Fertility issues often defy standard medical explanations, leaving women with few answers and a lot of frustration and heartbreak. Once we address 3 commonly overlooked causes of infertility, the chances of pregnancy increase exponentially.
Infertility affects 1 in 8 couples trying to conceive. That includes women under age 35 who have been trying to get pregnant without assistance for over one year, and women over age 35 who have been trying for at least 6 months.
What this means is that women are NOT being provided information about commonly overlooked causes for fertility issues. Instead, they are left to try on their own. They experience all the stress of that process, and when they do qualify for infertility treatment, the recommendations still skip over common issues. This leads some women straight to the use of medications and assisted pregnancy, such as IUI and IVF.
What’s more, is women who have a miscarriage are NOT provided assistance until after having THREE miscarriages. They are seldom given information about causes they could address with dietary changes, lifestyle modifications, and supplements.
The three most commonly overlooked causes for infertility I identify in my practice are: Stress, leaky gut, and MTHFR. And when we address these three factors, the chances of pregnancy increase exponentially.
Ultimately, the current conventional medical system is not set up to be supportive of women to get pregnant naturally – and they’re left trying to figure it out alone. This is exactly when women call me to help them.
My Experience as a Naturopathic Doctor
As a naturopathic doctor and midwife for over 20 years, I love helping women to get pregnant, prevent miscarriages, and then providing – alongside their prenatal care providers – nutritional support during and after their pregnancies.
Each year I see so many women who come to me after conventional medicine has failed to give them answers. Half of these women I meet for the first time after they’ve been trying to conceive without success. This includes some who are currently undergoing IVF or other fertility treatments. For some, they found out that they have an MTHFR gene variation; others have had multiple miscarriages. And still others are women I’ve previously helped to address HPV and now they want to get pregnant with the same level of information and support.
What Causes Infertility?
Infertility is not a cut and dried condition. There are many factors that play into a woman’s ability to conceive. Unbeknownst to many, roughly 40% of infertility is actually attributed to the man.
Of the remaining 60% of infertility cases, 25% of cases are related to irregular ovulation. What’s more, 30% of couples are diagnosed with “unexplained infertility” – which means they didn’t identify a standard medical explanation for the difficulty conceiving.
But in fact, there are at least three commonly overlooked causes of fertility issues I believe should be discussed and addressed to help women.
1. Stress and Infertility
If it sounds like everything comes back to stress… it’s because it does. Stress in any form – emotional, physical, toxins, infections, food allergens, lack of sleep, blood sugar imbalances – affects cortisol levels and ovary function, making ovulation less likely. And just so we’re clear, ovulation is a MUST for conception.
That said, there is a spectrum when it comes to ovulation; it can be functioning 0%, 40% or 100% – and everywhere in between. Effective ovulation means not just releasing an egg but a HEALTHY egg (known as egg quality) and subsequently producing progesterone to maintain the pregnancy.
How the Menstrual Cycle Works
It seems like a simple concept but many women still don’t fully understand how a healthy menstrual cycle works.
- Day 1: The period starts and lasts roughly 4-6 days.
- Day 14-16: Ovulation happens and the ovaries begin making progesterone for 2 weeks.
- Day 16-28: I like to think of the progesterone – which is what is needed to secure the pregnancy – as a basketball aiming for the hoop. With the right amount produced, it continues its arch until the ball gets through the hoop; too little and it falls short. During this time estrogen is also released which is what prepares the uterine lining for implantation. During this time period, if the egg is fertilized, the embryo (fertilized egg) implants in the lining of the uterus.
- Day 28: If fertilization hasn’t taken place, progesterone and estrogen levels decrease, and the uterine lining and egg are sloughed as the next menstrual cycle begins.
When stress levels are high, cortisol inhibits ovary function and causes a decrease in effective ovulation, resulting in decreased progesterone, estrogen, and DHEA production. All of this makes pregnancy much less possible.
Stress and cortisol also cause:
- Intestinal cells to be less healthy, known as Leaky Gut
- Intestinal bacteria to become imbalanced, known as dysbiosis
- Fluctuations in blood sugar levels, which decreases ovary function
- Decreased thyroid and insulin function, which also affects fertility
- Increased likelihood of autoimmunity and inflammation, which can impede pregnancy
- Increased risk of infections, viral and bacterial, making pregnancy less likely
To counteract this, we must go back to our fundamental selfCARE tips:
- Clean Eating: Consistent and balanced meals of proteins, fats, and carbohydrates are important when preparing your body for ovulation and healthy pregnancies. Eating foods rich in the nutrients we need, such as folate, omega 3’s, antioxidants, and iron.
- Adequate Sleep: Many people know that when you’re exposed to darkness it helps your body to make melatonin. But did you know that when you’re exposed to light at night (during times you should be sleeping), it actually turns off your melatonin production? Additionally, for women, exposure to moonlight during days 14-16 of your menstrual cycle can actually promote ovary function and ovulation, because less melatonin means more signals go to the ovaries, proving once more, how responsive our bodies are to our environment. For these reasons, make sure you’re taking the right steps to ensure optimal behaviors and environments for a restful night.
- Reduce Stress: Try any of the stress-reducing activities found here.
- Exercise: Exercise is important but surprisingly many don’t know that you can actually disrupt your cortisol levels and turn off ovary function with too much exercise. Opt for 15 to 30 minutes, three to five days per week, of movement with activities such as pilates, yoga, walking, and strength training.
We also need to:
- Measure cortisol and adrenaline levels to find out how stress has affected your body.
- Address imbalanced cortisol and adrenaline using nutrients, herbs,* and Khavinson peptides to get them back to optimal.
- Identify and address leaky gut.
2. Leaky Gut and Infertility
Stress causes leaky gut and an imbalance of gut bacteria (further increasing leaky gut), which are known to be underlying causes of decreased fertility (references below). And yet 50% of the women with leaky gut don’t have digestive issues or symptoms that would lead them to think that their gut may be involved.
It is important that we consider leaky gut whether you have digestive issues, or not.
Gluten, for example, is a common cause of leaky gut. Yet a high percentage of people with Celiac disease and non-celiac gluten sensitivity have no idea they have it and have not been tested.
Studies have found a large connection between women with Celiac disease and undiagnosed infertility. Additionally, “a large Swedish study of 11,000 women found that fertility was reduced in the two years preceding the diagnosis of Celiac disease and returned to normal ranges following diagnosis and treatment with a gluten-free diet.” (1)
In my own experience, this is true of women with gluten sensitivity as well. Once we identify gluten as an issue using an IgA and IgG food panel and eliminate it from their diet, fertility improves.
It’s important to consider leaky gut even if you eat what is considered a healthy diet. Even healthy foods can be triggers if you have an undiscovered immune response to them, which affects ovary function.
- Doing an elimination diet (which is included in my Stress Remedy Program) or a food sensitivity panel (that you can do at home) to see what foods you are reacting to. Once you know, you can remove those foods from your diet.
- Take digestive enzymes* to ensure your food is well-digested and is less likely to trigger an immune response.
- Take glutamine and herb, such as the product Leaky Gut Support, to improve your intestinal lining, and improve your gut health.
Lastly in terms of leaky gut, if your gut health is not optimal then you are not absorbing the proper amount of nutrients your body needs. All of those essential vitamins and nutrients you’re working hard to consume are for nothing if you don’t address leaky gut.
3. MTHFR, Folic Acid, and Infertility
Speaking of nutrients, one nutrient you’ll hear most about when it comes to pregnancy is FOLIC ACID.
The only problem is – and this you are much less likely to hear – 50% of women are not able to use folic acid, or have a decreased ability to convert it to folate, due to a genetic mutation called MTHFR.
Still, many over-the-counter AND prescription prenatal vitamins contain folic acid.
Please go look at the label on your prenatal right now. Look for “folic acid” on the label. It might first list “folate” and then in parentheses say “folic acid.” That is a problem. That is, if you have even one, or two, MTHFR gene SNPs, then you won’t be getting the benefit from the folic acid in the bottle.
And yet, it is well established that “folic acid” is needed in early pregnancy to prevent neural tube defects and miscarriage. That research has been around for decades and is why there is folic acid in prenatal vitamins.
In more recent years, since the human genome project, it has become clear that women with MTHFR C677T and/or MTHFR 1298A gene variations are not as able to convert the much less expensive and synthetic folic acid into active folate, which is the form needed by our bodies. That means that even when taking a prenatal vitamin, women with an MTHFR gene mutation have an increased risk of miscarriage.
I believe all prenatals (and multivitamins for that matter) should be required to change over to folate. This is printed on the label as 5MTHF or methyl-folate. Until which time that happens, you have to choose wisely for yourself.
You may want to be tested for MTHFR – which can be done in blood work, but is sometimes not covered by insurance. So many women choose to do an Ancestry gene panel, which I then process through software to interpret the results. I discuss this process fully in my MTHFR Online Masterclass.
Then, the next important step is to check your homocysteine level in blood work. Keep in mind that even though this test can be done by usual labs, and is often covered by insurance, most practitioners don’t order this test. You can order the homocysteine test here.
When homocysteine is about 7, that means you have adequate folate intake, as well as vitamins B12 and B6. If homocysteine is higher than 8, it means we need to increase your dose. If it is lower than 5, it means we need to help your body replete and recover from homocysteine deficiency, and that you might have more folate than your body needs.
Yes, there is such a thing as too much folate, even methylfolate.
A mistake I often encounter is women who found out they have an MTHFR gene variation, and then their practitioner told them to take an astronomic amount of folate – like 10 to 15 milligrams – without any guidance on how to evaluate the dosage. There are important steps and considerations BEFORE taking folate, especially high dosages.
Monitoring homocysteine has simply not yet been integrated into standard gynecological or prenatal care. It should be.
In the meantime, it is up to you to request that your homocysteine be checked and to then modify your dose of folate and B vitamins to ensure that you have enough (but not too much) for your body and baby.
Improving Your Fertility Chances
For help with address these 3 common and often overlooked underlying causes for not getting pregnant, or for having a miscarriage, please reach out to my office to find out how we can work together. You can check out my Women’s Wellness and Fertility Program which includes the health panels mentioned in this article, as well as follow up sessions with me to guide you along the way.
For more assistance to address leaky gut, consider joining my Healing Leaky Gut with Dr. Doni (Online Course). It includes a food panel, 30-minute session with me, as well as help for implementing my protocol.
If you happen to have HPV and need help to address it before trying to get pregnant, please know that it is possible to get rid of HPV. I can guide you either one-on-one or in my online course here.
The most important thing is to not give up. If you have been trying to get pregnant without success, or have had miscarriages, please know that there are potential causes that you can address without medications and with expert assistance. By addressing these 3 commonly overlooked issues, we can improve ovulation effectiveness, egg quality, progesterone production, and pregnancy success.
I am here to support you. Nothing is more rewarding than helping families conceive the children they have been waiting and trying for, for so long.
23rd April 2020
*Please keep in mind that any and all supplements – nutrients, herbs, enzymes, or other – should be used with caution. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.
- Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41–47.
- Vitale SG, La Rosa VL, Petrosino B, Rodolico A, Mineo L, Laganà AS. The Impact of Lifestyle, Diet, and Psychological Stress on Female Fertility. Oman Med J. 2017;32(5):443–444. doi:10.5001/omj.2017.85
- Butler MM, Kenny LC, Mccarthy FP. Coeliac disease and pregnancy outcomes. Obstet Med. 2011;4(3):95-8. doi:10.1258/om.2011.110007
- Tersigni C, D’Ippolito S, Di Nicuolo F, et al. Correction to: Recurrent pregnancy loss is associated to leaky gut: a novel pathogenic model of endometrium inflammation?. J Transl Med. 2019;17(1):83. Published 2019 Mar 15. doi:10.1186/s12967-019-1823-5
- Nelen WL, Steegers EA, Eskes TK, et al. Genetic risk factor for unexplained recurrent early pregnancy loss. Lancet 1997; 350: 861–861