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 explores many of the possible underlying factors and can be considered alongside conventional treatments.
Below is a case study by one of our Functional Medicine Practitioners.
[signup]
Chief Complaint: Infertility, Hormone Imbalance, Endometriosis, & Hashimotos
Julie was a 32-year-old woman who visited my office seeking support for balancing her hormones. She experienced heavy and painful cycles, severe PMS, and challenges with fertility.
Julie was newly married and hoped to become pregnant. She had been trying to conceive for over one year without success. Before consulting with me, she was diagnosed with endometriosis and underwent surgery to address it. She consulted with fertility specialists and underwent three rounds of IVF without success. The fertility specialist identified hypothyroidism and started her on a low dose of Synthroid.
Patient History
She used combined oral contraception (COC), also known as 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 for conception.
Upon stopping oral contraception, her heavy and painful periods quickly returned. She also experienced fatigue, premenstrual headaches, bloating, hives, mood swings, worsening asthma, allergies, and symptoms of irritable bowel syndrome, including diarrhea and constipation. Her symptoms were more pronounced than before she started 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 manage symptoms temporarily, but discontinuing the pill may lead to a return of old symptoms or even new ones. Some clinicians refer to this as “Post Birth Control Syndrome” (Beyond the Pill, Dr. Jolene Brighten).
The pill prevents pregnancy by delivering high doses of synthetic estrogen and progestin to suppress ovulation. These high levels of synthetic hormones can accumulate in the body and may contribute to various side effects, including weight gain, headaches, increased intestinal permeability, mood changes, and hormonal imbalances after stopping the COC.
Based on Julie’s symptoms of heavy and painful periods prior to starting COC, I considered the possibility that she might be experiencing elevated estrogen levels, low progesterone levels, or both. This pattern is sometimes referred to as “estrogen dominance.”
Common manifestations associated with estrogen dominance 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 consideration of estrogen dominance. I was also concerned about her thyroid function and suspected this might be contributing to her period symptoms, fertility challenges, and other symptoms.
I recommended the following tests to gain 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 supporting fertility.
Results:
Genova Rhythm Plus Test
This test can be 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 patterns that may suggest estrogen dominance.
Results:
- High estrogen throughout her entire cycle with very elevated estrogen to progesterone in the second half of the cycle
- Low progesterone in the 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 processing her estrogen and that she needed to address the 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 imbalances in gut bacteria and overgrowth of candida.
Results:
- Overgrowth of candida
- Low bifidobacteria levels
- High beta glucuronidase, which may contribute 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 may contribute to chronic health conditions. Identifying and removing reactive foods often helps manage symptoms.
Results:
- 3+ sensitivity (highly reactive) to gluten, dairy, corn, soy, many vegetables, suggesting a potential issue with gut health.
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 ++, indicating a potential challenge with estrogen processing, caffeine detoxification, and neurotransmitter breakdown
- MTHFR C677 ++, suggesting a need for methylated B vitamins
- High need for folate, B6, magnesium
Interventions
Thyroid
Julie was identified with Hashimoto’s thyroiditis due to her elevated TPO antibodies. Her TSH and free levels were not optimal for supporting conception, and her reverse T3 was high, which may have affected her ability to convert T4 to T3. Her thyroid formula was adjusted to a compounded blend of T4 and T3 with 100 mcg of T4 and 5 mcg of T3.
Female Hormones
Her hormone testing suggested 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 may have contributed to this pattern.
To address this, she was provided with DIM to support healthy estrogen metabolism, calcium d-glucarate to support healthy estrogen processing, magnesium, and a 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 began a program to support her gut health and address her hormone balance. Based on her Genova food sensitivity results, she was advised to follow 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 their potential impact on TPO antibodies.
Based on her stool test results, a 5R plan (remove, replenish, repair, reinoculate, & relax) for gut health was customized for her.
She REMOVED problem foods as described and addressed the candida with oregano oil three times daily for two months.
She REPLENISHED digestive support with ox bile for gallbladder support, pancreatic enzymes, and betaine HCL.
She REPAIRED her intestinal lining with nutrients like 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 supporting fertility.
She was encouraged to continue supporting her estrogen processing and was provided with a detox protein shake for three weeks in addition to her elimination diet to support this process.
She was advised to wait to conceive for 3-6 months to allow her body to fully support detoxification and complete her herbal regimen before attempting pregnancy.
Follow Up
At her six-week follow-up visit, repeated lab work showed an improvement in thyroid function. She reported feeling better energy, fewer 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 health program and stopped all herbal supplements and estrogen support 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 well.
After years of hormonal imbalance and fertility challenges, Julie was able to use targeted functional medicine laboratory testing and interventions to support her hormone balance and achieve her family goals.
%201.svg){kind=logo}
