This is part of a series on fertility. Start with the first post Functional Fertility Basics. Here we dig into the most common female factor causes of infertility. Many of these are things you can check out on your own, or with your medical provider, before seeking help from a reproductive specialist.
Female factors are only 50%
Causes of infertility are about 1/3 due to male factors, 1/3 to female factors and 1/3 are mixed or unknown. Of the 2/3 with known causes, it’s 50/50 between men and women. We often assume it’s a female problem, and this is not always the case.
However, if it is a female factor, the first step is to identify what it is, and the next step is finding out what to do about it. Start by exploring these questions…
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.
Is ovulation at the right time?
Cycle day 14 is ideal, however, it’s possible to get pregnant if you ovulate earlier or later. I have seen women conceive with an early day nine ovulation, and as late as cycle day 24. We try to get ovulation close to day 14, but it is not essential to be spot-on to conceive.
If ovulation is too early, your egg may not be mature enough for conception. You may not have enough fertile cervical mucus. Your uterine lining has less time to develop for healthy implantation of a fertilized embryo. Early ovulation can happen from an imbalance in your signaling hormones, stress, travel, or excessive alcohol or caffeine intake. Smoking and age can also play a part.
If ovulation is too late, your egg may be overripe, and not suitable for conception. Your fertile cervical mucus may be gone, and your uterine lining not sufficient. Late ovulation is often caused by PCOS.
You need the right amount of follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and thyroid hormone to ovulate on time.
Is your luteal phase insufficient?
This is when the time between ovulation and your period is too short to maintain a pregnancy. The no-brainer here is to measure progesterone – if it’s low it can cause a short luteal phase. In addition, thyroid hormone plays a part – you need both 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 a 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 at least three or four months.
Natural progesterone appears to be a safe intervention for a 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.
Are your thyroid hormones too low?
Low thyroid hormones interfere with conception and cause early pregnancy loss. It’s essential to have enough thyroid hormones in order to conceive and hold a pregnancy. Fortunately, you can take thyroid hormone replacement – the ideal amount is one that gets your thyroid stimulating hormone (TSH) in a sweet spot between 0.9 and 1.5.
While replacing thyroid hormones, you can explore the root cause of your hypothyroidism. If the cause is Hashimoto’s autoimmune disease, then calming the autoimmune inflammatory response is helpful as well. If it’s not autoimmune, often there are root causes that can be treated.
Is there a structural issue?
Blocked fallopian tubes mean your sperm and egg won’t connect. A simple test called a hysterosalpingogram (HSG) will tell you if your tubes are blocked. This is 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. 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 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.
A heart-shaped, or bicornuate, uterus can interfere with implantation and growth. 1% of women have a heart-shaped uterus.
Functional root causes
Besides the above questions to root out causes of female factor infertility, we functional doctors check out the following potential drivers, many of which explain “unknown” infertility.
Your sex hormone milieu isn’t right
You may have sex hormones that are too low, too high, or a combination of both. We test these at the right time in your menstrual cycle. The beginning of your cycle, on day three, is a great time to test follicle stimulating hormone (FSH), estrogens and anti-mullerian and hormone (AMH). Approximately seven days after ovulation is a good time to test progesterone and the androgen hormones testosterone and DHEA. These can be simple blood tests. Many conditions can be picked up with comprehensive hormone testing, including:
- Polycystic Ovarian Syndrome (PCOS), the leading female factor! Take this quiz to assess if you have PCOS.
- Luteal Phase Deficiency, which is when your luteal phase (days from ovulation to bleeding) is short. The ideal is 13 to 14 days.
- Premature Ovarian Insufficiency (POI), which is when your ovaries shut down hormone production at an early age, before 40.
- Poor egg quality as assessed by AMH. Note that this test is controversial. Learn more.
Most sex hormone imbalances can be helped with holistic approaches within Functional and Chinese medicine. Please don’t hesitate to book a free consultation to discuss your situation.
Your hormone communication isn’t right
There’s some overlap in this category with the above category. This is because often it’s often the communication between your hormones and your brain (specifically your hypothalamus and pituitary glands) that causes levels of hormones to be off.
Hormone-brain communication is more complex to assess than hormone levels. We have to look at relationships. Your sex hormones have relationships with other hormones as well, all orchestrated by your hypothalamus and pituitary glands in your brain.
We functional docs like to assess your H-P-O-A-T communication or axis. This means hypothalamus-pituitary-ovarian-adrenal-thyroid axis. We can do this with comprehensive bloodwork, as well as functional labs like the Dutch hormone test. And again there are many holistic ways to improve these relationships!
Your gut bugs aren’t right
An imbalance of gastrointestinal microbes is called dysbiosis. Your gut microbes are highly involved in hormone signaling and processing. Dysbiosis can include not enough good bacteria, an overgrowth of bad bacteria or yeast, or both. Dysbiosis is common in PCOS, endometriosis, and Hashimoto’s.
Your nutrients are low
Even if you live in a well-fed country, it’s still possible to have suboptimal levels of nutrients that are necessary for hormone signaling as well as follicle and uterine lining development. These include iodine, iron, B vitamins, vitamins D and A, and zinc. Some of these can be tested by bloodwork, some can be assessed by symptoms, and others can be assessed by a functional urine analysis such as the Organix test.
If you supplement randomly without actually testing, you may go overboard on a nutrient. For example, women trying to conceive usually take a prenatal multivitamin. These always contain iron. However some women don’t need iron, and too much iron is inflammatory.
Inflammation and immune dysregulation
Your immune system is part of your reproductive system. It’s important to have the right amount of inflammation for follicle development and conception. Not too much, not too little, just the right amount. Factors to investigate that get in the way of a healthy inflammatory response include:
- Autoimmune antibodies.
- Inflammation or infections in your nose, sinuses, gastrointestinal tract, lungs, bladder, or vagina.
- Food intolerance.
- Stress which is inflammatory.
- Environmental allergies, asthma, and histamine responses.
- Blood sugar dysregulation, which is inflammatory and also affects sex hormone balance.
- Estrogen dominance from environmental endocrine disruptors.
Immune regulation is a complex subject and you can learn more here.
With a holistic approach, often known AND unknown female factor infertility causes can be identified and resolved.
How to get help with female infertility?
Hopefully, this article gave you some ideas about what to explore. You can ask your doctor to help investigate with you. If your doctor is not receptive, or not doing enough, consider finding another one that will work in a partnership with you. Remember that you hire your doctor, and you have a choice about who you hire.
You can develop a reproductive health care dream team. This can include your favorite:
- Reproductive Endocrinologist (RE)
- Functional Medicine practitioner for the root-cause work
- Therapist or counselor
- A support group such as Resolve
When your team works together, you can make great strides to identify the source of your infertility and make steps to resolve it!
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