Infertility: A Lifestyle Disease?

A deep dive on causes and treatment of infertility

Breanna Lockwood went viral in 2020 when her mother became a gestational surrogate to her baby girl. Yes, Breanna’s mom, Julie— age 52 at the time— gave birth to her own grandchild. At 29, Breanna had already had 476 injections, eight in vitro fertilization embryo transfers, seven surgeries, an ectopic pregnancy, and two miscarriages. Ultimately, she chose surrogacy after one of the surgeries damaged her uterus and left her permanently infertile. While the end of Breanna’s story is unconventional, her infertility journey isn’t.

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In the US, one in eight couples, or 6.7 million people struggle to conceive. A quick Twitter search of “IVF” will return scores of women sharing heartbreaking stories of failed IVF rounds and crushing miscarriages, like Breanna. Each year, the use of assisted reproductive technology (ART) increases 5-10%. Considering that our only real job, biologically, is to procreate, this is very alarming.

Probably the most popular (and controversial) work regarding infertility comes from Shanna Swan, an environmental and reproductive epidemiologist and professor at the Icahn School of Medicine at Mount Sinai. In her book Count Down, Swan finds that sperm count in Western men has dropped by more than 50% in the last forty years. Even more shocking, Swan predicts that by 2045, we’ll have a median sperm count of zero, and most people will have to use ART to reproduce. The cause of this “Spermageddon?” Swan points to weight, alcohol, smoking, and, most importantly, endocrine disruptors.

Endocrine disruptors are chemicals like phthalates, bisphenols (e.g. BPA), pesticides, and flame retardants, which are found in everyday items like plastic, food, clothes, and skincare. When we absorb them (through eating, breathing, applying lotions, and wearing clothes), these chemicals can mess with our hormones. For example, phthalates are known to lower testosterone which, in turn, lowers sperm production. Research shows that women with polycystic ovarian syndrome (PCOS)— the most common cause of female infertility— have higher levels of BPA in their bodies. Even exposure to these chemicals in small amounts can have major effects on the body, as delicate hormone levels are already controlled by only slight changes.

One of the most surprising things about endocrine disruptors is that they begin to affect the body in utero, via exposure to the mother. In a previous newsletter, I wrote about new research that found BPA-containing microplastics in human placentas. Not only is it terrifying to think about “cyborg babies” (babies made out of a combination of human cells and inorganic entities) being born, but scientists have also found that the chemicals in the microplastics have an effect on the fetus’s reproductive health. After all, a female fetus develops all the eggs she will have in her lifetime in utero. One study looked at the effects of BPA in mice and found that it caused birth defects in the mice’s grandchildren; the first generation mouse’s BPA exposure disrupted its fetus’s egg development, resulting in chromosomal abnormalities in the next generation. This suggests that the effects of endocrine disruptors can be multigenerational. In male fetuses, exposures to endocrine disruptors like phthalates have been shown to result in smaller penis size and, in adulthood, lower count sperm.

So, what are options and treatments for infertility? The simple answer is to subtract: remove all the substances hindering the body from being in its natural, fertile state. If you look around, humans have been reproducing just fine for a while— the addition of toxic chemicals, alcohol, and processed foods are preventing us from being able to procreate naturally. On a practical level, we obviously can’t get rid of all chemical exposure overnight, and certainly not at the individual level. What we can do is reduce plastic use, eat organic food, and use clean beauty and household products. Another important but underrated area to focus on? Gut health.

You might remember reading about Pottenger’s cats in an earlier newsletter. To summarize, Dr. Francis M. Pottenger analyzed the generational effects of diet in cats. He found that one of the outcomes of feeding cats an improper diet was that the third, and unhealthiest, generation of cats could no longer reproduce; they all became infertile. Could we be seeing a similar phenomenon in humans?

Research has found that women with recurrent pregnancy loss had higher prevalence of leaky gut syndrome, leading scientists to believe that gut inflammation may have induced miscarriage. What’s the cause of leaky gut? A poor diet filled with processed food, refined sugar, meat, dairy, and oils high in omega-6 fatty acids. Feiby Nassan, a researcher at the Harvard T.H. Chan School of Public Health, went so far as to proclaim, “Your sperm is what you eat.” His research found that men who ate a Western diet had a lower sperm count than men who ate a diet with lots of fruit, vegetables, fish, and chicken.

We all know that diet affects hormone levels. One way this happens is through the gut microbiome. Research shows that bacteria in the gut microbiome is responsible for estrogen metabolism, in what’s coined the “estrogen-gut microbiome axis.” If a person has gut dysbiosis, this process can become impaired and lead to endometriosis, PCOS, endometrial hyperplasia, and infertility.

Lastly, microplastics and toxic chemicals have a better chance at exiting the body if we have healthy digestion and elimination. Eliminative organs like the liver, kidneys, and colon aren’t just processing what we eat— they’re also flushing out substances that shouldn’t be in our bodies, like endocrine-disrupting chemicals. If we overburden our eliminative organs with a poor diet, our system can become sluggish in getting rid of chemicals. We can avoid this by eating a diet that’s high in fiber and easy-to-digest foods. This means reducing/eliminating processed foods and eating a lot of fruit and vegetables. One study found a 60% reduction in BPA levels when participants ate fresh food— as opposed to packaged food— after only three days.

It’s empowering to know how much diet affects reproductive health. This way, we can have more control over at least one facet of fertility. It’s not all doom and gloom!

There are obviously medical treatments that help people conceive like IVF. IVF can be a saving grace for people who can’t conceive naturally, but it doesn’t come without risks (more on this in upcoming newsletter) or a hefty price tag.

I hope this shed some light on the infertility crisis and options for treatment. Remember, the choices you make today will have lasting impacts on future generations.

Until next time,
Zeina