Exposure to organic pollutants and endocrine-disrupting chemicals (EDCs) like PCBs and TCCD dioxin affect fecundity: According to the NIH, “EDCs alter the function of the hormonal system, a key component in fertility. The LIFE study found that the EDC methyl paraben af- fects fertility in women, while phthalates and the UV fi lter benzophenone-2 affects fertility in men.”


Infertility Evaluation


With six months to a year already behind most couples before seeking evalu- ation for fertility, it is vital to assess both partners. Female and male evaluation is crucial before identifying the most effective treatments. There is nothing more crushing for a couple to spend months and months treating a “probable” female cause, when a semen analysis on the male partner has never been done. Remember, 40% of infer- tility is a male partner issue, with another 20% male and female combined issue. Therefore 60% of the time the male partner may need treatment.


Female evaluation will include a de- tailed history of health, cervical health his- tory (abnormal Paps, LEEP procedures, cone biopsy), and mental/emotional assessment.


Included in the initial screening will be a physical exam and blood tests. Functional testing such as the DUTCH test can offer insight into many causes of infertility with a few samples of dried urine. The gold stan- dard in functional fertility testing, it looks at multiple facets contributing to infertility, such as sex hormones, stress hormones and toxic burden markers. Additional testing may be ordered if baseline testing indicates a deeper investigation is needed.


The “test de jour” for infertility is anti- mullerian hormone (AMH). A lower AMH level indicates decreased ovarian reserve. Recent studies show AMH may be less ac- curate though with Vitamin D defi ciency. The CDC reported in 2011 that 50% of women ages 19-50 were insuffi cient in Vitamin D, and 23% were defi cient. Antral follicle count is another test to detect ovar- ian reserve using trans-vaginal ultrasound to determine the number of follicles in each ovary. Studies show that decreased ovarian reserve is associated with fewer eggs avail- able, but does not change the ability to get pregnant. However, it may be more diffi cult to conceive. This point is very important to make when considering the fear many woman experience when told AMH and AFC numbers are low.


Male evaluation will include a simi- lar detailed history of health, testicular health/injury, occupational exposure, and mental/emotional assessment, along with a physical exam and blood tests. A semen analysis is critical to avoid lengthy and often unnecessary testing and treatment of the female partner.


Fertility Treatment 1. Timing!!!


Sound obvious? According to an Albert Einstein College of Medicine 2019 study, only 20% of women knew they were fertile 3-6 days out of a month’s cycle, and 16% of woman in the study believed they were most fertile during their menses. Timing is essential because an egg is only fertile for 12-24 hours after being released from the ovary. Sperm can survive in the female reproductive tract for up to 5 days, so the fertile window is considered 5 days before and one day after ovulation.


Teaching woman their body’s ovulation prediction kit (OPK) helps remove uncer- tainty about “well-timed” intercourse, and allows the physician to rule out timing as the issue. The body’s OPK consists of cervi- cal position, cervical fl uid, and basal body temperature (BBT). A study in the journal


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