I Am Not Getting Pregnant…Now What? Where Do I Start with Fertility?
Some things in life come with specific instructions. Applying for a new job is pretty clear-cut: look at job listings, choose an interesting opening, research the company, and submit an application. We don’t know what will happen in terms of the outcome, and we don’t even know for sure if we want to work there until we interview and meet people, so we aren’t 100% invested in our application until the very end of the process. The fertility journey is... different.
If pregnancy doesn’t just happen on its own, then we are left wondering what to do next, but we sure know that the outcome we want—a baby!— and on a certain timetable. We know the outcome and we are vested, but there are no clear instructions on how to get there, especially if we don’t fit a standard diagnosis.
Many of you may be asking some questions I commonly get such as: “How to boost fertility in your 30s or your 40s?” “How to improve egg quality?” “How does diet affect fertility?” “Is there such a thing as fertility boosting foods?” “Are there foods for ovulation stimulation?” There are answers to all of these questions and functional nutrition provides us some very good answers. However, not all fertility practitioners have expertise in functional nutrition. It is important to get both standard fertility care and additional support for lifestyle and nutrition changes that can boost your odds at conceiving.
The standard ob-gyn advice is to try for six months and if that doesn’t work go to an IVF clinic. I was recently talking to someone with a 17-year-old and she said she got the exact same advice 18 years ago! I find it slightly disheartening that with all the new available science, fertility guidelines have not changed in two decades.
So, where do you start? What should you do?
If you look online, there is endless advice. Yet, what is right for you? What makes sense given your health history, genetics, and age?
This is why I do what I do: I believe fertility plans should be customized, made easier, and result in more successful outcomes.
My role is to guide women through their fertility journey with a functional medicine model. Here are the recommended steps in this evidence-based approach to creating a custom plan:
Find a practitioner
I think it is critical that you find a practitioner who will listen to your health story. A place where you are not a number nor strapped into a one-size-fits-all protocol.
Your practitioner should ask an array of questions about your health: Do you have a history of thyroid disorders or autoimmunity in your family? Do you have genetic SNPs that predispose you to need certain types of nutrients in a different form such as MTHFR and methylated folate? Did your mother or other family members have difficulty conceiving or repeated miscarriages? Have you had genetic testing done on both you and your partner? What do you use to tell if you are ovulating?
The practitioner you work with should really do a full assessment to help understand where you are in the fertility journey. Not everyone is the same and you have a unique genetic blueprint and a unique experience that needs to be taken into consideration when formulating a fertility plan.
Finally, you should feel comfortable and supported by your healthcare provider. All too often, I hear my own clients feel stressed or lack confidence when interacting with their provider. It is very important that you feel you are on the same page. Your provider should give you expertise, experience and a roadmap of what to do next. They should be listening to what your experience has been so far, dig deeper for answers and provide you with kindness in how they communicate and care for you.
Get the right testing done
What do your labs look like? Have you done properly timed hormonal testing, gut function, and nutrient testing? This testing gives us a foundation to understand how well your body is absorbing nutrients and producing hormones and whether those hormones are in sync with the ovulatory rhythm.
Do you have other testing such as a uterine sonogram or HSG to see if there are any physical reasons for infertility such as cysts or blocked fallopian tubes? Standard labs to look at blood glucose and immune function? There is no reason to guess when we can have answers. My motto is “test don’t guess.”
There is a difference between standard labs and functional labs. We cannot test for every vitamin/mineral on standard labs, but we can on functional labs. Your nutritional status is important for your body's ability to make good quality eggs (and it is just as important for your partner too!) You might feel like you are generally eating well, but you could not be eating the right foods and taking the correct supplements for genes, your body type, your lifestyle and how often you exercise. Another common cause of not having adequate nutrients is gut health. If you suffer from dysbiosis, IBS, SIBO or constipation - your nutrient absorption could be suboptimal. We will know this through clinical signs and functional testing.
Check your methods
What have you done so far? Are you timing ovulation? How? Are you looking at cervical mucus, BBT, cycle days, or referring to an app? Are you definitely ovulating? Not all women are on a 28 day-cycle are ovulating on day 12 and this can make a big difference if you are off on your timing.
In my practice, we go over the methods. It is something most of us were not taught in sex ed, which is how to actually get pregnant. As we age, the timing can shift and the ovulatory window can shorten. When you’re in your 20s, you have a longer time each month that you are more likely to conceive. For women into their 40s, that window can be a day. Therefore, knowing all the clues for ovulation are critical to maximize your chances each month.
It is also important to figure out whether you are actually ovulating. Women can have regular cycles, but not be ovulating. There is specific testing that can be done at home to assess whether you are ovulating. This can save wasted time if you are not ovulating and get right to the source of the infertility.
We look for and get answers. There is no need to be left in the dark.
Start lifestyle change now
What do I love about what I do? There are no side effects to getting healthier. It will only make you feel better, be stronger, and increase your chances of conceiving naturally, but also with IVF. Optimum health is like a blank check – the possibilities are endless. Changing how you eat is not “trying to remember to eat a few more fruits and veggies.” Clean nutrition is a way of living that embraces reduced chemicals, natural food, healthy cooking, and getting full nutrients targeted to your body type and needs.
Simple things to start
Eat real food only.
Focus on good quality organic grass-fed protein, gluten-free grains, and lots of veggies.
Drink filtered water and use electrolytes.
Green your home and cleaning and beauty products.
Schedule moderate physical activity daily.
Take prenatal vitamins with methylated folate.
Have a game plan
There is no reason to do the “wait and see” approach before discovering more that is the standard decades-old advice. After doing testing, analysis, and appointments, you will have a personalized game plan—What to try, how long to try, and what the next step is. That will give you the assurance and security that you are not left out there on your own.
Leap, and the net will appear
At some point, you have to have a plan to move forward with your dreams and your life. Don’t wait until you get the baby, or until you finish IVF, or until…. something. Life is short and the days don’t stop when we are focused on fertility. If you are looking to switch jobs, pursue something creative you love or have more time to take care of yourself. These are important things to include in life and don’t wait. You come from a position of strength knowing you have done everything you could do, and the future possibilities open up.
There is so much I can do to provide you with specific guidance based on your health needs, genetics, lab results, and current lifestyle. Make an appointment to get both the exact personalized program designed just for you and the support you’ll need to make it work.
Would you like to talk?
Schedule a free 15-minute call.
Annina is a PhD, Registered Dietitian, Licensed Dietitian Nutritionist and Board Certified in Functional Medicine specializing in nutrition and functional medicine for fertility, pregnancy and new mom and baby. She has 7 years of practice experience and has co-authored several books on infant, child nutrition and obesity prevention.