Natural Killer Cells - are we being pulled into the hype?

I see a lot of clients and have over the past few years been increasingly aware of the area of reproductive immunology. Like most the starting point for this was the book ‘ Is your body baby friendly’ by Dr Alan. Dr Alan Beer is the man behind the whole area of reproductive immunology and the originator of the ‘Chicago protocol’. He set up his clinic as a pioneer and he was instrumental in the fertility world with regards to looking into the immune system as a causative factor to multiple miscarriage and failed implantation. As a result, many IVF clinics started looking at Cytokines, the bodies ‘war’ machine and as I like to call them the ‘ Special forces’ or more commonly know - Natural Killer Cells.

What are NK cells and how are they relevant to pregnancy?

Natural killer cells are under normal circumstances a natural and healthy part of the immune system. They are there to eliminate anything harmful that could cause a threat to your body. They are a type of white blood cell that provides a rapid response to infected cells and go to task particularly if they are needed in the case of tumours that start to form but equally get in there with viruses, parasites and bacteria.

When we get pregnant, NK cells need to get the signal to ‘ power down’ - after all although it is the most natural thing in the world  to be pregnant, it is essentially 50% foreign DNA. At the time of pregnancy (and normally the first 12 weeks) the brain needs to give the signal to lower the natural defences of the body, a situation that can understandidly confuse things. It must be really hard for the body's immune system to ignore what looks like a pathogen starting to develop, via the uterus, as during this early time - implantation starts a whole chain reaction where it then starts to establish its own blood supply!

http://www.notesformedicalstudents.com/2013/09/antigen-representing-cells.html 

What should happen before an expensive blood test for NK cells

If you have had multiple miscarriages or grade A eggs at IVF and your partners sperm has also been verified as good with no DNA fragmentation, then the next step for me is always a hysteroscopy. This procedure involves taking a biopsy of your uterine lining and the results will show if there is unusually high NK cells. For me this is the most effective way to establish if NK cells are invasive and could be causing miscarriage.

What normally happens…

If you are working with a progressive IVF centre, they may after 3 or more failed IVFs or miscarriages, send off for a raft of blood tests, which cost a pretty penny!

What you need to know before ordering or letting your reproductive specialist lead on some very expensive tests is the difference between blood NK cells and uterine  NK cells. Another thing to keep in mind which takes it a little deeper is you should know is that NK Cells are deemed Bright NK, Super Bright and Dim NK cells http://www.jimmunol.org/content/181/3/1869.full.pdf

..’During implantation, CD56^bright NK cells are reputed to play an important role whereas CD56^dim NK cells are mostly negatively associated with reproduction'.

In a few studies they found that the proportion of the uterine CD56^dimCD16⁺ NK cells was significantly lower in IVF patients as compared to the controls (6.9 and 13.7% ) The proportion of CD56^bright NK cells  was no different between IVF patients and controls in the uterus (28.8 and 33.5%) This data indicated a shift in the ratio towards the beneficial CD56^bright NK cells and away from the harmful CD56^dim NK cells…’http://molehr.oxfordjournals.org/content/10/7/513.full

In peripheral blood there is no shift in the CD56^dim/CD56^bright ratio

Blood NK cells are very different to uterine NK cells leading some experts to conclude that “measuring any parameter of NK cells in blood is not useful in trying to understand the cause of reproductive failure” http://humrep.oxfordjournals.org/content/early/2015/12/05/humrep.dev290

The important thing to keep in mind when you have had multiple miscarriages is that the you need to know a little more about these new tests before proceeding to the next stage and what inevitably can then involve more costs. It is my view that a biopsy is the only way to confirm high NK cells which may be causing some issues with implantation and growth of the baby.

1.Gilman-Sachs A, DuChateau BK, Aslakson CJ, Wohlgemuth GP, Kwak JY, Beer AE, Beaman KD. Natural killer (NK) cell subsets and NK cell cytotoxicity in women with histories of recurrent spontaneous abortions. Am J Reprod Immunol. 1999 Jan;41(1):99-105. 

2.https://www.researchgate.net/publication/51477139_The_effect_of_pregnancy_on_uterine_NK_cell_KIR_repertoire

3. http://www.ncbi.nlm.nih.gov/pubmed/10783371 

4. http://www.jimmunol.org/content/181/3/1869.full.pdf 

5. http://humrep.oxfordjournals.org/content/early/2015/12/05/humrep.dev290 

Vitamin A ~ is is safe in pregnancy?

The new year has started off with a bang! Lots of clients who have been working with me for 3 months or more are now pregnant – Yay! As most are new mums a few have got in touch about Midwives and Drs misconceptions and concerns about vitamins and minerals, as this is where the medical community start to get involved. One of the concerns is about Vitamin A and its ability to cause birth defects; so let me respond and shed some light on this.

I have looked into this issues myself quite thoroughly and the research links I have cited below mention that the research is over 30 years old in regards to the potential causes of birth defects. I will say that again.... In time frame only 18 cases have been cited where this has caused deformities. 

I’m sure you are aware that any adverse reaction to drugs need to be reported.  All medicines are reported under the medical misuse category.

Drugs cause death and other health conditions by the hundreds of thousands annually. vitamins don't cause death http://bit.ly/1Ogey41  We don’t have anything for supplements to report on this, but as always if anything does show ‘Teratogenicity ie potential for birth defects it has to be reported as such.

A basic look into drugs commonly used to help women conceive and to help those with sticky platelet, such as Aspirin have far more potential to cause birth defects, http://www.mayoclinic.org/drugs-supplements/analgesic-combination-acetaminophen-salicylate-oral-route/before-using/drg-20069948 and not to mention fertility drugs that many use unwittingly without looking into the small print, that can also cause deformities and also death. http://www.drugs.com/pro/clomid.html  My point here, is many of my clients are getting all wound up about something, without looking into the issues more closely, and colleagues in the medical profession are making a point of issuing notice on Vitamin A without also mentioning that drugs, many of them used in fertility circles, have far more of a chance of giving ladies birth defects,  And those were taken at the correct dosage!

Of the 18 reported cases over the last 30 years who had babies with deformities all of the women in regards to Vitamin A took over 25,000IUs of Vitamin A, which exceeds the RDA on this by an exponential amount. As always the devil is in the detail. Most  supplements will show 2 forms of Vitamin A – the one that can cause more damaging effects at high levels  is retinol only and not a mixed between Retinol and beta carotene,  which is what most supplements have in them.

It is worth noting also in this instance that Natural Vitamin A ( retinol) is found in high doses in organ meat, such as liver. Which up until the 1970s was consumed and readily available. Many children, like our parents who, were born after the war were given cod liver oil daily, to ensure they didn't have deficiencies. This form of fish oil has a much higher form of Vitamin A.

One of the sources of this information is NHS choices website. In this website, which I find extremely unhelpful and very uniformed it says things like ‘ you should be able to get all you need nutrients from your diet and don’t need any extra vitamin A’. Also rather unhelpfully in the article they put the measurement in Mgs not IUs, which is the standard international unit used to measure Vitamin A, so right from the start shows a fundamental misunderstanding about vitamin A.  http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-A.aspx

In terms of its use in pregnancy it is vital and essential nutrient and the most important and well known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye ( Xerophthalmia) and corneal changes. It is also used for retina function. 500,000 people lose their site each year due to vitamin A deficiency. Vitamin A levels are also inportant in thyroid health as it is needed for the uptake of idone and is required for thyroid hormone triiodothyroxine (T3) to bind to intracellular receptors. 

Vitamin A is needed in pregnancy for:  - Growth, Immunity, epithelial tissue maintenance and during cell proliferation, ie foetal growth!

http://ajcn.nutrition.org/content/71/5/1325s.full

I work with many clients and look into deeper analysis of fertility issues and pregnancy complications and one area I am fascinated in is Epigenetics. Many people who have polymorphisms in their BCMO1 gene have an issue converting beta carotene into retinol. So I welcome the use of mixed vitamin A for them in a retinol base, as they will have a problem converting Beta Carotene in the body http://www.ion.ac.uk/blog/anonymous/tue-2014-06-17-0954/are-you-converting-enough-beta-carotene-vitamin-55-people-may-not  Many of the studies on the populations in the human genome project also had the potential for poor eye sight also so were really in need of vitamin A, should the gene express.

I ask questions about eyesight as part of my consultations and also look at this from a family health position, as there is the potential here also to pass this on to off spring! One anecdotal thing I’m noticing much more than when I was a child is that there seems to be a huge amount of kids with glasses at a young age. I only remember a few in my whole school growing up, so I’m wondering if reduced amounts of vitamin A in pregnancy are a result of this?

WHO recommendations. More recent than 1995 http://www.who.int/elena/titles/vitamina_pregnancy/en/

American Teratology Society information on Vitamin A http://www.teratology.org/pubs/vitamina.htm

Further information on Vitamin A http://lpi.oregonstate.edu/mic/vitamins/vitamin-A#safety

On a personal note. I have used many American supplements for the last 8  years of working with women all of which have mixed vitamin A around 5000IUs and I have confidence on these levels of Vitamin A.  I have worked with hundreds of ladies and so far no issues with this, with my recommendations!

I hope this helps you to make a more informed decision about vitamin A and its use in pregnancy and preconception.

References

1.http://www.teratology.org/pubs/vitamina.htm 

2.Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23 ;333(21):1369-73 

Wiegand, et al. 

3.Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6. Rothman, et al. 

4.Teratogenicity of high vitamin A intake. NEJM. 1995 Nov 23;333(21)1369-73. 3. Miller, et al.

5.Preconceptional vitamin A use. Reprod Toxicol. 1998 Jan-Feb; 12(1)75-88 

6.Tolerable levels of 10,000IUs https://umm.edu/health/medical/altmed/supplement/vitamin-a-retinol

           
    

OvuSense a new Fertility Monitor that works (part 2)

I have been promising this review of OvuSense  for a while but I wanted to hang on - to really put it to the test and last month it didn't disappoint. 

As you may remember in Part 1 I got the monitor some months ago and was trailing it alongside BBT charting. Last month things really turned a corner with using this.

I was ill for a few days and my basal body temp went up to 37  degrees randomly right before I begin the phase just before ovulation. Temps stayed highish for a few days during this time, as I was fighting something off which never materialised ( cold for an hour, cold sore and achy bones) 

In my own predictions this would put me to ovulation on day 13-16, a prediction also confirmed by OvuSense to  around the 5th August. I have posted the pictures below but it’s a real example of how OvuSense, as it follows core temps, will show the real dates of ovulation in unison with natural progesterone in the body.

Ovusense  is in fact, according to its trails 99% accurate in detecting ovulation. As already mentioned Ovusense uses core body temps to predict ovulation. One of the biggest bonuses though using core temps, is that it can predict any cycle and for women who have periods only a few time a year -  this is valuable knowledge. The other bonus is if the temps stay low, then its time to trot off to the doctors to look at progesterone as this maybe why you aren’t getting pregnant as levels are just too low!  This is something that Ovusense picked up with me this last cycle, as its been a pretty stressful month with lots of things going on for me and as mentioned in previous articles if cortisol is high i.e. stress it will actively steal progesterone from your body! 

Below is an example of my normal cycles where I have good progesterone which was also confirmed by blood tests.

As OvuSense will pick up ovulation when temps rise, it is an amazing resource for Women who are diagnosed with Poly cystic Ovarian Syndrome (PCOS) Timing is everything with trying for a baby and you get a 24-72 hour window, depending on sperm health. Also  if you only ovulate 3 times in that year, you bet you are going to want to get busy having sex when you need to if you aren't cycling regularly!  

I have a lot of clients who suffer from PCOS. It a condition that 1 in ten women suffer from and something I have been supporting a lot in the last 10 years.  I'm pretty passionate abut this condition and I volunteer on a Facebook Forum sponsored by Ovusense for PCOS Women that has over 6000 members. I have to say the forum is an amazing resource. The ladies who support it Laura and Lucinda who work for OvuSense respond and support a whole raft of technical issues and also brave emotional support and give encouragement when ever possible. Kate Davies also supports the ladies and comes from a background of nursing via her own company Your Fertility Journey. Kate has over 20 years of specialist knowledge in Fertility and gynaecology. and support the ladies who have an Ovusense monitor with a free consultation with her; for others a 15 mins sessions is offered for free. OvuSense also have women so passionate about the monitor that they give up their free time as admins to help out and support the running of this page. The balance on the forum is great and its more of a support network than anything else where those who have bought OvuSense can post up charts and others ask advice on BBT charting and also diets and supplements. ( that’s where I come in where I can!) If you have PCOS and are curious I’d say jump in and join! 

https://www.facebook.com/groups/PCOSfertilitysupportUK

All in all out of all the monitors I have tried, for £295 you can’t go wrong with Ovusense. They also offer monthly plans to pay so its affordable! It is in its early days as a fertility monitor and there are some teething probs like faulty monitors now and then. But to be honest, many monitors out there do also have these issues. It is a hefty piece of machinery in terms of packing a punch with what it has to do daily!

When I had a sensor that stopped working this was courier out the next day and it didn’t cause any disruption to my cycle. This is something also reported on the Facebook Forum. I haven’t seen one bad comment about the teams commitment to sending out and replacing equipment if not working. Everyone loves the OvuSense team as they get straight on it if there is an issues!

In the future OvuSense may also be used as contraceptive! In the meantime I wholeheartedly endorse it as a fertility monitor to help women who want to get pregnant! In fact speaking of that OvuSense have had 50 pregnancies since the beginning of 2015! Pretty good going I'd say! 

I have now been using it for over 6 months and  can say with some assurances I know how it works and look forward, every morning to seeing the little blue monitor building my picture and letting me know when I’m in my fertile window and when I’m not! 

What’s not to love about that as a woman and how amazingly empowering is that? As a Fertility Nutritionist it makes my job easier and it helps me to support clients where I can who use it. I look forward to the day that Ovusense is in high street Chemists alongside other things like OPK kits and Clearblue fertility monitors, leading the way and giving modern women one less thing to worry about in terms of their fertility!

Disclaimer: OvuSense gave me a fertility monitor for the purpose of this review

Ovusense the Fertility Monitor that works! (Part 1)

A study done in Australia in 2013 by the Journal of advanced nursing found that 13% of Australian Women were unable to define their fertile window in order to support conception. This lead researchers to identify that ‘ poor fertility awareness’ is one of the contributing factors to infertility. This figure is I’m certain not just a reflection of Aussie women, but in fact also emulated all over the western world.  In my experience when I start working with women and talking to them about their own fertility knowledge this  figure seems more like 40%!

There are many other reasons for fertility issues and as a nutritionist I'm passionate about turning this over and uncovering how to bring your fertility back into balance again by changes to lifestyle, dietary suggestions and supplementation when possible.

Times definitely are a changing and I often think that my job wouldn't have been around some 50 years ago! Amazingly only a few generations ago women would have been eating foods that were right for them and seasonally based food -  this would have helped their fertility immensely. We weren't travelling huge distances, stress was less and we had more of a community to give us the support we needed from a female perspective and we learnt about our bodies through our sisters! Women back then also just seemed to know the signs and how to effectively predict and track their fertility throughout the month unlike today.  In the olden days this information was passed down from women to woman and in many traditional societies becoming a woman and knowing you can create life is a right of passage. In today's modern life where we have an app for everything, fertility is bundled up in this world . This is not a bad thing in itself as women of younger generations are learning from technology about fertility now, and we have online communities to support our issues! In other words we no longer sit round the campfire sharing knowledge as we look to the internet and technology for fertility awareness.

As a modern girl ( I hope) I try to keep up with technology and as part of my job I teach and coach women on fertility awareness. Over the years I have also tried many devices that identify your fertile window. This has included the clear blue monitor ( persona) and using ovulation predictor kits.  I also used the OvuCue for a while which I quite liked which is based on predicting ovulation based on your saliva. I’ve also tried looking at saliva ferning patterns. You name it I’ve tried it to help my clients and myself!

The most consistent method over the years I have used, is to look at body temperature as a marker of definition between follicular and luteal phases. Before testing your HcG levels, raised body temps are a real indication of pregnancy as high levels indicate a good level of progesterone, which is something that sustains a pregnancy and a hormone that will naturally raise your bodies temperature once you have ovulated. In this 2 week wait from ovulation to menstrual period, progesterone will stay high regardless of pregnancy, but will increase steadily if pregnancy occurs in the feedback loop from brain to the endocrine and reproductive cycle.

I love using BBT charting to see where I am in my cycle. It is a fabulous tool! I have to admit I am a prolific Basal Body Temperature charter in fact ‘ Hello my name is Angela and I’m addicted to BBT charting’  I have been doing this for the last 7.5 years.  Funnily enough I found out my parents also used this method to conceive all 3 of us Heaps! It’s a great method, its been used for years by so many people  and is coupled together with other methods that look at other signs of fertility like cervical position and cervical fluid to shows that your body is ready to release an egg from a follicle and that ovulation has occurred.   When I first started working with Natural Fertility Expert and Andrew Loosely who uses this method readily he was amazed how many BBT charts I had ‘under my belt’.

When it comes to supporting my clients I do walk the walk in regards to understanding fertility and your body. I have also been known to use my own charts in consultations in order to show women what to look for in terms of fertile signs in the female body. However the one thing that throws this picture into a loop is that it relies on taking a reading orally and when you are ill the picture is then out of whack as it records basal body temps which will remain high if your immune system is fighting something off!  I didn’t know how to remedy this, and if you were ill, well when it comes to this, its something to work around as a practitioner!

Until Ovusense…. I was introduced to this fertility device around a year ago. I met Robert Milnes the CEO of Ovusense UK and Kate Davies a specialist nurse brought in from her own practice Your Fertility Journey to support them at the Fertility Show in London 2014. I was at the show as part of the Natural Fertility Expert(NFE) team. This device followed the principals of BBT charting but it used core body temperature! Which made my ears prick up. This would mean that illness would not affect the reading.  When I heard this - I was hooked and approached them to trial  the device on myself this year.  Which they agreed to do and sent me out a monitor and sensor in the post as soon as we had agreed I would be trialing it! I was delighted to be trialing something which showed such promise - Hoorah bring on the temps! As a comparison – even though it isn’t as such - I used it along side the BBT charting also.

How does it work?

The monitor arrived a few months ago and weighed very little ( handy for taking it on holiday!) It also looks like very much like a mini computer, which will hold all the data you input into it. It comes with a sensor, which I think looks like a giant sperm.. or a tampon which you insert into your vagina every night. You do wash this before and after use every day and is made from the highest grade medical material so nothing sticks to it germs wise I’m guessing!

Starting the trail

You only start using the sensor after your period ends for hygiene reasons, so I waited until this was over and started using the device on day 6 of my cycle.  Apparently as the sensor is inside you it will take a temperature every 5 mins while you sleep. In reality when I mention this to some people they are horrified- but It was actually more comfortable than a scratchy tampon ( which I don’t ever use fertility peeps)

You ‘wear’ it overnight – or for at least a few hours for enough readings to be taken. When you wake, thankfully you don’t have to lie there like a corpse while you take your temp like BBT charting and you can get up immediately! Bonus if you already have kids and they wake up in the night or at 6am and bam,  You’ve lost your BBT window to take your temps!  You then take the sensor out wash it and place it back on its cradle and press the down arrow for the data to be transferred! The monitor will then use algorithms to predict your fertile window each month and after using it for 2-3 months this becomes eerily accurate as it begins to see a pattern. This pattern fitted exactly to my cervical fluid patterns also which made me feel more confident from the outset

.  

The good thing about OvuSense – (well there are lots actually) - is it gives you a ‘Fertility Window’

 which is really handy as if you are a long term BBT chart user, you know there is never a window and as useful as it is you can miss your window if your body is ‘ off’ that month! Also OPKs can be unreliable in my view as can surge a few times in the month particularly if you have PCOS! It occurred to me that this device had many uses from a fertility perspective not least as is invaluable if you are using a sperm donor as it will give you a day or 2 notice. If getting pregnant via sex, it also means you have that prior knowledge that you have a day or 2 to get ready! I do also recommend you use other methods alongside this like cervical position and cervical fluid as this just gives you the ‘green light’ when you are already in the race with OvuSense.

I will go into more detail in part 2 about the Facebook Page that supports this app and what Ovusense picked up that my Fertility Friend didn't which was very exciting!

B Vitamins and PCOS

Today I'm really excited to talk to you about a group of vitamins really vital for female health useful for ladies particularly with hormone dysregulation, PCOS and weight issues.

The B vitamins are very important in helping to improve the symptoms of PCOS. In nature if we get a balanced diet we get lots of the B vitamins in things like Meat, Fish, Eggs, Milk and green leafy veggies. If you want to have them in one source ie a vitamin, Its really important to make sure you have these vitamins in a combined formula as they all work together on different elements! 

Vitamins B2, B3, B5 and B6 are particularly useful for weight and maintaining and managing it. One of the B vitamins - Vitamin B2( riboflavin) helps to turn the food you eat via fat, sugar and protein to the energy we need to survive(its also the one that turns your wee bright yellow!)  B3 another vitamin, s an important co-factor in supporting glucose tolerance factor (GTF), GTF is something  that allows your body to keep an eye on blood sugar . It needs vitamin B3 to help this process, almost like food for your GTF! Vitamin B5 is also important as it helps your body metabolises fat, so important if you are overweight and need to lose weight to qualify for fertility support!  B6 is also marvellous as it supports proper hormonal balance and may be one deficiency present if you suffer from PMT. It helps to maintain blood sugar, oestrogen and also progesterone and helps in mood regulation via serotonin. Many women with PCOS have deficiencies in this and also low progesterone, so worth topping up your levels with B6 in this case. B6 is also part of a ‘gang’ with B2 and B3, that will help your body to make and move thyroxine, needed for normal thyroid hormone production.

Let’s not forget folate B9! Many of you maybe on folic acid for your fertility as this is the basic component of many B complex vitamins. However I like to super charge my ladies and always go for the superior version of folate called Methlyfolate. Folate is such an important substance, its not just needed for helping to prevent Spina Bifida and Neural tube defects, its needed for all our cells to replicate which happens hundreds of thousands of times a second in our bodies, so vital for health, not just to get it in supplement form but in natural forms through leafy greens!

Folate works in conjunction with B12 also a co-factor and together they help to reduce a substance or by-product of methylation called homocysteine. This can have implications of cardiovascular issues if too high and homocysteine can creep up if taking metformin, without replacing both B12 and folate in the diet.

Deficiencies in these vitamins can happen easily if you have an inflammatory condition like PCOS, so having a great combined  B vitamin will enable the body to maintain balance more easily so it can do its job!

B12 is an important vitamin and many people are deficient in this mineral. It is found in lots of foods such as Meats, fish and dairy, so often vegetarians can become deficient in this vitamin,  particularly people who don't eat a healthy diet. B12 together with folate is really needed by the body to help cell replication and DNA, which we need constantly as cells die and are replenished. When we eat protein B12 is released and is then further broken down by something called intrinsic factor which helps B12 to get absorbed into the blood stream. You need good levels of Hydrochloric acid for B12 to be released so for many this may be the issue of constant low B12 despite supplementation. So taking some cider vinegar in war water before food helps with stomach acid support.  B12 becomes deficient in the body by using metformin, so it really important to take this to help red blood cells and oxygenated blood travel round the body. Thorne Research Basic B has a super absorbable B12 called Methylcobalamin in it, which is an excellent version of B12, and one of only 2 I recommend together with Adenosyl cobalamin and Hydroxocobalamin. I'm not a fan of the standard  B12 forms you see in most supplements – Cyanocobalamin. I’ll be honest it isn't my favourite form as it uses cyanide as a binding factor instead of more natural forms. It is a very small amount and we do have naturally occurring cyanide in some food, however I like my B12 without a side order of poison personally!  So if you, like me, are not into this, always read the labels of supplements to see what’s in them and if possible go for active b Methylfolate.

The B vitamins are also essential for the liver , which has 2 phases. The first one processes substances such as hormones and toxins and metabolises them – B vitamins particular B2, B3, B6, B9 and B12, are important at this stage. The second stage is where these substances are ‘ conjugated’ . B vitamins do their thing at this stage also and help the liver to get rid of  excess and old hormones so they can be eliminated by the body. If you have PCOS its more than likely you have an excess of oestrogen, so this is where B vitamins can really help your liver!

Here a diagram to show how well absorbed methylfolate is in the body compared to folic acid as well as where B12 and Homocysteine come into things as we break the vitamins down via food and supplements for the body to use.

Many ladies with PCOS I’m working with are having great results combining this supplement with Inositol which also helps regulate blood sugar via the insulin receptors. It also works on the liver to support its function and in trial has supported reducing higher FSH and reducing oestrogen. In trails particularly for IVF this has helped egg quality and also improved outcome in IVF. There are also loads of studies on using Inositol for PCOS.

.

1.    http://www.ncbi.nlm.nih.gov/pubmed/15644580

2.    http://www.obgyn.net/polycystic-ovary-syndrome-pcos/hormone-levels-and-pcos

3.    http://www.naturalnews.com/027045_vitamin_B12_cyanocobalamin_methylcobalamin.html#  

4.    http://www.ncbi.nlm.nih.gov/pubmed/11304860 B12  

5.    http://ajcn.nutrition.org/content/85/1/265S.full 

6.    http://pubget.com/paper/17952759/myo-inositol-in-patients-with-polycystic-ovary-syndrome-a-novel-method-for-ovulation-induction 

7.    http://www.ncbi.nlm.nih.gov/pubmed/21300338

8.    http://www.ncbi.nlm.nih.gov/pubmed/21463230 

9.    http://www.nejm.org/doi/full/10.1056/NEJM199904293401703 

10.  http://www.ncbi.nlm.nih.gov/pubmed/18854115 

11.  http://www.ncbi.nlm.nih.gov/pubmed/18854115 

12.  http://www.ncbi.nlm.nih.gov/pubmed/18854115

Frequently Asked Questions on a Womans Cycle

I have put together a FAQ for reference, as these are the most common questions I get asked from time to time about a Woman's cycle.

When does the cycle start is it still during my period? CD1 and where it all begins is the first full day of your period. Don’t count it until it is in full flow for you. This means there should be enough blood to require sanitary protection.

What's the process of ovulation? Fertility is a complicated process and hopefully I will help you to understand the importance of each and every hormones to help you in order for you to successfully conceive, and sustain the pregnancy. It is possible that at this stage you have been for some blood tests at your doctors. For those of you who are effectively in the ‘dark’ about the fertility; It all starts with sex hormones. Hormones are complicated. I’m amazed on a daily basis how these wonderful substances manage to build up and then pass on the mantle so to speak to the next phase. As such, I see it in women as a relay race to the finish. Different hormones will come into the race when each in turn reaches a certain point. In some women when their fertility is less than optimum they will have weaker runners at different stages, but ultimately the race will always run. The organiser is always the main organ the hypothalamus and his second in command is the coach – the  pituitary gland, who ultimately grooms the hormones to ensure they are ready and brings on new runners at different stages. The second coach is also the ovaries themselves, who listens to the pituitary and responds on the ground. The cycle for a woman is cut into 2 main phases. The Follicular  ( building) and the Luteal phase ( sustaining). Fertility can be a complicated process, particularly for women as there are some hormones that are vital messengers during your cycle and in order to build the messenger, as well as the major hormones, it is vital the ‘machine’ ie your body produces the right effect in your reproductive system in order for the egg to meet sperm and for fertilization to happen. Hopefully you will have been to your doctor prior to reading this, to check everything is in working order.If you haven’t now’s the time to order a few blood tests.

In the early stages of the cycle the important hormones are: Follicular – (day 1- 16 approx)1.Follicle Stimulation Hormone (FSH) 2.Oestrogen  (E2 or Oestradiol) 3. Luteinising Hormone (LH) Testosterone. and in the Luteal phase ( after ovulation day 12- 28/30 aprox) 4. Oestrogen ( E2 ) 5 .Progesterone  (P4) *Testosterone a) Follicle Stimulating Hormone (FSH) is produced by the pituitary gland located just behind the eyebrows in the brain/ This gland is super important as it stimulates the development of a follicles and eventually a primary follicle. (b) follicles cells produce oestrogen which in turn increases FSH in a positive feedback loop. (c) oestrogen will thicken the lining of the uterus in preparation for a fertilised egg. (d) oestrogen production peaks at day 12  (aprox) causing the pituitary to release a surge of LH. This loosens the now mature egg from the dominant/Primaryfolicle which is released at ovulation.

LH reduces the secretion of Oestrogen
LH stimulates the empty follicle to develop into the corpus luteum
(e)Progesterone and oestrogen together stop any more LH and FSH being secreted from the pituitary. (negative feedback)
This prevents further follicle development or ovulation.
(f) Progesterone maintains the lining of the thickened endometrium in preparation for the implantation of a fertilised egg. (g) If implantation does not take place then the Corpus luteum falls apart. The progesterone production stops and from day 28 ( approx) a drop in progesterone triggers:

The endometrium breaks down and the 'menstrual period' begins
FSH and LH begin their secretions again
A new cycle has begun

What is the LH surge?The LH surge (seen in the top diagram) is luteinizing hormone which is responsible for the trigger of ovulation. As you can see it comes in fast and leaves fast! I like to see it as the needle that pierces the follicle to allow ovulation! This only lasts a very short time a well, a few hours tops, so once you see this surge its high time to get busy making a baby as you will only have a day at most – however this can vary from person to person.  Some women find that they get a fait line for LH or none at all. Its hard to nail this hormone down, and just because you get it it doesn't mean you are releasing an egg. Many women get quite obsessed with OPK sticks to measure this. What I would advise is rather than using them is getting to know your cycle through charting first. Then use OPK, as the body will ' try a few rounds' of LH to get the follicle to trigger and burst, and if you have PCOS there may be a few highs of this hormone as it tries to balance out during the cycle, so OPK isn't the best measure, all it means is that it is trying to burst the follicle, not that you have actually ovulated. Ovulation can only be confirmed by an ultrasound and pregnancy!

I am charting my cycle and noticed I ‘ peak’ early, is this normal? Most women are snowflakes, we all ‘peak’ or ovulate at different times. Also this won’t always be on a set day each month as we all have months where things change our hormones. We are all told if we have a 28 day cycle we ovulate on day 14. Not always true. Some women can ovulate on day 6, others on day 18. However a more healthier ovulation where the follicles have time to build up to around 18mm is at least 12 days if it is later than 18 days also it can mean that the th hormones have 'hung on' longer often this is seen with PCOS, where the body will try to mature the follicles to allow them to burst and release and egg. Its all about the follicular and luteal phase, which we will talk about in a moment! Its all about the timing as is everything in life!

If I get to know my cycle, when is the best time to have sex to make a baby? Start charting your cycle to understand your phases. I recommend you use something like http://www.fertilityfriend.com/ - although it isn’t designed to show you when you can have sex to conceive, it is a fabulous tool to help you to get to know your cycle, so you are more ‘ body aware’ Once you have followed your cycle for around 2/3 months you will have a bit more of a clue as to your ‘fertile window’. Some ladies find they have a short Luteal phase by doing this, which can have implication to sustaining a pregnancy.

The best time to make sure egg meets sperm is to have sex 2 days before ovulation, the day before. Then have it the day of ovulation. I’ve had clients who assumed they were a classic ‘ 14 day ovulater’  and they were in fact not ovulating until day 16, so were missing it every time!

Cervical mucus – sounds gross, and I have seen this jelly like stuff before, what the heck is it?As we build and sustain you will have noticed over the years that there are, well some changes in your pants! This isn’t anything to worry about, in fact its perfectly normal. There are on average 5 different types of CM to look for.

Dry – a sign your body might be low in oestrogen or you could be very badly dehydrated!

Sticky – not fertile at this time, has a sticky consistency but not stretchy

Creamy – not fertile at this time, and looks like lotion!

Watery - Fertile.  Usually clear to touch, feels cold as a pose to menstruation wetness which is warm.

Egg White (EWCM) - This is the most fertile CM. looks and feels like raw egg white and is very stretchy. If you touch it between your thumb and finger it will stretch without breaking. This stuff feeds the sperm and projects it to the egg faster. EWCM is mostly clear.

As oestrogen builds in your system you will  see changes in our CM as it gets more watery and then more like egg white.

How can I see this happening in me, now I know what to look for? Some women will see obvious signs of CM but unless you have super tight vaginal muscles that expel it outwards, you may not get to see it on your pants. One way to check, is by putting 2 fingers into your vagina and drawing out some of the CM.

I have never seen any fertile types of CM, does this mean I am not ovulating? No. Some women just never see the changes in their CM but it doesn't mean it's not there, they may be up further in the pipes so to speak!

What happens to CM after I have ovulated? After ovulation CM will usually return to an infertile state straight away.

What is the difference between the follicular and luteal phases, I keep hearing about having a ‘ Luteal phase defect!
As mentioned above in ‘ what’s the process of ovulation’  your egg builds based on a concoction of hormones and the follicle will grow to a max of 18mm - 25mm. During the final days before ovulation there will be a ‘fight’ for dominance between 1 or 2 follicles.This is very different if you go for IVF, as the drugs you will be on there will push your body to produce sometimes up to 10 follicles, which can give you up to 20 eggs in some cases! Under normal circumstances you will have 1 follicle which will produce 1 egg. ( or if you are lucky enough, naturally you can produce two eggs to have non identical twins!) When you ovulate your hormonal signals will switch from FSH and LH and Oestrogen to Progesterone and Oestrogen. Progesterone is the hormone that will start to flow as soon as we ovulate. It is produced from the site of the corpus luteum ( where the follicle has burst.) – so on the collapsed follicle, progesterone will start to flow. We have now moved from Follicular phase ( building) to luteal ( sustaining) If we haven’t fed our body adequately nourishing the production of progesterone, this will be a ‘weak’ hormone.  This is often indicated by spotting in the luteal phase or a shorter time from ovulation to period after charting for a few months. Anything less than 11 days, is seen as an indication of low progesterone. However this needs to be confirmed by a blood test and I would say one of the most important tests to go for, so ask your reproductive specialist to order this of you have had problems conceiving. If you do indeed become pregnant if the uterus is not stocked full of Progesterone from many moons of making good levels, when the body switches the ‘tap’ from the corpus luteum to the uterus to produce progesterone, from week 7 – 10, this is often the time when early miscarriages happen, as the growing embryo is feeding from the uterus for progesterone and not like in the early days fed from the corpus luteum and it isn't strong enough to keep it flowing.

Feeling Overwhelmed and Stressed by Fertility Issues?

Hello

Are you finding your fertility journey stressful? Focusing on your fertility 24/7 can be all consuming and draining. Perhaps you’re looking for a way to transform your thinking?

Maybe you’re also curious about how your emotions could be impacting on your fertility. Do your past and present experiences, your thoughts and beliefs have an impact on your ability to conceive?

Can visualisations, meditation, hypnosis and EFT support fertility? And if so, how can your harness their power?

These topics and many more are about to be explored by a panel of leading fertility experts, and I’d love to invite you to listen in.

The Fertility Focus Telesummit is an amazing “virtual event” that you can attend for free and have access to top quality fertility support from the comfort on your own home. Find out more here: http://bit.ly/17gxRfs

The first and biggest event of its kind, The Fertility Focus Telesummit is now in its 6th year and has already reached 20,000+ listeners from all over the world. Join this global audience and receive your own positive experience to transform your fertility journey!

This first Telesummit of 2015 will be focussing on The Power of Your Fertile Mindset where you’ll discover how to transform the emotional aspects of your fertility, unlock your true potential and be armed with support and techniques for success. 

Here are the details:

Event: The Fertility Focus Telesummit ~ The Power of Your Fertile Mindset

Dates: 8th - 14th March 2015

Cost: FREE access to main event (with low cost Golden Ticket upgrade option)

Location: Your home - listen in to the whole event online!

Register: Click here to register your FREE place now http://bit.ly/17gxRfs

You can listen in to all the fertility-focused presentations online every day of the Telesummit for FREE, starting on Sunday 8th March. 

Grab your free place now to attend this exciting event, and discover what you can do to transform your fertility journey and prepare yourself for conception.http://bit.ly/17gxRfs

Here’s what previous attendees said about the Fertility Focus Telesummit:

“I just wanted to let you know that the Fertility Focus Telesummit in 2014 really was the key to me finding the missing piece of our jigsaw! You all had a huge impact on my journey and I'm now expecting our first baby. Thank you so much and keep up the amazing work of giving hope and inspiring women to take back control in what can sometimes seem like a helpless and very lonely situation.” - A

"Well I followed some of the advice given from the last telesummit and am now pregnant!  I'm in my second trimester! So happy to have had a chance to listen to the telesummit. Thanks for offering it!" – Heather

“I was told at age 41 that my eggs were too old and IVF was the only way. When IVF failed something inside me was adamant that was not the way. Your Telesummit last year opened my viewpoint completely and  through listening in and then following some of your speakers’ advice I became pregnant! Thank you so much Sarah for bringing me to a journey of discovery, acceptance, hope and joy.” - Roisin

Be sure to sign up here for your FREE place at this event: http://bit.ly/17gxRfsThis could be the best thing you do this year for you and your fertility.
 

P.S. Do you know anyone else who is struggling with fertility issues?  Please pass this email on to them and I’m sure they’ll thank you. http://bit.ly/17gxRfs

With much love

http://www.fertileground-nutrition.com
angela@fertileground-nutrition.com
Fertility Nutritionist, NT, mBANT