Unexplained Infertility Explained

The Diagnosis and Treatment of Unexplained Infertility

unexplainedinfertilityAbout 15-30% of infertile couples are diagnosed with what is called “unexplained infertility”.  Well what the heck does that mean?  This is a large population of individuals searching for an answer as to why they haven’t been able to conceive naturally or carry a healthy baby to term.  This blog entrance will hopefully give you some insight as to what to do with this diagnosis and how to move forward. Time to explain the unexplained.  When it comes to natural healing and our bodies, there is a reason for everything.

What is Unexplained Infertility?

Infertility is customarily defined as the inability to conceive after 1 year of unprotected intercourse (6 months if the female partner is >35 years of age).   At this point, the infertility evaluation is typically initiated, and couple undergo a series of testing including semen analysis, ovulation assessment, a hysterosalpingogram, ovarian reserve, and hormone assessment.  When these results all come back negative, the couple is given the bogus diagnosis of unexplained infertility. (SIGH) I hear you…there is nothing like going through a year of unsuccessful conception, months of doctors appointments, and testing, and the physical and emotional stress of the unknown, just to be told “we can’t figure out the problem”.  So what’s a couple to do?

Here are your next steps

It is critical to cover all the basics, including additional testing that may need to take place.

(1) Make sure your male counterpart is tested!  Male factor infertility accounts for 30% of couple’s issues alone, and is a contributing factor in an additional 20-30%.  The semen analysis remains the most important tool in the investigation of male factor infertility.  The semen analysis will closely investigate the health of the sperm, looking specifically at volume, pH, concentration, count, motility, morphology, and more.  It is CRITICAL to take this step…women are not alone in this fight.

(2) Consider further testing.  As a Naturopathic doctor with a special interest in fertility, I never cease to undergo further investigation to determine exactly what is at the root of the couples fertility issue.  Further testing such as a thorough investigation of thyroid, adrenals, hormones, diet and nutritional deficiencies, an environmental and workplace toxin evaluation, and an assessment of mineral status are equally as important as the standard infertility work-up.  With this expanded testing, fewer than 15-30% of couples will have unexplained infertility.

(3) Consider Alternative Medicine as a treatment strategy.  Naturopathic Doctors and Chinese Medicine practitioners have been treating infertility for decades.  Modalities such as Botanical Medicine (herbal medicine), Acupuncture, and Nutraceuticals show promising advances in fertility success rates.  Today, even medical reproductive specialists are looking into the mysterious world of Chinese medicine to help those fertility patients for whom western science alone is not enough.

 Potential Causes of Unexplained Infertility

There are numerous potential causes of unexplained infertility. Some areas may or may not apply to you, but some may have not been taken into consideration.

  • Menstrual cycle irregularities including a cycle that is too short, too long, too heavy, too light, too frequent, or not frequent enough: Any irregularities in a cycle can be a sign of hormonal imbalance or a more serious pathology (such as PCOS, Endometriosis, Uterine Fibroids, Ovarian cysts, etc).  The following hormones, if imbalanced, can be a direct cause of an irregular cycle and issues with ovulation and fertility: Estradiol, Progesterone, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), ACTH, Prolactin, Testosterone, DHEAS, Thyroid Stimulating Hormone (TSH), and Morning Cortisol.  For men, hormone testing should consist of Testosterone, DHEA, Estrogen and Prolactin.
  • Nutritional Excesses / Deficiencies:  Optimal levels of nutrients such as Essential Fatty Acids (EFA’s), iron, vitamin B12, Zinc, Copper, Selenium, Vitamin D and Iodine are all essential in achieving a healthy conception.  Don’t forget adequate intake of lean protein and healthy carbohydrates as well.  Caffeine and alcohol intake is also highly linked to infertility.
  • A BMI that is too high (overweight/obesity) or too low (underweight):  Being either overweight or underweight has serious affects on your menstrual cycle and ability to conceive.  In men, excess body weight is linked with altered testosterone, estradiol levels, poor semen quality and infertility. In women, a BMI <20 or >24 has been linked to ovulatory infertility. Overweight women also have a reduced fertilization rate and embryo quality is impaired in younger women who are obese and undergoing fertility treatment. Underweight women and those that are extremely athletic are at a higher risk of amenorrhea (or lack of a cycle).
  • Heavy Metal Toxicity: Heavy metals (Cadmium, Mercury and Lead) found in foods, environmental pollution, drinking water, medications, old homes, and household chemicals have a negative impact on ovarian and pituitary function.  Signs of heavy metal toxicity can include neurological changes, anxiety, headaches, fatigue, digestive upset, ADD/ADHD, vision changes, and more.
  • Thyroid disorder: Thyroid dysfunction is very common and affects male and female reproductive structures, interferes with reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy outcome.  Awareness of the thyroid status in the infertile couple is crucial.  Luckily, addressing the thyroid can have a reversible or preventable effect on infertility.
  • Stress and Adrenal Function: Ongoing psychosocial stress can significantly increase or reduce optimal cortisol excretion throughout the menstrual cycle, which can affect the hormone profile in critical stages of the fertilization process.
  • Low cervical mucous:  You may not have been thinking that your cervical mucous is important until now.  If you do not have adequate amounts, or if it is too acidic, the sperm will not be able to reach the cervix.
  • Environmental toxin overload: Many toxins, known as endocrine disruptors, affect the levels of your natural hormones. They make it difficult for women to conceive and men to achieve healthy sperm. These chemicals are found in our genetically modified foods, pesticides and fertilizers used on our lawns and on our growing produce, in our water, our household cleaning produces, and environment. These include: Bisphenol-A (BPA) found in plastics, inside tin cans, and in dental sealants; Parabens primarily used as a preservative in cosmetics and pharmaceuticals; Phthalates added to plastics to make them more flexible including soaps, detergents and plastic bags; Dioxins found mostly in industrial environments; and Organophosphates in pesticides and fertilizers.
  • Inaccurate timing of sexual intercourse: Perhaps the most common and easily fixable cause of infertility.  It is essential to ensure unprotected intercourse during the critical window of conception.  This window will vary depending on the individuals cycle, but should fall between Days 8-17, if women are ovulating around Day 14.  Timing intercourse 6 days prior to and including ovulation has the highest chance of conception. I suggest purchasing an Ovulation Test Kit or tracking your basal body temperature to know exactly when you are ovulating.

What can you do now?

(1) Optimize Cervical Mucous by ensuring adequate water intake, increasing your physical exercise to enhance blood flow to the uterus and cervix, and treating low progesterone or low estrogen levels naturally by consulting a natural healthcare provider. Bump up Omega 3, 6 and 9 in your diet or supplement with Omega 3′s, Evening Primrose Oil, or Borage Seed oil to regulate hormones, increase blood flow to the uterus, reduce sensitivity to Prolactin (which can halt ovulation), and increase cervical mucous. You can also consider L-arginine, and herbs such as Red Clover, Licorise root, and Dandelion leaf.

(2) Reduce stress and adopt an active lifestyle that is balanced with yoga, meditation and other relaxation practices.

(3) Eat a well-balanced whole foods diet that is mainly plant-powered.  This means that 50% of your food intake is fruit and vegetable based to ensure that you are receiving adequate antioxidants and reducing inflammation in your body.  Food should always be in its most natural state possible, and intake should consist of organic produce, antibiotic and hormone-free eggs, dairy and meat products, and contain no added sugars.

(4) Detox your body and your home.  Eat well and partake in regular detoxification practices such as drinking lemon water or dandelion root tea, using castor oil packs, taking epsom salt baths and using infrared saunas to rid your body of excess toxins.  In addition, cleanse your home of chemical products and switch to organic shampoos, soaps, creams and make-up.

(4) Consult with a naturopathic doctor that specializes in fertility, so they can perform a thorough investigation for you as well as provide you with an individualized treatment plan for both you and your partner.

As always, if you have any questions or comments, please leave me a message below.

In health,

Dr. Jessica Sangiuliano, Naturopathic Doctor

Dr. Jessica Sangiuliano, Naturopathic Doctor

 

 

 

 

 

 

References:

Damti, O., et al. Stress and distress in infertility among women. Harefuah. 2008 Mar; 147(3): 256-60, 276.

Gerhard, I., et al. Impact of heavy metals on hormonal and immunological factors in women with repeated miscarriages. Hum Reprod Update. 1998 May-Jun; 4(3): 301-9.

Nguyen, R., et al. Men’s body mass index and infertility. Hum Reprod. 2007 Sep; 22(9):2488-93.

Pandey, S., et al. The impact of female obesity on the outcome of fertility treatment. J Hum Reprod Sci. 2010 May-Aug; 3(2): 62-67.

Quaas, A., Dokras, A. Diagnosis and treatment of unexplained infertility. Rev Obstet Gynecol. 2008; 1(2): 69-76.

Rich-Edwards, J., et al. Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology. 2002 Mar; 13(2): 184-90.

Trokoudes, K., Skordis, N., Picolos, M.  Infertility and thyroid disorders. Curr Opin Obstet Gynecol. 2006 Aug; 18(4): 446-51.

 

 

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