Are you trying to conceive? Have you gone a year or more without getting pregnant, or have you had one or more pregnancies end in a miscarriage? Have you felt supported by your ObGyn or your Reproductive Endocrinologist?
There are doctors out there who are willing to dig in and investigate, but most do a very basic evaluation of infertility. Standard protocols include a chart day 3 and 21 lab draw, a semen analysis, and an HSG to check the fallopian tubes. Some practitioners may include an endometrial biopsy, or a post coital test to check for sperm after intercourse.
This is a good start, but there is more that can be done. What should your doctor be doing to provide an accurate diagnosis, develop a complete, effective treatment plan, and provide the best chances for a healthy conception and pregnancy?
1. Watching you ovulate
The only way to confirm ovulation is to use ultrasound to watch the process. Despite hormones, cycles, and temperatures appearing “normal,” in some cases a women is not releasing an egg. This is called lutenized unruptured follicle syndrome, or LUFS. In addition to LUFS, there are a number of other ovulation disorders that can be identified with ultrasound monitoring through the pre-ovulatory phase of a woman’s cycle. In addition to confirming ovulation, ultrasound monitoring can confirm normal, healthy ovulation and full proper development of the egg. Treatments are available if ovulation issues are found.
2. Evaluating cervical mucus
Conceiving and carrying a healthy baby to full term requires a good egg and good sperm. While many women know to check for fertile cervical mucus to time intercourse, their physician rarely evaluates the quality and quantity of cervical mucus, despite the fact that mucus is critical to sperm survival and movement toward an egg. If mucus issues are found, there are some relatively simple supplements and medications that a doctor can prescribe that can significantly improve cervical mucus.
3. Considering Endometriosis
Endometriosis can range from mild to severe, and while some women with endometriosis experience severe pelvic pain and very heavy menstruation, endometriosis can be present with no obvious symptoms. In some cases, the only symptom is infertility. In addition to causing damage to the fallopian tubes, endometriosis can also be cause adhesions and scarring that may preventing successful implantation.
4. Testing for MTHFR
If you are not familiar with MTHFR, many of us (at least 40%) have a version of this mutation. Having this mutation can impact fertility in many ways (and is correlated with other conditions that can impact fertility). Two things it can do are impair detox and interfere with the processing of folate, which is a critical preconception and prenatal nutrient. If you test positive, you should not be consuming folic acid, but instead folate from food sources, along with methylated folate. You may also be advised to take precautions to avoid blood clotting (linked to MTHFR mutations) which cause miscarriage. You can find more about how MTHFR can affect pregnancies here.
5. Reviewing a month long hormone profile
When you have your blood drawn 7 days post ovulation, we can tell what your progesterone looks like on that day. However, progesterone can be at an appropriate level 7 days post ovulation, but be too low prior, or drop off sharply immediately following. If you have a sharp drop off 9 days after ovulation it often is not enough time for proper implantation, and the pregnancy will end early. To see what is really going on throughout your entire cycle with your month long hormone profile will provide a more accurate picture.
6. Having you chart your cycles
A charted cycle can provide so much critical information. Critical clues can be found when reviewing cycle length, luteal phase, quality of bleeding, and quantity of bleeding. Did you know that one or 2 days of brown bleeding can be normal, but 3 or more days likely indicators an infection or hormonal deficiency? There are a number of other clues that may appear in your chart.
7. Recommending an anti-inflammatory diet
Many of us are reacting to gluten, dairy, sugars, and grains. This can lead to inflammation which may be causing or exacerbating some of our health issues, including infertility. Our local infertility specialist often recommends cutting out gluten or dairy. This isn’t something you will necessarily need to do forever, but taking a couple of months to cut back and then cutting it all out for a month or two (Paleo or Whole30) may be helpful for both men and women. You may notice that some minor health issues improve - better digestion, focus, or energy. If you don’t notice any difference, you can add each item back in gradually to make see if you notice any reaction. While eating this way often requires more prep and pre-planning, it can be worth it to eliminate problem foods and increase consumption and absorption of more nutrient dense foods. Additionally, many grains have synthetic folic acid added to them- please check your labels.
Beyond treating the infertility, which is technically a symptom of an underlying condition, we also want to treat the underlying condition for the sake of health. Why? Because infertility is a risk factor for a number of serious conditions, that vary depending on diagnosis, but range from IBS to hormonal dysfunction to cancer, obesity, and hypertension, among others.
Women often tell me they went months or years without a thorough evaluation. Only after pursuing NaPro did they feel like a doctor was truly trying to figure out what was going on and working to create the ideal environment for a healthy conception and pregnancy.