Feeling Like a Number in the Fertility Process? Get Expertise + Support!

One thing sadly missing for women in the fertility process is sufficient support! Are you with me on this?

I think of it as a gap in health care.

In contrast, from the very beginning, I try to extend that support. I really like the complimentary 15-minute “get to know you” phone calls that I do with prospective clients because they allow women to see if they feel comfortable with me and my approach and to ask questions, and for both of us to sense if Simplina would be a good fit. Do we communicate well? Do the services I offer make sense and sound well-targeted to their needs? Do they have the feeling that this is the level of expertise and support they are looking for?

I think of it as the beginning of women who work with me experiencing being treated like human beings, with the respect and support they deserve.

On a call this morning, Melissa (not her real name) said, “I’ve never had anyone look at my whole fertility picture. I’ve been to my OB-GYN, I’ve been to IVF, and I’m still trying to figure it all out on my own. And I’m overwhelmed!”

I completely understand and that’s why I am here. All women seeking to conceive need someone to look at our health with expertise and understanding; to listen and put together all the pieces of our individual puzzles to orient us towards the best possible outcomes; and to treat us with respect, support, and care.

The goal of Simplina is to make your fertility journey easier, more positive, and more compassionate.

You may well be asking, What type of practitioners can provide the fertility expertise and support that I need? You might be looking in the wrong places.

Healthcare Providers in the Fertility Space

Some of the most common questions I get on my 15-minute discovery calls are “Why can’t I get this care at my doctor’s office?” “Can’t my OB-GYN help me get pregnant?” “Are there other ways to get pregnant besides IVF if I can’t?” and “What is a fertility specialist?

It might help to look at what specific practitioners do in the fertility space.

OB-GYNs and midwives provide critical care from once you conceive to delivering a baby. Increasingly, many work in a high-pressure environment with tremendous demands on their time and fluctuations in their schedules although midwives can be more available. Being a mom myself, I am so deeply appreciative of the care I received when I was pregnant and all through labor. However, OB-GYNs are allotted only 15 minutes on average for a well-woman visit. In that slim period of time, they need to do an exam and order tests. They simply don’t have enough time to go through potential causes of infertility. Furthermore, their training is focused on the pregnancy and delivery stages, not the preconception stage. That is why when you ask “Why can’t I get pregnant?” you might not get much information.

Reproductive Endocrinologists are the doctors at IVF clinics. Their field is a surgical subspecialty of OB-GYN and they are trained in assisted reproductive technologies (ART). IVF treatment includes IIUI, IVF, egg freezing, and using donor eggs. They can also have additional surgical training that allows them to do specific reproductive surgery if there is a physical reason for infertility. The procedures they can do include: removal of ovarian cysts or polyps; myomectomy, the removal of uterine fibroids; tubal ligation reversal, which unties your tubes; and others.

Reproductive Endocrinologists are there to help you figure out what could be causing your infertility. They are excellent at doing diagnostic testing including HSG, saline sonogram, and a full blood work-up including genetic testing for you and your partner. I think the diagnostic testing offered at IVF clinics is important and I highly recommend clients struggling with infertility do this analysis. Most Reproductive Endocrinologists' time focuses on getting you pregnant and utilizing assisted reproductive technologies to do so. If you do have a physical reason for your infertility, such as blocked tubes, you need to utilize IVF.

While IVF may end up being the answer, there are a number of reasons that can be reviewed in more depth and detail by other health practitioners.

Taking a Deeper Dive Into “Why Am I Not Getting Pregnant?”

From my perspective as a functional medicine and nutrition practitioner with a speciality in fertility, there is a long road between the OB-GYN who tells you to “go to IVF” when you can’t get pregnant and that first IVF appointment, much less getting your basic assessment. In Washington DC, average wait times are about a month to get in and in some places, it’s longer. You’ll start with a full work-up, get the recommended diagnostic testing, and make sure there is not a physical cause of infertility. This takes time.

Beyond the IVF assessment, a functional medicine and nutrition assessment will look at how well your body’s systems are working and into the root causes of health issues. If you have been diagnosed with “unexplained infertility” a very frustrating diagnosis, then it is especially important to take a deeper dive into why you are not getting pregnant.

There are a number of causes of infertility— autoimmune, nutritional, genetic, thyroid-related—that the IVF clinic may not be looking for. This is where other fertility specialists come into the picture. There are an array of allied health providers with additional training or specialization with fertility and these include Functional Medicine, Nurse Practitioners, Naturopaths, Nutritionists, Acupuncturists, Doulas, and Fertility Coaches. These providers can work in conjunction with one another or alone to help you put pieces of your fertility puzzle together. They can help answer the question of what’s causing unexplained infertility and discuss with you what other options are there besides IVF?

Depending on their training, these providers may have different answers for what causes infertility in males and females. For example, acupuncture looks at the body from a very different perspective than western medicine and can yield interesting answers—plus there is evidence that acupuncture can be helpful for infertility.

Someone Should Hear Your Story and Not Treat You Like a Number

The most common complaint I get from IVF clients is that they feel like they are just a number and get rushed in and out of their appointments. Another common complaint is that they feel bad after the appointment because of what was said. I’ve heard of physicians saying “Why did you wait so long? You are in overtime now….Come on!” Or a reason for recurrent miscarriage being, “You are just unlucky.”

Emotional shame has no role to play in the fertility process. When you are seeing any provider, whether it be a fertility provider or another, you should expect them to carefully review your existing labs, listen to your story and experience, order additional testing, and treat you respectfully and with care. The treatments that you undergo should take into consideration your health history and the quality of your life. They should take into account that you are a person. You deserve this, by all means.

What Causes “unexplained” Infertility?

I often get asked for the common cause of not getting pregnant. In order to get pregnant, you need to ovulate successfully. It is thought that the most common cause of infertility is abnormal or absent ovulation. Many women experience missed periods, Polycystic Ovarian Syndrome (PCOS), and irregular periods. These are all signs that you are not ovulating. You could also have a regular period and still not ovulate, which is why I recommend a range of therapies to test for ovulation.

There are many other contributing factors to infertility. It could be genetic, MTHFR, hormonal, gut infections, your partner’s sperm, nutrient deficiencies, age and increased risk for chromosomal abnormalities, cortisol imbalance, thyroid imbalance, adrenal, poor egg quality or poor sperm quality, blocked tubes, cysts, fibroids or polyps blocking implantation, thin uterine lining, failure to produce enough progesterone to allow the fetus to grow, implantation failure, blood clotting disorders, phospholipid antibodies, and autoimmune conditions, among others.

The point is that there are many factors commonly outside the scope of conventional medicine that can contribute to not getting pregnant and these factors can be found in both males and females. Your and your partner’s issues might not be unexplained if they are appropriately explored.

What to Look for in a Fertility Provider

I believe there should be an option for all women who want to find out more about why they are not getting pregnant before beginning IVF therapy. Right now this is a gap in the healthcare system and one that I am filling.

In my practice, I do a careful case history review. I look at related medical records and lab tests. My own intake consists of over 100 data points to get to know you in detail. I also order additional testing to formulate a fertility program personalized for you. My motto is “test, don’t guess.” There are very simple things we can find out like iron status as well as more complicated things like genetic SNPS, but all are useful knowing to put together your fertility puzzle.

I believe in leaving no stone unturned.

We work together to help you improve your egg quality and your partner’s sperm quality, address nutrient imbalances, promote full gut functioning, hormonal balance, and lifestyle change. And, we get started right in the first appointment. You don’t need to wait weeks more to start your personalized program to optimize fertility.

We then review test results and new data and how you respond to various changes to build out your personalized fertility plan. Your partner is in this too and gets recommendations and testing done as well. We also have a timeline and plans for further bumps in the road. If X happens then we will proceed with Y. This way you are not left hanging….wondering what to do next.

Our appointments can be done if you want to continue to try to conceive naturally, before proceeding with IVF or in conjunction with IVF.

I am a nutritionist and not a Medical doctor. My work does not replace your primary care, OB-GYN, or reproductive endocrinologist. I can, however, take more time to really look at your case history, order additional testing, and start to make sense of your fertility puzzle.

You are not alone and you should not feel overwhelmed. It’s my wish that all couples have the support and care that they need when dealing with infertility. I hope you become one of them!