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A Functional Medicine Approach to Infertility: A Case Study

A Functional Medicine Approach to Infertility: A Case Study

Infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. It affects approximately 1 in 5 heterosexual women ages 15 to 49 years.

A Functional Medicine Approach to Infertility addresses many of the possible underlying causes and is an excellent option alongside conventional treatments.

Below is a case study by one of our Functional Medicine Practitioners.

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Chief Complaint: Infertility, Hormone Imbalance, Endometriosis, & Hashimotos

Julie was a 32-year-old woman who presented to my office for help balancing her hormones. She struggled with heavy and painful cycles, severe PMS, and infertility.

Julie was newly married and wanted to get pregnant. She had been trying unsuccessfully to conceive for over one year. Prior to consulting with me, she was diagnosed with endometriosis and had surgery to remove multiple sites of endometriosis. She consulted with fertility specialists and underwent three rounds of unsuccessful IVF. The fertility specialist diagnosed hypothyroidism and started her on a low dose of Synthroid.

Patient History

She used combined oral contraception (COC), aka the “birth control pill,” from age 15 to 31 to help manage her heavy and painful periods. At age 31, she stopped COC to prepare to conceive.

Upon stopping oral contraception, her heavy and painful periods quickly returned. She also suffered from fatigue, premenstrual headaches, bloating, hives, mood swings, worsening asthma, allergies, and irritable bowel syndrome symptoms, including diarrhea and constipation. Her symptoms were worse than before she went on the pill!

Many women commonly start oral contraception to manage various hormonal issues, including heavy and painful periods, irregular periods, amenorrhea (no period), premenstrual tension syndrome (PMS), premenstrual dysphoric disorder (PMDD), or for other symptoms besides contraception.

For many women, the pill can help symptoms temporarily, but discontinuing the pill causes a rebound of old symptoms or even new ones to emerge. Some clinicians label this “Post Birth Control Syndrome” (Beyond the Pill, Dr. Jolene Brighten).

The pill prevents pregnancy by delivering very high doses of synthetic estrogen and progestin to suppress ovulation. These high levels of synthetic hormones can accumulate in the body and cause many side effects, including; weight gain, headaches, increased intestinal permeability (leaky gut), depression, anxiety, hormonal imbalance, and hormonal issues after stopping the COC.

Based on Julie’s symptoms of heavy and painful periods prior to starting COC, I suspected that she might be suffering from elevated estrogen levels, low progesterone levels, or both. This pattern has been called “estrogen dominance.”

Common estrogen dominance manifestations include heavy and painful periods, PMS, breast tenderness, ovarian cysts, fibrocystic breasts, uterine fibroids, and endometriosis.

Her diagnosis of endometriosis after stopping the pill further contributed to my suspicion of estrogen dominance. I was also concerned about her thyroid function and suspected this might be contributing to her period symptoms, infertility, and other symptoms.

I ordered the following tests to get a comprehensive view of her health.

Lab Work

Recommended testing included: Comprehensive Thyroid Panel, Female Hormone Panel, Stool Test, Food Sensitivity Test, and a NutraEval Panel.

Comprehensive Thyroid Panel

To assess for autoimmune thyroiditis and determine if Synthroid dose was optimal for fertility.

Results:

Genova Rhythm Plus Test

This test is helpful for women trying to conceive as it not only tests levels of hormones but also tracks hormones throughout the month to help determine the best days for ovulation and conception. It also identifies estrogen dominance.

Results:

  • High estrogen throughout her entire cycle with very elevated estrogen to progesterone in the second half of the cycle
  • Low progesterone second half of the cycle
  • Ovulation at day 14
  • High cortisol
  • High normal DHEA

DUTCH Complete

I also ordered the DUTCH complete test to evaluate estrogen metabolites. This was collected on day 21 of her cycle. Certain breakdown products of estrogen can be more pro-inflammatory, and I suspected Julie was not properly detoxifying her estrogen and that she needed to detoxify all that synthetic estrogen from taking COC for 15 years.

Results:

  • Low progesterone
  • High 4-OH metabolites
  • High estrone
  • High cortisol
  • High normal DHEA

GI Map Stool Test

To assess for dysbiosis and overgrowth of candida.

Results:

  • Overgrowth of candida
  • Low bifidobacteria levels
  • High beta glucuronidase-contributes to high estrogen by recycling estrogen back into circulation
  • High steatocrit
  • Low pancreatic elastase

Genova IgG Food Antibody (Food Sensitivity Test)

The IgG Food Antibody Assessment is a blood test that measures antibodies to commonly consumed foods. Adverse food reactions can lead to distressing symptoms and chronic health conditions, including autoimmune disease and chronic inflammation. Removal of the reactive foods often results in the resolution of symptoms.

Results:

  • 3+ sensitivity (highly reactive) to gluten, dairy, corn, soy, many vegetables-This tell me that she has suspected leaky gut syndrome.

Genova Nutreval

The NutrEval FMV is both a blood and urine test that evaluates over 125 biomarkers and assesses the body’s functional need for 40 antioxidants, vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients.

Results:

  • COMT ++-increased risk for impaired estrogen detoxification, caffeine detoxification, and excitatory neurotransmitter breakdown
  • MTHFR C677 ++-increased risk for impaired methylation and high need for methylated B vitamins
  • High need for folate, B6, magnesium

Interventions

Thyroid

Julie was diagnosed with Hashimoto’s thyroiditis due to her elevated TPO antibodies. Her TSH and free levels were not optimal for conception, and her reverse T3 was high, further impairing her ability to convert T4 to T3 and blocking utilization of T3 at the cellular level. Her thyroid formula was changed to a compounded blend of T4 and T3 with 100 mcg of T4 and 5 mcg of T3.

Female Hormones

Her hormone testing confirmed estrogen dominance, particularly in the second half of her cycle. In addition to the synthetic estrogen she used in the COC, she had genetic variations in COMT and MTHFR that contributed to estrogen dominance.

To address this, she was prescribed DIM to support healthy estrogen metabolism, calcium d-glucarate to support healthy estrogen excretion through the stool, magnesium, and prenatal vitamin with methylated B vitamins to support healthy methylation and detoxification, and topical progesterone cream days 12-26 of her cycle.

Gut Health

Julie also started a program to heal her gut and detoxify her excess estrogen to restore balance to her hormones. Based on her Genova food sensitivity results, she was prescribed a modified elimination diet. She was instructed to remove foods with a score of 3+ for 3-6 months and consider indefinite removal of gluten and dairy due to the potential to increase TPO antibodies.

Based on her stool test results, a 5R plan (remove, replenish, repair, reinoculate, & relax) for gut healing was customized for her.

She REMOVED problem foods as described and treated the candida with oregano oil three times daily x 2 months.

She REPLENISHED digestive deficiencies with ox bile for gallbladder support, pancreatic enzymes, and betaine HCL.

She REPAIRED her intestinal lining with gut-healing nutrients, including glutamine, zinc carnosine, and aloe.

She REINOCULATED her gut with a mix of traditional and soil-based probiotics.

And she REBALANCED her system with stress management and acupuncture tailored for improving fertility.  

She was encouraged to continue to support her estrogen detoxification and was prescribed a detox protein shake for three weeks in addition to her elimination diet to support this process.

She was instructed to wait to conceive for 3-6 months to allow her body to fully detoxify, mobilize and excrete toxins prior to conception. I also wanted her to complete her herbal regimen before getting pregnant.  

Follow Up

At her six-week follow-up visit, repeated lab work showed an improvement in thyroid function. She reported feeling better energy, less asthma and allergy symptoms, improved digestion and IBS symptoms, much less PMS, and less painful periods. Her mood swings and premenstrual headaches had also improved.

After four months, she completed her gut healing program and stopped all herbal supplements and estrogen detoxification herbs. She continued on a modified elimination diet with gluten, dairy, and sugar removal.

After two months of trying to conceive, she became pregnant with her daughter. She had a healthy pregnancy with minor adjustments to her thyroid dosing during pregnancy and post-partum.

Two years later, she became pregnant again and had another healthy daughter. She is currently pregnant with her third daughter and is doing great.

After struggling with years of hormonal imbalance and infertility, Julie was able to use targeted functional medicine laboratory testing and interventions to balance her hormones and have the family of her dreams.

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