What Tests Can Be Done To Check Female Fertility?
I recently had a client tell me that she has had PCOS (Polycystic Ovary Syndrome) for over 10 years and when she told her fertility doctor, the doctor just shrugged and said “it shouldn't matter.”
Let’s be clear: your whole health matters. Taking care of your health and any health conditions you currently have, can improve your chances for getting pregnant and staying pregnant.
In a previous blog, “Why am I not getting pregnant,” I talked about some issues that can be making it difficult for you to conceive including age, environmental toxins, timing conception, stress and taking medication that interferes with fertility.
In this blog, I’ll discuss how different systems not working properly—thyroid, adrenal glands, hormones, and your gut—can contribute to infertility. And how assessing these systems are part of an intelligent, functional medicine evaluation of female infertility, providing important information to help maximize your chances for success.
The functional medicine approach to fertility
You might be asking, how can I gain or regain fertility naturally?
I have answers for you.
Functional medicine looks at the root cause of disease and disorders. Instead of finding growing plaque in your arteries and saying, “Here is a drug to stop it,” a functional medicine doctor asks, “What is happening in your life and the terrain of your body that’s influencing your heart’s ability to function properly?”
The same is true with fertility. Instead of saying “Let’s use drugs to bypass the whole process,” a functional fertility expert will ask, “Why are you not getting pregnant or staying pregnant in the first place?”
The foundation of health is how every cell works, every organ works, and how the whole system works in sync. Conception is a process of syncing in the body much like a symphony. Every instrument has a role to play at a certain point in the musical score, and every instrument needs to be in tune to achieve an excellent result.
Depending on your current state of health, a range of infertility treatments might improve fertility for you. Let’s explore what some of those might be.
All about your thyroid and infertility
Your thyroid is your master gland. It’s a small butterfly-shaped gland located in your neck near your throat. Thyroid-stimulating hormone, or TSH, is a pituitary hormone that stimulates the thyroid gland to produce thyroxine (T4) which is long-acting and then triiodothyronine (T3) which is short-acting. These hormones are necessary for all the cells in your body to work normally and help you regulate your metabolism, which converts food into energy for your body.
While “normal” on the lab chart is as high as 4.5, this is not true for fertility. The optimal range for TSH for fertility is 1.0-3.0.
Hypothyroidism and ovulation
If your thyroid is “low,” meaning the number is above 3.0 (thyroid terminology is very confusing), then low thyroid hormones can can elevate your prolactin and reduce the chance that your ovary is releasing an egg through ovulation—an essential step for pregnancy.
Most OB-GYNs and reproductive endocrinologists will check your TSH, Free T3 and Free T4 along with thyroid antibodies such as TgAB and TPO (to make sure you don’t have an autoimmune reaction to your own thyroid hormones.
It is worth noting that TSH has increasingly been seen as highly variable. For example, if you have a cold or are stressed on the day of your blood test then it can change. It’s worth getting it re-tested at the same time of day and again if it shows your levels are elevated when they normally are not.
If your thyroid levels are abnormal, your physician will likely recommend thyroid hormone replacement therapy.
Adrenal glands, cortisol levels, stress and ovulation
Stress? What stress?
Infertility is one of the most stressful events many of us experience in our lives because there is no definite end date and no definite answer for so many of us.
When you are stressed your body produces cortisol. It actually produces cortisol everyday, but stress causes extra output. If you have been stressed for a long time, your adrenal glands get fatigued and don’t produce enough cortisol. Cushing's syndrome is the clinical disease state with low cortisol, but many people are walking around before they get to Cushing's syndrome with fatigue and feeling so tired.
Stress levels matter for fertility and so do cortisol levels. If you don’t have enough cortisol, this can contribute to low-ovarian reserve. Not having enough eggs reduces your chances of conceiving.
Cortisol testing is becoming more common and I recommend it because it’s pretty easy to do to see if low-cortisol might be a contributing factor to your ability to conceive.
Balancing abnormal cortisol levels is a lifestyle modification. It involves more sleep, moderating your schedule, increasing your energy in the morning, better blood sugar control with a low-glycemic diet and supplements. The side effect: you are going to feel better.
Which hormones should be tested for fertility, and how?
Getting your hormones tested is a first step for the fertility journey. The catch? You need to have your hormones tested at the right time.
All too often, I see clients who got everything at one time. Your progesterone can look very low if it is done at the beginning of your cycle or your estrogen can look very high if it is done at the end of your cycle.
Timing is everything with hormones. There is testing now available that measures hormone levels every day of the cycle and there is also more commonly used testing that is done on day 3, day 12, and day 21.
Here is what you want to get:
Low hormone levels or high hormone levels impact your ability to ovulate, build a thick endometrial lining and support an embryo if one does attach to the endometrium.
The sweet spot is in the middle. There are functional medicine solutions and medication depending on what’s found with your hormonal levels. The first step is to know. Your physician can also do a vaginal ultrasound around ovulation to count your eggs and look for any polyps.
The effect of estrogen levels on female AND male fertility
Your estrogen levels can impact both male and female fertility. If they are too high they alter the hormonal balance. For men, high estrogen means low testosterone and a reduction in sperm. For women, high estrogen can increase your chances of PCOS or endometriosis which reduce your chances for getting pregnant.
The effects of gut dysfunction on Fertility:
Did you know that your GI system has over 100 trillion microbes? It’s like a rainforest ecosystem right in your own body!
We’re only just beginning to appreciate how much the gut does. It doesn’t just help you digest your food! Your gut is your second brain. It has more neurotransmitter receptors than any place other than your brain.
This is why what you eat can impact your mental health. Your GI system processes all your nutrients. It excretes harmful chemicals and hormones out of your system and the microbiome in your gut—how the bacteria all live together and how healthy they are—influence your vaginal biome.
Lesser well known is that chronic GI issues or a recent infection from something like a foodborne illness can contribute to having difficulty conceiving. To say it again: Your gut microbiome can change your chances of getting pregnant.
Overgrowth of bad bacteria and microorganisms like H.Pylori, which is found in 50% of people worldwide, reduces chances of conception along with a host of other health issues. Women with PCOS are more likely to have H.Pylori and are less likely to get pregnant. The more we learn, the more we realize how interconnected all body systems are–and fertility is all about connection.
Can celiac disease cause infertility?
The answer is yes, and checking for celiac disease is a simple blood test that you can get done as well. Celiac can reduce fertility, impair thyroid hormones, harm the intestinal lining of your gut and reduce your body’s ability to absorb nutrients. It is a test worth getting even if you eat wheat and seem to feel fine. When it is the answer, it’s fixable.
Gut testing is the one thing that is not really done routinely for fertility testing, yet so often I find things in my own clients have results in their GI testing that need to be addressed.
H.Pylori, candida, overgrowth of bad bacteria, parasites, worms—it all sounds gross, but it matters for your overall health and it matters for your fertility. Treatments can include herbs, antibiotics, dietary changes and eliminating certain foods. It all depends on what is found, but this is stuff that needs to be addressed prior to conceiving if at all possible.
Nutrition for fertility
While you’re waiting for testing and test results, don’t wait to take care of you. Eating well can help your body be in optimal health.
This means really good quality organic fruits and veggies and lots of them (2-3 servings of fruit and 5-9 servings of veggies a day), a rainbow assortment of colors on your plate (signifying nutrient density), organic grass-fed protein (red meat, dark meat chicken, and cold water fish), no added sugars, and limited nutrient-rich whole grains.
You might benefit from a specific diet like gluten-free or dairy-free based on your lab results. You’ll want meals to be high in antioxidants, low in inflammatory foods, and for each meal to be a powerhouse of energy to support ATP production, which goes into intensive gear when the body is trying to successfully conceive and implant an embryo.
Targeted nutrition therapy and clinical care based on specific health conditions identified in lab testing can personalize your fertility plan to best address your individual needs. I would get testing done even if fertility is something in your future plan, but not what you are doing today.
As always, if you are having difficulty figuring out where to start, book an appointment and we’ll get you on your way. :)
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.