• Ovarian reserve: cycle day 3 follicle- stimulation hormone; estradiol levels; clomiphene citrate challenge test; antral follicle count.
• Uterine and fallopian tube: hysterosalpingogram to test tubal patency and uterine contour; follicu- lar phase transvaginal ultrasound.
Eumenorrhea, or normal menstrual
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cycles by history, is a highly accurate marker of ovulation, and anovulatory levels of serum progesterone (<3ng/mL) are found in only a very small minority of normal menstrual cycle patients. Therefore, if you do not have normal menstrual cycles and are considering conception, whether in the near or far future, it is advisable to seek out treatment for your abnormal cycles.
The results of ovarian reserve testing are not absolute indicators of infertility, but abnormal levels correlate with decreased response to ovulation induction medication and lower birth rates after IVF, which is of concern when considering advanced repro- ductive technology treatment options.
Unexplained Infertility
When healthcare providers cannot find a specific or likely cause from the standard testing above, the term “unexplained infer- tility” is used to describe a couple’s fertility status. Unexplained infertility cases apply to approximately 30% of infertile couples and it has been shown that unexplained infertility couples have a greater rate of spontaneous conception than couples with an identifiable cause for their fertil- ity struggles. According to the Journal of Reproduction and Infertility, spontaneous pregnancies have been reported to be 13– 15% in the first year of attempts, increasing to 35% the next two years of attempting to become pregnant, and can reach as high as 80% in younger couples in the following three years of unprotected sex. It is argued that with such a high rate of conception in unexplained infertility, no further fertility treatment is necessary.
26 Natural Nutmeg May/June 2021
The argument to stop here and wait can seem like torture for many eager couples who urgently wish to be pregnant, leading many physicians to refer patients to advanced reproductive technologies (ART) prematurely and unnecessarily. While many unexplained infertility couples will become pregnant without assistance, it is worth taking a look at other reasons for the couple’s inability to conceive. Often these reasons are not identified or addressed by mainstream doctors; therefore, couples will need to make an appointment with a functional medicine practitioner.
“Unexplained infertility can be even further explored through examining diet choices, lifestyle habits, and sleep disturbances/ habits, which, once corrected, can improve a couple’s chances of becoming pregnant.”
Unexplored Categories with Fertility Impacts
• Adrenal Dysfunctions: The gluco- corticoid (GC) cortisol has numerous studies showing high levels adversely impact health, including direct inhi- bition of the brain hormone, GnRH, that regulates FSH and LH release. GC also affects estrogen, progester- one, and ovulation.
• Thyroid Dysfunctions: Autoimmune thyroid conditions, even without elevated TSH, are linked to infertility with increased risk of miscarriage. Most physicians stop at TSH testing and never look at a full thyroid panel.
• Gut Health: Improper bacteria, poor intestinal lining integrity, and dysfunctional digestion and absorp- tion can all indirectly influence fertility health. Your liver’s role in removing hormones is another reason to look at the health of the digestive system.
• Nutritional Deficiencies: Due to genetic variants, some people are unable to create the active form of important fertility nutrients. Folate is one such nutrient and is vital for proper fetal development. Genetic mutations for activating folate into methyl folate are associated with recurrent pregnancy loss. Vitamin A is another commonly overlooked fertility nutrient. Deficiency of vita- min A can cause a genetic mutation wherein the body does not effec- tively convert food beta-carotene into the active form the body uses, retinol. Women with this muta- tion can have what is described as “golden ovaries” due to the accumu- lation of beta-carotene, as well as other menstrual abnormalities.
• Environmental Toxins: Environmental toxins can alter immune cell func- tion, produce inflammatory markers in the body, create progesterone
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