It’s Infertility Awareness Week in Canada and in this post I’m answering some of the common questions that I get around fertility. The focus of this post is female-factor infertility, but obviously that’s only half the story.
HOW DO I TELL IF I'M OVULATING?
The body is constantly giving us signs and clues as to what’s happening on the inside. Here are some tips for figuring out when you’re ovulating:
- Track your cycle (at the very least, do the 2Cs and 2Ps i.e. cervical mucus, consistency of flow, period days, and premenstrual symptoms)
- Cervical mucus will be more copious and egg-whitey (you should be able to stretch it between your fingers) around ovulation time. Once your fertility window is over, your cervical mucus becomes a bit more tacky and thick under the influence of progesterone to prevent other things from getting into the uterus in case conception happened.
- Your cervix becomes softer and goes up higher.
- Positive LH strip or ovulation predictor kit test.
- Your basal body temperature rises AFTER ovulation and can provide a good retrospective on ovulation time. Use a 2 decimal place thermometer because it’s going to go up by a fraction of a degree.
- Your period starts 10-12 days after ovulation and can provide a retrospective on ovulation time.
I HAVE PCOS. WILL I HAVE TROUBLE CONCEIVING?
If you have PCOS, there’s hormonal and metabolic issues that need to be addressed. Once we do that, your chances of conceiving and carrying to term are actually quite good. Here are some of the contributing factors for PCOS-related infertility and subfertility:
- Lack of ovulation (if there’s no egg, it can’t be fertilized!)
- Irregular cycles and irregular ovulation (you may not know when you’re ovulating which means you don’t know when to time intercourse)
- High androgens
- High insulin levels
- High amounts of inflammation
- Low vitamin D
- Concomitant thyroid issue
All of the above-listed factors will also contribute to the higher miscarriage risk we see in PCOS.
MY AMH IS LOW. CAN I STILL GET PREGNANT?
AMH isn’t a good indicator of whether or not you’ll be able to get pregnant naturally because you only need one egg to conceive. It’s a bigger factor if you’re conceiving using assisted reproductive technology.
DO I NEED SUPPLEMENTS TO BOOST MY FERTILITY?
Maybe. What you need will depend on who you are and what’s happening with you. Here are some considerations:
- A good prenatal multi that has active-form vitamins and minerals is important so that you have at least the bare minimum vitamins and minerals you need for a healthy pregnancy and for foetal development. The prenatal should have active-form folate (5-methyltetrahydrofolate) since some of us can have difficulty converting folic acid to active-form folate), selenomethionine, iron, B12 (preferably methylcobalamin), choline, and not too much vitamin A since it can be teratogenic.
- Vitamin D3 is often deficient in my patients — testing and making sure you’re replete is important for conception and healthy pregnancy outcomes.
- Omega-3s are important for you and also for babe especially if dietary omega-3s are low and inflammation is high.
- You may need egg quality support especially if you’re closer to 40 years old.
- Additional support can look like: herbs to decrease high stress chemistry, egg quality and antioxidant support like CoQ10 and melatonin, blood sugar and insulin support if that affects you, autoimmune support if that impacts you.
IS THERE ANYTHING I CAN DO TO SUPPORT MY IVF/IUI?
Yes! If you’re on meds, about to do an IUI or about to have IVF, there are ways to augment these procedures with naturopathic medicine. Talk to your ND or functional med doctor — this is important because we do not want to interfere with the actual process and there are lots of natural things that can decrease the efficacy of your fertility meds. Herbs, nutrition, avoiding alcohol and caffeine, and acupuncture can all help with these procedures.
HOW CAN I DECREASE MISCARRIAGE RISK?
Most of the time, we don’t know why a miscarriage happened and sometimes there's not much we can do. Here are some factors that can contribute to miscarriage risk:
- Subclinical hypothyroidism
- Chromosomal abnormalities
- Structural issues
- Progesterone deficiency
- Developmental issues
- High insulin levels and blood sugar dysregulation
- Autoimmunity
If you have a history of a miscarriage, along with a blood test for hCG, other parameters to consider adding would be TSH and progesterone (and anything else relevant to you). My colleague, Dr. Jordan Robertson, ND has a great book called "Carrying to Term" that you can check out.
