Written by Elizabeth Boham, MD
Clara’s Case Study: Overcoming Infertility

Clara’s Case Study: Overcoming Infertility

Dealing with infertility is an overwhelming, confusing, and heartbreaking issue for an estimated 10% of women in the US who are between the ages of 15 and 44. It’s defined as the inability to get pregnant after one year of trying for women less than 35 years of age, or six months for those who are over 35. Here at The UltraWellness Center, we’ve seen an increasing amount of women who are struggling with infertility for a wide variety of reasons. While these statistics are scary, the good news is that by using the principles of Functional Medicine we can often regain fertility and support happy, healthy pregnancies. This case study is the perfect example of that.

My patient Clara was a 33 year old woman who was recently married and interested in starting a family. She had not been using any birth control for the last 6 months and had not yet gotten pregnant; she began wondering if she should make an appointment with a fertility specialist.

Clara had a history of irregular periods ever since she hit puberty. She was placed on birth control pills starting at the age of 16 to help regulate her periods and reduce her acne breakouts, then stopped them at age 32. One of the practitioners she saw mentioned that she may have PCOS (polycystic ovarian syndrome) but she never had a work up to confirm a diagnosis. Since she stopped the pill she has had a few periods, but they are not completely regular as they sometimes skip a month or two.

The first step I took with Clara was to do testing to see if she had PCOS.  Her fasting insulin was slightly high at 9 (ideal is <5 at the UWC, conventional medicine often wants it to be <12).  She had some chin and cheek acne and had a little extra weight around her belly, which can both be symptoms of PCOS. When we did her hormone panel, it was normal. We determined that she may have some signs of PCOS and put her on a lower glycemic impact diet. This means that we removed added sugar and refined carbs from her diet. We made sure that she had a healthy fat and protein source at each meal to help balance her blood sugar and we also focused on eating a high-fiber diet to help slow the digestion and absorption of her foods and therefore stabilize her blood sugar and insulin levels. Some examples of foods high in fiber are vegetables, ground flax seeds, nuts and seeds, and beans and legumes.

In addition, we thoroughly tested Clara’s thyroid. We did a full thyroid panel including free T3, free T4, TSH, and thyroid antibodies. We found that she had some borderline elevated thyroid antibodies, indicating an autoimmune attack on her own thyroid. Her TSH was still in the normal range, but her free T3 and free T4 were a little low. Because of the thyroid antibodies, we removed gluten from her diet, as this has been shown to exacerbate that reaction in some people. She did not officially have celiac disease, but we did suspect that gluten may be contributing to the thyroid antibodies. In addition, we tested her iodine and selenium levels. They were both slightly low, which is common with depressed thyroid function and autoimmunity. So, we supported her thyroid with iodine rich foods (nori, kelp powder) and selenium rich foods (1-2 Brazil nuts per day).

3 months later, her periods started to become more regular and she lost the extra 5 lbs that she had around her belly. But she still had not become pregnant. I started her on a little thyroid hormone since her thyroid was still slightly low and she still had thyroid antibodies. Clara begame pregnant 2 months later!

I hope you find Clara’s story inspiring; infertility does not have to be permanent. Working with a Functional Medicine practitioner can help you get to the root cause of your fertility issues while helping you regain optimal whole-body health. Here are ten things to support your hormonal health and improve fertility:

    1. Support thyroid function – Hypothyroidism is more common than hyperthyroidism, however both can impact your ability to get pregnant and cause imbalances in your hormonal cascade. Your physician can check for these with a simple blood test, just be sure to ask for free T3, free T4, TSH, and thyroid antibodies to get the full scope of your thyroid health.
    2. Stabilize blood sugar and insulin – Chronically high blood sugar levels cause the body to become resistant to insulin, leading to weight gain, inflammation, and diabetes. These two imbalances are also linked to PCOS which affects other hormones and is a common cause of infertility. Eating a low-glycemic diet full of real, whole foods that are high in fiber and combining healthy fats and proteins with carbohydrates is the best way to stabilize your blood sugar.
    3. Address adrenal imbalances Chronic stress and inadequate sleep can lead to depleted adrenal glands as well as other hormonal disruptions. Focusing on reducing stress with methods like yoga, meditation, journaling, and deep breathing.
    4. Support sleep – An important part of nourishing the adrenal glands, high-quality sleep needs to be a priority. Be sure to embrace good sleep hygiene habits, like avoiding screens an hour before bed and allowing yourself enough time to get 7-8 hours. Using magnesium before bed can help you relax and is also beneficial for hormone metabolism.
    5. Fix nutrient deficiencies – When your body is lacking essential nutrients, it doesn’t feel prepared to nourish a new life and infertility can result. A Functional Medicine doctor can help you find out if you’re suffering from any nutrient deficiencies; folate, vitamin B12, omega-3 fat, and iron are especially important in this scenario, though many others play a part as well.
    6. Reduce toxic burden – Sometimes the body is overcome by toxins and knows it’s not a safe place to grow a baby. There are many toxins that impact our hormones, like  BPA, phthalates, parabens, and pesticides, just to name a few. Heavy metals like mercury are also an issue. It’s important to avoid plastics and be aware of what you’re putting on your body, using around your home, and what ingredients are in your food if you want to completely detoxify your life. Be careful not to undergo an in-depth chelation protocol, though, if you may get pregnant within the next year, as toxins can circulate for quite a while as your body works to eliminate them and this could be harmful for a baby.
    7. Support elimination – This step goes hand in hand with detoxification. If your bowels aren’t working properly, you’re not properly eliminating toxins. Eating high-fiber foods, avoiding refined/processed ones, and drinking plenty of water all help your digestive tract work more efficiently. If you have specific symptoms, talk to your practitioner and find which natural approach (there are many) is best to support your needs.
    8. Avoid over exercising – Many women engage in intense physical activity several days a week. Though it depends on the individual, this can sometimes alter hormones in a way that can lead to infertility. If your period is absent or your cycles are always on the longer side and you exercise often/at a extreme level, this could be the cause. Assess your current fitness routine and if you’re trying to get pregnant consider cutting down to just 1-2 intense days a week and enjoy moderate to mellow activities on the other days.
    9. Eat enough – A calorie deficit can also cause hormonal irregularities. Many women are concerned about weight gain and thus end up regularly eating too little. The body is wise, though, and when it believes it’s starving it doesn’t want to bring a baby into the same situation. Once again, if your period is irregular or absent this could be the cause. Be sure to eat three balanced meals of real foods each day, the more colorful veggies and leafy greens the better, and don’t be afraid to incorporate healthy snacks like nuts and seeds when hunger strikes.
    10. Identify sensitivities – Unknown food sensitivities can create many types of imbalances throughout the entire body. If you’ve noticed poor reactions—bloating, brain fog, diarrhea, joint pain, rashes, or a host of other symptoms—when eating, you may very well have a sensitivity. The tricky part, is that sometimes you won’t notice any reaction at all. Working with a qualified practitioner can help you pinpoint possible food sensitivities and work on an elimination diet.

There are many underlying reasons for infertility and the stress and emotional grief of dealing with it alone will only make matters worse. Talk to friends and family, reach out to a Functional Medicine doctor, and be sure to nourish yourself during this hard time, it’s essential for your overall health. There are many steps you can take to improve your chances of conceiving while discovering what it’s like to feel your best.

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