Infertility is a devastating and common condition affecting approximately 19% of women in the United States. In general, infertility is defined as the inability to conceive a baby after one year of having unprotected sex.

Becoming pregnant is actually quite a complex process with multiple steps involved. First, an egg must be released from one of the ovaries. Next, a sperm must swim up through the cervix and uterus to the fallopian tube to reach and fertilize the egg. Then the fertilized egg (now called an embryo) must travel through the fallopian tube into the uterus, where it must attach to the uterus wall (this part is called implantation).

Infertility can result from any issues with any part of that process. And, sometimes there are issues in multiple parts of the process. Clinically, this can make getting to the root cause quite challenging.

While men are often forgotten about when it comes to infertility, they should not be overlooked! Male factor infertility is solely responsible for 20-30% of infertility cases, and there is a male factor contribution to infertility about 50% of the time overall.

A functional medicine approach to infertility allows practitioners to dig deeper and uncover the root causes. Once there is a clearer picture of what is going on in both the female and male reproductive systems and overall bodies, a lot can be done to heal and boost fertility.

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Infertility Signs & Symptoms

The main sign and symptom of infertility in men and women is the inability to conceive a child.  

However, for women, there may be signs and symptoms of a hormonal imbalance or menstrual irregularities, which could both be contributing to infertility.

For example, a woman might notice that her menstrual cycle is too long when it is consistently 35 days or more. On the other hand, her cycle might be too short if it is regularly less than 21 days. Some even notice that their menstrual cycle is absent or just so irregular that they can’t predict if or when their next cycle will begin. These are all signs that ovulation is not happening, or at the very least, not happening predictably enough to consciously conceive in a given cycle.

Men may also see some symptoms of a hormone imbalance, such as problems with sexual function or decreased sexual desire, abnormal breast growth, or reduced facial or body hair.

Men should also be aware of physical issues that may impede fertility, such as pain or swelling in the testicles or a varicocele, which is when the veins of the testicles are enlarged (this is often described as feeling like there is a “sack of worms” in the scrotum).

Possible Causes of Infertility

Female infertility can be caused by a dysfunction in the ovaries, fallopian tubes, or uterus. Male infertility is caused by issues with the sperm.

Failure to Ovulate

The most common cause of female infertility is the failure to ovulate, and there are a few different causes of this. For example, PCOS (Polycystic Ovarian Syndrome) is a common cause of ovarian dysfunction. PCOS leads to hormonal imbalances and disrupts ovulation.

Diminished Ovarian Reserve (DOR)

Diminished Ovarian Reserve DOR is also a condition that disrupts ovulation. This is when there are fewer eggs left in the ovaries than expected for the woman’s age.

Primary Ovarian Insufficiency (POI)

Premature ovarian failure, which now goes by the name of primary ovarian insufficiency (POI), is a similar condition where the ovaries are no longer maturing the eggs that are left. While baby girls are already born with all the eggs they will ever have, healthy ovaries further mature the eggs in preparation for ovulation. This occurs until menopause. However, in POI, the ovaries stop maturing eggs in women under the age of 40 (which is about ten years younger than the average age of menopause).

Hormonal Dysregulation

Hormonal dysregulation can also disrupt ovulation. One example of a hormonal condition is called hyperprolactinemia, which is when too much prolactin is being produced. Prolactin is a hormone produced during breastfeeding and can interfere with ovulation. Other possible causes of prolactin overproduction include medications, pituitary tumors, an underactive thyroid gland, ongoing irritation to the chest, and pregnancy.

Hypothalamic Dysfunction

Hypothalamic dysfunction is when the hypothalamus, a gland in the brain, has difficulty properly communicating with the pituitary gland, which is a gland that produces major reproductive hormones.

Therefore issues with the hypothalamus also indirectly cause ovarian problems. Hypothalamus dysfunction can occur after extreme weight fluctuations, excess exercise, traumatic brain injury, concussion,or high stress.  

Fallopian Tubes Blockage

Endometriosis, previous abdominal surgery, history of sexually transmitted dieseae or infection, or pelvic inflammatory disease can all cause fallopian tube blockage.  

Fibroids

The most common fertility issue with the uterus is uterine fibroids. Depending on the size and location of the fibroids, they can block implantation.

Sperm Dysfunction

Causes of sperm dysfunction include genetic or chromosomal disorders (such as Klinefelter’s syndrome), hormonal imbalances, environmental/chemical exposures, alcohol or drug use.

Lastly, unexplained infertility is a label given when none of the above causes are plausible for the fertility struggles that a couple is facing. This may be the most frustrating finding (or lack of finding) because the root cause has not been determined.

Functional Medicine Labs to Test for Infertility

There are a few functional labs that are very beneficial for digging deep into infertility’s root cause. However, before jumping into those, it’s imperative to talk about some more conventional labs and tests that should also be done.

Since fully functioning female and male anatomy is necessary, having a thorough physical exam and pelvic exam is a must before moving forward with other tests. This will also likely include imaging to visualize the uterus, ovaries, and fallopian tubes. A semen analysis should be done for men as an initial sperm screening.

My favorite functional medicine labs for infertility include DUTCH Cycle Mapping (Precision Analytical), GI-MAP (Diagnostic Solutions), and Essential Thyroid Profile Blood Spot (ZRT).

DUTCH Cycle Mapping Test

When it comes to understanding female hormones, the DUTCH Cycle Mapping test is vital. The DUTCH Cycle Mapping Test is a dry urine test that women can take home and take throughout the month. The benefit of a dried urine test over a blood/serum test is that it can capture the overall hormone picture throughout an entire cycle rather than just a snapshot of what the hormones look like at the moment of the blood draw. This allows practitioners to “catch” hormone imbalances that may be missed from blood draws.

Comprehensive Stool Test

Gut health (assessing the microbiome) is important for fertility because it can show us if inflammation and oxidative stress are factors involved in the overall health picture. Gut issues can also affect hormone balance. Dysbiosis, an imbalance of the beneficial bacteria in our gut, is a root cause of many conditions, including infertility - so we don’t want to miss this in our diagnostic search!

Complete Thyroid Panel

The Essential Thyroid Profile Blood Spot gives an excellent overview of thyroid health. The thyroid hormone affects nearly every cell in the body. It communicates with the other hormones that are responsible for reproduction. So, it is imperative to understand how healthy the thyroid is when infertility is in play. I like this test over a more standard thyroid panel because it includes Anti-TPO, which are thyroid antibodies. Because of this, we not only learn about the thyroid but also learn if there is an autoimmune picture presenting itself within the thyroid.

Functional Medicine Treatment for Infertility

There are many functional medicine treatment options for infertility. The focus should be on both the woman’s and the man’s fertility.

Female infertility can be complex to treat, but there are many options for boosting fertility with functional medicine. Improving egg quality and overall ovarian health is essential for boosting fertility, especially if there is a known ovarian dysfunction.

Nutrition

The Mediterranean Diet is rich in antioxidants and has been studied and shown to boost egg quality. Eggs typically take between 3-4 months to fully mature before ovulation, so this is the minimum length of time that a diet should be tried before expecting to see an improvement in egg quality. Other key nutrients for egg and ovarian health are zinc, folate, B6, B12, iron, and vitamin D.

Complementary and Alternative Treatments (CAM)

• Pelvic physical therapy is one evidence-based option that may provide a non-surgical solution for blocked tubes.

• Chinese Herbal Medicine and EGCG, an extract in Green tea, have been shown to reduce the volume of uterine fibroids.

• Acupuncture has been shown in many research modules to be a successful treatment in restoring fertility in both men and women by improving sperm quality, ovaries function, and balancing the endocrine system and hormones. (11), (12)

Men Infertility Treatment

Typically we can see quicker results when treating male factor infertility in comparison to female infertility since new sperm are produced daily.

Assuming that the male anatomy is functioning correctly, the primary treatment for healthy sperm is healthy nutrition, focusing on adding some key nutrients in a supplement form. Studies show that a healthy diet for sperm health includes fruits and vegetables, nuts, seeds, whole grains, fish, and poultry. This diet resembles the Mediterranean Diet, the most studied diet for fertility for both men and women.

Micronutrients

A quality multivitamin is an excellent start for sperm health to ensure that there are enough basic nutrients present, such as zinc, vitamin D, and folate. In addition, many studies have looked at various antioxidants and their ability to improve sperm health. The most common findings are that CoQ10 and alpha-tocopherol (a form of vitamin E) have improved sperm count. Carnitine is an antioxidant that improves sperm motility and morphology. They also show that taking vitamin E alongside vitamin C reduces sperm DNA damage.

Summary

Infertility is a heartbreaking condition affecting both women and men. It is complex since many hormones, organs, and glands are required to work in harmony for conception to be successful. Understanding the root causes may take some deep digging, but that’s where functional medicine can shine.

Functional medicine gives us the tools to dig, find, and fix the root causes of infertility. When we know why this is going on in more detail, we are better able to devise a successful treatment plan.

Articles That May Interest You

• ‍A Functional Medicine Approach to Infertility: A Case Study
• ‍A Functional Medicine Approach to PCOS

Podcast That May Interest You

• ‍Fertility with Dr. Dan Kalish, DC, IFMCP, Founder at Kalish Institute