appropriately to external cues, the ability of thyroid hormone to function effectively within the cells will be impacted. Consequently, if the adrenal gland, i.e. the sugar-insulin pathway, is out of balance, the ovary may not receive the right signal to ovulate or produce adequate progesterone levels to support a pregnancy and a loss will occur.
- Gut Imbalance: As far removed as this may seem to impacting baby making, many female hormone issues begin in the gut.
- The right balance of beneficial bacteria in the gut is critical for regulating the metabolism of key female hormones: estrogen and progesterone.
- Gut infections (which are often undetected) create a constant level of inflammation in the body. Inflammation is one of the biggest triggers of stress hormone release. Abnormal stress hormone levels will then impact female hormone balance leading to possible pregnancy loss.
- Abnormal gut bacteria will impair thyroid function. Poor thyroid function can be the cause of infertility and miscarriage.
- Gut permeability (or “leaky gut”) means that the normal barrier to infection, exposure to endotoxin (toxic substances released from pathogenic bacteria) and poorly digested food products can result in increased toxicity and autoimmune disease. Accumulation of toxicity in the body can lead to disruption in DNA synthesis, cell division and cell repair. When the liver’s detoxification ability is overwhelmed, the body’s ability to properly metabolize female hormones and maintain the right hormonal balance will be impacted, leading to possible pregnancy loss.
- Low stomach acid, insufficient bile acid production and digestive enzyme deficiency can cause a nutrient imbalance that will disrupt the balance of the hormonal system leading to possible pregnancy loss.
- If the immune system is under active (i.e. cannot adequately control infections or limit inflammation) or if the immune system is overactive (i.e. begins to attack its own tissue, a condition known as “autoimmunity”), the uterine environment will not be prepared or healthy enough to receive, implant and nurture a pregnancy. Therefore, it is critical that the immune system maintain the right balance of alertness against dangerous intruders and passivity to pregnancy tissue.
- Cell division and repair mechanisms must be functioning well in order to create a healthy baby. If your body’s cells are not able to divide normally or repair DNA damage, the billions of cell divisions required to create a baby will be impaired causing the body to perceive a problem and expel the pregnancy. Assessing the cell’s ability to create energy for growth and repair, to protect itself from toxicity that can injure DNA, and to repair injury from inflammation, infection or toxic exposures is key to ensuring a healthy pregnancy.
- Gut infections, food allergies, inflammation may lead to hampered digestion, poor breakdown of food and poor absorption of key food building blocks. Bacterial or viral infections, as well as infections with yeast, parasites or certain bacteria may result in competition for nutrients between the infection and the fetus leading to an increased demand for energy production (at the expense of the pregnancy) to help repair gut wall inflammation and intestinal injury.
- Immune dysfunction related to inflammation can also result in increased requirements for nutrients, as well as increased toxicity in the body.
- Adrenal dysfunction, sugar-insulin imbalance and thyroid underactivity can also result in increased demand for nutrients thereby impairing the health of the fetus.
(3, 4 , 5, 8)
Thus based on the above, a Functional Medicine Evaluation can be very important in bringing about reproductive health and optimizing your fertility. For further information, read “How to Prevent Recurrent Miscarriage and Pregnancy Loss Part Three: Treatment.”
WHAT IS A FUNCTIONAL MEDICINE EVALUATION?
“Good Morning Dr. Sadaty,
I have exciting news to share with you. I took two pregnancy tests last week and both were positive! In the three years we have been trying to have a baby, it has never once said that I was pregnant.
I already called your office and scheduled an appointment. Thank you so much for your help. I look forward to seeing you in June!”Jill N. - Manhasset, NY
Dr. Anita Sadaty, MD is a board certified Obstetrician-Gynecologist who is in private practice at Redefining Health Medical in Roslyn, New York. She graduated from Cornell University Medical College with honors and is an assistant clinical professor at the Hofstra Medical School, Northwell Health System. She has been in practice for 19 years and is currently completing a fellowship as a certified Functional Medicine Practitioner from the Institute for Functional Medicine. In addition to offering obstetrical and gynecologic care in her practice, she has created a functional medicine program called “THRIVE Medical Wellness Program” to address underlying mechanisms of chronic disease, hormonal imbalance and sub-optimal health.
1. Evaluation and treatment of recurrent pregnancy loss: a committee opinion The Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility vol. 98 No. 5 November 2012
2. Excerpt form Miscarriageassociation.org
3. Anesthesia, Pregnancy, and Miscarriage: A Study of Operating Room Nurses and Anesthetists. Anesthesiology vol 35 No.4 October 1971
4. Occupational exposure in dentistry and miscarriage. Occup Environ Med. 2007 Feb; 64 (2): 127-133
5. Occupational exposures among nurses and risk of spontaneous abortion. Presented at the 3rd North American Congress of Epidemiology, Montreal, QC, Canada, June 21-24, 2011, and the National Occupational Research Agenda (NORA) Symposium 2011, Cincinnati, OH, July 12-13, 2011
6. Researchers from the Stanford University School of Medicine, Stanford, California, presented their data at ASRM, held in October in Boston