The treatment of unexplained infertility usually has two different approaches. The first is the discovery and treatment of multiple small factors which contribute to infertility. None of these factors on their own may be large enough to raise a red flag and diagnose infertility, but the synchronized impact of minor issues can lead to a significantly delayed time to pregnant. The second approach is the discovery of a significant fertility condition not yet diagnosed. These factors are frequently shared among both partners.
Some of the common factors which contribute to infertility but go overlooked include:
1. Thin Uterine Lining: often presenting as a very light period for many months. The amount of blood discharged is directly correlated to the thickness of the uterine lining. Some Women notice that they only have one day of actual flow and then go right in to spotting. This is often a sign of a thin uterine lining. Or even a few days of extremely light flow. A thin uterine lining creates an unfavourable environment to support implantation. You may remember how thick or thin your lining was during an assisted reproductive technology (ART), such as IVF or IUI, but this number cannot be used to determine how thick your uterine lining is during natural cycles as the IVF/IUI meds will often help to thicken the uterine lining.
2. Poor Sperm Health (or poor sperm epigenetics): most common fertility tests check for a portion of the basic sperm tests (concentration and motility), but will skip morphology, sperm DNA fragmentation testing and more detailed hormone testing. Even if the concentration and motility appear to be normal, the elevated sperm DNA fragmentation along with lower normal sperm morphology can contribute to declined embryo quality, increase the risk of certain health conditions in the offspring, and significantly increase the risk of miscarriage. The only way to reduce sperm DNA fragmentation seems to be related to lifestyle, diet, and antioxidant supplementation. Treatment of any organic condition such as varicocele or infection (if present) is also key!
3. Abnormal Advanced Thyroid Function Tests: up to 15% of Women of reproductive age are estimated to have elevated thyroid antibodies. Even when the usual thyroid testing comes back normal, the thyroid antibodies may be an issue. They independently damage the zona pellucida of an egg and can damage egg quality. They increase the risk of developing mild hypothyroidism by decreasing thyroid hormone production during pregnancy, which can increase the risk of miscarriage.
4. Low Egg Quality: often a factor in more young Women than before. Egg quality declines with age. By the age of 35 the quality of follicles declines and sometimes earlier. There is no exact way to measure this other than seeing poor results with an IVF (i.e. very few follicles matured or progressed to day 5 blastocyst stage after fertilization). In many cases, the egg quality can be supported with nutraceuticals in pharmacological doses to help support healthier embryo quality and support more positive outcomes during fertility treatments.