Unexplained Infertility
Getting a diagnosis of unexplained infertility can leave many couples feeling frustrated and powerless. On one hand, all the conventional medical testing has said everything is looking healthy and they are unable to find anything “wrong”. This should be good news, right? After all, nothing is wrong. But it leaves the question, “Why aren’t we pregnant yet?”. This diagnosis may leave couples feeling like there is nothing they can do except expensive fertility treatments. And if those fail, what is left to do?
As a naturopathic doctor, I have found there are several additional considerations that I make when working with cases of unexplained infertility.
Egg Quality
It all starts with the egg and sperm. Most of my practice involves the female partner looking to optimize fertility (although many cases of infertility are male cause in origin), so I always want to look at egg health. Egg quality can become more of an issue as women age, but I find it is useful to support this when dealing with unexplained infertility at any age.
Luteal Phase Defect
After ovulation the corpus luteum secretes progesterone. This is an important hormone in the maintenance of the pregnancy. If that luteal phase is shorter than 10 days, that may be a factor in unexplained infertility. Conventionally progesterone is only measured on Day 21 (or 7 days after ovulation) and this may not adequately assess the health of the luteal phase. There are additional tools used in my medical practice to assess the luteal phase.
Immunological Infertility
The job of the immune system is to keep us safe from organisms it deems as foreign (non-self). Therefore, it makes sense that the immune system would take notice of a foreign body like a fertilized egg implanting within the uterus. The female body has distinct mechanisms in place to account for that but the shift to allowing the development of the implanted embryo to continue growing within the uterus can go awry. Further examination of this dysfunction and investigation into the presence of autoantibodies like those in celiac disease, IgG food sensitivities, anti-thyroid antibodies, anti-thyroid peroxidase antibodies (as in Hashimoto’s), anti-nuclear antibodies and anti-phospholipid antibodies can often give more answers. The health of the microbiome and gut is assessed given its role in healthy immune function and hormone balance.
Sperm Health
Many couples have had a semen analysis at some stage and been told, “its fine”. Just as we spend time optimizing health with the female partner it is useful to spend time optimizing the male partner. There are many naturopathic tools that can impact both the commonly tested parameters for sperm health (semen volume, sperm concentration, motility, ph) and the less commonly considered male fertility factors such a levels of DNA fragmentation in sperm, testosterone levels, coital practices, immunological factors, and age.
Stress Effects
Fertility challenges can be incredibly stressful. The stress can impact your health and life in ways that are profound both for your fertility and your overall well-being. Stress can also arise from a busy working life, challenging family issues or chronic anxiety. All these situations may result in excessive stimulation of your internal stress response and the release of stress hormones. This stress response may shunt blood flow away from pelvic organs or impact key reproductive and thyroid hormone secretions as part of a natural survival mechanism that downplays reproduction’s priority during highly stressful times. Healthy stress management tools are a key part of natural fertility support and may include strategies like mindfulness practices, meditation, yoga, nutrition, herbal medicine, and acupuncture.
Adrenal and Thyroid Health
Naturopathic doctors view these hormonal systems through a different lens than conventional physicians. Where conventional medicine is looking for overt pathology, naturopathic medicine asks, “Is this optimal?”. It is through the optimization of adrenal and thyroid health that fertility can be supported. For this reason, often a more thorough thyroid assessment is included as part of your naturopathic fertility assessment. Adrenal dysfunction may be tested via laboratory methods but often can be identified through your health history.
Holding Space
The heartbreak of infertility is very real and powerful. This is not something you asked for and likely never thought you would encounter. We spend so much time as young women working hard to prevent pregnancy that it can sometimes come as a surprise when that pregnancy Is not achieved as easily as we feel it should. If you are struggling with infertility or have been given a diagnosis of unexplained infertility, please know that you don’t have to navigate this alone. Let me help you sift through the science and the steps to optimize your health and get you where you want to go.
Dr. Nicole Shortt, ND
Dr Nicole Shortt, BSc, ND is a Naturopathic Physician who is passionate about naturopathic medicine and the choices it gives people in health care.
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