I often ask women at a consultation: ‘what have you been told?’ and their reply very often is ‘I'm infertile.’ This can be a really frustrating diagnosis. Remember, no one can tell you you can get pregnant, and no one can tell you can't get pregnant.
What does unexplained infertility mean?
Medically it means that you have been trying for one year and you've had tests, and nothing has shown up, this is called primary infertility. Secondary infertility is when you've had one successful pregnancy and live birth and find it hard to get pregnant the second time around. Some diagnosis of unexplained fertility goes on for years. It's not uncommon to see somebody that's had five or six years of unexplained infertility.
Medical tests and investigations
One of the difficulties is medical tests and investigations differ from clinic to clinic, especially on the NHS so it's hard to know which test you haven't had. The basic blood tests will only look at your hormone levels throughout your cycle, these are generally done at the beginning of the cycle, on day two to five and then again, looking at progesterone on day 21. And the standard tests include looking at FSH oestradiol, luteinizing hormone, prolactin, and testosterone.
FSH stimulates the follicles on the ovary at the beginning of your cycle to increase the growth of eggs in the ovaries. Generally, with FSH the lower the blood result is, the better. This generally goes up with age or if there is an underlying factor. If you are young, you should look out for indication of perimenopause or early menopause, or PCOS. It’s an indication of how well your ovaries are performing.
Oestradiol is taken again at the beginning of your cycle leading up to ovulation. It’s an indication of how well your ovaries are performing.
The luteinizing hormone triggers ovulation so any imbalance here may be associated with factors that affect or disrupt ovulation, often seen with PCOS.
Testosterone is also checked for, it’s produced by many different tissues in the body, but it's also in the ovaries and helps to maintain oestrogen levels. If this level is too high, it can be an underlying factor of PCOS.
Prolactin is generally associated with pregnancy. But if during fertility your prolactin levels are too high, it will interfere with ovulation, it may even stop ovulation.
TSH stands for thyroid stimulating hormone and is crucial for regulating your thyroid. A TSH test is a blood test that measures this hormone. TSH levels that are too high or too low may be a sign of a thyroid problem and will indicate whether your thyroid levels are within the right reference range for fertility.
Your progesterone levels are tested on day 21 of your cycle. But if your cycle is shorter or longer, it won't be a day 21 test, it may be on another day.
There are number of investigations that may be performed such as ultrasounds, to monitor your cycles and look at the cavity of your womb for factors such as endometriosis, polycystic ovaries, blocked fallopian tubes, and other abnormalities.
A laparoscopy can also be undertaken where the doctor can assess factors which could be endometriosis, polycystic ovaries blocked fallopian tube or structural abnormalities, or perimenopause. Anything that is going to help lead to a diagnosis.
How can you help yourself?
Tests and investigations
Number one is medical testing and investigations. Underlying factors to look out for are heavy periods, inconsistent cycle, no periods, pain when you have your cycle and family history of early menopause.
An AMH test measures levels of anti-mullerian hormone, which corresponds to a person's egg count so you can see what your egg reserves are. In general, the higher the number, the better. This is usually done in combination with the antral follicle count scan. If you are young, this does not mean, though, that you will not get pregnant. But it might mean that you need to act sooner than what you might have been thinking.
It sounds simple, but make sure you're having sex at the right time. Women today are obsessed with the gadgets, apps, and their gizmos. Learn to understand what's actually going on for you individually.
Mindset and emotional health
Dealing with fertility issues is really difficult and dealing with the uncertainty makes you even more anxious. There is a link to the rates of depression and anxiety among women struggling with infertility. The more distressed women are prior to fertility treatment, the lower the pregnancy rates as you see cortisol levels increase due to stress. To help with mindset, I encourage seeing a therapist or acupuncturist to help release neurons and endorphins to help counter stress.
Things like hypnotherapy and counselling can also be useful. I'm a huge believer in visualisation and if you visit HUG Health there are many visualisations on there that will help you. I really believe the mind body connection is huge for some women with unexplained infertility, and the answers are generally due to a previous termination, bad mental health, low self-esteem, any type of abuse: sexual, physical, mental. Your psyche contributes massively.
It is very important to balance your blood sugar. There is so much information on nutrition in my book Eat Yourself Pregnant. I don't believe in a balanced diet; I think women are ruled by their moods and hormones. I do believe in supplements because I think fertility is a whole-body event and if you're stressed it's going to be hard.
Here are a few nutrients you need to make healthy eggs and sperm. Some of the most supplements are vitamin D, omega 3, inositol & folate, all of which you can find in our product collection.
The vaginal microbiome plays an important role in maintaining a woman’s overall health, but it is a very different environment than the gut. Whilst the gut is home to trillions of bacteria from several different species and a well diverse gut microbiome is an indicator of good gut health, the vaginal microbiome is dominated by the Lactobacillus genus (with L. crispatus being the most dominant) and the diversity is much lower when compared to the gut.
Femceive has been specifically formulated to achieve a balanced endometrial-vaginal microbiota and prepare the optimal environment for preconception. It helps to prepare the endometrium to achieve optimal microbial biodiversity during the pre-implantation stage, and maintain this during the wait before a pregnancy test.
Lifestyle is really important. Most women already depleted, make sure that you rest often, don't overdo it. Exercise is important, but again, in moderation. But also, taking the pressure off one another and looking after your relationship is really, really key when it comes to trying a baby for a baby.
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