Why I don’t believe in the term ‘unexplained infertility’

+ 5 sneaky culprits that could prevent you from getting (and staying!) pregnant

An unexplained infertility diagnosis can be both devastating and frustrating, often leaving those affected feeling helpless to be told there’s no apparent reason for the fertility challenges that they are experiencing.

However, while this might be controversial, I don’t believe in the term ‘unexplained infertility’.

Yup, I said it.

As a registered nutritionist specialising in women’s hormonal health and fertility, I believe there is ALWAYS a reason for fertility challenges, and this diagnosis just means that all the factors and possible issues that contribute to fertility problems haven’t been properly investigated…yet!

Of course, there are SO MANY factors that must be perfectly aligned for successful conception and implantation to occur, and this blog aims to explore why the term ‘unexplained infertility’ may not be particularly helpful, what 5 sneaky factors I commonly see that are often overlooked in fertility challenges and why further specialised testing and investigations are crucial if you’ve been given this diagnosis.

The limitations with this diagnosis…

Many couples are given this unhelpful and very blanket diagnosis only after some BASIC testing has been performed and has come back satisfactory (e.g., a day 3 hormone and day 21 hormone test, testing a woman’s ovarian reserve) along with an internal scan and an initial semen analysis.

While these tests can be helpful to rule out anything obvious preventing a couple from getting pregnant, they can often fail to uncover any underlying issues that may contribute to difficulties in conceiving. Couples are then often pushed into thinking that IVF may be their only option to conceiving naturally, which isn’t necessarily the case.

I therefore encourage couples experiencing unexplained infertility to embrace a holistic approach to fertility. By focusing on things like optimising nutrition during the preconception period, reducing their exposure to toxins, managing stress, and getting optimal sleep, couples can take proactive steps to enhance their fertility journey.

What sneaky factors could be preventing you from getting pregnant?

Here are 5 sneaky factors I commonly see that are often overlooked in those experiencing fertility challenges:

1) The Vaginal Microbiome

While you may have heard all about the role of beneficial bacteria for a healthy digestive system, you may not know that just like the gut, the vagina is also home to millions of bacteria. Known as the vaginal microbiome, when in balance, it plays a vital role in optimising reproductive health and fertility!

Research conducted by Tommy’s found that the dominance of a particular bacteria species (called Lactobacillus Crispatus) in a woman’s vagina has been linked with higher pregnancy success rates in both term pregnancy and live birth. However, lower levels of Lactobacillus and dominance of other bacteria have been associated with miscarriage.

Also, the presence of ureaplasma infections are frequently neglected in fertility investigations. These infections can affect both male and female partners and can contribute to infertility – particularly in those who have been given an ‘unexplained’ infertility diagnosis.

Functional testing can help identify these hidden culprits, and appropriate treatment can improve the chances of conception. Personally, I love using the Vaginal EcologiX in clinical practice to assess a woman’s microbiome for optimal fertility. For more information on the link between vaginal health and fertility, check out my previous instagram post. Here’s a snapshot of the results:

2) Sperm DNA Fragmentation

Traditionally, sperm quality has been assessed based on parameters like count, motility, and morphology which are all assessed in a basic semen analysis test. However, recent research has shed light on another crucial aspect: sperm DNA fragmentation which is often neglected in primary fertility investigations. High levels of DNA fragmentation can impair fertilisation, embryo development, and increase the risk of miscarriage and has been associated with a significantly increased risk of pregnancy loss after IVF and ICSO, according to studies.

3) Hormone Imbalances

Another factor that I see hugely overlooked when it comes to unexplained infertility is a hormone imbalance, which can have a significant impact on a woman's ability to conceive. Among these imbalances, a frequently unrecognised issue is a short luteal phase, which refers to the duration between ovulation and your period. Surprisingly, this crucial aspect of reproductive health is not typically included in basic hormone tests, leading to potential cases of unexplained infertility going undiagnosed.

A shortened luteal phase, usually lasting less than 10 days, can present significant challenges for conception. During this phase, the hormone progesterone, responsible for maintaining the uterine lining, can be low and often result in a uterine lining that may not adequately support implantation, leading to difficulties in achieving and sustaining a pregnancy.

Unfortunately, basic hormone tests often focus on assessing the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestrogen, and progesterone at specific points in a woman's menstrual cycle. While these tests provide valuable insights into hormone levels, they fail to shed light on the duration of the luteal phase.

In my clinical practice, I lovely using the DUTCH test to assess my client’s hormonal health as it goes far beyond hormone testing via the GP. Check out this post I did on why it can be particularly helpful for those with fertility challenges.

4) Coeliac Disease

Another overlooked factor in fertility investigations is coeliac disease, an autoimmune disorder triggered by gluten consumption. Undiagnosed coeliac disease can have a profound impact on reproductive health. The body's immune response to gluten can cause inflammation and damage the small intestine, leading to nutrient deficiencies and hormonal imbalances. These factors can affect fertility in both men and women.

For couples experiencing unexplained infertility, considering coeliac disease as a potential underlying factor, and following a gluten-free diet may improve their chances of conception. For most children and adults, the best way to test for coeliac disease is with the Tissue Transglutaminase IgA antibody (tTG-IgA), which can be done via your GP.

5) Thyroid Issues

While many are familiar with the TSH (thyroid-stimulating hormone) test, this level only provides a snapshot into your thyroid function. It’s also worth mentioning that ‘normal’ NHS ranges for thyroid health are also somewhat different to functional ranges for optimal fertility.

For example...

'Normal' NHS range for TSH = 0.27-4.2 mIU/L.

Optimal TSH range for fertility = 1-2 mIU/L.

Not in range? Your thyroid could be struggling.

To get a comprehensive understanding of your thyroid health, it's also crucial to go beyond TSH and opt for a full thyroid blood test, including antibodies. Sadly, this is something I see missed off so many of my clients' initial fertility blood work, but it can have a BIG impact on fertility and even miscarriage risk.

But what are thyroid antibodies?

Thyroid antibodies are proteins produced by your immune system that can mistakenly attack your thyroid gland. Two common antibodies are thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb).

When these antibodies are present, they can trigger inflammation and hinder your thyroid's ability to function optimally. This immune response can have a profound impact on your fertility and the presence of thyroid antibodies increases the risk of first trimester pregnancy loss by up to 24%, according to some studies.

I recommend all my clients get a full thyroid panel done, either via their GP or privately, by a lab such as Medichecks. Click here for the exact test I recommend (and feel free to use my discount code HAYLEYDOWN10 for 10% off).

Anyway, I hope this article has been helpful and hopefully know you know that receiving a diagnosis of ‘unexplained infertility’ should not mean giving up hope.

It's essential to advocate for further testing and investigations beyond the standard fertility workup. Collaborating with practitioners who are willing to explore additional diagnostic avenues can help uncover underlying issues and guide appropriate interventions.

Feeling overwhelmed and ready for some personalised fertility support?

If you’re feeling overwhelmed with where you’re currently at with your baby-making journey, please know you’re not alone! Get in touch to book your free 30-minute call to chat about your options.