Fertility is an area that many people are scared to really look into very deeply. Many of us pass our most fertile years in higher education, in an intense career, or happily enjoying single life. That is wonderful, but then when you decide to actually try for a baby, there may be some surprises on the journey.

Fertility is something that most of us assume we have, but what happens when your fertility milestones pass (see last week’s post if you don’t know what those are), and you don’t have a baby?

The Next Step is To Find Out What Is Going On, But Lots of People Skip This.

So let’s talk about why finding out the cause of your reduced fertility is pivotal to getting to baby-in-arms.

First, many couples put the burden of fertility care on the woman, but…

  • Female factor infertility makes up  37 percent of infertile couples in developed countries 
  • Male factor infertility is the issue in 8 percent 
  • Both male and female factor infertility represents 35 percent  

This means that if you’re only working on the woman’s fertility, you’re missing the big picture, and not helping on the journey toward a baby.

infertility, infertility and MTHFR, causes of infertility, female factor infertility

Getting a diagnosis:  The causes of female infertility 

The most common identifiable female factors, which accounted for 81 percent of female infertility, were:


  • Ovulatory disorders (25 percent)
    • PCOS 
    • Thyroid
  • Oocyte aging
    • Including premature ovarian insufficiency


  • Endometriosis (15 percent)
    • Endometriosis has been estimated to affect 10 to 15 percent of women of reproductive age. Of women with endometriosis, 30 to 50 percent are estimated to have infertility. Of women who present with infertility, 25 to 50 percent are estimated to also have endometriosis.
  • Pelvic adhesions (12 percent)
  • Tubal blockage (11 percent)
  • Other tubal abnormalities (11 percent)
  • Hyperprolactinemia (7 percent)

Of special note:  Celiac disease — Women with untreated celiac disease may have an increased frequency of reproductive abnormalities, including infertility, miscarriage, and intrauterine growth restriction

“Unexplained Infertility”

“Unexplained infertility” is the diagnosis given to couples after a thorough evaluation has not revealed a cause. Many cases of unexplained infertility may be due to small contributions from multiple factors including MTHFR polymorphisms, COMT polymorphisms, nutritional deficiencies, etc…  This is another great time to see an ND if you haven’t already.  

Many conditions overlap to contribute to both repeat miscarriage or difficult conception. Factors can include genetic polymorphisms like MTHFR and more than 100 other single nucleotide polymorphisms, chromosomal abnormalities, nutrition, hormone balance, and mental and emotional factors. Even stress has been shown to reduce fertility across the conception window, which is difficult news for anyone feeling stressed about conceiving. We’ll talk about that in more detail in an upcoming episode.

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Causes of Recurrent Miscarriage, Repeat Pregnancy Loss, or RPL 

Recurrent miscarriage means early pregnancy loss (EPL) for nonviable, intrauterine pregnancies within the first trimester, that has happened more than once.

This situation should get its own specific diagnostic work-up and has its many causes.  Causes can be:

  • Structural like uterine polyps
  • Immunologic like antiphospholipid syndrome
  • Endocrine like hypothyroid or low progesterone
  • Genetic like MTHFR or thrombophilia 
  • Combination like COMT mutation and endometriosis with pelvic adhesions

The most important thing to understand is that some issues are structural and even if you’re doing all of the right things for fertility, it isn’t going to happen unless you fix the structural problem. No amount of good nutrition, progesterone, or natural medicine is going to fix that. Great examples of this are pelvic adhesions and tubal blockage.

There is no one-size-fits-all with fertility care and you have a relatively brief window of time to figure this out, so it really matters to be proactive about your fertility and find the cause as much as you are able.

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