FACEBOOK LIVE: Looking in to unexplained infertility and potential advanced testing and diagnosis

February 19, 2020

FACEBOOK LIVE: Looking in to unexplained infertility and potential advanced testing and diagnosis

The following is a transcription of a Facebook Live for your convenience. Please either read the transcription below, or watch the video itself! Enjoy!

The topic we wanted to chat about today that we've been preparing for the last week is unexplained infertility. And with regards to unexplained infertility, you know, it's… it's something when you get that diagnosis, there is… it's… it's a hard diagnosis to swallow particularly because, when you're having trouble conceiving, you… the first thing you want to know is why. And when you're given an expression of unexplained fertility, it just kind of sounds like a made up, you know, term on, well, it sounds like, you know, you don’t know what's happening. So, you know, we just don't know what's happening and no one's really… sometimes, it can feel like no one wants to, you know, look further to why you might be having trouble conceiving. 


So, unexplained infertility, I find this is one of the most challenging conditions, and many of you may, you know, agree with that. But particularly with unexplained infertility, what we've seen over the last few years where there's actually these very curious additional conditions or additional tests which seemed to provide a much more detailed insight into these particular scenarios, which we're going to chat about in a bit, that might be contributing to your inability to conceive. And the first one that I'd like to talk about is thin uterine lining.


So, for patients that are trying to go through fertility treatments, or they're trying to conceive on their own, what can happen is that the lining of the uterus is actually a lot thinner than it should be. So, optimally, when we're looking at the thickness of the uterine lining, it should be between 7 to 12 millimeters in thickness. And many conditions or in many scenarios, it's below 17, or it's above 12. And what happens is, if the uterine lining thickness is below 7 millimeters, we see that implantation is much less likely to occur. If it's above 7 millimeter or sorry, above 12 millimeters, we see that again, there's a decline in implantation rate. So, that sweet spot is really between 7 to 12 millimeters when it comes to trying to conceive. So, that's like a nice, you know, thick pillow in the lining of the uterus, really to help with a proper, you know, there's conception, there's a healthy embryo to give it that nice cushion to just implant in… implant into to grow the blood vessels, for it to have a healthy blood flow and, and nutrition from the mother there. 


So that's a very, you know, I think, reason why I put this in the unexplained infertility discussion is because a lot of patients go through IVF or IUI and, you know, they noticed that they're lining thickness is fine. So, you know, they assume that it's not an issue. But when you're taking a lot of these injections that are common with IUI or IVF such as Gonal-F and the works, we see that they actually thicken the lining up as well. So, there is a portion of patients there that, on their own when they're trying to conceive naturally, you're not actually making it to that 7 to 12 millimeter mark. And, you know, during a fertility treatment, an assisted fertility treatment, you might be able to make it to that level. But on your own, sometimes it's a bit more challenging to get that 7 to 12 millimeter thickness. 


So, that's the one of the key things I can contribute it to some cases of unexplained infertility. And what I look at when trying to see if someone has a thin uterine lining is really at their menstrual flow. So, we want, you know, a nice healthy flow for at least 2 to 3 days. So, you know, if you notice that, “I'm only having 1 day of, you know, right regular flow and then it's right into spotting,” usually that might be an indicator that you might have a thin uterine lining. Because what your… you know, during menstruation, what's coming out is that lining from the previous cycle. So, that's something to look at.


Another common contributor or factor when it comes to unexplained infertility, and this is something that I really advocate about frequently to patients, because I find it something that's brushed off very easily, and it's regarding male fertility. So, the male fertility component, what I want, you know, you to understand is, basically, we have basic sperm testing and then we have advanced sperm testing. And at a fertility clinic, usually what they're doing is a basic sperm analysis. And I think that's sufficient for a lot of individuals who might just be having, you know, it's their first time, they want to look into fertility treatment options. But for someone, you know, who's a, I would say, fertility veteran, you know, thing… the treatments haven’t been working, you're not having the success, you know, you should have had with like the quoted ‘treatment success rates’ you can be provided, then something important to consider is the advanced sperm testing. 


And the reason for this is because we're seeing over the last 4 to 5 years, there's a significant amount of research supporting that say something like a sperm DNA fragmentation. So, a sperm DNA fragmentation is that genome in the sperm cell actually has fragments in it. So, it gets kind of these hairline fractures. And it's not… this is different from regular genetic testing. So, you have the healthy amount of genes there, but what happens is when that genetic component needs to be expressed, and you know, we take protein from it, we see there's a decline in live birth rate. So, it can increase miscarriage rates. There's some research suggesting it might decrease embryo quality and the DNA fragmentation test is something that many clinics offer. Sometimes you have to ask for it or have that conversation with your fertility physician about it. But the DNA fragmentation is a… is a key test to look at when you're dealing with unexplained infertility. 


And often, sperm morphology, a test that's not tested on in some clinics, because what we've seen in research is morphology doesn't seem to affect the success rate of an IVF when it comes to the sperm health. But if morphology is low, and morphology is looking at how many of these you know, X number of sperm cells look like healthy sperm cells. And if there's a low normal morphology, there's a really strong correlation to having elevated DNA fragmentation rates in the sperm. So, it's a good test to look at when you're looking at, you know, potentially going through your next no fourth or fifth IVF and you want to see if there's something else that might be contributing to this, you know, I guess the factor that's contributing to why the previous treatments didn't provide the same success you were hoping for. 


And another thing to look at is advanced thyroid testing. So, usually, typically, what we'll check for is something called thyroid stimulating hormone. And that's a very like important hormone. It gives us a rough overall picture to understand how the thyroid is performing. But there's 2 key thyroid tests, particularly… particularly anti... thyroid peroxidase antibody and thyroglobulin antibody. And those 2 antibodies on their own, there's research suggesting that 15… up to 15% of women of reproductive age actually have elevated antibodies for the thyroid, even when TSH is normal. And that's a significant downfall when it comes to your fertility because the antibodies on their own, independent of all the other thyroid hormones, seem to negatively affect fertility and can negatively affect egg quality and follicle integrity. So, we see that, you know, like the border of the egg, you know, if this is my makeshift egg here, the zona pellucida is that… the cell wall around that egg. 


And we will see that those antibodies, when they concentrate in the follicle, actually harm the quality of the follicle as well. So, when it comes to thyroid antibodies, it's important to have that tested to when you're dealing with unexplained infertility because, like I mentioned, some of the research suggests that anywhere from 16 to 6… to 15% of women of reproductive age may have elevated thyroid antibodies. So, it's something that will usually go miss because no one's really testing for it, unless you see an endocrinologist, you have a previous history of thyroid disorders, that's usually the typical association. But when it comes to fertility, it has a very important role, and in this case, a negative role in decreasing your chances of conceiving there. 


Another important factor to look at, and I think this is a factor that many people are aware of, but what happens is we don't know how to deal with this. And the factor is low egg quality. And this unfortunately, we're seeing more and more of even in younger patients. So, patients as young as, you know, 30 having low egg quality. And really, the only way to know if you have low egg quality is to go through a treatment like IVF and seeing the outcomes where you get, you know, X number of embryos, but very…  X number of follicles, excuse me, but a very few of them actually make it to day 5 blastocyst stage, or show that they have, you know, good integrity enough to be frozen. So, if you go through that process and you find you're left with, you know, a very small portion, significantly less than what you started with from eggs that were retrieved to eggs that mature, fertilized, and then seeing how many going to make it to day 5 blastocyst stage. If there's a significantly less amount, sometimes it's related to low egg quality or low sperm quality. 


And that's something important to address, especially because nutraceuticals and supplements have been shown in research to support healthy follicle integrity, healthy egg quality. And there was a Cochrane Review actually published in 2017, and what they looked at was when some of these nutraceuticals were used for about 3 to 6 months, I believe, women were twice as likely to conceive on their own naturally compared to patients that didn't use those supplements. So, it's a significant change in your likelihood of conceiving with something that simple. And so egg quality, you know, unfortunately, unless you go through an IVF and you see that, you know, diminished or, you know, outcome that's below what your expectation or what your doctor's expectations were, that's when we start engaging in the conversation about egg quality. 


And when it comes to egg quality, the best way to tell address it is usually through the nutraceuticals, and then other lifestyle things which, you know, may or may not be there a lot of the time, a lot of cases are not there. But, you know, removing tobacco use, cannabis use, staying in a healthy weight range. So, your body mass index should be around 20 to 25. Once you see it's a higher than 25 or 30, we see decline in egg quality, decline in success rates for IVF. So, egg quality is that one factor that, because of our environment, we're more likely to have issues with egg quality or sperm quality because of the oxidative stress and inflammation from our, you know, the chemicals in our environment or from our poor lifestyle habits and choices and dietary habits can all contribute to that. 


So, the most important thing when it comes to egg quality is I'd say, you know, looking at the most modifiable factors. And, you know, I say that with you know a lot of emphasis because a lot of factors can be modified when it comes to egg quality and fertility, and that really comes down to your, you know, own decision making. And sometimes, we just need the proper guidance and suggestions to help make the best, you know, decisions that are evidence-based and have the best seen outcomes for that. So, you know, basically having 5 to 7 fruits of… servings of fruits and veggies a day. Avoiding things like dairy products seems to help. Making sure you're having a lot of good antioxidants. Exercising on a regular basis before fertility treatment, being in a healthy weight range and mind-body, you know, being in a place where you're less stress, less anxious, and you're taking care of your mental health as well. 


So, a lot of these factors are important things to look at when it comes to unexplained infertility. And there are a lot more factors there as well. But I think these are the ones that we see in research over the last 2, 3 years at least, are starting to pop up and they’re not necessarily being evaluated. And they don't need to be evaluated for the average fertility patient, but for someone who's gone through fertility treatments, so we still don't know what's happening, we're still not seeing a positive pregnancy yet, these are important factors to look at. And it was, you know, I hope you enjoyed the live stream today. So, my goal is to provide you with information that is useful, with information that's going to answer some questions out there that, you know, to open up discussion about some of these important topics and look at the research on it as well. So, you know, if you have suggestions for future topics, we're going to be posting more live streams regularly, probably on a weekly basis now. So, just get in touch, send me…, send me a direct message. And you know, I'm going to be doing this anyway, so I really want to do it on something that you're going to, you know, benefit from, you're going to take something positive away from and learn from, and hopefully, you know, help make that fertility journey just that much easier.


 So, anyways, I really enjoyed doing this. I love sharing this information. There's over 120 research papers at least published a week in fertility, and it's my passion to go through and pick out some of those best ones, the most interesting one. So, I'm always excited to share, you know, all the new information, and I think it's also very helpful. So, anyways, have a wonderful afternoon, everyone. Enjoy the rest of your week. I won't see you until next week, so Happy Family Day weekend if you're an Ontario. And, again, shoot me a message if you have any questions or if you have any suggestions for the next live stream topic.

 

So, if you have any questions, feel free to type them in here or get in touch with us at NutriChem. 

 

 





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