Female infertility is devastating and common and affects approximately  19% of women in their reproductive age.

Infertility doesn't strike all women equally. There are groups of women who are more prone than others to suffer from this experience. For example, women between the ages of 40-44 are approximately 11 times more likely to be infertile than younger women. Women who completed high school (or higher education) were half as likely to be infertile as those who didn't. Races are also not affected equally. Non-Hispanic Black women are 44% more likely to suffer from infertility than other races.

Conventional medicine has helped millions of couples conceive via Assisted Reproductive Treatments (ART). In fact, about 2% of all babies born in the US each year are conceived using ART. However, the national success rate for ART resulting in a live birth is only about 25%, and it is also invasive and expensive.

Functional medicine can provide an alternative (or adjunctive) care option to those struggling with infertility. Often there are root causes that are not detected with routine lab work. When discovered, more holistic treatment plans may become available, giving a woman (and couple) a higher chance of success whether she decides to continue with natural conception efforts or goes the ART route.

[signup]

What is Infertility?

Infertility is a term for individuals who cannot get pregnant (while having frequent unprotected sex) within a specific time frame. If women are under 35 years old, they have to try and conceive for one year without success. Women over 35 will be diagnosed with infertility after only six months of not successfully conceiving.

Conception requires a precise process and environment. Women's hormones, ovaries, fallopian tubes, and uterus must all be in optimal health to perform their notable roles. Issues with any of those (or multiple) areas could result in infertility. Male infertility is also a concern and should be thoroughly evaluated when conception efforts have been difficult.

Hormones must be balanced in order to orchestrate the process. Ovarian health is required for mature, healthy eggs to develop and release. The fallopian tubes must be open, and this is the location where conception occurs. Then the embryo will travel from one of the tubes into the uterus, which must be healthy for implantation.

If a woman can conceive but has recurring miscarriages, this would also be considered a form of infertility. A recurrent miscarriage is classified after three consecutive losses, which occurs in about 0.5% of women.

What Causes Infertility in Women?

Because there are multiple steps involved in a successful conception and pregnancy, there are several areas that can be a cause for infertility in females.

Hormone Imbalances

• When hormones are irregular, it leads to changes in the menstrual cycle. When the cycle is irregular, it can mean that ovulation is not occurring each month or that ovulation is occurring at an unpredictable time.
• Pituitary gland dysfunction including:

• High prolactin levels reduce estrogen production, leading to reduced fertility.
• Hypothalamic dysfunction occurs with excessively high or low body weight or extreme physical or emotional stress. This condition can disturb the production of follicle-stimulating hormone (FSH) and Luteinizing hormone (LH), which are produced in the pituitary gland and are required for fertility.

Issues With Ovulation or Egg Quality

• Polycystic Ovary Syndrome (PCOS) is the most common cause of female infertility. This condition results from insulin resistance, affecting the ovaries and shifting hormones out of balance.
• Premature Ovarian Insufficiency (POI) is also called premature ovarian failure, which is the loss of eggs before age 40.
• Poor egg quality is when eggs are ovulated but not in good health for conception.

Uterine or Cervical Issues

• Endometriosis is when the endometrium, the tissue lining the uterus, grows outside of the uterus, causing inflammation in the pelvic cavity and potentially ovulation issues if it grows on the ovaries.
• The uterine wall may not be thick enough to support healthy Implantation.
• The cervix must produce healthy and sufficient cervical mucus to nourish the sperm on its long journey to the fallopian tubes.

Infections & Structural Issues

• Various Sexually Transmitted Infections (STIs) can lead to Pelvic Inflammatory Disease (PID), which creates a poor environment for conception. Other infections, such as bacterial vaginosis (BV), can also cause issues with fertility.
• Fibroids within the uterus could block implantation.
• Blocked fallopian tubes would make the physical location for conception unavailable.

Unexplained Infertility

• Environmental Toxins may play a role, particularly endocrine disruptors, as they disturb the hormone balance.
• Blood sugar imbalances throughout the day can also lead to slight hormone imbalances that could affect fertility even if hormones are within the normal range in blood work.
• Certain nutrient deficiencies, such as folic acid, vitamin D, and iodine, are associated with infertility.
• Abnormal circadian rhythms can also affect the menstrual cycle and affect fertility.

Functional medicine particularly shines when it comes to Unexplained Infertility because it can uncover underlying root causes that typically go unnoticed in conventional medicine or routine lab work.

7 Functional Medicine Labs to Test for Root Cause of Infertility in Women

A thorough physical exam, including a pelvic exam, is required before moving to functional labs. These examinations and imaging, such as hysterosalpingograms and ultrasounds, can help identify structural issues, such as fibroids and fallopian tube blockages, endometriosis, and other uterine and cervical abnormalities.

Hormone Tracking

The DUTCH Cycle Mapping Plus is one of the top functional labs for female infertility. This is a dried urine test that spans an entire month. It evaluates the fluctuating hormones to assess hormonal imbalances that would otherwise go unnoticed in routine blood work that tests only on a single day. It also helps detect issues with circadian rhythm since it tests the Cortisol Awakening Response (CAR). This test also shows estrogen metabolites, indicating how well your body metabolizes and detoxifies estrogen. If there is an issue in estrogen metabolism, this could be an underlying cause of a hormonal imbalance. Lastly, this test evaluates adrenal hormones. High androgens, like testosterone, may be coming from the ovaries (like in the case of PCOS) or can come from the adrenal glands. So, assessing this is essential.

Nutrient Evaluation

The NutrEval FMV test by Genova Diagnostics is a valuable tool for detecting many nutrient deficiencies, which is especially important for those with unexplained infertility. This test also evaluates oxidative stress, which is linked to poor egg quality.

Vaginal Infection Testing

Vaginal infections are associated with infertility. Bacterial vaginosis is three times more common in infertile women than in fertile women. Doctor's Data has a Vaginosis Profile, a great tool for suspected infections. This test helps distinguish between bacterial and fungal infections and gives antimicrobial susceptibility testing to show which prescriptive and natural agents would most effectively overcome the infection.

Insulin Resistance

PCOS is the result of blood sugar imbalances. However, insulin resistance is also a cause of recurrent miscarriages, another form of infertility. Therefore, assessing insulin resistance would benefit an infertile woman with PCOS, recurrent miscarriages, or other known or suspected metabolic issues. The HOMA-IR panel, consisting of fasting glucose, fasting insulin, and HOMA-IR (an indicator of insulin resistance), is a great panel to screen for blood sugar dysregulation. This test, paired with an HbA1c test, which looks at the average glucose levels over the previous 2-3 months, gives an excellent overview of how well your body regulates blood sugar.

Toxin Panels

Lastly, environmental toxins play an essential role in female infertility. Many chemicals are "endocrine disruptors," which affect your endocrine system (hormonal system). The Environmental Pollutants Profile by US BioTek is an excellent test if any exposures are suspected.

Thyroid Dysfunction

It is known that thyroid dysfunction can contribute to decreased fertility. A thorough thyroid evaluation, such as the Thyroid Panel Comprehensive by Access Med Labs‍, can help assess current thyroid function if a thyroid disorder is known or suspected.

Comprehensive Stool Analysis

Gut dysbiosis, an imbalance of beneficial and pathologic microbes, can affect hormones and is also associated with infertility. A comprehensive stool analysis, such as the GI-MAP, would be helpful if there are known or suspected gut issues. This test analyzes gut microbiota DNA to examine the present microbe strains thoroughly. If dysbiosis is discovered, it could be a significant underlying cause of hormone imbalances.

Integrative Medicine Treatment for Infertility in Women

It's an unfortunate truth that women are on a timeline when it comes to fertility. There may be a point for older women when a form of ART is recommended as the best chance for conception. However, functional medicine treatment plans that heal the root causes will give you the best chance at natural conception. If you choose an integrative approach, addressing the root cause(s) will also boost your chances of success if ART is the route you end up taking.

Nutrition

A diet filled with nutrient-dense plants and healthy animal products is vital to boosting fertility. For proper function, hormones and eggs require vitamins, minerals, proteins, and healthy fats. There are many diet options out there, and many of them have good takeaways. However, the most well-researched in terms of hormone health and fertility is the Mediterranean Diet.

The Mediterranean Diet addresses many health concerns that an infertile woman may have. For example, it contains many macro and micronutrients and fiber, which are beneficial for hormone development and ensuring an adequate nutrient status. Healthy plant-based proteins and omega-3 fatty acids are also helpful for blood sugar stabilization.

Complementary and Alternative Medicine

Outside of a healthy balanced diet, correcting any nutrient deficiencies that may have shown up through functional testing is crucial. Vitamin D, iron and iodine are the most common deficiencies affecting female fertility. However, there are no clear guidelines on supplementation for fertility other than correcting nutrient deficiencies.

There are many alternative medicine options for balancing hormones. One of the easiest (and most effective) methods is a therapy called Seed Cycling. It's a method where you eat certain seeds at specific times of your menstrual cycle. Pumpkin and flax seeds help to balance healthy estrogen levels in the first half of the cycle, while sesame and sunflower seeds help to balance progesterone in the second half of the cycle.

Acupuncture is commonly used in many fertility and IVF clinics. Acupuncture works by stimulating blood flow to specific areas of the body and can help address specific medical conditions that may be affecting fertility including polycystic ovary syndrome (PCOS), fibroids, endometriosis, and issues with ovarian reserve and sperm quality. It can also help relieve some of the side effects associated with fertility drugs (such as bloating and nausea). A study on a group of 160 women undergoing in vitro fertilization (IVF) showed that adding acupuncture substantially increased the success of the IVF therapy vs the control group.

Resetting your circadian rhythm is important for hormone production and a healthy menstrual cycle with predictable ovulation. Some tips for getting back on track are to:

1. Go to bed around the same time each night and have a similar routine that you follow.
2. Exercise regularly during the day to help with melatonin production at night.
3. Avoid alcohol and caffeine (especially in the evening).
4. Limit screen time and turn them off at least 30 minutes before bed.
5. Try to avoid naps during the day.

Probiotics are beneficial in promoting robust gut health, which indirectly encourages healthy hormones. However, probiotics can also be helpful if bacterial vaginosis (BV) is present. Studies have found that probiotics can both treat and prevent BV.

Curcumin has been well-documented in its ability to influence healthy female reproduction and PCOS, oxidative stress, and ovarian insufficiency.  

Avoiding environmental toxins/endocrine disruptors is essential for fertility. The Environmental Working Group provides excellent resources for reducing exposures, such as their Clean Fifteen and Dirty Dozen lists to help shop for produce with fewer pesticides. They also have a resource called Skin Deep that can help you understand the toxic level of personal care products.

Summary

Female infertility affects many women and can be a devastating life event. Conventional medicine does have a lot to offer. Unfortunately, their offerings are expensive, invasive, and have a relatively low success rate.

Functional medicine helps women find the underlying root causes of their infertility to boost their foundational health and, therefore, their fertility in a more holistic manner. Many functional labs can help evaluate the nuances of infertility deeper than conventional lab work. A more thorough treatment plan can be created after we get new answers about why female infertility is occurring.