Fertility and Nutrition: A review of data 

Dian Shepperson Mills
Cert Ed., B.Sc., B.A., Dip ION, M.A.
Clinical Nutritionist

01323 846888
dian@endometriosis.co.uk
www.endometriosis.co.uk
The reproductive system 
• The body is not  a set of disparate organs
• The reproductive system is dependent upon 
the digestive and immune systems to 
maintain nutrient supply and health
Infertility
• In the USA 15­20 per cent of couples or 1:5 
have fertility problems
• 65 per cent of these are helped by drugs and 
surgery to achieve a pregnancy
• Ballweg ML, Overcoming endometriosis NY p76
 Fertility
• In the UK 750,000 babies are born each year
• 1:5 couples are sub­fertile
• 40,000 babies are early and of low birth weight
• 1:150 babies are lost through stillbirth
• 1:4 pregnancies end in miscarriage

IVF
• At present the success rate is only 10­30 per cent success 
rate 
or

• 70 ­90 per cent failure rate!!
 Female sub­fertility
• Blocked fallopian tubes
• Chlamydia/pelvic inflammatory disease
• Hypothyroidism
• Endometriosis
• Amenorrhoea
• Anovulation
• Polycycstic ovaries
• High pesticide or heavy metals
 Chlamydia
• Chlamydia trachomatis
• Sexually transmitted pathogen
• More antibodies are found in infertile 
couples as opposed to fertile ones
• 50 per cent of infants born to chlamydia 
positive women develop infections
 PolyCystic Ovary Syndrome

• Multiple follicles on ovary
• Six or more immature ova
• Hyperinsulinism
• System loaded with insulin
• Ovary produces testosterone instead of 
oestrogen
• Low chromium and zinc
• Sugar/carbohydrate craving
 Polycystic ovaries
• Hirsuitism
• Erratic menstrual cycle
• Acne
• Weight gain ­ thighs, hips, stomach
• Male pattern baldness
• Skin tags, nigra
 Endometriosis
• Normal endometrium tissue begins to grow 
in the wrong place outside the womb
• Bleeding occurs within the peritoneal cavity 
giving rise to pain on intercourse, pain at 
menstruation and ovulation
• Ovarian ‘chocolate’ cysts may form
 Symptomatology of Endometriosis
Dysmenorrhoea and/or pain throughout menstrual  95%
cycle

Fatigue 87%
Diarrhea, etc w/menstruation 83%
Abdominal bloating 84%
Heavy/irregular bleeding 65%
Dyspareunia 64%
Nausea, etc w/menstruation 64%
Dizziness/headaches w/menses 63%
Low resistance to infection 43%
Infertility 41%
Low­grade fever 32%
From 4,000 case histories from the Endometriosis 
Association Research Registry ­ compiled 1998
 Women with Endometriosis are 
more likely to have:
• Auto­immune disorders ­ lupus, RA, MS
• CFS ­ 100 times more likely
• Fibromyalgia ­ twice as likely
• Hypothyroidism ­ seven times more likely
• Asthma, eczema, and allergies (atopic)

– Sinaii M et al, 2002, Human Reproduction, 17, 10, 2715­24
 Male infertility
• Undescended testicles
• Poor sperm quality
• Low sperm count
• Testicular cancer
• Inaequate thyroid function
• Impotence
• Prostate problems
• Genito­urinary infections
• Malabsorption
 Sperm
• 60 per cent of miscarriages are due to 
defective sperm
• 1: 20 men are subfertile
• Spermatogenisis in the human takes 120 
days to recover if mutagens are around

 
– Skakkebaek N, KeildingN, Changes in semen and testes. BMJ 309:1316­17, 1994
 Pregnancy outcomes
IDEAL ­ 
• Live birth ­ healthy & vigorous baby

ADVERSE ­
• Infertile
• Miscarriage
• Stillbirth
• Perinatal death\sick baby
 Terminology
• infertility ­no pregnancy after 12 months 
unprotected intercourse
• preterm ­ less than 38 weeks
• low birth weight ­ less than 2500gm
• congenital malformation
– 18 per 1000 births
– foetal alcohol syndrome
– infection syndrome ­ rubella
– iatrogenic disaster ­ thalidomide
 Ovaries
• All the eggs a woman will ever  make are 
created in the foetal stage of her own 
development
• The egg that produces the grand­daughter 
was created by the grandmother
• New research suggests that women may be 
able to produce eggs throughout life
oxytoxin Posterior Anterior
Pituitary PituitaryFSH
LH
prolactin
(-)
(-)

LH
Prog esterone
Oestrog en
Ovum
(+)
FSH Corpus
Luteum

Blood
Vessels

Oocytes
Granulosa
Cell
Follicles Ovary Oestrog en &
(+) Prog esterone
 Preconceptual care

• Assessment of the health and well­being of 
prospective parents to allow this to be 
optimised for conception

Who needs preconceptual care?

•First time parents
•Couples with fertility problems
•Couples with previous poor pregnancy outcomes
•Everyone?
 The aims of preconceptual care
• to conceive
• to have an uncomplicated pregnancy
• to have a normal delivery
• to breast feed
• to adjust to a new baby
• to give children the healthiest start in life
 Fertility assessment

• Genetic and family history
• Medical conditions
• Occupational risks
• Lifestyle ­ exercise, nutrition, toxin 
exposure, stress
 Requirements for conception
• normal menstrual cycle & ovulation
• healthy sperm in sufficient numbers
• healthy reproductive organs
• normal sexual function
• timing
 Importance preconceptual care
• Healthy gametes
• Before attachment to the placenta nutrients 
must be high in the endometrium
• Rapid embryonic growth rate
• Foetus almost fully formed by 8 weeks
 Fallopian Tube

D Uterus
C E
B

A
Lig ament
F

Endometrium

Lumen
(centre of
G uterus)

Ovum Ovary

Myometrium

Sperm g ranulosa cells

A B C

D E F G
 Fertility
• There is an endocrinal mechanism by which the females of 
all mammalian species become infertile if food supplies are 
inadequate
• Down on the farm, in animal husbandry, it is well known
that animals conceive on a rising body weight, not when
weight is falling. All animals have a fertility threshold and
in farming there still exists the practice of ‘flushing’. “The
practice of giving ewes which are in fairly poor condition an
improved diet for a few weeks before mating so that they
are in a rapidly rising condition when they meet the ram.
Flushing is not fattening up, it means supplying all the
essential nutrients to make the hypothalamus and pituitary
gland (and ovaries) provide an excellent hormone profile”.
– Coop IE. ‘Effect of flushing on reproductive performance of ewes’. 1966. J Agri Sci
(Camb): 67:305-323
 Poor Nutrition
• Research into restricted calorie intake has been done at the
University of Pittsburgh, and it was discovered that ‘fasting for
one day alone can change the suppression of luteininzing
hormone (LH)
• The implication for slimmers is that even short-term deficiency
can have a profound effect on endocrine function
• Other studies offer similar conclusions, suggesting that
‘restrained eating may be a marker for metabolic and
emotional disturbances, and may also be associated with
biological suppressed, no message would be sent.
• Women with abnormal menstrual cycles experienced ovulatory
disturbances including low progesterone and short luteal cycles
• If you are restricting nutrient intake in order to lose weight,
you may be damaging your chances of becoming pregnant
 Fertility
• Inability to ovulate is clinically called ‘luteinized
unruptured follicle syndrome’ or LUF.
• In the LUF syndrome, women will have the normal
sequence of endocrine events and a normal menstrual
period but their ovary will not release the egg.
• Non-steroidal anti-inflammatory drugs give rise to LUF,
research has shown.
• In women with LUF syndrome, steroid hormone
concentrations in the peritoneal fluid are much lower after
the ovulatory cycle. It is felt that this may facilitate the
development of endometriosis.
– Konnninckx PR, DeMoor P, and Brosens IA, “Diagnonsis of the lutenized
unruptured follicle syndrome by steroid hormone assays on peritoneal
fluid” in Eur J Obstet Gynaecol, 87:929-34, 1980
 Fertility
• “In pregnancy it is known that nutrient requirements
alter. Women on good diets are seen to have healthier
babies than those on poor diets”.
– Wynn AHA, Wynn M ‘The Case For Preconceptual Care in Men and
Women’ AB Academic Publishers, Bicester, Oxon 1991

• “Riboflavin (B2) deficiency causes hormonal

imbalances and is essential for the liver clearance of
steroid hormones (oestrodial and progesterone).
Deficiency inhibits the LH secretion from the pituitary
and GnRH from the hypothalamus. Riboflavin (B2)
works closely with vitamin B5 and if levels fall below
80 per cent then the reproductive system fails”.
– Esch M.W., Easter R.A., Bahr J.M., ‘Effect of riboflavine deficiency on
estrous cyclicity in pigs’. Biol. Reproduction : 25 : 659-665. 1981
  
Fertility
• “Low intake of B vitamins may also slow down
the ripening of the egg before conception and
be affecting fertility. The hypothalamus in other
mammals reacts to a severe deficiency of any of
these B vitamins by inhibiting GnRH secretion
and so causing infertility”.
– Watteville H, Jorgens R, Pfalz H, ‘Einfluss von Vitaminmangel auf
Fruchtbarkeit, Schwangerschaft und Nachkommen’ Schweiz Med
Wochenschr. 84. 875-882.1954
 Research at Hackney Hospital
looked at the weights of new babies
• “Mothers of low birthweight babies had been
eating meat, meat products, white bread, refined
sugars and soft drinks in greater amounts.
Mothers of the healthy weight babies had been
eating nutrient-rich foods, three regular daily
meals, (breakfast being the most important), and
wholegrain cereals, muesli, oats, nuts and seeds
daily, eggs, egg dishes, wholemeal bread, dairy
foods, and lots of fresh fruits and vegetables”
(41).
– Doyle W et al, Maternal nutrient intake and birthweight’ in J Hum
Nutri Diet, 2:415-22, 1989.
 HEALTHY BABIES
• Burke et al looked at mothers who had eaten good/excellent
diets, they gave birth to babies judged to be in good/superior
health 94 per cent of the time. Contrasted with mothers
whose diet were classified as poor and whose infants had
good health only 8 per cent of the time.
– Burke BS, Harding VV, Stuart HC. ‘Nutrition studies during
pregnancy’. J Paediatrics. 1943 Vol 23; 506-515
• “If the mother’s nutrition stores are inadequate during the
time when the placenta is developing, then the placenta will
develop poorly. As a consequence, no matter how well she
eats later, her unborn baby will not receive optimum
nourishment”.
– Aherne W, Dunhill MS. “Morphology of the human placenta’.
British Medicine Bulletin. Vol22 (1) 5-12. 1966
 Fertility Conclusion
• The conclusion is that a developing embryo/foetus
requires abundant nutrients via the placenta, in order to
become a healthy bouncing baby.
• High-calorie, empty-nutrient over-refined foods were
obviously detrimental to the developing baby in the
womb. “The hypothesis of the Hackney study, that the
diet of the mothers of low birth weight babies had too
few nutrients in their diets was supported”.
– Wynn AHA, Wynn M. ‘The need for nutritional assessment in the
treatment of the infertile patient’, in J Nutri Med., 1:315-24, 1990
 HypothalamusGnRH
Pineal
Gland Pituitary FSH LH
Melatonin Oxytoxin
Prolactin

Thyroid Thyroxine

Thymus Thymic hormone

Liver Pancreas
Adrenaline
Gall Bladder Adrenal g lands Oestrog en
(on top kidney
) Testosterone
Kidney
UterusProstag landins

Ovary Oestrog en
Progesterone
Vag ina
 The importance of sound 
nutrition on health
– Dr Weston Price, Dr. Francis Pottinger, Sir Robert 
McCarrison
• It is the quality of food eaten which confers 
good health on the recipient
• Healthy food was seen to emanate from healthy 
soil and good farming principles
• We are all biochemically different and that 
some individuals requirements for nutrients 
may be different due to body biochemistry
 The Nutrient Content of and nutrient 
availability from the modern food supply is 
different from that of palaeolithic times
• Reduction of omega­3 fatty acids from fish
• Intensive livestock farming = nutrient deficiencies of 
these animals and problems with infections
• Intensive farming techniques = soil demineralisation, 
overuse of pesticides
• Agrichemicals and environmental pollutants find their 
way into the food chain
• Reduced nutrient content of foods = compromise of 
nutritional status = reduction in individual adaptation
 Fats and Oils
Fish oils
Vegetables Meat
Walnut oil
Nuts Diary products
Linseeds
Seeds

Linoleic Acid Arachidonic Acid Linolenic Acid

{
Zinc
GLA B6 Biotin
Magnesium
Vit C
Calcium

Prostaglandin  Prostaglandin  Prostaglandin 

series 1 series 2 series 3

Anti­inflammatory  Pro­inflammatory  Anti­inflammatory 

PGE 1 (inflammatory leukotrines) Reduces blood 
clotting
 Omega 3 and Omega 6 Essential
fatty acids and pain reduction
• In a group of Danish women, a higher intake of
omega 3 fatty acids or a higher ratio of omega
3/omega 6 fatty acids was associated with
reduced Menstrual pain.
– Deutch B. Menstrual pain in Danish women correlated with low omega 3
polyunsaturated fatty acid intake. Eur J Clin Nutri 1995;49: 500-16

• Women should reduce their saturated and trans

fatty acid intake by half - then oestrogen levels
will be around 20% lower
 Omega 3 and Omega 6 Essential 
fatty acids and pain reduction
• Animal fats from meat and dairy foods and
manufactured foods should be reduced
• Omega 3, omega 6 and omega 9 cis fatty
acids should be eaten to maintain levels of
anti-inflammatory prostaglandins PGE1 and
PGE3
• Use oily fish, nuts and seeds, dark leafy
vegetables, cold-pressed extra virgin olive
and walnut oils
 Gastric Disorders Survey
• 69% of the population surveyed showed signs 
of one gastro­intestinal disorder over the 
previous three months
• In the USA annual medical costs for gastro­
intestinal disorders are $41M (£25.6M)
• Constipation affects 4 million Americans each 
year
• Americans spend $725M a year on laxatives
 Gut Flora
• 2­4 lbs of gut bacteria live in the intestines.
• 100 trillion organisms make up this flora
• 400­500 different species provide an active 
metabolic action equivalent to the liver
• They provide a protective atmosphere and are a 
critical factor in immune stimulation
• Antibiotics, oral contraceptives, hormone 
replacement therapy and steroids, non­steroidal 
anti­inflammatories disrupt flora.
 Gut Associated Lymphoid 
Tissue (GALT)
• GALT tissue and Peyers patches exclude all 
infectious agents, allergenic material, toxic 
substances from entering the bloodstream
• GALT makes the GI tract the largest lymphoid 
tissue/immune organ in the body
• 1010 immunoglobulin producing cells per metre 
of small bowel account for 80% of all 
immunoglobulin cells in the body
• GALT is the bodies first line of defence against 
alien invasion
 Immune System
• Research  has  shown  that  subclinical  autoimmune 
disease  may  be  involved  with  reproductive  failure. 
“Forty­four  per  cent  of  women  who  miscarried  were 
seen  to  have  antibodies  implicated  with  anti­
cardiolipin, it has also been speculated that two thyroid 
autoantibodies  are  involved  with  reproductive  failure. 
Thyroid autoantibodies have been used as as guides to 
point to women at risk from miscarriage”. 
– Singh A, Nery Danta Z., Stone S.C., Asch R.H., ‘Presence 
of thyroid antibodies in early repproductive failure: 
biochemical versus clinical pregnancies.’ Fert. and Ster. 
1995: Vol 63(2) 277­281
 Food Allergies/intolerances
• One man’s meat is another man’s poison
Common allergies - fish, peanuts
• Common intolerances - wheat, bovine
dairy, citrus, deadly nightshade family
• Chemicals
• Pollens, dusts, moulds
 Immune system
• Research  suggesting  a  link  between  coeliac  disease 
and  autoantibodies  to  the  thyroid  warrants  further 
investigation.  “Adults  tend  to  present  with  these 
problems  in  their  30’s  and  40’s,  tiredness,  mouth 
ulcers,  malaise,  fertility  problems    and  malabsorption 
being the main problems”  (22). 

• All  women  with  unexplained  infertility 

should request these very basic tests.
– Howard S., ‘Module 16: Current Thinking in Coeliac Disease:’ Pharmacy 
Magazine Feb. 1997: CEI ­ CEVIII
 Dietary Strategies
1. Substantial breakfast ­ some of the following:wholegrain 
cereals, eggs, nuts, seeds, fruits, dairy foods
2. Regular unhurried meal patterns
3. Shopping frequently for fresh fruits and vegetables
4. Adequate intake of fresh fruits and vegetables, particularly 
green leafy vegetables
5. Avoidance of stimulants ­ tea, coffee, coke, chocolate, 
alcohol, cigarettes
6. Use of unrefined, cold­pressed unhydrogenated vegetable oils 
e.g. sunflower, safflower, olive, organic butter
7. Use of oily fish in the diet
8. Drinking plenty of fresh filtered or mineral water
 Supplementation
Take a course of basic supplements for 3­6 months, whilst the 
diet is being corrected.
Multi­vitamin/mineral (yeast, gluten, dairy and sugar free)
• Vitamin C with bioflavinoids 1000mg
• Evening primrose and fish oils 2000mg
• Acidophilus 4 billion
• Slippery elm tablets
• Digestive enzyme with each meal
• Magnesium malate 300mg
• Zinc, vitamin E and vitamin B6
Kelp tablets (optional for metabolism increase
Agnus castus for PCO/irregular periods
Common social poisons
• Smoking
– Increases the risk of  cleft lip and palate
– Minor brain damage
•   hyperactivity,
•   deafness
• squints, asthma, sids
• Alcohol
• Increased risk of:
• Short length / small head
• Lowered IQ / retardation, hyperactivity
• Extreme nervousness, facial malformation, 
• Heart defects
• Street drugs
• Central nervous system damage
• Chromosome damage
• Heart defects
• Behavioural problems
Vitamin A deficiency 
• Eye defects, heart problems, hydrocephalus, 
urogenital deformities, diaphragmatic hernia
• Excess  can cause facial deformities and floppy 
baby syndrome ie. over 7,500iu. keep to 2000iu 
per day
B complex deficiency
• Sterility, small birth weight, perinatal death, low 
mental ability, blood disorders, short limbs, 
malformed jaw, cleft palate/lip, kidney problems, 
limb and heart defects, lack of myelination, 
damage to eyes, lungs &central nervous system 
disorders, stomach & liver damage
Vitamin C 
• deficiency poor teeth
• gums and bone weakness
• anaemia
• vulnerability to infections
Vitamin D deficiency
• Poor tooth & bone development
• Deformities of skull
• Jaw & palate deformity
• Low mental ability
Vitamin E deficiency 
• Miscarriage
• Exencephally hydrocephalus
• Neonatal jaundice
Essential fatty acid deficiency
• Poor growth
• Damage to kidneys
• Brain and blood vessel damage
Calcium deficiency
• Rickets
• Poor tooth and bone development
• Cramping of maternal uterus
Magnesium deficiency 
• Calcium deposits
• Heart abnormalities
• Anorexia
• Convulsions
• Death
Copper deficiency
• Poor growth
• Depigmentation
• Anaemia
• Fragile bones
• Ataxia
• Small brain
Iodine deficiency
• Slow growth
• Abnormal mental development
Iron deficiency 
• Eye defects
• Bone defects
• Brain defects
• Learning difficulties
Chromium deficiency
• Eye abnormalities
• Blood sugar imbalance
• Polycystic ovaries
Manganese deficiency
• Malformation of inner ear
• Ataxia
• Bone malformation
• Poor co­ordination
• Head retraction
• Tremor
• Hyper­irritability
• Cartilage & heart problems
• Learning difficulties
Nickel deficiency 
• Liver problems
• Kidney and heart abnormalities
Selenium deficiency
• Lung disorders
• Chromosome abnormalities
• USA research links it with Down’s syndrome
Zinc deficiency
• Growth retardation
• Anorexia
• Loss of hair & seborrhoea
• Apathy
– defects in eyes, kidneys, brain, bone
– heart problems
Toxic metals 
• High lead, cadmium, aluminium linked to:
– infertility ­ miscarriage, stillbirth, premature birth
– skeletal deformity
– learning difficulties/behavioural problems/mental 
retardation
To detox heavy metals
• Lead ­ vitamin C, iron and zinc
• Cadmium ­ vitamin C and zinc
• Mercury ­ selenium, zinc, iron, sulphur
• Arsenic ­ sulphur and selenium
• Aluminium ­ zinc and silica
  
‘The important thing is not to stop 
questioning.’

Einstein
“Endometriosis: a key to healing 
and fertility through Nutrition

Dian Shepperson Mills &Michael Vernon
Thorsons
ISBN 0­00­713310­3