This is part of a series of posts on Fertility. Start with the first post called Functional Fertility Basics.

Female Factors are Just 50%

In cases of KNOWN infertility causes, it’s 50/50 between men and women. In ALL infertility cases, about 1/3 are due to male factors, 1/3 to female factors, and 1/3 are mixed or unknown.

These statistics are so important to drill in. We often assume it’s a female problem, and this is true less often than you may think. However if it is a female factor, let’s identify what that is, and what to do about it from a functional perspective!

The first place to start: are you ovulating?

Ovulation is when your ovary releases an egg. Without an egg, you can’t conceive. Problems with ovulation are the main cause of female infertility. Go back to Functional Fertility Basics to learn how to track ovulation. If you are not ovulating at all, or irregularly, it’s usually due to a hormone imbalance.

PCOS

Hands down, Polycystic Ovarian Syndrome (PCOS) is the top cause for anovulation (no ovulation) and irregular ovulation. This is a hormone imbalance that at least one in 10 women have. Yet most of the population hasn’t heard of it or doesn’t know what it is. Conventional medicine doesn’t have great options for getting PCOS women pregnant, other than fertility drugs and procedures like insemination and in vitro fertilization.

It’s a no-brainer to screen for PCOS in all infertility cases. We used to think all PCOS women were overweight. It’s true that 70% of PCOS women have insulin resistance, however 30% don’t. Even the ones who do have insulin resistance don’t always show it. Meaning, they may be thin and fit. Months or years can be wasted before identifying this common cause. You can read more about PCOS in this series of articles.

Or, head over to my sister site My Hormone Answers to learn much more about PCOS, including the PCOS SOLUTION Program. PCOS is absolutely reversible, first with lifestyle factors, and then finding out what drives your PCOS in order to treat it. A Functional Medicine root cause approach takes all drivers into account.

Second, if ovulating, is it at the right time?

Our ideal is ovulation around cycle day 14. Apps assume this happens if they do not actually track your cycle. However it’s possible to get pregnant with ovulation sooner or later. I’ve seen countless women get pregnant with ovulation as early as day nine and as late as day 24.

Why is early ovulation a problem?

If you ovulate early, your egg may not be mature enough for conception. You may not have enough of, or the right kind of cervical mucus. Your uterine lining has less time to develop for healthy implantation of a fertilized embryo. Early ovulation generally happens from an imbalance in your HPO axis, stress hormones, travel, or excessive alcohol or caffeine intake. Smoking and age can also play a part.

Why is late ovulation a problem?

Late ovulation means your egg may be overripe, and not suitable for conception. Your fertile cervical mucus may be gone, and your uterine lining again not sufficient. You especially need the right amount of follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and thyroid hormone to ovulate on time. Late ovulation is often caused by PCOS.

Luteal phase insufficiency

Classic luteal phase insufficiency is when the time between ovulation and your period is too short to maintain a pregnancy even if conception happened. The no-brainer here is to measure progesterone, as if it’s low it can cause a short luteal phase. In addition, thyroid hormone plays a part. It’s really important to make sure there’s enough active thyroid hormone (free T3) and progesterone on board to have a sufficient luteal phase.

Signs of luteal phase insufficiency:

You ovulate close to cycle day 14, but then start your period less than 10 days later.
Your period may start with spotting, or you may spot during your luteal phase.
Recurrent miscarriages.

Lower progesterone levels are normal in your late 30s and early 40s. However, younger women, even in their 20s, can have low progesterone. Many women take chaste tree or Vitex which has the reputation for increasing progesterone. It doesn’t increase progesterone directly. However, in certain cases of pituitary dysfunction, Vitex can influence your pituitary to increase progesterone production. This takes three or four months.

Natural progesterone appears to be a safe intervention for a “mature” woman in her late 30s or early 40s. For younger women, small doses of natural progesterone can make a big difference when it’s is low.

Hypothyroidism

Hypothyroidism, and Hashimoto’s thyroiditis (autoimmune hypothyroidism) can both interfere with conception and can cause early pregnancy loss. It’s essential to have enough thyroid hormone in order to conceive and hold a pregnancy. Hashimoto’s is an immune disruption, and from a functional point of view we want to calm immune disruptions before conceiving.

Structural factors

Blocked tubes

A common structural factor is one or more blocked fallopian tubes. These tubes go from your ovaries to your uterus, and if blocked your egg won’t join up with sperm or reach your uterus for implantation. Fallopian tubes can be blocked from scar tissue caused by previous infections or surgeries. A simple test called a Hysterosalpingogram (HSG) will tell you if your tubes are blocked. The name is not simple, but the test is. It’s an in-office procedure that takes a short time. Your doctor injects fluid into your uterus and takes x-ray images to see if the fluid goes through your tubes.

If you heave never had an HSG test, and you’ve never been pregnant, it is a mystery whether or not your tubes are open. If you get this test done, you will know. Plus, an added benefit is that right after this test, your chances of conception go up. Think of it as cleaning your pipes.

Endometriosis or fibroids

These can create structural blockages that affect your tubes or your uterus. Fortunately fibroids show up on an ultrasound. Endometriosis is more tricky because you need a laparoscopy in order to identify it. This is when your doctor uses a fine fiber-optic tool to look inside your abdominal cavity, and if endometrial tissue is found, it can be removed immediately.

I refer women to check for endometriosis or fibroids if they have extremely heavy and painful periods. Other things can cause heavy and painful periods, such as low thyroid hormones. However, just as with blocked tubes, it’s better to know then to guess. So if symptoms are there, it’s best to get checked out.

Heart shaped uterus

This is also known as a bicornuate uterus. The heart shape can vary from slight to quite significant. If it’s quite significant, it means that your uterus is functionally almost divided in half. This won’t interfere with conception necessarily because that happens in your fallopian tube, but it can interfere with implantation and growth.

Only 1% of women have a heart-shaped uterus, however it’s another potential fertility impediment that’s important to know about. With all structural causes you may have options for treating them directly, or instead going around them with assisted reproductive technology.

Let’s get to functional treatment

When a woman comes with infertility, we of course want to start with identifying whether or not there are known factors, and who they belong to! There is no judgment in this process, just compassion. We need to figure out whether or not we treat the woman, the man, or both.

It makes the practitioner’s job easier if you’ve already identified structural factors with your gynecologist. Remember, we can’t guess about structural factors. If we can rule out structural factors, then we either identify the underlying infertility drivers, or functional root causes.

Functional causes include, but are not limited to:

HPO (hypothalamic-pituitary-ovarian axis) imbalance
HPA (hypothalamic-pituitary-adrenal axis) imbalance
Thyroid hormone disorders
Dysbiosis (imbalance of gastrointestinal microbes), a common driver in PCOS, endometriosis, and Hashimoto’s
Nutrient deficiencies (iron, ferritin, B vitamins, vitamin D, zinc, magnesium, and more)
Malabsorption issues (from dysbiosis, food intolerances, and GI inflammation)
Inflammation and immune dysregulation
Estrogen dominance from environmental endocrine disruptors

One important thing to point out with functional causes, is that often unknown or unexplained infertility causes ARE identified through a functional root cause lens.

How to determine Functional causes, and what to do

A qualified Functional Medicine practitioner takes a good health history, and orders functional blood labs. Often that is enough to identify functional causes. We may use Functional Medicine tests to identify specific factors such as the type of dysbiosis, or adrenal hormone imbalance. Your story will point us where to dig deeper on this collaborative journey.

Once we identify root causes, we determine whether or not you can overcome them naturally, without assisted reproductive technology. This really depends on your individual situation.

We do consider age. While it’s true that fertility does decline after age 35, our concern is just how much time we have to help you conceive naturally. This depends on your priorities, and how much time you are willing to give it! Ideally, the more time you have, the more time you can relax. Preferably six months to a year. That does not mean it will take that long though. It’s very common that women get pregnant with a functional approach!

Functional treatment

What is Functional Medicine treatment? The essence of Functional Medicine is identifying root causes from a systems biology perspective, rather than looking solely at individual parts, organs, or systems. In infertility for example, we assess how your detoxification, digestion, and adrenal systems affect your reproduction. We don’t only look at your reproductive system organs and hormones. It’s a whole person systems approach.

The tools we use vary according to our toolbox as individual practitioners. True, we all tend to opt for the safest treatment in all cases. However, we apply integrative techniques from traditional and modern medicine.

My toolbox includes lifestyle reorganization, and the applied use of supplements, herbal medicine, and small doses of bioidentical hormones. In person, I use acupuncture in most cases of infertility. If distance, I may collaborate with your local acupuncturist if she or he is not trained in fertility acupuncture.

Read on to learn more about Fertility Acupuncture.

Functional Fertility: Female Factors

Female Factors are Just 50%

The first place to start: are you ovulating?

PCOS

Other ovulation problems