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[Disclaimer: I am not a doctor or medical practitioner. Any medical information is strictly my opinion based on research and personal experience, and not to be taken as advice. Always seek the advice of a licensed physician for your medical needs. Read my full disclaimer here.]
I’ve talked before about the frustration of unexplained infertility and my determination to pinpoint the cause (and my general recommendations). I’ve also talked about how I highly recommend finding a functional medicine doctor who can help suggest possible causes of unexplained infertility (and order more advanced testing that another doctor might not, such as the NutraEval test and the Dutch test, both of which I’ve done — read more about those tests here).
Now, let’s look at 3 things my functional doctor checked on as possible causes of unexplained infertility (that neither my OB nor my fertility specialist ever did):
Note: These possible causes are what my doctor checked for me personally, given my medical records and history. Your doctor might have other things to check too based on your health history — read more about that in my TTC tip for infertility or in my post on functional medicine.
1. Gluten intolerance…even though your digestive system seems to be working great
This is tricky, because GF diets seem to be all the rage right now…and other people claim that all of this stuff about gluten is a hoax.
EITHER WAY: It turns out that Celiac’s Disease is much more prevalent among women with undiagnosed infertility (see this study)…and it’s possible you may have it (or a gluten sensitivity) without even realizing it, as symptoms can be mild or nonexistent. (I won’t go in to all of the research on all of this…but if you’re interested, I found this article very helpful.)
And when you consider the cost of fertility treatments and medications, this is totally worth trying, as it costs nothing (okay, GF stuff is more expensive than regular, but still). You can also try this at home on your own, without a blood test!
How to check for it
Here’s what my doctor suggested: Eat GF for 3 weeks. On day 21, eat a small amount of gluten twice that day. See if you feel any different — but “different” doesn’t just mean digestive issues. (Note: Many people notice a difference not during the GF weeks, but upon the reintroduction of gluten.) Since gluten can affect many parts of the body, my doctor told me to pay attention to not just bloating/digestive issues, but also to skin changes/itchiness, brain fog, fatigue, joint pain, etc.
My experience
I admit I was skeptical going in to this (my stomach can handle anything!), and by the end of the three weeks I was convinced nothing was different. However, I was shocked that I did notice some things after reintroducing gluten (changes in respiratory system rather than digestive)…which could have been a placebo effect, but given that I was so convinced gluten was not a problem for me? Seems like an uncanny coincidence that the day I introduced gluten again I noticed some changes.
I’m still not convinced, but I’m going back to GF to try it again.
Tips
Go totally gluten free for three weeks, even avoiding cross contamination. Then you can completely rule it out. Download the GF Scanner app on your phone. At the store you can scan barcodes to see if items are gluten free, may have trace amounts of gluten, or contain gluten. Many GF items are together in a section in the grocery store, and breads and other items are in the freezer aisle.
Update: I don’t think this was one of the causes of my unexplained infertility, as I went back to gluten-containing foods later and didn’t notice a difference. However, I have still tried to reduce gluten in my diet.
2. Thyroid imbalance…even though your doctors say your level is “normal”
A normal TSH level appears to be between 0.4 and 4.5-5 mU/L.
HOWEVER: Studies (like this one) have consistently found that women with unexplained infertility are much more likely to be on the high side of normal, with TSH levels above 2.5. There seems to be a correlation between higher TSH levels (even if they are still technically “normal”) and infertility. This has not been widely studied, and researchers still conclude that more tests need to be done before they would recommend treating women with a TSH level above 2.5.
My experience
My functional doctor tested my TSH levels, but also my T4 free, T3 free, and T3 reverse. (Many doctors neglect to test all of these, although it’s important to determine how they are working together.)
My TSH level has always been consistently above 2.5, but no doctor has ever said anything. This last time it was 3.3, and my functional doctor recommended I immediately start on a natural (not synthetic) thyroid support supplement called Thyrotain. I have not gotten my levels rechecked yet to know if it worked.
Even if all of your results for your thyroid have always come back “normal,” this is something worth asking about or re-checking! (This should go without saying, but never take any thyroid medications or supplements unless they are prescribed to you!)
Update: The natural thyroid support supplement didn’t seem to work for me, but a synthetic thyroid medication that I went on later did. I think that was indeed the cause of my unexplained infertility, because I got pregnant shortly after getting my thyroid levels below 2.5. Read more on that here. Unfortunately that pregnancy did end in miscarriage. HOWEVER: A cycle later, I’m pregnant again! Read more on how that happened here.
3. Folate (folic acid) deficiency (MTHFR gene mutation)…even though you’re taking a prenatal vitamin
This is a relatively new discovery. Interestingly enough, we talk all the time about how important folic acid is for pregnancy…but actually, it’s folate. Folic acid is what you typically get in a prenatal vitamin, which your body then converts to folate, which is what your body needs.
However, if you have the MTHFR gene mutation, your body doesn’t convert the folic acid to folate…so it never gets what it really needs. Unless, that is, you’re taking a prenatal with folate instead of folic acid (which you probably aren’t, because those are rare).
My experience
Before testing, my doctor thought this could be the case for me…but after testing, I found I do not have the mutation. Therefore, I admittedly didn’t do a ton of research on this. (Side note: I did the NutraEval test + MTHFR genetics test add-on — as ordered by my doctor — to find out that I did not have this gene.)
However, my doctor did recommend this prenatal vitamin (Smarty Pants) because it has folate rather than folic acid. And even though I don’t have the gene, she still recommended I take the active form of folate in my prenatal, rather than folic acid. This blogger — who does have the mutation — has a lot of great information here if you want to find out more.
Now, I know the title of this is “4 possible causes” of unexplained infertility, and thus far I’ve only listed 3. This last one is not something my functional doctor has tested, but rather something I have researched (though my doctor did mention it).
4. High sperm DNA damage
I thought this was worth including, because there was a study out of Queen’s University Belfast that claims that 80% of unexplained infertility is actually due to high sperm DNA damage. (And that wasn’t the only study that has been done on that either — check this one out too.)
And although the typical male fertility workup checks for a lot of things, it never checks for the quality of the sperm.
Therefore, this possible cause is worth including based on the sole fact that although the male fertility workup may come back normal (leaving YOU to alter your lifestyle completely to try a billion different things to figure out what you’re doing wrong), unexplained infertility could actually still be male factor infertility. Interesting, right?
Still, there hasn’t been enough data on this, so doctors will not test for this (at least none that I know of). It isn’t recommended, as many researchers claim that it’s unlikely to be the ONLY reason for unexplained infertility.
It is worth knowing, though, because it’s worth making sure your husband continues to lead a healthy lifestyle to prevent sperm damage. And it could be contributing as one of the causes of your unexplained infertility.
Some recommendations
According to the research presented here, sperm DNA damage can be treated with lifestyle modifications such as:
–Stop smoking/drinking
–Exercise regularly
–Avoid hot tubs
–Taking a supplement like FertilAid that contains ingredients shown to protect sperm against DNA damage (Vitamin C, E, selenium, CoQ10, and L-Carnitine)…also check out my post on the top male supplements + foods for fertility (+ the research)
sometimes there are one or more medical reasons why a couple isn’t able conceive….reproductive disease such as endometriosis, polycystic ovarian disease, or tubal blockage are common reasons. There is often hormonal, estrogen and progesterone related, and/or ovulatory defects. I recommend learning the Creighton Model System of FertilityCare because the charting gives insight into what is happening in the body and what the cause of infertility may be. If a couple is not able to conceive using the Creighton System, a doctor trained in NaProTechnology can assist further to diagnose and treat the root cause of the disease. I recommend this approach over IVF because there are no frozen embryos or ethical considerations, it is more effective than IVF and it is healthier for both the woman and the child.
Thanks for bringing up the Creighton Model. I completely agree. And like you said, if that doesn’t work (which is the point I’m at, and I think many other people too if they have been diagnosed with “unexplained infertility”), I agree that you should see another doctor. In my case, I saw a functional doctor who is looking for the root cause (and is checking for the things I listed, among other things), but the NaProTechnology sounds interesting as well. I completely agree with your recommendation of finding the root cause of infertility!