Authored by; Dr. Shannon Vander Doelen, ND
If you’ve been working with a fertility clinic to try to figure out why you haven’t had success in getting pregnant, receiving a diagnosis of Unexplained Infertility can be incredibly frustrating. On the one hand, you’re relieved to hear that “nothing is really wrong,” but on the other hand, you’re left with more questions than answers, and may not feel clear about the right next step. Though fertility clinics are often quite thorough in their initial assessment for a patient or a couple who have been trying to conceive, sometimes a few tests are overlooked, but may explain your infertility. Double check that you’ve had the following tests performed:
Vitamin D Levels
Vitamin D deficiency has been linked to many different health outcomes, including infertility. The sunshine vitamin serves so many roles in supporting us to get pregnant, starting with egg quality, our immune system function, our lining quality, and early embryo development, just to name a few. And just because you are taking a supplement or spend time outside does not mean your levels are adequate! A test is really the best and only way to determine your levels, and will allow you to supplement accordingly to boost your levels up into the optimal range.
Thyroid Antibody Tests
Autoimmune thyroid conditions have also been linked to infertility and miscarriage risk. Doctors will very often test our Thyroid Stimulating Hormone (TSH) levels, and if they are good, they may not look further. Our thyroid antibodies (called thyroid peroxidase antibody, or TPO, and anti-thyroglobulin, or anti-TG) can be elevated even in cases of normal TSH levels, and they can impact our fertility independently of TSH levels. It’s especially worth looking into these levels if you are experiencing secondary infertility (or trouble conceiving a second/subsequent child), as a previous pregnancy/postpartum experience can be taxing on your thyroid.
CA-125 for Endometriosis
Endometriosis is a condition where the tissue that is normally found inside the uterus is found outside of the uterus. It is thought that endometriosis can impact our fertility in numerous ways, from creating scar tissue, to overall creating a more inflammatory environment. Frustratingly, endometriosis cannot be seen on a standard ultrasound evaluation. And even more frustratingly, the severity of symptoms of endometriosis (pain mainly, with our periods, with urination/bowel movements, or with intercourse) don’t always correlate with the severity of disease, with some people not having any symptoms at all. CA-125 is a blood marker that when elevated, may indicate endometriosis. So when it is elevated, we can rule in endo (but if it is normal, we can’t necessarily rule out endo).
Insulin is a hormone that manages our blood sugar when we eat. In general, we don’t want elevated levels of insulin relative to our blood glucose (this is referred to as insulin resistance). Testing our fasting insulin along with our fasting glucose, and then comparing the ratio between these values helps us assess for insulin resistance. Insulin resistance can negatively impact egg quality, ovulation, hormone levels, and implantation. Insulin resistance can be asymptomatic, but can also show up as non-specific symptoms like fatigue, stubborn weight loss, acne, cravings for sweet foods, and changes to skin pigmentation.
Progesterone, Tested 7 Days After Ovulation
I often see progesterone being tested along with our other Day 3 hormones. To be perfectly honest, the result of this test on this day is not particularly valuable, because our body only produces progesterone after ovulation, so we’re not usually expecting to have much progesterone in circulation on Cycle Day 3. However, we do want to make sure we’re getting a good progesterone surge approximately 7 days after ovulation to support the growth and maintenance of your endometrial lining, and to support implantation. So even if you’ve had your progesterone tested, double check which day of your cycle it was done on!
If you have not had these tests done, you can definitely speak with your fertility clinic about them, or consider meeting and working with a Naturopathic Doctor who can facilitate a thorough initial assessment of your fertility and fertility history, and then recommend any testing that may be pending to help round out your fertility assessment to ensure you have ALL of the information you need to make an informed decision moving forward.
I am currently accepting new patients and welcome you to book a free 30 minute meet and greet call so we can discuss your health and what options are available to you moving forward!