5 Reasons You Are Not Getting Pregnant and What You Can Do About It

This week’s Guest Blog is written by Inna Topilar, a Functional Nutritionist and Founder of Complete Nutrition and Wellness. She has focused on hormonal health and fertility for many years and always has a thoughtful approach.

While there are lots of different reasons for the inability conceive and for miscarriages, the most common are because the egg or sperm just wasn’t genetically sound, this is especially true for the miscarriages that happen early on (between 4 and 9 weeks.) Typically, the body is supposed to know that something is off once the egg is fertilized and it would not even allow for implantation. This is one of the reasons people who try, don’t get pregnant; something may be fertilizing but the body is seeing there are genetic errors and not implanting. Other times it may take the body a little time to realize there are genetic errors so the embryo implants but then the body does its natural process of eliminating what doesn’t belong. Egg quality issues are super common but we also have to be mindful of inflammation and hormone balance which all play a role so let’s go through the top 5 things to look into for egg quality and fertility.

 #1 is diet. When we eat foods high in sugar and processed carbs as well as foods our body may have sensitivities to, we increase inflammation. The inflammation combined with increased stress (which often goes along with fertility) is a double whammy on your body.

 You want to make sure that you are eating a balanced diet where you are getting lots of vegetables, clean proteins, good fats and unprocessed carbs which is going to be your base. Additionally, it is very helpful to address any food sensitivities. I actually just did a podcast episode on this (episode 60) so if you missed that one, please have a listen. Doing the right food sensitivity test to see which foods your body doesn’t like is very helpful because those foods will create inflammation which will in turn affect your fertility. 

Some of the biggies I often see are gluten and dairy. Gluten can really be detrimental in some people and can actually affect your progesterone levels which are so important for maintaining the pregnancy. One of my favorite tests is by Vibrant America because they do a really compressive gluten panel.

If you are not able to do a food sensitivity test and have never tried going gluten free, doing a trial and going gluten free can be helpful to see how you feel. In the case of fertility, you would want to do the trial for 3 months.

#2 is properly evaluating and addressing your hormones. When seeing a conventional OB or even a fertility doctor, they typically test your FSH and LH and sometimes estrogen on day 2 or 3 of your cycle. It is important to make sure FSH is within range, ideally below 10. However even if that is the case, there are so many people that continue to have fertility issues. This is because these hormones are just the tip of the iceberg and there are so many more things to look at when it comes to hormones.

While it’s important to have an FSH that is in range, you also want to make sure you have adequate levels estrogen and progesterone but those can’t be seen on day 3. Let me explain.

When you look at your cycle, Estrogen and progesterone are typically both low during your period, (so day 3 when you take your FSH really doesn’t tell you much about estrogen or progesterone, as we expect them to be low). Then estrogen is going to spike right around ovulation, it will go down a bit and spike again about 7 days after ovulation and then slowly go down for your next period.

Progesterone is going to remain low from your period till you ovulate and then will slowly go up around day 14 or when you personally ovulate and that can vary from person to person even in a 28 day cycle, it can be as early as day 10 or late as day 18 and still be considered more of less normal. It will then spike 7 days post ovulation and then if you’re not pregnant will go down and become low again for day 1 of your period next period. The decline in progesterone is what actually tells that body that you are not pregnant and initiates a period.

So when looking at these levels through blood, the best time to do the test is on day 21 or 7 days after you ovulate because then you are catching those hormones at their highest levels so you can see if they are sufficient. I like to see a progesterone level of 12 or above on day 21. This shows the person is ovulating and has enough progesterone to maintain the pregnancy should it happen.

I am also a big fan of cycle charting to uncover information about how your hormones are doing throughout the cycle. For a complete guide to cycle charting, refer to the cycle charting blog post.  It can reveal some issues such as short or long phases, anovulation and low progesterone (which may be due to different factors, one of which is estrogen dominance.)

Some symptoms of estrogen dominance are: weight gain, especially around your period, having swollen or tender breast around your cycle, having longer, heavier cycles with more cramping and more headaches before your cycle.

In those cases, avoiding estrogenic foods like soy and paying attention to xenoestrogens like chemicals in plastics and certain skin care products is important while also working on the liver and detox pathways. Calcium D Glucarate is one of my favorite supplements for estrogen dominance. 

Therapies like acupuncture are also wonderful for hormone balancing. Gluten and other inflammatory foods can also contribute to this so it is important to explore if that may be an issue for you.

Another hormone that is super helpful to check in a blood test is DHEA. When requesting this blood test, you want to ask for DHEA Sulfate, its written as (DHEA-s). This helps to see adrenal function and acts as a precursor to estrogen and testosterone.

There is a good amount of research on the benefits of taking DHEA for egg quality and many fertility doctors recommend this, HOWEVER and this is a big however, I find that it is recommended fairly blindly to most people going through fertility issues but like with anything else, if you don’t need it, it will not work for you AND since this is a hormone precursor, I find that many people can have side effects and it can sometimes do more harm than good.  So, it’s always best to have levels tested to make sure if would be the right fit for you and if so, at what dose.

Along with DHEA, I often hear CoQ10 as a recommendation because there was a study looking at the effects of Dhea and coq10 on eggs and since then many fertility clinics recommend it. Coq10 is safe and I don’t have any issue with people tryig it. However again, if you are not deficient in it you (can see that on a blood or organic acid test,) it will likely not help. The study was done with 600 mg which gets quite pricey so while it should typically not hurt to take, you could be spending a lot of unnecessary dollars if your levels are sufficient.

#3 is evaluating your stress. We’ve all heard that stressing about getting pregnant is not helpful in getting pregnant but of course, I totally understand its easier said that done .We must find ways to manage stress and that is going to be different for all of us. I personally like meditation and listening to relaxing music, however those are just a few tools. You may like journaling, breathing techniques, taking a walk, getting a massage, talking to a friend or anything else that you enjoy. The important thing is to put something into practice and do something every day. It doesn’t have to be the same thing each day either. I recommend setting aside 15 to 20 minutes per day to do something that is just for you. And when I say setting aside, I don’t mean saying yes I am going to do it at some point but actually scheduling it into your day, if it doesn’t get scheduled it typically doesn’t get done that is just the reality.

#4 is evaluating and addressing your thyroid. I talk a lot about thyroid because optimal thyroid function is crucial for so many things and it certainly is for fertility. One of the reasons why the body may not pick the best eggs is because thyroid function is off. While most doctors will check TSH which is just one of the markers, TSH alone is not nearly enough to truly determine thyroid function and over 50 % of people can be completely missed for hypothyroidism (especially the sub clinical kind.) If your doctor told you your thyroid is normal, please ask for your results and make sure that they ran not just TSH but all of the hormones which are:

-TSH

-Total T4

-Total T3

-Free T4

-Free T3

-Reverse T3 and

-Thyroid antibodies

And lastly, #5 is making room for the baby in your life even before the baby is here.
This is not specifically biochemical like the other 4 things I just talked about but I think it is very important.

What I mean about making room for the baby before the baby is here is just that. So many of my fertility clients tell me that they are so busy with work and all of their extra curricular activities that they may not have time to eat the way I recommend or do some of the suggested therapies. I totally get it, you are busy, so am I but you know what, when that baby is here, you are going to have to make changes because its going to require A LOT of your time and LOT of your attention. So from an energetic standpoint, it is helpful to start thinking about how you would adjust your schedule when the baby is here and actually start doing some of those things right now. This creates a welcoming space.

We want to work on the biochemistry and really look into the first 4 things I discussed but we also want to be mindful about the timing and things you can do in your life now to make room for the baby. So Look at what you may want to do that you haven’t yet, is there anything you need to work on, either personally and professionally? Anything you may need to work on in in your relationship? Anything that may not be working in your life? The more you balance things (and I mean not just biochemically but also emotionally and energetically) the more balanced your body will be as a whole and this is key for fertility!