Dr. Paul Bergh
A few years ago, a woman came to me on the edge of desperation: she and her husband couldn’t get pregnant naturally and they weren’t having luck with IVF, either. She had many failed embryo transfers out of state when she came to my clinic in New Jersey asking for help finding a gestational carrier, nearly hopeless. She couldn’t understand why she wasn’t getting pregnant— she was young, healthy and there were no fertility red flags that would cause concern. Her testing showed a good ovarian reserve, she had no blockages in her fallopian tubes and her husband’s semen analysis was fine. She was creating healthy embryos that were tested for normal chromosomes in the IVF lab, but they just weren’t implanting in her uterus. Why couldn’t she get pregnant, she asked me. It was, as we say in reproductive endocrinology, a case of unexplained infertility; everything looks right, but it’s just not working. This patient came to me at a time when I was becoming involved in functional medicine, a preventative form of medicine that focuses on the root of medical conditions instead of the symptoms. In short, functional medicine looks at diet, environmental exposure and lifestyle and its impact on your physical health. As a fertility doctor, I was most interested in apply - ing functional medicine to those difficult cases where patients colHere’s how: functional medicine research has shown that certain common non-communicable diseases like psoriasis, eczema, diabetes, celiac disease and irritable bowel syndrome are linked to changes in our gut that cause increased intestinal permeability. This permeability is also referred to as “leaky gut,” which is when food and toxins we ingest leak into our blood - stream and cause inflammation, autoimmunity and food intolerances.
This research was incredibly insightful to me – if these common conditions were related to leaky gut, and leaky gut caused inflammation and other problems in the body, the chances of leaky gut affecting the uterus were not insignificant. So, I told my patient I thought I could help her. We’ll start looking for a gestational carrier to carry your embryos, I said, but in the meantime, why don’t you take a test for leaky gut? When that test came back positive, I told her my big idea: let’s heal your gut and have you change your diet and take some key supplements for several months and then try one more time to have your uterus accept your embryo. She agreed, and, several months later, I performed an embryo transfer. A few days after that, her nurse called and told her what she’d been waiting years to hear: you’re pregnant. And now, she’s a mother.
So what did she stop eating and how did it help?
The gut is the largest surface area between our outside world and us. Compared to our skin which is the size of a piece of plywood, our gut is close to the size of a tennis court. It is tasked with processing several tons of food in our lifetime and selectively taking in nutrients while keeping toxic and inflammatory substances out of our system. In fact, 70% of our immune system resides in the gut – thus highlighting the size and the importance of this border between the outside world and us. Many things work together to maintain the integrity of the gut, but one of the most critical components is the gut microbiome. The gut microbiome consists of the many bacteria that live within our gastrointestinal tract and play a critical role in our health. Disruption of this microbiome (dysbiosis) can occur with exposure to environmental toxins, antibiotics and certain foods. This dysbiosis then leads to a break down in the integrity of the gut (leaky gut) and our immune system is activated when it is exposed to foreign substances passing through this leaky border.
This activation of the immune system leads to chronic systemic inflammation and can result in a host of autoimmune conditions. Focusing on diet, environmental exposures and lifestyle to heal the gut and thus reduce inflammation may play a role in increasing the chances of an embryo success - fully implanting inside a woman’s uterus – especially in women with unexplained recurrent implantation failure. Pretty amazing, isn’t it?
While the field of functional medicine is still young and research into how it relates to infertility is even younger, there is growing evidence that changes to diet – like the elimination of certain foods with the addition of key supplements – can help women with unexplained infertility, particularly those who continue to fail even after advanced treatments. While our clinical experience appears promising, much work still needs to be done in this area to validate this approach including the development of rigorous scientific trials. Since that particular patient, I have used this approach for many women with recurrent implantation failure with promising results. After putting one patient on this protocol in preparation for an embryo transfer, she called with surprising news before the transfer even happened: I’m pregnant! She had her first baby naturally, and, when she was ready for her second child, she again used the same protocol to conceive naturally. She is now a mother of two, and I am continuing to counsel patients with unexplained infertility about how diet, some key supplements and lifestyle could play a key role in the solution some women are searching for in their quest for a baby.
Dr. Paul Bergh is a founding partner of Reproductive Medicine Associates of New Jersey (RMANJ), a leading infertility clinic in the state and part of the biggest IVF provider in the world, IVI-RMA Global. Dr. Bergh helps his patients achieve something invaluable: a family.
To make an appointment, visit rmanj.com