When I first started looking into why I wasn’t getting pregnant almost 10 years ago, I went to my local, regular Ob/Gyn. The experience was underwhelming, to say the least. Not only was the doctor dismissive of my natural family planning approach, but he didn’t seem to accept the importance of fundamental parts of female fertility, like cervical mucus. He did blood work to check my reproductive hormones on only one day of my cycle, and then prescribed Clomid for three months. When that didn’t do anything (other than make me moody, give me hot flashes, and dry up my cervical mucus), he ordered a hysterosalpingogram test. When that came back clear, he gave up and referred me – at age 24 – to IVF.
IVF wasn’t an option for me, for faith, financial, and common sense reasons. (If I had undergone IVF without addressing my underlying issues, the IVF would have failed.) Fortunately, I found out about NaproTechnology, a medical approach that views infertility as a symptom of an underlying cause. I began working with a Napro Ob/Gyn who was committed (and trained) to find the underlying problems and to resolve those with the goal of conceiving naturally.
Before I jump into a rundown of the (many) tests I’ve done I want to explain one thing and acknowledge another.
First, keep in mind that the human body works in systems (you learned about these on The Magic School Bus and in biology class). This means if one part of the system is thrown off, then other parts of the system are affected, usually negatively. The reproductive system is part of the endocrine system – a system that makes and regulates hormones that affect metabolism, the stress response, and reproduction. Some of the major organs and glands in the female endocrine system are your hypothalamus and pituitary at the base of your brain, your thyroid in your neck, your adrenal glands that sit on top of your kidneys, your pancreas, and your ovaries.
Striving to overcome infertility is full of many – often conflicting – emotions. That’s totally normal.
Secondly, I want to acknowledge that looking at a big list of possible things to examine can be both overwhelming and comforting, and that’s okay. Striving to overcome infertility is full of many – often conflicting – emotions. That’s totally normal. You might look at this list today and feel encouraged that you have a direction, a resource of things to test and address. Or you might look at it and cry because it’s all TOO MUCH. That’s okay too. Coping with infertility is hard. It just is.
Start by Learning about Your Cycle
Trying to figure out why your body isn’t “working” will only be even more frustrating if you aren’t educated about your body. This is the perfect time to learn about your cycle, the hormones at work throughout your cycle, the phases and patterns of a healthy cycle, and the biomarkers of fertility (like cervical mucus and basal body temperature).
Many all-natural family planning methodologies, like Creighton Model and Billings Ovulation Method, can teach you about your cycle and help to identify issues – simply by looking at the patterns of your cycle. That’s why your cycle is often a good indicator of your reproductive and overall health.
With that in mind, here are the tests I’ve done to determine what exactly was off in my cycle:
1. Check Your Hormone Levels throughout Your Cycle
Observing your cycle is an external way of mapping what’s going on. Getting bloodwork done throughout the course of a cycle can give you more information about what’s happening internally with your hormones. I did blood draws every other day for a whole cycle to track my levels of estrogen and progesterone. This is also a good time to track your FSH and LH levels. FSH, or follicle stimulating hormone, tells your ovaries to grow an egg for ovulation and it increases estrogen production. LH, or luteinizing hormone, helps the growing egg to mature and triggers the act of ovulation.
Charting your cycle is an external map, and bloodwork is an internal map of your hormones.
2. A Hysterosalpingogram To Check Your Fallopian Tubes
A hysterosalpingogram is a test that checks the integrity of fallopian tubes and the size and shape of the uterus. When an egg is ovulated from the ovaries it travels down the fallopian tubes into the uterus. If your fallopian tubes are blocked, the egg can’t get down to implant in the uterus and the sperm can’t get up to fertilize it.
You will be awake for this test, lying on your back with your feet propped up. Your vagina will be propped open with a speculum, similar to a pap smear, and your uterus will be filled with a contrast dye that gets pushed up through the fallopian tubes. An X-ray will be taken to observe the path of the dye and make sure it’s getting through. If there is a slight blockage, sometimes the dye can clear it.
3. Ultrasounds To See Ovulation
Sometimes the patterns of your cycle can indicate if you’re ovulating or not. Or you might be like me – have a regular cycle with lots of not-obvious underlying issues. The only way to know for sure if you’re ovulating is to do a series of ultrasounds that tracks the growth and release of the egg.
I was able to do the ultrasound series at my Ob/Gyn’s office. Once my period ended, I went for an ultrasound every other day. They first watched both ovaries until it was clear that my left ovary was going to ovulate, and then they tracked that side until they saw that the egg had been released. The day of ovulation (with ultrasound proof) coincided with the ovulation pain I sometimes feel, so that was a nice confirmation that my physical sensations were actually tied to ovulation.
If an egg is developing, but not being released, then your doctor might recommend a “trigger shot.”
If your ultrasound series shows that you’re not ovulating at all, you now have solid information to work with! If an egg is developing, but not being released, then your doctor might recommend a “trigger shot,” which is basically an injection of hormones that helps your ovaries finish the ovulation.
4. Check Your Thyroid Hormones
Your thyroid is a small butterfly-shaped gland in the front of your neck that’s hugely important in regulating your metabolism and, as it turns out, your cycle. The thyroid produces several hormones: thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and calcitonin.
Ovaries actually have receptors for T4 and T3! These hormones affect egg growth and maturation, progesterone and estrogen production, and even fertilization.
Abnormal levels of TSH can interfere with ovulation, and thyroid dysfunction (both too little and too much) can disrupt your cycle, cause inflammation, and increase your risk of miscarriage and preterm birth. Hypothyroidism (too little hormone) can stop ovulation and can cause progesterone levels to be too low after ovulation.
Your doctor can test your thyroid hormone levels with a blood test. When I have my thyroid checked annually (because I have hypothyroidism), my doctor checks for Free T4, TSH, Total T4, Total T3, and Reverse T3. I take two daily medications to supplement my low thyroid hormone levels.
5. Test for Insulin Resistance
Insulin is a hormone secreted by your pancreas that regulates your blood sugar and metabolism, as well as how glucose is stored in your body. Insulin allows cells to take in glucose and use it for energy. When someone is insulin resistant, that means their cells need larger and larger amounts of insulin to be able to take in glucose. Insulin resistance is a factor in PCOS and can lead to obesity and type 2 diabetes.
Testing for insulin resistance is a two or three hour blood test. You will need to be fasting when you show up at the lab or your doctor’s office. They will take a baseline blood draw, then give you a small bottle of sugary “juice” to drink. Over the next two to three hours, they will take more blood to see how your body is responding to the glucose in your system. You will have to stay at the lab the whole time, and you won’t be able to eat or drink anything, not even water.
6. Check Your Adrenal Hormones
Your adrenal glands sit on top of your kidneys, and they’re responsible for producing several hormones, including one you’re likely very familiar with – cortisol. The adrenals also produce adrenaline, DHEA, androgens, aldosterone, and pregnenolone.
Pregnenolone is the starting material, or precursor, in the production of testosterone, progesterone, cortisol, and estrogen, so an insufficiency there could lead to low hormone levels. Androgens are often too high in women with PCOS. Excess cortisol, especially in cases of chronic stress, can lead to inflammation and adrenal exhaustion (producing too little hormone). Cortisol dysfunction can also interfere with sleep.
Pregnenolone is the precursor for testosterone, progesterone, cortisol, and estrogen.
You can test DHEA and androgens with a blood test. If you want to test your cortisol, one option is an at-home salivary cortisol test. When I did mine, I tested at four times throughout the day by chewing on a sterile foam roll, and then dropped the samples off at the lab the next day. The worst part of this test is that you can’t drink any caffeine for three days before it!
7. Do a Biopsy for Uterine Infections
One of the most painful tests I've done is a biopsy of the lining of my uterus to check for infections. A thin, rod-like tool with a cutting clamp is inserted into your uterus and a small chunk of endometrial tissue is removed to check for bacterial and fungal infections. My body was not happy about being violated by a medical device and proceeded to painfully cramp throughout the whole procedure.
From what my doctor told me, uterine infections are usually not serious, but in some cases, they can prevent implantation. I did end up having a bacterial infection and took antibiotics to clear it up (which they checked with another painful biopsy).
8. Laparoscopic Surgery
After I was diagnosed with PCOS (polycystic ovarian syndrome), my Napro Ob/Gyn suggested surgery to remove the cysts. Given my family history of endometriosis, we were guessing it was likely I had that too (I did). Fortunately, my Ob/Gyn was trained in laparoscopic surgery, a surgery that uses a slender tool with a light and a video camera on the end to see inside your abdomen – removing the need for large incisions. In one lengthy surgery, she was able to remove the cysts using an ovarian wedge resection and to excise (cut out) the endometriosis she found in my abdomen. Since this surgery several years ago, I have been cyst free!
Tests at the doctor's office aren't the only way to deal with a disrupted cycle. Here are some other lifestyle and diet changes I've implemented during my journey:
1. Targeted Supplementation
Besides all the bloodwork, there’s lots of information about using supplements, vitamins, and nutrients to support specific issues. When I first started seeing my Ob/Gyn, she gave me a multi-page handout that paired supplements with specific issues. For example, Myo-inositol is great for PCOS and insulin resistance. Vitamin B improves cervical mucus quality. N-Acetyl cysteine and Vitamin E can be used to suppress endometriosis. Vitamin D and fish oil are good for hormone production. Alpha lipoic acid and co-enzyme Q10 are good for improving egg health and quality. Magnesium can help relieve heavy cycles and cramping. Vitamin C and ashwagandha help support the adrenals.
Alpha lipoic acid and co-enzyme Q10 are good for improving egg health and quality.
2. Diet and Lifestyle Changes
And of course, there’s always the diet and lifestyle changes. These can be hugely impactful, but are much harder to establish and maintain than just dropping by the lab for a quick blood draw.
Cutting out gluten and dairy is usually recommended for women with PCOS and endometriosis as they usually cause inflammation. Reducing processed sugar and alcohol are also recommended for the same reason.
One thing I started doing recently was paying more attention to regulating my blood sugar. I now eat four meals a day instead of the regular breakfast, lunch, and dinner. I found that a protein-rich afternoon snack, like an apple and peanut butter or sheep’s milk yogurt and muesli, prevents the headache and bad mood I would get as it was approaching dinner time.
Another new dietary development for me is I cut out coffee a few months ago. I suddenly realized it no longer tasted good, it made me unquenchably thirsty, made my stomach feel icky if I had a second cup, and it gave me acne. Drinking black tea instead in the morning still gives me a caffeine kick, but without the other side effects. Now if I indulge in coffee, it makes me feel anxious, which makes the experience not worth it. Plus I realized that my afternoon coffee was a misreading of my body’s signals – I was feeling tired because I needed food, not another cup of coffee.
And of course, there’s the always touted exercise regularly and manage stress. I personally am not good at either of those, but I know they’re proven to help!
3. Chiropractor and Acupuncture
Western medicine has yet to embrace chiropractic and acupuncture, unfortunately. I love getting adjusted by the chiropractor. It’s as relaxing as getting a massage for me. The thinking behind chiropractic for fertility is that if the body is aligned then it can work optimally, which can only help!
I did acupuncture for about seven months. When I started, I went twice a week, and then weekly, then twice during my cycle. Acupuncture is proven to “increase fertility by reducing stress, increasing blood flow to the reproductive organs, and balancing the endocrine system.” For me, it helped my body respond better to my hormonal supplementation – my body began to make more progesterone on its own. It didn't solve my long-standing hormonal issues single-handedly, but it was definitely a positive factor.
It does take two to make a baby, so don’t overlook your husband’s fertility.
Don't Neglect To Check the Man’s Side
I know the majority of fertility testing is female focused, but it does take two to make a baby, so don’t overlook your husband’s fertility. There are several tests your husband can do, like a semen analysis (to check his sperm health and count), a scrotal ultrasound (checks for blocks, issues with interior structure, and blood flow as too much heat can kill sperm), targeted supplementation for sperm health (like CoQ10, Vitamins E and C, carnitine), increasing meat and exercise for testosterone production, and wearing 100% cotton boxers, not whitey tighties (also for heat reasons).
He should also get his thyroid checked, as hyperthyroidism can reduce sperm volume, density, motility, and morphology. Hypothyroidism can cause a reduction in sperm morphology, low sperm count, erectile dysfunction, and low libido.
Trying to figure out why you’re not getting pregnant can be incredibly stressful, time-consuming, expensive, and emotionally draining. It takes an undeniable toll on you, and sometimes on your marriage. It’s okay to cry, to be angry, and to take breaks from trying to resolve your infertility. It’s normal to feel like your body is broken or has betrayed you or that you’re less of a woman because getting pregnant doesn’t come as easily as it should. It’s normal to want to ignore your fertility issues one day and then want to attack the problem the next. Like I said, coping with infertility is A LOT.
I hope my experiences have at least given you hope for finding a solution. And if not today, then hopefully tomorrow.
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