Candida and Infertility

Candida and Infertility

By Chinenye H.G Ofokansi

A seminar presentation to the Department of Medical Laboratory Sciences, Nnamdi Azikiwe University, Awka.


The incidence of infertility in today’s world is an issue of current health concern across the globe. Among the factors which are thought and known to contribute to this global health problem are infections. These infections include those caused by bacteria, fungi and protozoa. Hidden among the suspected causes of infertility is this fungus called candida, generally known to be a commensal in the human body.
The aim of this article is to expose the reader to the severity and the consequences of the disease caused by this subtle organism.

What is candida?
Candida is a genus of fungi. They are unicellular fungi that reproduce by budding. They are members of the normal flora of the skin, mucous membrane and gastrointestinal tract. Candida species colonize the mucosal surfaces of all humans during or soon after birth.

Candida exists mainly in two forms: a round yeast that remains in the colon of man and is actively reproducing and the other is pseudohyphal form that eats through the intestinal wall and can travel via the blood to any site in the body. The species of candida include Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata and Candida dubliniensis. All these species of Candida are capable of causing endogenous opportunistic mycosis.

When Does Candida Become Pathogenic?
The normal flora ‘candida’ becomes pathogenic following an increase in the local census of candida and damage to the skin or epithelium that permits local invasion by yeasts and pseudohyphae. Widespread use of antibiotics, which clear not only the pathogenic bacteria but also the beneficial bacteria creates a favourable environment for the growth of candida.

Of the various species of candida, Candida albicans is the most capable of causing infection. Other species are less common in causing infections in humans. The percentage estimate of the infections caused by the different species of candida are:
Candida albicans: 50-60%
Candida glabrata: 15-20%
Candida parapsilosis: 10-20%

Pathogenesis of Candida albicans
The intact or physiologically normal epithelium is usually resistant to candida invasion. If however, there is marked increase in the number of candida present or if the skin and the mucous membrane(mucosa) are traumatized or hormonally altered, these barriers are susceptible to candida invasion. Iatrogenic surgery or hyperalimentation are often successfully managed by the normal host defense mechanism. However, the ability of patients with hormonal imbalances, immunodeficiencies and malignancies to control invasion of deeper tissues is limited.

Candidiasis is an infection caused by the yeast candida albicans or other candida species. Candida is the principal fungal infectious agent in humans. Superficial infections of skin and mucous membranes are the most common types of candidal infections of the skin. Cutaneous candidiasis is an opportunistic infection that arises, in most cases, from endogenous saprophytic candida blastophores that selectively colonize oral, gastrointestinal, vaginal and cutaneous epithelium.

It has been well demonstrated that specific candida species, notably, Candida albicans, selectively adhere to vaginal mucosal cells. This selective adherence is thought to contribute in part to predominance of C. albicans in human host.

Most candida species are known to produce virulent factors including protease factors. Other antigenic structures that have been identified by the use of absorbed anti-sera are immunodominant enolase and heat shock proteins. The ability of the various yeast forms to adhere to underlying epithelium is an important step in the production of hyphae and tissue penetration.
In cases in which the epithelial barrier or most immunity is impaired, candida species may cause opportunistic infections of the skin and mucosal surfaces.

Fungi generally cause disease in humans in one of four ways.

First: A person may develop an allergic reaction to fungal spores or vegetative cells. Example , allergic diseases such as hay fever, asthma; can result from inhaling fungi or their spores.

Second: A person may react to toxins produced by fungi.

Third: The fungi may actually grow on or in the human body, causing disease or mycoses.

Fourth: Fungi can destroy the human food supply causing starvation and death.

Certain physiologic changes in otherwise healthy individuals provide the setting for opportunistic candidiasis. The physiologic changes in the cervical and vaginal mucosa result in the overgrowth of candida and have been correlated with:
An increase in the moisture and carbohydrate substrates on the mucosal surface.

A local decrease in transferrin, which would lead to increased levels of available iron, an essential growth requirement for candida.
Increased secretion of steroids which might promote candidiasis indirectly by reducing local host defenses such as phagocytosis.
A decrease in the concentration of specific IgM secretory component.

Hormonal Imbalance and Systemic Candidiasis
Part of the hormonal system, the endocrine system is comprised of glands such as the testes, ovaries, adrenals and thyroid – all controlled by the pituitary and hypothalamus glands, which are located in the brain. These glands are instructed by the brain to release hormones into the bloodstream. The hormones circulate until they find their receptors, the place where they are needed.

Hormones have a profound impact on the brain and body and play a major role in our physical, psychological health and well-being. Among other functions, they regulate mental processes,mood, metabolism, growth, prenatal development, sexual development and function, metabolism and tissue function.

Hormones play a major role in depression, anxiety, memory and other mood related disorders because, they have a significant impact on neurotransmitters in the brain like serotonine, dopamine, GABA, norepinephrine, acetylcholine and beta-endorphins, as well as neurons and receptors. For instance, oestrogen has an excitatory impact on the brain while progesterone has a calming effect. Testosterone can decrease neurotansmitter levels, but enhances neurone function.

Hormone imbalance is a very common condition in our society today, found not only in women but men as well. It is the root of many undesirable and disruptive psychological and physiologic symptoms. It occurs mostly in women at 30’s and 40’s as hormone levels begin to fluctuate with age. But now, it is impacting teenagers and women in their twenties and men of all ages, because of high level of environmental toxins. These environmental toxins disrupt the proper functioning of the endocrine system.

Female Hormone Imbalance
Female hormone imbalance occurs when the two primary female hormones; oestrogen and progesterone, do not remain in balance as they should. There may also be problems with testosterone but the most common imbalance occurs in oestrogen and progesterone.
During a woman’s natural monthly menstrual cycle, a particular level of oestrogen(determined by the body) is produced approximately during the fifth to fourteenth days. When ovulation occurs, then progesterone is produced. If fertilization does not take place, both oestrogen and progesterone levels drop and menstruation occurs. When all is functioning well, the body produces the amount of oestrogen and progesterone that is needed at that time. But if there is a malfunction, these hormones will not be produced in the levels and at the time they are needed. Thus, hormone imbalance occurs. These imbalance may be in the form of too much oestrogen or too much progesterone, or not enough oestrogen or progesterone. When this happens, a variety of psychological and physiological symptoms can occur.

Symptoms of female hormone imbalance
The symptoms of female hormone imbalance are numerous and may vary from woman to woman. They can range in severity- from mildly annoying to completely debilitating. Symptoms may also vary within each individual, from month to month, depending on a variety of factors.
Symptoms of too much oestrogen(oestrogen dominance)
When a woman has too much oestogen and not enough progesterone, this is commonly referred to as oestrogen dominance. This is the most common imbalance found in women today, because of environmental toxins and diet that alter and disrupt oestrogen .

  • tender breast
  • breast swelling
  • heavy menstrual flow
  • fibrocystic breast
  • rapid and erratic mood swings
  • irritability
  • migraines and cyclical headaches
  • cyst on the ovaries
  • retaining water
  • extra weight in the abdominal area
  • anxiety
  • dizziness
  • insomnia or disrupted sleep
  • low libido
  • difficulty in concentrating
  • elevated triglyceride levels
  • uterine fibroids
  • painful menstrual cramps
  • leg cramps
  • short term memory loss
  • sugar cravings
  • hypoglycemiagall bladder problems
  • irregular menstrual cycle
  • lack of ovulation
  • infertility
  • acne
  • breast cancer

Symptoms of insufficient oestrogen

  • brain fog
  • depression
  • vaginal dryness and irritation(one of the primary symptoms)
  • incontinence
  • irregular menstrual cycle
  • headaches
  • hot flashes
  • bone loss
  • memory problems
  • disrupted sleep
  • frequent vaginitis and/or vaginal infection
  • loss of sex drive
  • joint pain, stiffness and swelling
  • heart palpitations
  • night sweats
  • low self esteem
  • loss of breast fullness
  • intolerance to exercise
  • excessive perspiration
  • recurring bladder infection

Symptoms of not enough testosterone

  • abdominal weight gain- a pot belly
  • hair loss
  • fatty breasts
  • depression
  • fatique
  • concentration problems
  • mood swings
  • anxiety
  • decreased muscle strength and mass.

It should be noted that many of female hormone imbalance overlap from one imbalance to another. Hence, it is important to do hormone saliva test to measure hormone levels and know the particular hormone that is insufficient.

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Causes of Hormone Imbalance

The two primary causes of hormone imbalance in both men and women are environmental toxins and diet. However, stress, neurotransmitters,candida overgrowth and adrenal fatique are common contributors as well.

Environmental Toxins: common everyday chemicals found in our food, home, workplace, air and water, personal care products, plastics, pesticides, herbicides, household cleaning products, cosmetics etc contain toxins called hormone disruptors. These hormone disruptors disrupt, alter and impede normal functioning of hormones. A particularly subclass of hormone disruptors called xenoestrogens, actually mimic natural oestrogens in the body and/or prevent hormones from performing the job they are required to do. They also alter the way natural hormones are generated, discharged and metabolised. When these occur, a variety of abnormal reactions occur in the body and result in symptoms such as found in hormone imbalance as well as other detrimental impact to the entire endocrine system, immune and reproductive system.

Diet: this is the second biggest contributor to hormone imbalance – a diet high in white flour and other refined carbohydrate, sugar and caffeine and lacking in nutritional value. These types of food alter and destroy the endocrine system and metabolic functioning. Hormones are regulated by the endocrine system.

Neurotransmitters: these are chemical messengers used in communication systems of the brain and body. They are involved in regulating basically all the systems in one way or another and play a crucial role in hormone imbalance. Neurotransmitter deficiencies or imbalances are extremely common in the population today because of environmental toxins, sugar, caffeine, white flour, nicotine, alcohol and lack of protein in the diet. When these occur, it results in numerous psychological and physiological symptoms we find in the society today. Hormone imbalance is one of the most common symptoms to develop. When an imbalance or deficiency of neurotransmitter occurs, the body is not capable of producing and maintaining hormones in the body as it should. This can create hormone imbalance or exacerbating an already existing hormone imbalance.
Too much stress: high levels of ongoing stress put too much demand on the endocrine system and deplete neurotransmitters, which are highly involved in the regulation of hormones. When the endocrine system and neurotransmitters are not functioning adequately, hormones are not produced or regulated adequately.
Adrenal fatique: hormones have a significant impact on adrenal function and vice-versa. Hormone imbalances contribute to adrenal fatique and adrenal fatique can contribute to hormone imbalances. They have a reciprocal effect on each other. This is especially important as we age and the sex hormones are more dependent on the adrenal glands.

Candida Overgrowth: An overgrowth of the yeast, candida albicans, is another common contributor to hormone imbalance. Candida albicans eats progesterone, therefore resulting in excessive levels of oestrogen in the body.

How Does Candida Affect Endocrine Functioning?

Candida can bind to hormones, altering their shape so they are no longer able to fit into their target receptors, making such hormones inactive. This creates a hormonal imbalance. Many of the symptoms of Candida overgrowth are caused by hormonal imbalances.

Oestrogen is a hormone that is produced in the ovaries (in premenopausal females), in the adrenals (in men and post-menopausal women), in fat cells and in the bowel.

Progesterone plays a greater role, in females than in males. It is produced by the ovaries, corpus luteum and adrenal cortex. Both of these hormones have other functions apart from their involvement in the female monthly sexual cycle. They control the bladder and bowel functioning and regulate blood sugar. Endocrine disruptors, also known as hormone disruptors or oestrogen mimics, such as dental mercury amalgam, the chemical found in dry-cleaning materials, paints, pesticides, plastics, corticosteroids etc, are known to block oestrogen receptors.

Once candida has overgrown and spread to bloodstream, it can bind to hormones changing their shape and hence, they cannot fit into their receptors. By this mechanism, Candida albicans effectively in activates the circulating hormone, making all endocrine problems much worse. Candida overgrowth produces many different toxins to wreak havoc to the immune symptoms. Candida waste product produces a false oestrogen which tricks the body into thinking it has happened adequate levels of the hormones of the hormones, signalling a reduction of its own oestrogen.

Similar messages can also be sent to the thyroid, reducing thyroxin production and initiating or worsening a hypothyroid problem. Some oestrogen will literally feed candida overgrowth, which is why birth control pills and oestrogen replacement therapy put women at a greater risk of developing candida overgrowth. Using progesterone, even natural progesterone, may increase candida overgrowth due to its effect on other hormones and acidity levels.

A direct link to candida and hormones imbalance is shown in Autoimmune Polyendocrinopathy Immune dysregulation Candidiasis Hypersensitivity Syndrome(APICH). This syndrome was identified in the USA in the 1980’s as an endocrine disorder connected to people with candida overgrowth that do not respond to conventional treatment. It is far more prevalent in females; symptoms include ovarian, thyroid and adrenal insufficiency. So if candida overgrowth is a side effect of an endocrine(hormonal imbalance), a vicious circle could develop with candida overgrowth at one end and the APICH syndrome at the other end. If candida blocks oestrogen receptors, this can lead to relative dominance of progesterone, a hormone candida loves and feeds on,. The result is insufficiency in both oestrogen and progesterone.

Short-term antibiotic use as well as causing thrush can have another effect: oestrogen is passed into the intestine the intestines in bile fluids for conversion to a more active form by bacterial action of flora flora bacteria, this process is stopped, oestrogen levels are therefore lowered.

One of the functions of oestrogen is to keep the pH of the vagina more acidic. When oestrogen levels are lowered or when the endocrine system cannot produce sufficient oestrogen by the body, the pH of the vagina is raised and it becomes alkaline. This alkaline Ph is less hospitable to the good bacteria(normal flora) that protect the vagina. If the normal florae die, the vacated space would be taken by an organism that likes an alkaline environment such as Candida albicans.

What causes candida overgrowth?

During birth or shortly thereafter, all humans acquire and become colonized by candida species. The risk of endogenous infection is thus clearly ever present.
The growth of Candida albicans and other species of candida is held in check by
1. Normal flora bacteria
2. Normal body defense

Normal Flora Bacteria
-Normal flora bacteria are known drivers of 85% of the immune system. They act by stimulating it to produce antibodies.

  • They help in the digestion of ingestion food and release important vitamins such as biotin, folic acid, vit B12 and vit k. These help in the absorption of the digested food, and are also anti- carcinogenic in nature.
  • The normal flora bacteria also help to eliminate carcinogenic hormones and chemicals like oestrogen, nitrosamines, cadmium and mercury. They produce anti- cancer chemicals from food.
  • Their favourite foods are whole foods, whole grains, Candida albicans and microbes. At night, they can digest roughly 2.2kg of yeasts and microbes. They are the first line of defense mechanism.

The above roles played by normal flora bacteria can be brought to a permanent halt by antibodies. Apart from a minor problem that they may be toxic to brain cells and other vital organs, antibodies kill many strains of bacteria in the body including the friendly bacteria – the normal flora bacteria in the gut and other organs.
The Journal of the American Medical Association has reported a study on 10,000 women in which women took over 500 days of antibotics in a year 17year period. From that study, it was found that these women had twice the risk of breast cancer as those that took none at all. This shows the anti-carcinogenic role of that normal flora bacteria play.

It is important to mention at this juncture that candida overgrowth also contribute the development of cancer. The wiping out of the normal flora bacteria will lead to the following:

Malnutrition due to insufficient digestion and absorption of ingested food.
An overgrowth of non- bacteria normal flora mostly candida species.
The undigested foods find their way into the bloodstream where they are seen by the immune system as foreign bodies. They stimulate the immune system to produce antibodies against them. This leads to autoimmune disease and immune deficiency.
The excessive growth of candida species leads to production of toxins by candida which also find their way into the bloodstream, causing allergy and other clinical manifestations.
Occasionally, Candida overgrowth occurs throughout the body, including the liver and blood. Once in the blood, the fungus can be carried anywhere in the body resulting in a myriad of health problems including frequent urinary tract infections, respiratory problems, gastrointestinal and liver problems, decreased immunity, frequent or chronic fungus infections of the skin and nails, weight gain or loss. This is referred to as systemic candidiasis.

To Be Continued!

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