True Potential Health’s Doctor Michelle Marcoux, ND shares her expertise about optimizing fertility:
I’ve been helping couples optimize their fertility for years now and I can tell you that it is, hands down, my favourite area of treatment. Helping someone achieve their fertility dreams is very rewarding, mainly because, in most cases, there are underlying barriers that have not been addressed by the medical system. The removal of these barriers greatly increases the odds of getting and staying pregnant. It also increases one’s overall health, which results in better pregnancy and postpartum health.
Getting Pregnant: What the Medical System Likely Won’t Tell You
There are 3 areas I tend to focus on when someone comes to see me for fertility support. These are areas that the medical system either doesn’t recognize as issues or overlooks because bloodwork and tests looks “normal.” Most of the people who see me have been given a diagnosis of “unexplained infertility.”
I can assure you that there is always an explanation for why someone is having a hard time getting pregnant. It’s a matter of digging deeper, usually into one of the three following areas:
1. Hormone Imbalance (despite “normal” bloodwork)
When it comes to hormones, the range that is considered normal is very broad. So broad, in fact, that most people will look “normal” when they have their hormones tested.
Normal vs Optimal Hormone Levels
I would like to suggest that there is a difference between normal and optimal. Normal simply refers to the general range that most of the population falls into. Optimal hormone ranges are associated with peak functioning of our body and are more likely to result in a successful pregnancy that is carried to term.
Thyroid, adrenal, and sex hormones all work together to create an environment that is conducive to pregnancy.
The actual level of your sex hormones is important, but so is the ratio of one hormone to another, something that is not often considered when hormones are tested. In my practice I use narrower ranges for hormones levels, as well as testing certain ones together in order to determine how they are affecting each other.
Thyroid, adrenal, and sex hormones: an imbalance in just one of these hormones can result in an imbalance in the others, and this can affect your fertility, even though your bloodwork looks “normal.”
In my practice I use a combination of your symptoms and bloodwork to help determine what your hormone status is. Once this information is gathered, I can usually determine where the imbalance is occurring and use things like diet, vitamins, and herbs to rebalance it. In some cases, bio-identical hormones may be an option, if your MD is willing to prescribe them.
Here is a list of all the tests I recommend for assessing your hormone status:
- Thyroid: TSH, free T4, AND free T3. The T3 is rarely tested nowadays but it is important. Your TSH and T4 can be normal, but your T3 may be too low. This is most common in people with high stress or nutrient deficiencies, and it can affect fertility. If you have a family history of Graves or Hashimoto’s Disease, you should also have your thyroid peroxidase and thyroglobulin antibodies tested.
- Adrenal: I do not use bloodwork to assess your adrenal glands. Instead I use a combination of symptoms you report and a special way of checking your blood pressure called orthostatic blood pressure testing.
- Sex Hormones: sex hormones should be tested at 2 different times during your menstrual cycle.
Day 1-3 of your period: LH, FSH, estrogen, testosterone, DHEA, and prolactin. These will help us determine if your hormones are in proper balance to ensure optimal ovulation and egg fertilization. They also help us rule out conditions such as polycystic ovarian syndrome.
- Progesterone, estrogen: (1 week after ovulation) These 2 hormones are required to be at a certain level and in a certain balance after ovulation in order for pregnancy to occur and be maintained. Conventionally, progesterone is often tested, but not estrogen. If you estrogen is too high at this time, you may have more difficulty getting pregnant, despite a normal progesterone level.
- Fasting Cholesterol: anytime (i.e. with either of the above set of tests): This test is important because your sex hormones are all made from cholesterol. Some people have low cholesterol and this can impact your body’s ability to produce hormones. Getting this tested helps us determine if we need to change your diet to help optimize your hormone levels.
2. Insulin Resistance (despite “normal” bloodwork)
Insulin resistance is one of the most under-recognized conditions that contributes to fertility challenges, mostly because it starts long before your bloodwork shows any abnormalities.
If you have signs of blood sugar dysregulation (see below), you should have the following tests done to determine if you are insulin resistant. Likely both of these tests will be “normal”, as will a glucose tolerance test. That doesn’t mean you aren’t insulin resistant.
Insulin resistance starts as a gradual increase of the following symptoms, and can progress to more serious conditions such as polycystic ovarian syndrome (aka PCOS) and diabetes. But long before any of that happens, your insulin will surge and drop throughout the day, causing you to feel unwell and making your cells less responsive to insulin over time. The more this happens, the more likely it is to affect your sex hormone balance, and hence your fertility.
Signs and Symptoms of Insulin/Blood Sugar Dysregulation:
- Fatigue, especially after meals
- Constant hunger
- Inability to lose weight OR weight gain over time despite healthy diet and exercise
- Sugar or carb cravings
- Migrating aches and pains
- Anxiety, shakiness, “hangry” feelings when you go without eating for too long
- Brain fog
Testing: fasting glucose AND fasting insulin. Note that these may both be normal, as will a glucose tolerance test and your Hemoglobin A1C if those are recommended instead. The glucose and insulin are used to calculate your HOMA-IR ratio (Homeostatic Model Assessment of Insulin Resistance) which will reveal if you are insulin resistant long before it shows on a blood test. This model is used in research studies to determine if people are insulin resistant1. If insulin resistance is part of your health picture, have no fear! There are some well-studied supplements and diet changes that can correct this imbalance in a relatively short period of time.
3. Hidden Inflammation
Much like the above scenarios, hidden inflammation is primarily revealed in symptoms, while bloodwork often appears normal. Inflammation changes the environment of your body by sending a lot of white blood cells into your tissues. This alters the pH of the fluid surrounding your cells. This, in turn, affects how those cells function and can lead to changes in ovulation, egg quality, sex hormone secretion, and the health of your uterine environment.
The primary underlying cause of inflammation is often related to a food sensitivity.
Note that this is different than a food allergy, which results in immediate symptoms such as hay fever, hives, or anaphylaxis. Food sensitivities are mediated by a different antibody and result in a slower, more gradual set of symptoms related to the inflammation they cause as they accumulate in your body.
Common symptoms of food sensitivity include:
- Digestive issues
- Skin issues – eczema, rashes, etc.
- Chronic headaches or migraines
- Chronic muscle and/or joint pain
- Brain fog, low energy/fatigue, poor sleep
- Endometriosis, painful periods
Testing: hsCRP (aka high sensitivity C-reactive protein), CBC (aka complete blood count), and ferritin. Your hsCRP and ferritin can be elevated if you have inflammation but these values will often be normal if the inflammation is not severe. Even if both of these values are normal, we can indirectly determine if inflammation is likely based on your reported symptoms and the results of your CBC. If you your white blood cells are on the high end of the “normal” range, AND the ratio of 2 of your types of white blood cells is elevated, we can conclude that inflammation is likely, and that a food sensitivity test and/or a trial elimination diet may be warranted.
Trying to Get Pregnant? Book an Appointment
As you can see, there are many additional considerations that are not typically addressed when one is experiencing fertility challenges. When you come to see me for an initial appointment, we will go over your entire health history and I will assess each of the above areas to determine if there is one we need to focus in on.
If necessary, I can also order all of the above tests for you. If you are coming for an appointment and you have had some or all of this testing done, I recommend you request copies for yourself and bring them to your visit. This will greatly decrease the time it takes for us to get to the root of what is going on.
I hope this information is helpful to you on your fertility journey.
Use and Abuse of HOMA Modelling http://care.diabetesjournals.org/content/27/6/1487
Inflammation in Reproductive Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107847/
IgG Testing http://rmalab.com/medical-laboratory-tests/allergy/igg-sensitivity