Interview with Dr Natalie Getreu from Hertility Health.

I interviewed Dr Natalie Getreu, Co- Founder and COO of Hertility Health on all things reproductive health. She talks about the taboo fertility faces and its link to gut health, the possible implications of IBD and stoma surgery on reproductive health.

As many as 1 in 7 of us experience infertility, so why are we still treating it as a taboo topic? Hertility stand for people taking control of their reproductive health! They say, “we live in a world where we can keep track of just about anything – steps, calories, sleep pattern – you name it. So it’s about time we gave the same amount of attention to our fertility.”

Please see a doctor if you are experiencing symptoms or have any health concerns. Although this interview was conducted with a medical professional, this should not replace seeing a doctor! Please see your doctor if you are concerned about anything.

 Why is it so important to be clued about your reproductive health?

Sometimes we think of our reproductive health as just being relevant when we’re planning a family, but it’s so much more than that! Even if you decide that having children isn’t for you, it’s still important to look after your reproductive health.

There are a whole host of reproductive health-related issues that can impact your daily life. Pain and discomfort associated with sex or your menstrual cycle should not impact your quality of life. Likewise, a diagnosis like endometriosis, PCOS, premenstrual syndrome (PMS), and gynaecological cancers like cervical and ovarian cancer, doesn’t mean you should resign to a life of pain and discomfort. Being clued about your reproductive health means you are equipped to recognise and manage your symptoms.

If you decide in future to go down the route to parenthood, being clued up about your reproductive health earlier in the journey might make all the difference. Understanding what’s best for your body now and knowing how to reach your best reproductive potential, might reduce the risk of problems interrupting your plans later on. Sometimes you might even find an issue now that can be dealt with and managed before it grows into a bigger problem.

Photo credentials: Hertility Health Instagram

Is there a link between gut health and your fertility/reproductive health?

You should aim to enter pregnancy in your best possible health and for some that might mean making lifestyle changes. This can include changes to your diet to improve your gut health. There are lots of sites boasting about “fertility-foods” and preconception multivitamins, but trying to understand the link between diet and fertility and deciding which (if any) changes you might want to make can seem overwhelming. A professional can guide you through it!

There is a link between gut health and fertility and we’re only just beginning to understand it. Your gut can affect weight, inflammation, thyroid activity, and oestrogen levels – all have the potential to impact your fertility.

–   Gut Health and Hormones

The gut microbiome can help manage how your body regulates hormones, including sex hormones like oestrogen. Excess oestrogen is removed from the body through the gut, but sometimes instead of getting rid of extra oestrogen, microbes in the gut reabsorb it; leading to higher levels of oestrogen circulating around your body.

It’s essential for your fertility the balance is maintained between oestrogen and progesterone – another vital hormone. If this balance is upset because your gut is unable to remove extra oestrogen, it could lead to a higher risk of miscarriage. High oestrogen is a factor in many other reproductive health concerns, including PCOS and endometriosis.

–   Gut Health and your Thyroid

Your thyroid is a butterfly-shaped gland in the neck. It is a major player when it comes to regulating your metabolism, your hormones and your immune response. To function properly your thyroid needs essential micronutrients like iodine, iron, zinc and copper. If your gut bacteria is out of whack, your body can’t extract these nutrients from the food you eat and the thyroid might not be able to carry out its usual function. This can affect your mood, metabolism, energy levels, and can cause excess weight gain or weight loss.

You can read more about the thyroid and its role in your fertility here.

–   Gut health and your immune response

Your gut communicates with your immune system; helps to fight off infections and reduce inflammation. Inflammation is a natural response to injury or illness, but prolonged inflammation can lead to problems. It can affect ovulation, hormone production and has a role in both endometriosis and PCOS. Recent research found that many women who experience recurrent miscarriage were likely to have an undiagnosed gut disorder, often related to inflammation.

If the balance is off between your good microbes and bad microbes in the gut, it can dysregulate the immune response. This can make it difficult to fight off infections. This included infections of the vaginal tracts like bacterial vaginosis and thrush, as well as sexually transmitted infections (STIs); there is a link between some STIs and infertility if they’re not treated properly. It may also cause autoimmune disorders, like those of the thyroid, and cause insulin resistance, often seen in PCOS.

So, if you want to be sure your immune system is in tip-top shape to help you and your fertility stay at the top of your game, looking after your gut health is a good place to start.

–   Gut health and male fertility

If you are going through your fertility journey with a male partner, make sure you’re both eating a healthy, balanced diet. Gut health has been shown to affect the sperm making process and the quality of the sperm produced.

Can I improve my gut health to benefit my fertility?

Gut health is all about having a diverse microbiome and that can be influenced by a lot of different factors. The good news is evidence suggests changes in the microbiome can be seen in as little as 24 hours after changing your diet.

Research suggest things like probiotic foods promote a diverse, happy microbiome. This includes fermented foods like kimchi and natural yoghurt. Prebiotic foods are for feeding all your friendly gut bacteria and can be found in bananas, legumes, honey and apples.

Anti-inflammatory foods are important for promoting a good immune response. These include proteins, such as those found in beans, nuts and lean meat. But don’t be afraid of carbs! Whole grains are a good source of fibre and antioxidants. Your gut microbes love fibre!

Most importantly, make sure you’re getting enough vitamins and minerals from your diet. The best way to do this is to eat a varied, balanced diet. If you do, you shouldn’t need to take any dietary supplements, but if you have dietary restrictions, allergies, or if you’re vegetarian or vegan, you might need a little help getting all your nutrients. If you’re unsure about supplements, speak to your GP or registered dietitian.

However, if you are actively trying to get pregnant, it is recommended you take folic acid supplements daily till you’re 12 weeks pregnant. Folic acid can help prevent neural tube defects such as spina bifida. If you suffer from inflammatory bowel disease or have had bowel surgery for any reason, speak to your doctor who might recommend a higher dose. This is because bowel surgery can affect your gut’s ability to absorb folic acid.

Inflammatory bowel disease and fertility

If you suffer from IBD you might find the idea of pregnancy or having children daunting. It is true that IBD sufferers are more likely to not have children. However, it is generally accepted that this is because they have safety concerns for both themselves and their baby – not because they have issues conceiving.

If you have Crohn’s disease, studies have found your fertility is not reduced when you are in remission. Most people with Crohn’s disease who conceive in remission will have a normal pregnancy, followed by the birth of a happy, healthy baby (always case dependent).

If you do become pregnant with active disease, symptoms generally persist throughout the pregnancy. Active disease is associated with low birth weight and other possible delivery/ labour complications. So if you are thinking of pregnancy, it might be best to wait till you’re in remission for a few months first. Speak to your IBD team or GP and let them know you’re thinking about having a baby.

Will bowel surgery impact my fertility?

If you’re thinking about pregnancy after bowel surgery, your doctor might ask you to wait a year or two before trying. This can be to ensure everything has healed fully inside. While there have been studies that looked at bowel surgery and fertility, these are rare and often not great quality. However, some trends are appearing.

If you have had surgery for IBD, your fertility might be more affected than your counterparts who could treat their condition with medication. People who had open bowel surgery were more likely to have difficulty getting pregnant, than people who had key-hole surgery. Bowel surgery can sometimes leave behind scar tissue on the surrounding organs, including the ovaries and fallopian tubes. This can make it harder to conceive.  

After bowel surgery, it’s not unusual to experience a longer time to conception and some people may require the help of IVF. If you do become pregnant, a C-section might be recommended to you for your delivery, but it is possible to have a normal delivery. As for pregnancy complications, you’ll be assured to know the evidence so far suggests you are at no greater risk of preeclampsia, gestational diabetes and miscarriage than before your surgery.

Will my stoma complicate things?

If you are thinking of having a baby, having a stoma isn’t a barrier tho conceiving! It shouldn’t prevent you from getting pregnant and many people can have a normal delivery. If you are having trouble conceiving, don’t assume it’s down to your bowel surgery. Be sure to check in with your GP just to make sure there are no other issues.

Why is fertility a taboo subject and how do you feel this can be tackled? 

Fertility has become a taboo topic. It’s something that not many people know about unless they’ve dealt with it directly. It can be an uncomfortable subject and there isn’t a lot of education or information out there. 

The only way that’s ever going to change is if we start talking about it more and educating people by:

Increasing education from the professionals.  It would be helpful if we weren’t just educated about how to prevent pregnancy and STIs, but also informed about the possibility of infertility. What if OB/GYNs educated patients about their risk of infertility?

Make fertility testing more accessible. Only 20% of all fertility treatments are covered by the NHS. Diagnostic testing for infertility is not covered but, what if this wasn’t the case? What if fertility treatment was part of your regular annual doctor’s visit once you reached a certain age? Or, if testing became more affordable?

Stop judging and start listening. Perhaps the simplest thing we, as a society, can do is to stop judging people with infertility. Even celebrities face criticism when owning up to the fact they went through fertility treatments. It’s easy to judge what you don’t understand. We should listen — really listen — to the stories of those who have struggled with infertility. And instead of judging or offering advice on how to get pregnant, we should applaud them for their bravery to share.

Improve marketing and activism around infertility. Although the National Infertility Association has a week dedicated to infertility awareness, I think a more unified, cohesive marketing effort to raise awareness would help bring this issue to light.

Photo credentials: Hertility Health Instagram

Tell me about Hertility!

 If you have concerns about your reproductive health, or simply want an insight into your fertility, Hertility can help! Our tests can give an insight into your ovarian reserve, (aka how many eggs you have left), menstrual cycle health, check if your sex hormones are happy and, *crucially* highlight any fertility red-flags.

Should you need it, we have an expert team of specialists, from fertility experts to counsellors to help guide you with your next steps. Whether you decide you want to go for egg freezing, fertility, treatment, need help managing your symptoms or are planning for pregnancy, we’re here to help. 

Check out Hertility Health on Instagram here!

Sources: 

https://www.nature.com/articles/d41586-020-00194-2

https://www-ncbi-nlm-nih-gov.libproxy.ucl.ac.uk/pmc/articles/PMC5017946/

https://www-ncbi-nlm-nih-gov.libproxy.ucl.ac.uk/pmc/articles/PMC6285284/

https://pubmed.ncbi.nlm.nih.gov/28778332/

https://journals-sagepub-com.libproxy.ucl.ac.uk/doi/full/10.1177/0193945917697223

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012711.pub2/full

https://www-ncbi-nlm-nih-gov.libproxy.ucl.ac.uk/pmc/articles/PMC5072556/

https://journals.viamedica.pl/ginekologia_polska/article/view/51716

https://www-ncbi-nlm-nih-gov.libproxy.ucl.ac.uk/pmc/articles/PMC5072556/

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