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Unexplained, Unexplored? Or Flat-Out Ignored?

Unexplained, Unexplored? Or Flat-Out Ignored?

The diagnosis of “unexplained infertility” has never felt right to me, especially when up to 30% of fertility struggles have this diagnosis. There’s always an underlying dysfunction when the body is not capable of doing what it is made to do. ALWAYS! Reproduction is vital to keep the human species going. It is a foundational requirement for humans. Not all humans reproduce, but we are made to be able to do so.

In a previous article, I explored the difference between unexplained and unexplored infertility. Categories for unexplored infertility were the importance of the male factor evaluation, immune system abnormalities, adrenal and thyroid organ dysfunctions, gut health, nutritional deficiencies, and environmental toxin exposure. All these categories impact the success of becoming pregnant from one month to the next, though they are rarely investigated by a medical doctor or fertility specialist.

Infertility Evaluations of Both Partners
The following standard evaluations are performed when infertility concerns arise.

  • Male partner standard evaluations include:
    • History: Prior paternity; undescended testicles at birth; trauma to testicles; medical and surgical review; medication, alcohol, tobacco, and illicit drug use
    • Examination: Testicular abnormalities; varicocele; absences of vas deferens
    • Semen analysis:

    WHO Semen Analysis Reference Ranges

    Semen volume
    >1.5 mL
    7.2 or more
    Sperm concentration
    15 million/mL or more
    Total sperm number
    39 million or more
    Total motility
    >32% progressive motile, >40% progressive and nonprogressive
    58% or more live spermatozoa
    Sperm morphology
    4% or more

  • Female partner standard evaluations include:
    • History: Prior pregnancies and outcome; medical and surgical review; sexual dysfunction; medication, alcohol, tobacco, and illicit drug use; menstrual disturbances
    • Ovulation: Urine luteinizing hormone ovulation predictor kits; mid-luteal serum progesterone
    • Ovarian reserve: Cycle, day 3—follicle-stimulation hormone; estradiol levels; clomiphene citrate challenge test; antral follicle count
    • Uterine and fallopian tube:
      Hysterosalpingogram to test tubal patency and uterine contour; follicular phase transvaginal ultrasound
    • Eumenorrhea, or regular menstrual cycles by history, is a highly accurate ovulation marker.

Behind Unexplored Infertility
Unexplored infertility categories exist because of how our medical system is organized and now trained. Gone are the days when doctors learn, focus, or frankly even consider the physiology of the body. Physiology is “the way in which a living organism or bodily part functions.” Physiology identifies the cause, THE WHY, of how the body functions and what creates a disease state. Doctors are now trained to focus on the disease state and how it can be corrected with medication and surgery, not what inherent functional disorder may be creating the disease state in the first place. This is the difference between being a country that offers sick care instead of a country that provides health care. Rarely are the basics of lifestyle, food, sleep, community, and mental well-being ever discussed, though those are the exact physiological problems causing the majority of disease.

Another downfall of mainstream medicine is isolating organ systems to fit a specific treatment within a specialty scope of practice. For example, reproductive health is typically isolated to the reproductive organs. Though nutritional deficiencies can explain some infertility struggles physiologically, these are rarely, if ever, looked at by mainstream medicine. Exploring underlying dysfunctions that may not be isolated to the reproductive organs specifically can explain away many “unexplained infertility” diagnoses. Even more importantly, though, it can heal this disheartening diagnosis and result in the conception of a healthy baby. Pretty awesome that the body can cure itself when given what it needs.

The Frustration of the Flat-Out Ignored
After working with patients struggling to conceive with conventional methods like timed intercourse or medicated natural cycles, advanced reproductive technologies (ART) such as IUI or IVF, and some natural-only attempts, I started to see the missing pieces. It was clear that for many patients’ unexplained infertility was simply unexplored infertility. Unfortunately, now I am seeing patients with flat-out ignored reasons that could be the WHY behind their fertility struggle.

Keep in mind that the flat-out ignored reasons are due to the fact that these are reversible causes of infertility and do not interfere with the success of IVF. If you can get pregnant via IVF, mainstream medicine tends to overlook what can be corrected prior to this profitable procedure. Another significant reason these are flat-out ignored is because of the need for more large-scale studies to prove that preliminary study findings were accurate.

To emphasize the dysfunction in our current medicine model: If this were an herb used for thousands of years that showed the slightest negative impact on fertility in a research study, it would be undeniably blacklisted and ruled not safe until further studies are done. But for the very commonly used drugs listed below, we are advised to continue taking them as usual because no study has truly shown detriment to your fertility or pregnancy outcomes.

Potential Causes of Infertility
Let’s expose some known potential causes of infertility you were likely never told could be creating your inability to conceive or carry to term.

  • Night Shift Workers:
    • Male: Night-shift work showed a
      four-fold increase in male infertility, including lower sperm production and testosterone levels.
    • Female: Increased likelihood of fertility treatment by 27–40% with 2.3 fewer mature eggs when working the night shift. Irregular menstrual cycles, hormonal imbalances, and lower estrogen levels were seen for night-shift female workers.

The night shift is also known as the “infertility shift” due to the higher rates of infertility among women who work nights. If you work the night shift and are trying to conceive, you may want to consider changing your schedule.

  • Selective Serotonin Reuptake Inhibitors (SSRIs) – paroxetine and escitalopram:
    • Male: SSRIs could cause dose and duration-dependent reversible adverse effects on male fertility parameters. A decrease in the number and viability of sperm and a disruption of sperm morphological structure were seen with SSRI use. It is advised that male patients avoid SSRIs.
    • Female: Experimental findings suggest that paroxetine and escitalopram may have a negative effect on the ability to conceive due to their stimulatory effect on uterine tube motility. This is the tube in which the egg meets the sperm to become fertilized.

This in no way implies that depression isn’t a serious condition that outweighs any side effects of the medication. However, please consider that there are alternatives to correct the physiology of why depression is present in the first place rather than simply using pharmaceuticals to keep more serotonin around the receptors.

  • Acetaminophen/paracetamol:
    • Male: Lower chances of female partner pregnancy each month, called fecundability. Lowers testosterone to luteinizing hormone and inhibin B to follicle-stimulating hormone ratios indicating anti-androgen action, and decreases prostaglandin levels.
    • Female: Maternal use negatively impacts male embryo reproductive organs, leading to decreased fertility for the offspring.
  • NSAIDs – aspirin, naproxen, ibuprofen, diclofenac, indomethacin:
    • Male: Lowers testosterone and prostaglandin (PG) levels. Prostaglandins are the primary component of seminal fluid facilitating sperm transport within the female reproductive tract by inducing peristaltic contractions and sperm motility.
    • Female: A 2015 study showed that diclofenac reduced ovulation in 93% of women taking it and a 75% reduction in ovulation for those taking naproxen. NSAIDs can result in luteinized unruptured follicle syndrome (LUF) and lower progesterone production. Although “this process is reversible, a woman is not going to get pregnant if she continues to take NSAIDs, and doctors need to advise women to stop taking these drugs if they want to be fertile,” says Sami Salman, MD, from the University of Baghdad. Ibuprofen was not included in this 2015 study.

Another study showed the use of ibuprofen as early ovulation prevention in IVF cycles to reduce the number of canceled cycles due to ovulation prior to retrieval. They used NSAIDs to prevent ovulation. If it works as an ovulation inhibitor for IVF, it can do the same each month when you are trying to conceive naturally.

  • Antihistamines – fexofenadine, diphenhydramine, chlorphenamine, loratadine, cetirizine):
    • Male: Lower sperm count and quality of sperm.
    • Female: These may affect both ovulation and implantation.
  • Histamine, like prostaglandins, is crucial for reproduction from sperm production, releasing the egg, fertilizing the egg, implanting the embryo, and early embryo development to making the placenta. These are all essential for a successful term pregnancy, of course. Histamine has an intimate relationship with estrogen levels as well. So how can removing histamine or blocking it from receptors not negatively impact the success of pregnancy? If you regularly take antihistamine medication and are struggling to conceive, consider alternatives to allergy and acid reflux symptoms.

Don’t Settle for Unexplained, Unexplored, or Flat-Out Ignored
How can 1/3 of fifteen percent of the population simply not have a reason for their lack of conception or loss of conception? Unexplained infertility can be further explored by examining diet choices, lifestyle habits, and sleep habits, which can improve a couple’s chance of becoming pregnant once corrected. These are unexplored reasons for infertility in many couples; they are also known to have a significant impact on your overall health.

As for the flat-out ignored causes of infertility, it’s crucial that you spend some time learning about the medications you take. Consider searching their side effects from the most commonly used search engines, as there are algorithms used in favor of Big Pharma on those search engines. Find a trusted practitioner who will not ignore potential reasons for your infertility struggle, will look at physiologic reasons for your struggle, and truly cares about your health and the health of your baby.

Dr. Nicole Kerr, ND, Lac, operates an all-natural fertility clinic in Wallingford, CT, Fertility Oasis. At Fertility Oasis, Dr. Kerr teaches her patients the importance of preconception care and about all treatment options available to couples struggling to conceive. Dr. Kerr addresses male and female infertility factors to offer comprehensive fertility care to her patients. Fertility Oasis, 857 N Main St Ext Suite 1, Wallingford CT, 203.265.0459.