Restoring my menstrual cycles for the first time at 36 and getting pregnant on the second cycle (Part 1)
Photo courtesy of Desmond Tan Photography
NOTE: In the next several posts, I will discuss my nutrition & lifestyle journey in restoring my cycles and getting pregnant (on my second ovulation!). This post will be the first part in a multi-part series.
Part 1- The Beginning - failed attempts at fertility treatments (warning: some graphic needle images), pivotal/frustrating moments in procedures, figuring out my endocrine system & balancing my glucocorticoids through food and lifestyle changes. Research behind the stress response, food intake, and hormones.
Part 2: Dietary changes - macronutrients and micronutrient adjustments. Sample 3-day record of my diet during our fertility journey.
Part 3 & 4: Other lifestyle factors I changed - water filtration, plastics and BPA, aluminum & non-stick pans, and the research behind these factors.
The beginning:
I always wanted to be one of those runners who trained hard, raced fast, and was having regular menstrual cycles. I wanted the process of getting pregnant to be spontaneous and easy.
I would look at runners such as Steph Rothstein, Lindy Davis, Lauren Floris, or Julia Webb, who continued to run marathon mileage & high intensity, had their periods (or at least Steph Rothstein has spoken to this), and got pregnant spontaneously.
Unfortunately (or fortunately… as I discovered A LOT about myself), that was not me. My journey towards parenthood was very different.
Throughout my entire adult life, aside from a few breakthrough periods, I did not have regular cycles; I was amenorrhoeic most of the time.
Whether it was the fact that some pathway in my endocrine system was misfiring or the fact that as soon as I had my first period I was put on birth control (the doctor said it would help with acne), my 20’s and some of my 30’s were spent either on birth control or not having my period at all.
Once I reached mid 30’s, my husband and I decided that it was time to pursue other fertility measures. We started going to fertility specialists- first at Kaiser, and then with Dr. Aimee “The Egg Whisperer” - to see what we could do to get pregnant.
After several unsuccessful attempts, a miscarriage, and a really frustrating conversation with an endocrine specialist at Kaiser (more on this below), I decided to look more deeply into the research behind fertility (and infertility).
Fertility journey
Truth be told, since 2005, my husband (then boyfriend) and I have been not NOT trying to have a baby (stopped birth control, and no other protective measures used).
At the time, we would have been happy IF we got pregnant. But, we were also very OK with not yet getting pregnant (Ryan was finishing up his Neurobiology, Physiology, and Behavior [NPB] Bachelor’s of Science degree, and I was in graduate school working on my PhD).
Once we reached mid-30’s, finished our degrees, started other careers, and still weren’t getting pregnant, the urgency to conceive became stronger. We needed to get more serious about fertility.
Fertility rates and accompanying pregnancy risks increase with increasing age, so our mindset in thinking “We’re going to get pregnant spontaneously & quickly” was no longer posing to be true.
We decided to begin looking into other fertility measures through Kaiser.
In 2016, we underwent a variety of fertility treatments- injections of different ovulatory and induction hormones, glucocorticoid treatments, estrogen decreasing hormones, and others.
It was quite the adventure (and I won’t lie, kinda scary!) to have Ryan poke me with a needle every night (See below… although if you’re sensitive to seeing needles, please skip past the images). I really disliked the process as a whole.
Fertility treatment injections
Fun times with fertility treatment injections
Fun times with fertility treatment injections
You could see and feel the bump on my abdomen from the fertility hormone injections
At one point (and IMO partly to blame for Kaiser’s “trial and error but don’t get to the root of the problem” model) I had something called hyperstimulation, during which MANY of my eggs grew in each ovary (typically during ovulation one egg grows and is then released. I had ~25 fully ready in each ovary).
This is, in fact, very dangerous, as your ovaries (because of the extreme weight of all grown eggs) can at any point “flip” and block off circulation to the uterus, possibly leading to other serious complications like death).
Thank goodness, after several weeks my ovaries went back to normal after stopping the treatment and basically not moving.
The epitome of our fertility journey frustrations came when I spoke to an endocrinologist (I wanted to get to the root of the problem).
Instead of continuing to take the mounds of injections/medications that were not working, my scientist brain wanted to get to the bottom of this. There was clearly something going on with my endocrine system, and I wanted to see how to fix it!
The conversation with the endocrinologist did not go in the “expert” fashion I was hoping for (testing hormones, seeing what’s off, asking questions, adjusting whatever needed to be fixed, etc. Otherwise known as a scientific method: hypothesize—-> test—-> conclude/repeat).
The endocrinologist did not want to do any hormonal, inflammatory, or metabolic testing, nor did he ask me very many questions. Instead, he lectured me on extreme exercise and nutrition.
As you can imagine, as a scientist and educator who has researched and taught nutrition for over a decade, this was not the answer I was hoping to hear.
I was very frustrated at the conversation, the lack of meaningful results, and, most importantly, at myself. As a nutritionist who helps people figure out how to attain their health goals on a daily basis, I could not figure out my own health issue of getting pregnant! Aside from the endocrine side of things (which I hoped the endocrinologist would help me with), I felt like this was something I should be able to figure out with dietary means.
So, began my in-depth research into what was going on with my body.
#stubbornpolak #dontgiveup.
I knew that I have been many different weights throughout my life (ranging in ~ 40 lbs. from my lightest to heaviest!) and never had regular menstrual cycles, so my weight was likely not a factor in fertility.
I also knew the women in my family had very irregular cycles and most if them had trouble getting pregnant, so there were likely genetic/endocrine system factors playing in.
Recently, I also had my stress and endocrine system checked out via the Dutch test and discovered I had above average (24-hour) Cortisol levels (a stress hormone), and below average hormones (results below):
So there was likely something going on with my glucocorticoid and sex hormonal pathways.
The science:
What I thought was possibly happening:
This higher than average Cortisol lowered my hormonal production into non-existence. Because of the feedback loops and connections of the stress response to hormones (see below), I was nudging my cholesterol precursors into glucocorticoid production (not only Cortisol but also other mineralocorticoids) leaving my sex hormones with low production.
Additionally, if you look at genetics research, much of the stress responses genes get passed on generation to generation. My grandmother lived through WW2, was anemic, and under stress pretty much all of the time. She also had a very difficult time getting pregnant.
These genes probably were passed on to me…
My mom and my sister also had periods of irregular cycles and problems getting pregnant (although not as severe as I was having).
I then was predisposed to having some of these stress response genes.
Secondly, with my particular lifestyle - lots of work/ teaching/ client obligations, continuous high intensity exercise, caffeine, sometimes lack of sleep, frequent intermittent fasting (debatable whether this had any influence), and probably most importantly, just my inherent way of being (very energetic, prone to be anxious at times, loves deep focus and intensity) - and you have the perfect storm to higher than average cortisol levels.
My estrogen and progesterone were low, likely because all of the energy and precursors were going toward the production of Cortisol. I was pushing these pathways into cortisol production and away from sex hormone production.
Here is what these systems look like (image via wiki):
All of a sudden, my Ph.D. work started to have a much more significant meaning.
Here is what we know from research into the stress response and food (and what I ultimately changed):
We know that food, and notably higher sugar and higher fat foods, lower the stress response. Multiple publications have been written in this field (Any of Elissa Epel’s, Mary Dallman’s, Kevin Laugero's, as well as many other scientist’s research).
So my goal was to adjust my food intake & lifestyle to adjust the stress response and hence nudge those precursors toward sex hormone production.
I didn’t want to include anything too refined or high sugar, as these foods are known NOT to be beneficial to health, but I did want to use similar macronutrients to mimic the responses…
In the next several posts, I’ll show you exactly what that looked like. :)
If you have a fertility journey of your own that you’d like to share, or questions about what I did, please ask/share in the comments!
With Love and Health,
Dr. Julita Baker