Infertility Case Studies:
Case Studies #1: Infertility as a Couple
Last year I met with a couple that is typical of the infertility cases that come to me. They have been trying to conceive for 14 months. There were a couple of issues on the man’s side, a couple of issues on the woman’s side and they had been unsuccessful after a year of trying but didn’t want to and couldn’t afford the IVF route. The majority of these couples don’t need to pursue IVF, but no one ever tells them that or offers a different option.
She’s 39 years old, concerned that her age is a factor in their inability to conceive. Her periods are regular, but cycles are a bit short only 25-26 days. She ovulates on her own each month (tracked with an ovulation predictor kit). Her periods are heavy and crampy on the first day and last for 5 days. She has never been pregnant. PMS symptoms include breast tenderness, headaches, and crying easily and she spots a day before her period starts.
He’s 41 years old, in good shape, but tends to rely heavily on coffee to keep up with the pace of his hectic legal job. Sperm count is normal, motility is normal, morphology is a little low (10%) and DNA fragmentation index is high at 49%. He has had a physical exam and ultrasound by his medical doctor that showed no presence of a varicocele.
Predictor kits are a good heads-up that ovulation may be happening in a day or two, but there’s no confirmation that ovulation was successful. For that, I prefer basal body temperature charting for at least one cycle to confirm the cycle day of ovulation and to see how consistent temperatures are post-ovulation. Anne has some signs of estrogen dominance – heavy periods, cramping, breast tenderness, emotional with PMS. She may be ovulating normally around day 14, but then have a shortened 11-12 day luteal phase that isn’t allowing for healthy implantation, the basal body temperature chart can help confirm this. A 7-day post-ovulation progesterone level can be helpful too to see what her peak progesterone level is like. Ideally, I like to see peak progesterone of about 50-60 nmol/L or higher. I started her on vitamin B6 and Vitex on the first visit and asked that she gather at least a month of basal body temperature data and gave her a requisition for a progesterone blood test 1 week after ovulation.
Stress reduction is important for Dan to reduce the oxidative stress in his system. He has committed to try to reduce his work hours and get more sleep, and add in exercise 3 times per week. Caffeine reduction is also important because of the high DNA fragmentation. I advised him to avoid excessive heat to the testicles like tight underwear, sitting with his laptop on his lap, hot tubs, hot yoga. I put him on a combination of antioxidants including zinc, selenium, vitamin C, vitamin E, CoQ10, alpha-lipoic acid, and l-carnitine. I also prescribed Cat’s Claw for the DNA fragmentation and a formula to increase the body’s own internal antioxidant system, Nrf2. I recommended a repeat semen analysis in 3 months.
First Follow-up (4 weeks)
Anne’s 7 days post ovulation blood test confirmed a less than optimal progesterone of only 31.3 nmol/L and Basal Body Temperature confirms a normal follicular phase, but a shortened luteal phase. We continued with vitamin B6 and Vitex for 2 more months.
Has followed through on his commitment to work less, increase sleep and relaxation time, and exercise regularly. He has cut back his coffee intake to one per day and has been consistent with his supplements. We continued Dan’s supplements until his follow-up semen analysis.
Second Follow-up (3 months)
Anne has noticed a lengthening of her menstrual cycles over the last 2 months by about a day each month, so she’s now at a full 28-day cycle. Basal Body Temperatures have improved in consistency after ovulation in the last month as well.
Dan has continued with exercise, stress reduction, consistent sleep, and lower caffeine intake. His most recent semen analysis shows normal morphology at 12% and DNA Fragmentation Index is improved at 28%.
Third Follow-up (5 months)
Anne & Dan are expecting their first child. Anne is currently at 6 weeks gestation. HCG levels show a healthy pregnancy so far. Dan intends to continue with his healthy lifestyle changes and a good quality multivitamin, while Anne transitions to prenatal naturopathic support.
Case Studies #2: “Too Old” at 33?
Bonnie came to me at 33 years old after trying to conceive for more than a year. Her family doctor referred her to a fertility clinic who told her that her egg quality was poor, her AMH was too low and that she “would never conceive on her own” her “only hope was to use donor eggs”. If a woman isn’t producing many eggs or the quality of her eggs is poor at only 33, there is a problem that needs to be addressed to reverse these issues. There is no way that an otherwise healthy 33-year-old woman shouldn’t be able to conceive and bear her own children.
As with all naturopathic treatments for infertility, we addressed each of the factors that were having an impact:
Egg Quality & Low AMH: The factors that influence egg quality are oxidative stress and hormone balance. I ordered thorough hormone blood work including tests that the fertility clinic had not yet done. Bonnie had slightly raised DHEAs and testosterone and slightly low estradiol and had an FSH of 13. To address the DHEAs and testosterone, we cleaned up her diet: substituting low glycemic index carbs for high ones, increasing intake of non-starchy vegetables and low glycemic index fruit, and including protein with each meal. She took Black cohosh at 20 mg per day for days 3-13 of her menstrual cycle to support ovulation. Bonnie came in for acupuncture once per week for 6 weeks to stimulate the normal function of her ovaries and after that once per month.
Difficulty Conceiving: Healthy progesterone levels are necessary for embryo implantation and maintaining the pregnancy. I tested her progesterone 7 days after ovulation and found that it was less than ideal at 31. We used Vitex tincture at 1 teaspoon 3 times per day and vitamin B6 to improve progesterone levels.
Two Months After Starting Naturopathic Treatment
Bonnie conceived and went on to have a normal, healthy pregnancy and deliver a healthy baby boy.