In the United States, 12% of women age 15-44 will have difficulty getting pregnant or carrying to term. There are chances that you or women you know have had or are having a hard time getting pregnant. The answer to WHY this is happening isn’t always clear when you go to your PCP or OBGYN. If you’ve been trying to conceive and are unsuccessful, your provider may say “come back when it’s been a year”. Since infertility is defined as the inability to conceive within 1 year, but what can we do in the in between? In Functional Medicine, we believe there’s a root cause to everything and there’s always room to optimize health!

Statistics about fertility:

  • About 6% of married women ages 15 to 44 years in the United States are unable to get pregnant after one year of trying (infertility). Also, about 12% of women aged 15 to 44 years in the United States have difficulty getting pregnant or carrying a pregnancy to term.
  • Most couples (about 84 out of every 100) will get pregnant within a year if they have regular sex and don’t use contraception. But women become less fertile as they get older. One study found that among couples having regular unprotected sex: aged 19 to 26 – 92% will conceive after 1 year and 98% after 2 years.
  • MTHFR gene mutation affects the body’s ability to breakdown an amino acid called homocysteine and convert B-vitamins from their inactive form to active. Studies have found that women with two gene variants have an increased risk for having a child with a neural tube defect or experiencing miscarriages.
  • One study indicated that of 394 women experiencing infertility, 23.9% had hypothyroidism. Of those women, 76% were able to conceive within 6 weeks to 1 year of treatment.
  • Optimal progesterone levels could prevent 8,450 miscarriages a year.
  • Low serum levels of progesterone are associated with low percentage of ovulation in infertile women with regular menstrual cycles and women with unexplained infertility.

Many conditions linked to impaired fertility (low progesterone, hypothyroidism, etc.) can be treated! Preconception testing will arm you with the knowledge you need to address root cause dysfunction and optimize fertility and health for conception, pregnancy, and postpartum!

FIRST, start by tracking your menstrual cycle! HERE is a helpful blog post to get you started.

Make note of:

  • Length of menstrual cycle (Day 1 being first bleeding day until start of next period)
  • Average day of ovulation
  • Length of luteal phase.

Request these markers from your provider:

  • Estradiol(E2)- secreted predominantly by the ovaries and also adrenal glands. Responsible for maturing and releasing the egg during ovulation. Helps to maintain pregnancy when released by the placenta. This is the most important hormone, along with progesterone, during female reproductive years.
  • Estrone (E3): Secreted from the ovaries, as well as the adipose tissue and adrenal glands.
  • Progesterone: secreted from ovaries and adrenal glands. Triggers the endometrium lining of the uterus to thicken in preparation to receive a fertilized egg.Optimal levels are needed for health menstrual cycle as well as sustaining a pregnancy.
  • FSH/LH: Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) communicate with the ovaries to mature and release oocytes (eggs) during ovulation.
  • Anti-mullerian hormone (AMH) is used to assess a woman’s ovarian reserve, egg count or marker of oocyte quantity.
  • Full thyroid panel- TSH, Free T3 and T4, possibly thyroid antibodies. Optimal thyroid function is needed, specifically during the luteal phase of the cycle to support ovulation. Dysregulation can affect fertility and the ability to conceive.
  • DHEA and Testosterone: The androgens seem to promote the growth of the follicles responsible for containing and then releasing mature eggs.
  • Cortisol: Stress hormone secreted from the adrenal glands and impacts conception.

When should labs be drawn?

Knowing the timing within the menstrual cycle is necessary in accurately interpreting hormone levels. We know that our hormones rise and fall in different patterns throughout the cycle. For example, estradiol should peak before ovulation while progesterone peaks after ovulation. Ideally, we draw a set of labs during the luteal phase, ~5 days after ovulation. It can also be useful to draw labs during the follicular phase to assess estrogen and FSH.

Other markers that impact fertility and optimal maternal and fetal health:

  • Methylation and MTHFR:
    • Check B12 and B9 levels as well as MTHFR gene mutation status.
    • Methylation is an epigenetic mechanism involving the transfer of a methyl group. The process helps repair your DNA, regulates hormones, produces energy, protects against cancer, supports detoxification, keeps your immune system healthy, supports the protective coating along your nerves, strengthens the nervous system and on and on and on. There are many vital components needed in this process, B-vitamins (B9 and B-12) being some of them. As mentioned previously, genetic mutations in the body’s ability to convert b-vitamins to their active form can result in neural tube defect and misscarriage.
  • Blood sugar:
    • Fasting glucose, A1C and insulin, which effect egg quality and maturity
  • Iodine:
    • Nutritional mineral necessary for optimal thyroid hormone formation.
  • Omega check:
    • Measures 3 major omega-3’s EPA, DHA and ALA as well as ratio of omega 6/3 levels.
    • Omega 3 Fatty acids can play a role in the quality of oocytes and are important for fetal brain development.
  • Vitamin D:
    • Optimal Vitamin D levels appear to be linked to higher rates of conception.
    • During pregnancy and fetal development, many physiological changes in the maternal body require higher Vitamin D levels. Maternal Vitamin D requirements can increase up to four- to five-fold to facilitate the availability of extra calcium required for fetal skeletal growth.

Functional Testing:

  • Toxic burden profile:
    • Test for the presence of excessive environmental toxin exposure.
    • Environmental toxins are cancer-causing chemicals and endocrine disruptors, both human-made and naturally occurring
    • An average of 200 industrial chemicals and pollutants were found in umbilical cord blood from 10 babies born in August and September of 2004 in U.S. hospitals. Of the 287 chemicals we detected in umbilical cord blood, we know that 180 cause cancer in humans or animals.
  • Nutraevel: Comprehensive functional and nutritional assessment to optimize fertility.
    • Assess for oxidative stress, mitochondrial function, omega imbalances, toxin exposure, and methylation imbalance.

The journey of becoming a parent is a unique one. No two people are the same. With this information, you can go into the conception period with more confidence and peace in the process. For ways to boost fertility, check our Dr.Kristin Oja’s blog post HERE!

Want to take the functional medicine approach to conception? Schedule an appointment with me HERE!

Learn more about Athena Newell, FNP-C HERE!