Unexplained infertility - is it really a thing?
Having now helped 100s of clients in practice with fertility challenges , I always challenge when they have been given the diagnosis of unexplained infertility. Far too many couples are being signposted to IVF without having had thorough checks and investigations done. At best , you may have been offered a basic hormone work up and a semen analysis is still hard to get on an NHS pathway.
I’ve helped couples with this diagnosis who have then had rounds of IVF, still not conceived who have then gone on to conceive naturally and then kept the baby to term.
Here is how I’ve approached it.
We always need at least 3 months as this is the time it takes to mature an egg and a fresh batch of sperm.
I take a holistic approach, I explain to my clients that their egg and sperm health is a direct reflection of their overall health. Gut health, blood sugar balance and nutrient status can all feed into their fertility.
I start with a thorough and in depth history taking lasting up to 90 minutes per person. A full history of their journey with their fertility, symptoms, menstrual cycle history , digestive health , hormonal health, their health growing up , whether they were breast fed and were a vaginal birth baby. Before we meet I already have some understanding of where they are as I send an in depth health questionnaire, 3 day food diary and body scan prior to us meeting.
Once the initial consultation has been done I would then look at relevant testing. Core baseline testing includes
Comprehensive blood tests, at 2 points in the cycle for females and initially once for the male. This includes information on hormones but much more - blood sugar balance, inflammation, a full blood count to look at red blood cell health and the immune system, nutrient status including vitamin D, folate and b12 (the active and available type), a full iron panel and sometimes magnesium, zinc and omega status all of which can give key information for fertility and egg and sperm health. The test also looks at overall health liver, kidneys and cholesterol all of which can give key information - dehydration, stomach acid health and other ways to assess inflammation. Thyroid health is also still a missing key part of fertility outcomes
Hair mineral analysis testing - a quick and easy way to assess stress , stomach acid health to help absorb nutrients , anti oxidant status with selenium, oestrogen and progesterone balance copper and zinc and immune status, ratios of minerals give insight into blood sugar balance , thyroid health and adrenal health. There is also an element on heavy metals including mercury arsenic and cadmium all of which can negatively impact fertility outcomes.
Reproductive microbiome testing - starting with the vaginal microbiome. Women have their own unique composition of microbes in the vaginal microbiome. It has very low diversity and should be dominated by lactobacillus, lactic acid producing bacteria which keeps the vaginal microbiome at a low acidic pH. Patients can be asymptomatic i.e without symptoms but still have presence of inflammatory/problematic bacteria such as those associated with bacterial vaginosis and ureaplasma. Presence of these bacteria and/or lack of beneficial bacteria can support time to conception, reduce miscarriage and aid full term pregancy.
Comprehensive semen analysis- male fertility accounts for 50% of infertility. If it is ignored and not investigated thoroughly then couples can continue trying for years and not get any further in their journey. Volume, count and motility as well as other markers covered on a semen analysis can be a useful first investigation into male fertility and if further investigation is then warranted. Often I refer to a male fertility specialist urologist /andrologist to work collaboratively to optimise outcomes for our patients. If you are going for multiple rounds of IVF and your outcome is not changing then please ensure to have male fertility thoroughly investigated as often this is overlooked.
The symptoms and test results paint a good picture of what might be feeding in to their infertility. These may then highlight need for further investigation -
Gut health - a poorly functioning gut will drive systemic inflammation, reduce nutrient absorption and reduce ability to eliminate toxins
Genetic testing- this can be revolutionary both for your fertility and overall health. Your individual ability to repair damaged DNA, the crux of fertility, the ability to produce utilise certain nutrients for fertility such as folate , B12 and choline and if these need to be supplemented in a specific form or certain levels. If you don’t produce glutathione the master anti-oxidant in the body needed to counter oxidative stress which can then impact DNA. Your ability to convert beta carotene to vitamin A , again another vital nutrient for fertility and propensity towards autoimmunity. If the immune system is not calm a pregnancy is not going to happen
Mitochondrial health - our mitochondria are the energy powerhouses of the cells and our eggs and sperm are densely populated with them. They help drive growth of these cells and make them robust. As we age and through stress and not fuelling well mitochondria can become damaged and not reproduce well
Mould exposure - a vaginal microbiome test, symptoms or questioning about the home environment can reveal possible mould exposure as well as accumulation. Mould exposure can drive inflammation and increase risk of miscarriage and more
Further reproductive microbiome testing - a shared microbiome. It is likely partners will have similar patterns in their microbiomes. We can check a seminal microbiome . The same bacteria can drive a lot of inflammation in the semen and we can check the uterine microbiome, especially if considering IVF or there has been recurrent implantation failure during IVF.
So if you have been told you have ‘unexplained’ infertility' then don’t give up hope. It is more unexplored. Unfortunately there are limitations in the NHS as to how much they can investigate and a lack of knowledge. There is almost always a cause and working with a functional medicine trained integrative specialist can help you get to the root cause and importantly address it through nutrition and lifestyle and in my case using relevant medication if needed.
If you have been on a fertility journey for years and would like a more holistic, root cause, full investigative approach then do get in touch.
I offer appointments online and in person at Omniya clinic, Knightsbridge, London. Contact medical@omniya.co.uk or use this link for a complimentary call https://thealternativepharmacist.practicebetter.io/#/5cd469e2627db31d78fff993/bookings?s=638a1c952150e027279ebe14
Testimonials: https://www.richapurihormones.com/testimonials-fertility-menopause
Fertility clinic: https://www.richapurihormones.com/fertility-clinic
As well as couples I support women on single motherhood journeys and women on egg freezing journeys.
Please email richa@thealternativepharmacist.com for any questions.