When you’re ready to get pregnant, you’re ready. Even if you’ve tried to ease your expectations by telling yourself that “it may take some time,” it can still be extremely frustrating and worrisome when months—or even years—tick by and the two pink lines still haven’t shown up on the pregnancy test, and you think, what are the possible causes of infertility?
Many women in the throes of trying to get pregnant may be discouraged and saddened about the process when it’s not immediate, says Dana Bufalino, a health coach at Parsley Health. While there may be underlying conditions and even some lifestyle factors that may be impact fertility, it’s also important to know that it’s not your fault, she says. Likewise, Parsley Health’s healthcare team is able to provide help on how to change your habits holistically to maximize your chances of becoming pregnant.
Below are seven reasons you may have trouble getting pregnant that can often be overlooked in conventional medicine. (Remember, these are not the *only* answers and coupled with physician recommendations and an understanding of your individual health, you may decide that pursuing medical intervention and due treatments are the best option. Know that Parsley Health clinicians and health coaches can support you before, during, and after your fertility journey.)
Both an underactive (hypothyroid) and overactive (hyperthyroid) thyroid can affect ovulation, cause irregular menstrual cycles, and lead to imbalances in sex hormones, which can impact your chances of getting pregnant. (Proper thyroid levels are also essential for a healthy growing fetus, as well.) “We see a lot of thyroid issues that contribute to struggles in the fertility journey,” says Bufalino. The problem is that symptoms of thyroid disease, like weight gain or loss, constipation or diarrhea, irritability, or sleep issues can all be attributed to other things, like a stressful schedule, so they’re easy to miss.
If your provider at Parsley suspects a thyroid condition, they may do a blood test to measure TSH, Free T4, Total T4, Free T3, Reverse T3, anti-TPO antibodies, and anti-thyroglobulin for the most wide-ranging picture of potential thyroid issues. From there, your doctor may speak with you about potential underlying causes of thyroid dysfunction before recommending treatment. Holistic treatment may include medication or changes to your diet.
It’s clear that fertility issues cause stress. Women undergoing fertility treatments report greater amounts of stress, anxiety, and depression, as detailed in Dialogues in Clinical Neuroscience. What’s less clear is if stress is a direct cause of fertility issues, though initial research has shown that women undergoing fertility treatments who participate in mindfulness-based relaxation programs lessen anxiety and have higher rates of pregnancy. This indicates a correlation between the two, if not causation, but the science checks out: “If the body senses that you’re in danger—and this can be from anything, like stress from work or family issues—functions that are not necessary for survival will become deprioritized,” says Jessica Wei, MD, a certified functional and integrative medicine physician with Parsley Health. That includes reproduction, and so resources are diverted away from the production of sex hormones and hormonal signaling is also disrupted.
“There is a cascade of physiological changes that happen when you’re in a worried and anxious state,” she says. There are numerous anecdotal reports of people who underwent fertility treatment for years “and the moment they decide that they’re not going to do it anymore and that stress lifts—boom, they get pregnant,” adds Dr. Wei.
Stress is going to happen, but you can learn to manage it in a healthier-for-you way. “I recommend getting in front of your stress and creating a relaxation practice. This will help you unwind and renourish your adrenal and hormonal system,” says Bufalino. Meditation will rewire your nervous system to better manage stress, for example, she says. Or it might be going for a walk with a friend, trying a gentle yoga flow, spending time alone, or—yes—taking a bath. Also important for managing stress? Sleep. “Sleep is one of the best practices to regulate your hormonal system,” says Bufalino.
Parsley Health doctors focus on both stress management and sleep with members. They may ask, for example: Do you go to sleep and wake up feeling rested? Do you wake up with night sweats? Visit the bathroom often in the middle of the night? Then, they’ll work to get to the root issue of why your sleep patterns may be off and help determine new healthy habits that promote good sleep, like initiating a relaxation practice before bed.
Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a condition marked by hormonal imbalances and metabolic dysfunction. PCOS is extremely common (though many women struggle to get a proper diagnosis.) According to the U.S. Department of Health and Human Services, PCOS affects 1 in 10 women of childbearing age, and it’s one of the most common causes of infertility in women, as it interferes with ovulation.
According to Bufalino, PCOS can be seen in three instances: women who have been on birth control for a long time and their periods don’t return after stopping; women who have high insulin levels (who may have trouble losing weight and have some of the more classic PCOS symptoms, like hair loss on the scalp); and women who have a more inflammation-based disease. “These women are not overweight but they have inflammation in their body due to factors like a high glycemic-index diet, high-sugar diet, and chronic stress,” she says.
Despite what you may have been told, it is possible to get pregnant naturally with PCOS. At Parsley, a health coach will work with you to maximize health practices, starting with a diet that balances your blood sugar. “This helps balance your hormones, as well as cortisol levels,” says Bufalino. Your plate should be comprised of 50 percent vegetables, 25 percent complex carbohydrates, and 25 percent of lean protein. Eating every few hours will also help stabilize blood sugar. She also recommends avoiding both added and artificial sugar.
Maybe you know you’re ovulating regularly because of the test strips that affirm you’re releasing an egg like clockwork every month. And still, you’re not pregnant. Is this a cause of infertility? “For many people who aren’t getting pregnant or are unable to stay pregnant, we find that they’re not producing enough progesterone in the second half of their cycle,” says Dr. Wei. The cause can be due to the aforementioned stress or nutritional needs that are missing. “There are tests we can run to identify those patterns so we can work on supporting optimal progesterone secretion that is needed to prep the lining of the uterus for implantation and to support a pregnancy,” she says.
This is where personalized medicine comes in, and what Parsley offers each woman who is ready for pregnancy. “We can do more investigation to find out what’s going on in your body that’s unique to you,” says Dr. Wei. Parsley considers the lifestyle issues that may be at the root of the problem. “Nutrition, relaxation, movement, and sleep are all fundamentals that are important to work on all the time,” she says.
Restrictive eating and intense exercising
Being “super healthy” should help with fertility, right? In actuality, it can backfire: A commitment to the gym and eating clean can turn harmful when taken to the extreme. And it can be difficult to recognize this in yourself, especially if you’re praised for the behavior. “Unfortunately, it’s common to think that you’re taking great care of yourself by society’s standard, but it can still be taxing to the system,” Bufalino says. One sign is that your periods are irregular (or entirely unpredictable) or you’ve lost your period altogether.
When it comes to exercise, “overexercise” can mean too much exercise or exercise that’s too intense for your body. “We think of workouts as being stress relieving, but they can raise cortisol levels if too intense. And raising cortisol in an unhealthy way will steal from other hormones that you need for a healthy cycle,” she says. If you have too strict a commitment to being healthy and you notice that your periods are irregular or absent, try to slow down with more walks and light yoga.
Loosening up your diet and giving yourself permission to eat more and stress less about having a perfect plate can also help. These eating habits aren’t cured overnight, but you can take steps forward by seeking the help of a health coach for guidance on adopting gentle nutrition practices.
Good digestive balance affects everything, and gut dysregulation is a common problem Dr. Wei sees. “If you’re not digesting or absorbing nutrients properly, you are not setting up the proper foundation for hormonal and overall health,” she says. GI health is one element needed to support a healthy pregnancy, so if a patient is struggling with fertility issues and Dr. Wei suspects gut dysregulation may be a factor, she may suggest pausing efforts to get pregnant for a period of time so that they can work on digestive health, something that (understandably) can be disappointing. You should do what you’re comfortable with, but this effort can be worth it. “When you come to a functional medicine practitioner who understands hormonal health, you may be able to unlock some of the mysteries behind trouble getting pregnant,” she says.
Endocrine disruptors are a class of chemicals that mimic or interfere with your body’s hormones, says the National Institute of Environmental Health Sciences. “We have so many in our daily environment from household cleaners to beauty products and in food storage,” says Bufalino. “These types of chemicals break down the communication between the brain and endocrine system,” she explains.
Research shows that men, too, suffer the effects of these chemicals. A 2017 study concluded that sperm counts have fallen by 50 to 60 percent, with endocrine-disrupting chemicals and pesticides two factors that may account for the drop. While research is ongoing in both men and women, there’s also evidence that certain pesticides, heavy metals, phthalates, parabens, and other chemicals may interrupt your menstrual cycle, suppress ovulation, leading to fertility issues, and cause a decline in fertility at an earlier age. Still, it’s unclear what dose of chemicals is needed to affect fertility and how the overall load of exposure affects each individual woman. Exposure in utero—which you had no control over—may also affect your future fertility.
These chemicals are ubiquitous, and so it can feel overwhelming knowing where to start. Bufalino recommends starting with the biggest players. Beauty products that cover the largest surface area of the body should be switched out first, like lotion or body oil. (Choose those that are phthalate-free, for example.) Eliminate fragrances in your home, like using unscented household cleaners, avoiding air fresheners, candles, and switching from perfume to essential oil, she suggests. Lastly, aim for a diet made up of mostly whole, real foods: Fruits, vegetables, complex carbs, protein, and healthy fats, which will help you avoid much of the potentially harmful chemicals found in packaging. Store food in glass or silicone containers rather than plastic.