But, that doesn’t mean it’s impossible. Or even unlikely. Quite the opposite, actually.

One of my favorite parts of my job is seeing patients get better, but the icing on the cake is when they have a truly dramatic and objective improvement, such as getting pregnant and delivering a healthy baby after sometimes years of unsuccessfully trying to conceive. Sometimes my pregnant patients have been previously told by other providers, including fertility specialists, that they will never conceive naturally…

As a functional medicine doctor, I’ve had the privilege of seeing women and couples from all walks of life conceive successfully and finally fulfill their dream of become parents, or perhaps become parents a second or third time after things didn’t go as smoothly after the birth of their first child(ren). Yes, this includes couples over 40, too.

In the world of fertility, time is of the essence. In today’s day and age, couples are waiting longer to start trying in the first place and, if fertility problems pop up, it really can throw a wrench in a couple’s plans. For this reason, many OB/GYN offices refer patients out for fertility treatments if they don’t successfully conceive after just 6 months of trying. While many couples who don’t have fertility problems naturally conceive without a problem within a year of trying, the setback of an additional 6 months turns into sometimes additional years once the decision to start IVF (after IUI attempts) has been made and finances secured. At some point, they say, a woman just gets “too old.” Or, does she?

I won’t dispute that age is a factor when it comes to fertility. Obviously, natural conception is virtually impossible after menopause. But, menopause aside, 40 is not “too old” to get pregnant despite what many fertility specialists might say.

I’ve seen plenty of women, both patients and otherwise, conceive successfully well into their 40’s. The key difference between women who conceive easily and women who don’t comes down to understanding a few key things about fertility. Let’s dive in…

1. Egg quality isn’t just about age

A woman is born with all the eggs she will have in her lifetime, but not all those eggs are fully mature at the same time. Rather, the primordial, pre-eggs reside in ovaries and ultimately develop and differentiate into mature eggs or “oocytes” over the course of a couple menstrual cycles. This maturation process depends on nutritional quality, hormonal balance, and control of factors that can degrade the quality of the eggs, such as environmental toxins and yes, aging. But biological age and oocyte age are not the same thing. There’s no “hard and fast rule” for what is too old to conceive. I’ve had young women in their 20’s with poor egg quality that we’ve reversed through functional medicine as well as women in their 40’s who have had excellent egg quality. (We measure this with Anti-Mullerian Hormone, or AMH, on blood work.)

Egg quality can be improved, and there are many factors that can help slow down the processes of aging and poor egg quality. The most important factors to improve egg quality are lifestyle-related ones like:

• Stopping smoking
• Reducing or eliminating alcohol
• Sleeping at least 9 hours per night
• Exercising 5 or more days per week
• Eating enough calories and cabohydrates, but also maintaining an ideal body weight
• Controlling insulin resistance (look into a CGM to get a better idea of your body’s glucose control)
• Drinking clean water and avoiding endocrine toxins like plastics, parabens and phthalates
• Managing stress

Egg quality can also be dramatically improved with supplementation techniques like:

• Melatonin
• Zinc
• CoQ10
• Pycnogenol
• Pterostilbene
• NAD

These supplements generate energy for the cells (powering up mitochondria), reduce oxidative stress, scavenge free radicals and help slow down the aging process of cells. A little supplementation can go a very long way, and these are staples in my fertility arsenal for any patient over 40.

2. You need to know what diagnosis you’re working with

“Unexplained infertility” is not a diagnosis. It simply means that the doctors haven’t yet dug deep enough to find an answer and create a treatment plan to solve the problem.

Conditions like hypothalamic amenorrhea (HA) and polycystic ovarian syndrome (PCOS) are hallmark reasons for irregular ovulation and difficulty conceiving. Perimenopause may also cause less frequent ovulation and unpredictable periods, making family planning efforts more challenging. That being said, perimenopause at any age, including over 40, does not prohibit pregnancy. But irregular periods can easily be chalked up to “probably perimenopause” if a proper diagnosis isn’t made. This means you need thorough testing to identify problems like:

• Low FSH/LH, meaning the brain is not signaling to the ovaries to develop an egg, as is the case in hypothalamic amenorrhea (HA)
• Elevated androgen levels, possibly elevated LH despite normal FSH, as is often the case in polycystic ovarian syndrome (PCOS)
• High or unpredictable levels of estradiol, low progesterone, and elevated FSH, as is often the case in perimenopause

But that all isn’t even to mention the impact of thyroid disorders, including hashimoto’s, which often go undiagnosed.

To add more to the list, endometriosis is also a common culprit for fertility disorders, with its abnormal tissue growth and accompanying inflammation that can damage the ovaries. While harder to diagnose than conditions which show up on blood tests (endometriosis requires surgery to formally diagnose, though it may show signs on an MRI), there are still hopeful options, such as excision surgery, anti-inflammatory strategies and even platelet-rich plasma (PRP) injections which all provide next steps for women of any age dealing with infertility.

Tip: the first two cycles after endometriosis excision surgery are often considered the “most fertile” time for women struggling with fertility and endometriosis.

3. You need to know your cycle

Are you ovulating How do you know

If you can’t confidently answer both of those questions, you might be experiencing some important road blocks to fertility in your 40’s which can easily be overcome.

One of the major shortcomings of our sexual education practices in America is that we emphasize birth control and pregnancy prevention, but don’t much dive into how to actually help couples conceive when the time comes. As a result, many women have no idea when to time intimacy in order to facilitate a swift family planning process. (Not all days of the month are equally fertile!)

In fact, most women I’ve spoken to have never heard of the concept of a “most fertile day,” or don’t know what their cervical fluid means. Still more have never even heard of luteinizing hormone, much less learned how to identify its surge.

I recommend that all my patients track their cycles using basal body temperature, or a home fertility tracking strategy such as over-the-counter test strips for urinary LH, or a fertility monitor such as Inito to predict and confirm ovulation. If you know for sure when you’re ovulating, you can streamline your efforts for trying to conceive to max on O-2, which is two days prior to ovulation, the day you most typically will see a positive LH strip (AKA ovulation prediction test kit), experience peak production of egg white cervical mucus (ewcm) and be the most fertile. Sex on this day will result in an abundance of healthy sperm waiting in the fallopian tube for a healthy egg to be released.

4. You need to know your options

If you have tried all the things and are looking to fertility treatments as a next step, don’t forget that alternatives do exist. That’s my bread and butter in functional medicine, which is helping identify the root cause. But, sometimes you just need to make it happen. If you haven’t already, check out my blog post regarding natural alternatives to fertility drugs if you’re looking for ways to avoid Clomid, bromocriptine, letrozole, and other prescriptions.

If you’re over 40 and TTC, it’s not too late for you. There is hope and you have options!

Baby dust!

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Get Pregnant After 40 (Without Fertility Treatment) appeared first on Dr. Alexandra MacKillop.

My patients share this nearly famous quote from their primary care providers all the time. That’s how they end up in my office, of course. Because they’re not fine. They feel terrible, with their hair falling out, gaining weight for no reason, freezing all the time, debilitating fatigue, brain fog. They look and act like a walking, breathing hypothyroidism textbook and yet…their other doctors say they’re “normal.”

What gives?

As a functional medicine doctor, thyroid disease is one of the main problems I treat in my office. While some patients walk in already knowing they have a problem and what it is (they’re looking to slow progression of their condition, or treat it without prescription medication), the majority have never gotten a diagnosis to finally explain their symptoms and start treating them at the root cause.

Why do thyroid problems so frequently go undiagnosed?

In my experience, there are typically three (categories of) reasons that my patients fail to receive an accurate diagnosis for their symptoms when they see other doctors. These are the three reasons that they might get told they’re fine when, in reality, they are struggling with thyroid disease. They might be told it’s in their head or (gasp!) probably perimenopause because, as if they didn’t realize it already, “You’re in your 40’s now…”

In my opinion, making an accurate diagnosis is not hard. Sure, the years of schooling that teach healthcare providers how to screen for all these different conditions and what they mean can be very challenging indeed. But, once you know the information, you just need to do the thing.

So, without further ado, here are the three reasons that my patients receive a misdiagnosis or have a missed diagnosis of a thyroid condition:

1. They’re not running comprehensive enough tests

This might sound obvious, but if you don’t test your thyroid you’re never going to accurately confirm a thyroid problem.

Unfortunately, most doctors don’t actually test thyroid function on screening labs. Sure, they run Thyroid-Stimulating Hormone (TSH) but fail to acknowledge that TSH does not actually test thyroid function.

TSH is a hormone the brain makes to tell the thyroid what to do. The thyroid is then, in turn, supposed to produce T3 and T4, which are the main thyroid hormones. The liver is supposed to make proteins called thyroid-binding globulins to carry these hormones through the blood stream to tissues, acting as a reservoir for these important hormones. The tissues themselves (gut, liver) are supposed to conver T4 into T3 as needed, per-diem to run metabolic functions in cells.

All of these functions are testable. Yet, most healthcare providers don’t test them.

Why?

They fail to recognize that TSH isn’t the full picture. Our brains are smart, but they’re even smarter than we give them credit for. Meaning, on account of other cellular processes going on in the body, the brain might be perfectly fine with an underfunctioning thyroid, thank-you-very-much, and carry on its normative signaling despite underfunctioning of our main metabolic regulator.

If you don’t test the full thyroid panel, you don’t get the full information. And if you don’t have full information, you can’t rightfully rule in, or out, a thyroid condition.

There are seven different main patterns for hypothyroidism, and I explain them all in my post titled: The Root Cause of Hypothyroidism. Check if out if you are curious what might be going on behind the scenes.

If you aren’t working with a functional medicine doctor, I’d encourage you to ask your PCP to run the full list of tests for you.

2. They don’t test frequently enough

You don’t need a medical degree to know that our metabolic needs when we’re sleeping differ dramatically form when we’re running a marathon. We also have different metabolic needs when we are resting versus when we are stressed. Our thyroid needs likewise differ when we’re sick, when we’re tired, when it’s winter versus summer, and according to the menstrual cycle. In fact, TSH levels on blood work even differ throughout the day! (They’re typically highest in the morning.)

If you’re concerned you have hypothyroidism, your doctor is going to be looking for an elevated TSH level. Remember that TSH is thyroid-stimulating hormone, meaning it’s released in order to stimulate the thyroid’s production of thyroid hormone. If the thyroid is under functioning, the brain will send a stronger and stronger signal to get the thyroid to pick up the pace, akin to an angry boss yelling at a lazy employee.

In many cases of hypothyroidism, the deficiency is subtle, with the TSH level only sometimes exceeding the reference range, typically only in the morning when TSH levels are highest. (That is, not to mention, that many labs and subseqently, many physicians, use a reference range that is far too broad; but that’s a different post for a different time.)

So, if you only test TSH (which most physicians do) and only test it once per year (which is the current standard “screen”) and don’t remind patients to remain off biotin supplements (which many physicians forget about) and don’t require a morning, fasted draw (which most don’t) then there is a good chance you will miss the elevated TSH level and your doctor will wrongly tell you that your thyroid is “normal” when it ism in fact, not.

But of course, you knew that, because your symptoms and intuition are hard to ignore.

3. They forget about the immune system

The most common cause of hypothyroidism is an autoimmune condition called Hashimoto’s Disease. But, here’s the thing: you can have Hashimoto’s and not yet have hypothyroidism.

Hashimoto’s as an autoimmune disease means that a person’s immune system is wrongly attacking their thyroid. The immune system is supposed to produce antibodies aimed at fighting off infections, like COVID or Epstein-Barr virus, or strep throat. But, with Hashimoto’s, the immune system instead starts making antibodies against thyroid tissue, called anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies.

The result is thyroid inflammation and evnetual thyroid tissue destruction, accompanied by all the immune symptoms that make you feel sick, like fatigue, brain fog, joint pain, hair loss, depression and…do I sound like I’m describing hypothyoridism yet?

Remember that TSH does not screen for Hashimoto’s Disease, yet Hashimoto’s Disease is the number one cause of hypothyroidism. Also keep in mind that while Hashimoto’s Disease often leads to destruction of the thyroid gland and eventual resulting hypothyoridism, it doesn’t always; but it still produces symptoms of its own accord that notoriously accompany hypothyroidism. Because of these symptoms, Hashimoto’s sufferers often feel too unwell to exercise, or eat well and likewise gain weight just as they would with full blown Hashimoto’s hypothyroidism.

Maybe you’ve already been tested for Hashimoto’s and told you don’t have it, but your symptoms are so suspicious that you’re not sure you believe the diagnosis. Of course, it’s possible that you don’t have Hashimoto’s or other thyroid disease, and you need to keep advocating for yourself and digging to find that answer.

But then again, remember this: most people with Hashimoto’s weren’t born with it. Rather, they were born with a genetic predisposition that was triggered by something, such as Epstein-Barr virus, COVID, gluten sensitivity, or, notoriously, hormonal and immune shifts such as those seen in puberty, pregnancy, postpartum and perimenopause. This means that even if you were previously tested for Hashimoto’s and the result was negative, that may have changed at some point throughout your life. My own doctor even incorrectly told me that if the antibodies are negative, they’re negative and there’s no point in retesting. I’m grateful that I had the knowledge to advocate for myself and get the appropriate lab work.

I want that for you, too.

So, friends, remember that you are the one who knows your health best. If something feels off, it definitely is; it’s just a matter of testing for it. (And that means running the right tests, running them frequently enough, and remembering to be comprehensive!)

I hope this helps you to get the best posible healthcare. You deserve it!

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Did Your Doctor Say Your Thyroid Is Fine (Three Reasons for a Missed Diagnosis) appeared first on Dr. Alexandra MacKillop.

The Gut Microbiome

The word “microbiome” refers to the microbial colonies that live in, on and around the human body. [Microbes = bacteria and yeast] Modern researchers estimate that as few as 30% of our cells are actually human, which means the remaining 70% are actually bacteria. This is an incredible number, but when we factor in all the functions of these bacteria, it’s not that surprising. See, the vast majority of the cells in our digestive tracts—an estimated 39 trillion—are bacterial cells responsible for clearing up waste products. Not only do these bacteria clear up our own waste after we’re finished with the food we eat, but they also get rid of all the contaminating chemicals we come into contact with throughout our lives…things like pollution, plastics and more. Our bacteria help break these chemicals down so that they don’t wreak havoc on our health. They also break down our own bodily chemicals, like old, broken-down hormones that are past their prime, and red blood cells that are no longer functional. Our liver filters our blood of these toxins and deposits them into our intestines where it then becomes the job of our bacteria to take care of the rest.

Unfortunately, we don’t always have enough of the right kind of good bacteria; and sometimes those good bacteria are crowded out by bad bacteria. This isn’t necessarily pathogenic bacteria, like E. coli or Salmonella, though those too can be problematic. Dysbiotic and inflammatory bacteria like Group B beta-hemolytic streptococcus are also of concern. These dysbiotic bacteria take advantage of us if we consume something contaminated, if we take antibiotics, if we don’t have a diet that is adequate in diverse types of fiber, and more. Even stress can shift our microbiome and make us worse for the wear.

Our gut microbiome is also closely connected to our skin microbiome. That’s because, in all actuality, the human body is rather hollow. We are an open tube from the points of input (eyes/ears/nose/mouth) to the point of output (rectum) and those openings seamlessly blend into the exterior epidermis—that is, our skin. In this way, the microbial populations of our gut hold a profound influence over the microbial populations of our skin. Yes, our skin has a microbiome too, and it plays a big role in preventing and mitigating disease.

Inflammation

When we have an imbalance in good and bad bacteria, our good bacteria is no longer sufficient to do the job of “cleaning” up inflammation in our bodies. Our good bacteria produce anti-inflammatory chemicals like butyrate which help protect our bodies from inflammation. Likewise, overgrowth of inflammatory bacteria produce additional inflammation. Inflammation in the gut becomes inflammation in the blood and on the skin and feeds forward into flare ups of chronic skin conditions. These can include psoriasis, eczema, acne and rashes like those seen in autoimmune diseases. From hives and itching to flaking and dryness, the microbioe plays a role. If you have any of these chronic skin conditions and notice flare ups in periods of stress it’s because inflammation increases in response to chemical stressors in the body, and stress likewise affects the function of our microbiome!

Immunoreactivity

Another way that the microbiome affects skin is because of how those bacteria control inflammation: through the immune system. The good bacteria in our skin and our gut stimulate anti-inflammatory divisions of our immune system such as interleukins (i.e. IL-10, IL-17 and IL-22) which protect us from infection. Our microbiome also helps teach our immune system to distinguish between self and non-self as in the case of autoimmunity, and to develop tolerance to benficial exposures like food and food allergens. Breakdown of the microbiome, or a microbiome that doesn’t have the chance to develop properly early in life can all lead to immune system problems that may manifest as skin reactions. These can include the rashes seen in autoimmune diseases (malar rash) or skin-related allergic and intolerance reactions (hives, itching, swelling, redness.)

Toxins

A third way that the microbiome affects skin is through toxins. Here’s a somewhat unrelated example to illustrate the point: sometimes newborn babies develop jaundice which involves a yellowing of the skin. This is because at birth, new babies are filled with extra red blood cells from their mothers. These red blood cells die off rather quickly and if they aren’t broken down and cleared away through the (you guessed it) GI system, chemicals from the old cells such as bilirubin will build up in the blood stream and cause damage to other organs in the system. This bilirubin chemical is yellow which is why the skin begins to look yellow when it isn’t cleared away properly. Otherwise healthy babies who drink lots of milk and have frequent bowel movements in the early days are typically able to clear away this waste product in their stools no problem. But if they aren’t digesting and metabolizing properly, and if their gut microbiome is malfunctioning, the bilirubin and toxin buildup could become fatal.

Adults process bilirubin too, as we all make new red blood cells every 3 months. However bilirubin is far from the only toxin we need to clear out of our bodies. We make new hormones every day, and consume food that needs to be broken down every couple hours. All of these processes involve waste products that need to be cleared away from the gut. Breakdown in that clearance system due to imbalances in bacteria easily leads to problems like hormonal imbalances, which can manifest on the skin as redness, acne, and other blemishes.

Let’s take a closer look at eczema, for example. Eczema is very similar to an autoimmune disease, in that the immune system creates localized inflammation on the skin which worsens in response to different immunological triggers. Exposure to irritants and toxins, such as fragrance or detergents, may flare up the skin, inflammation tumbles out of control, and the immune system reacts all the more aggressively to the now broken-out skin. It tends to create a snowball effect once bad bacteria start colonizing the breakouts—namely Staphylococcus species which are responsible for the angry, rashy redness we so often associate with eczema. Treating a condition like eczema necessitates a combination strategy that is anti-inflammatory and immune modulating, but also requires a deeper look at toxic exposures and immune triggers which are all mediated by the GI tract.

In the early stages of a flare-up, however, sometimes a topical solution is necessary to calm things down enough to get to the root cause. Ozonated oils kill inflammatory bacteria like Staphylococcus and also directly stimulate immunological healing of damaged skin. This buys the time to figure out the root-cause trigger and treat it holistically.

If you loved what you read here, check out these related posts:

• Diets and the Gut Microbiome
• Natural Eczema Treatment

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Here’s How Your Gut Health Affects Acne, Eczema, Hives and More appeared first on Dr. Alexandra MacKillop.