By Dr. Shawna Darou, ND
As a naturopath with a large hormone focus in my practice, I see many people with fertility struggles. The diagnosis that most commonly brings people to a me is ‘unexplained infertility’. This confusing diagnosis leaves women unsure of what to do next – should they move forward with invasive fertility treatments, or simply keep trying on their own?
Below are ten things I wish everyone knew about unexplained infertility to move through this diagnosis with optimal support.
1. Unexplained infertility simply means undiagnosed.
This point is the most important. In many cases, there has not been adequate testing done to identify the issue causing fertility struggles. If you have only had very basic bloodwork, one round of cycle monitoring and a semen analysis, keep looking!
2. Endometriosis is the most common cause of unexplained infertility.
Because endometriosis is not a condition that can be tested on bloodwork or seen on ultrasound, it is not often identified in a preliminary fertility workup. If you have painful periods (usually since puberty), painful intercourse, very heavy flow, or cramps leading up to menstruation, this could be the answer. Unfortunately, endometriosis can only be accurately diagnosed through laparoscopic surgery, but there are natural ways to reduce pelvic inflammation that can help.
3. Stress can affect your fertility.
Stress affects your ovulation response, progesterone levels, thyroid function and amplifies most health conditions. If everything else looks normal, look for ways to support stress management, such as yoga, acupuncture or mindfulness. Stress alone is rarely the answer, think of it as the amplifier that makes any other issues that may be present much bigger.
4. Your immune system can also affect fertility.
If you have immune conditions such as significant environmental allergies, eczema, asthma or an autoimmune condition (ex. thyroid disorders, rheumatoid arthritis, lupus, celiac disease, crohn’s disease or colitis), your immune system may not be receptive to pregnancy. Supporting your immune system and lowering inflammation through diet and specific supplements can be very helpful.
5. Egg quality can be an issue, even in your early thirties, and is very likely an issue in your late thirties or early forties.
Unfortunately our eggs age as we do, and in some cases prematurely. When all hormonal tests look normal, consider testing your ovarian reserve with a test called “Anti-Müllerian” hormone as one potential indicator. On a positive note, supplements such as coenzyme Q10 and PQQ which support mitochondrial function can help support egg quality to a degree.
6. Don’t let anyone blame your infertility on your age alone without a thorough work-up. Often women over the age of 35 are not sufficiently assessed.
On the flip-side, it may not be your age and egg quality. In many cases, a fertility assessment is less thorough in older women because specialists are making an assumption that it is just your age affecting your fertility. Request a full assessment before diving straight into IVF.
7. Take a good look at thyroid function, including thyroid antibodies.
Thyroid disorders are under-diagnosed, and thyroid function needs to be in an optimal range to support your fertility and sustain a pregnancy. Make sure you have had a thorough assessment, especially if you have other symptoms such as difficulty losing weight, long menstrual cycles, fatigue or feeling cold easily.
8. Don’t forget to check progesterone levels.
It’s amazing how often this is missed, and also surprising how often women have low progesterone. On the positive side, this is quite easy to fix either with herbs to support progesterone or directly with progesterone medications.
9. Your weight can affect your fertility.
Being both under or overweight can impact fertility. Underweight women can have low estrogen levels or irregular ovulation. This can also happen with over-exercising. Being overweight may be associated with hormone imbalance (ex. polycystic ovarian syndrome), inflammation and miscarriage. Seek sensible support to optimize your weight if this is a concern.
10. Make sure male factors have been thoroughly assessed.
Simply a single semen analysis is not sufficient to rule out male factor issues affecting your fertility. Hormone testing is a must, as is a test called “DNA fragmentation” especially if your male partner is over 40. In fact a very recent study found that sperm from men who’s partners had suffered recurrent miscarriage had twice as much DNA damage compared to the control group (1).
In conclusion, don’t give up hope if you have received this frustrating diagnosis of unexplained infertility. Seek a second opinion, ask for more testing and see a naturopathic physician.
(1) Channa N. Jayasena, Utsav K. Radia, Monica Figueiredo, Larissa Franklin Revill, Anastasia Dimakopoulou, Maria Osagie, Wayne Vessey, Lesley Regan, Rajendra Rai, Waljit S. Dhillo. Reduced Testicular Steroidogenesis and Increased Semen Oxidative Stress in Male Partners as Novel Markers of Recurrent Miscarriage. Clinical Chemistry, 2019; 65 (1): 161 DOI: >
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