Can Irritable Bowel Syndrome (IBS) affect fertility?

Pregnant woman standing in front of a barn door.

18-Jan-2021

Anybody who suffers from irritable bowel syndrome (IBS) knows it’s complicated. IBS may be due to dysbiosis such as small intestinal bacterial overgrowth (SIBO) or candida, emotional stress, food sensitivities, intestinal permeability, and often a combination of all of the above. But one thing’s for sure – it can really suck on some days. Like, really, really suck. The point of interest here being that IBS can considerably decrease one’s quality of life.

IBS and “functional” digestive issues are my main focus in clinical practice. Having had the disorder myself for over a decade, I have learned a great deal about IBS and more broadly functional digestive disorders. But there are new findings that surprise me regularly.

One of these areas is a potential link between infertility and irritable bowel syndrome. In a recent study published in November 2020, “A Review of the Complex Relationship between Irritable Bowel Syndrome and Infertility” by Anton et al., authors analyzed the available literature on the connection between IBS and infertility and concluded “oxidative stress is a plausible mediator of the connection between both female and male fertility and IBS [1].”

As there are numerous factors that affect IBS – including poor dietary choices, alcohol consumption, smoking habits, obesity, and active inflammation – the most important variable that may explain the IBS-infertility link, in both men and women, is stress.

In chemical terms, “stress” on the body is from oxidative stress, which refers to elevated levels of reactive oxygen species (ROS) that damage fats, proteins, and DNA. It all comes down to chemistry: there is an imbalance between ROS production and neutralization (anti-oxidants), which leads to oxidative stress [2].

In males, high levels of oxidative stress lead to decreased sperm motility, sperm number, and sperm-oocyte fusion [1]. This can directly impact male fertility. In females, high levels of oxidative stress can negatively impact both natural and assisted fertility [3]. Other studies have reported that if high concentrations of reactive oxygen species (ROS) are found in the fallopian tube or peritoneal environments, they may result in negative consequences both in the fallopian tube and peritoneal cavity, as well as affect eggs (oocytes), sperm-oocyte (sperm-egg) interaction, and the fetus [1].

How does one reduce oxidative stress?

As it relates to fertility and irritable bowel syndrome, the research recommends reducing oxidative stress by living a healthier lifestyle, including eating a healthier diet that is rich in micronutrients and limited in alcohol. Avoiding smoking and maintaining a healthy weight with regular physical exercise may also promote fertility and diminish IBS symptoms.

BUT, many patients with IBS who are trying to conceive have already implemented these healthy changes in their life. I often see patients who eat a clean diet, exercise regularly, and prioritize sleep and stress management. They’re doing everything right, taking all the supplements, working with a fertility clinic, and still experience difficulty with conceiving.

To date, there does not appear to be research that evaluates antioxidant supplementation in an IBS population experiencing concurrent infertility. However, clinical trials, in vitro, and pre-clinical studies support the effects of polyphenols (a type of antioxidant) in IBS improvement from different plant sources [4].

Below are antioxidants that have been studied to improve symptoms and offset oxidative stress specifically in IBS:

  1. Curcumin. Curcumin, the medicinal extract of turmeric, has traditionally been used as an herbal medicine for its anti-inflammatory, bile-supporting (choleretic), antimicrobial, anticancer, and liver-protective properties. As an antioxidant with carminative actions, curcumin has shown to improve stool formation, promote less frequent bowel movements, and improve abdominal pain and cramping in individuals with IBS [4].    

  2. Resveratrol. Resveratrol inhibits pro-inflammatory chemicals, including IL-1β, which is considered the primary stimulator of diarrhea and a major symptom of intestinal inflammation. Resveratrol also increases anti-inflammatory mediators like IL-10 which acts as an immune regulator [4]. Resveratrol can be found in many purple foods like red wine, grapes, and blueberries, however higher doses typically found in resveratrol supplements promote these pathways.

  3. Quercetin. Quercetin is an antioxidant that has also been shown to act as an anti-histamine. In animal trials, it has shown to reduce spasms and intestinal hyperactivity, specifically in animals with diarrhea-prone IBS.

  4. Soy isoflavones. Isoflavones are a type of polyphenol found in legumes, including soybeans, chickpeas, fava beans, pistachios, peanuts, and other fruits and nuts. Diadzein, glycetin and genistein are the major compounds of soy, and these compounds have a specific relationship with estrogen in that they have a high affinity for certain estrogen receptors. Interestingly, there is a hormonal link between estrogen and chronic visceral pain in women who have IBS, particularly during the menstrual period [4]. Low estrogen leads to increased gut hypersensitivity and permeability in women with IBS [4]. The estrogen-like compounds in soy isoflavones can stimulate estrogen receptors and reduce gut hypersensitivity. Indeed, supplementing with soy isoflavones in women with IBS can significantly improve quality of life scores, including abdominal pain severity as well as abdominal distension [4].

As it stands currently, there is more research needed on the IBS population subset that is experiencing fertility issues. However, naturopathic medicine offers a range of tools, including individualized dietary recommendations, targeted neutraceutical supplementation, and lab testing. If you have IBS, check out a related article here on the relationship between IBS and endometriosis, a major cause of female infertility.

If you are experiencing chronic digestive issues and trying to conceive, book an appointment to discuss your digestive and fertility health strategy.

Dr. Dominique Vanier is a naturopathic doctor in Burlington, Ontario. As a regulated health provider, she is registered to see patients in Ontario both virtually (online) and in person.



References:

[1]. Anton C, Ciobica A, Doroftei B, et al. A Review of the Complex Relationship between Irritable Bowel Syndrome and Infertility. Medicina (Kaunas). 2020;56(11):592. Published 2020 Nov 6. doi:10.3390/medicina56110592

[2] Balmus IM, Ciobica A, Cojocariu R, Luca AC, Gorgan L. Irritable Bowel Syndrome and Neurological Deficiencies: Is There A Relationship? The Possible Relevance of the Oxidative Stress Status. Medicina (Kaunas). 2020;56(4):175. Published 2020 Apr 13. doi:10.3390/medicina56040175

[3] Aitken R.J., Clarkson J.S. Generation of reactive oxygen species by human spermatozoa. In: Dormandy T., Rice-Evans C., editors. Free Radicals: Recent Developments in Lipid Chemistry, Experimental Pathology and Medicine. Richelieu Press; London, UK: 1987. pp. 333–335.

[4] Roudsari NM, Lashgari NA, Momtaz S, Farzaei MH, Marques AM, Abdolghaffari AH. Natural polyphenols for the prevention of irritable bowel syndrome: molecular mechanisms and targets; a comprehensive review. Daru. 2019;27(2):755-780. doi:10.1007/s40199-019-00284-1