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I spend a fair amount of time talking to couples who have been through one or more unsuccessful IVF cycles. Almost without exception I am always disappointed with how little investigation has been undertaken beforehand into potential causes of infertility, and into things that might make IVF success more elusive.
With that in mind, here is a basic checklist for anyone considering IVF:
Do You Have A Healthy Menstrual Cycle?
A healthy menstrual cycle can give you a really good foundation from which to launch into IVF if it is necessary. A healthy cycle usually indicates that the underlying hormone system is balanced and working correctly - and this will mean that the eggs that would be used in an IVF cycle have had a better start in life as follicles are in development for months prior to the point of ovulation (it doesn’t all happen in that last two weeks!).
Not all menstrual cycles are equal, but a healthy, fertile menstrual cycle is likely to have the following characteristics:
· Between 27-30 days from day 1 of the bleed to day 1 of the next bleed.
· The bleed itself should last for between 3-5 days.
· The bleed should start cleanly, ideally with no spotting before the bleed.
· The blood should be fresh and red, with minimal clots.
· The flow should be good, not too heavy, but not too light.
· Pain levels before and during the period should be easily manageable and not extreme.
· Pre-ovulation there should be some obvious egg-white cervical mucus.
Many cycles are not like this when clients start to work with me, but through a combination of acupuncture, nutrition and supplements it is usually quite straightforward to improve a cycle and move it closer to a cycle with these characteristics. There is very little that a medical doctor can offer to improve a menstrual cycle, to make these improvements you would be best to work with a holistic practitioner who specialises in fertility and women’s health.
Some women will find that the process of balancing and improving their menstrual cycle will restore fertility to the point that IVF is no longer required.
Do You Have Any Signs of Vaginal Microbiome Issues?
Too often women have ongoing or recent issues with vaginal discharge, vaginal soreness or itchiness - all potential signs of vaginal microbiome issues which could be having an impact on sperm survival, fertilisation and implantation. There is also a growing body of evidence showing that these issues can also cause early losses, premature births and even still birth – if there are any hints that things are not all OK down there, I strongly recommend you dig a little deeper into investigating what is going on.
I have written another article about vaginal discharges, what to look out for and the Invivo Vaginal Ecologix test that I work with in order to investigate this are. Check it this link for more details: https://www.essexfertility.co.uk/post/what-s-the-vaginal-microbiome-got-to-do-with-it
Not all vaginal microbiome issues are symptomatic, but if there are symptoms, it is definitely something worth checking out. While on this subject, if there are vaginal microbiome issues, there are often also semen microbiome issues – these things tend to be shared quite easily – so a semen culture may be another thing worth considering.
If there is something lurking in the vaginal microbiome it could be causing infertility. Infections or dysbiosis can cause localised inflammation which would have an impact on egg quality, it could lower AMH levels and result in a poor uterine environment. All these things would lower your chance of IVF success, but also once resolved, would mean your natural fertility should improve.
Do You Have Issues With Your Digestion?
This is a surprisingly big deal. A disrupted digestive system, loose bowels, constipation, bloating and general IBS symptoms can all indicate issues with the gut microbiome. This can impact how well we absorb vital nutrients, how well we might be able to provide fuel for building healthy follicles and a warm, soft, cushiony uterine lining and how well our body will be able to cope with elimination and detoxification of synthetic hormones after IVF.
Sometimes the only issue I find is that of a habitually slow bowel – and for that a combination of acupuncture and chia seeds works wonders. But for some of my clients, it is very obvious to me that we need to work hand in glove with a functional medicine nutritionist. For other clients we may opt to start with the Invivo GI Ecologix test to see what the gut microbiome looks like, and then take a decision on whether to involve a nutritionist.
Digestion also plays a part in sperm health – again through provision of nutrients, but also due to the impact poor digestion has on systemic inflammation which can have a negative impact on sperm health.
And yet again, I have seen cases where fixing the digestion is enough to move the fertility level up a notch to allow natural conception even though IVF had been on the cards.
Have You Really Looked At Sperm Health?
A semen analysis is not enough to determine fertility, approximately 15-20% of men who can ‘pass’ a semen analysis will be subsequently found to produce infertile sperm. And in my opinion, if someone is struggling with long term, unexplained infertility then they are more likely to be in this group.
A semen analysis looks at the sperm from the outside – it is like looking at a lorry and trying to work out if it is carrying top quality merchandise or shoddy stuff for a local market stall. A more detailed way to take a closer look at sperm to determine probable fertility is through a sperm DNA fragmentation test – this is more like opening up the lorry to take a look at what it is actually carrying!
There are some things that put a sperm DNA fragmentation test at the top of my list of things to check and I have written about this in more detail in the following article:
https://www.essexfertility.co.uk/post/when-to-check-sperm-dna-fragmentation
If I think it is time to look at male fertility in more detail, I would refer you for a COMET sperm DNA fragmentation test and I think it is best practice to do this before thinking about IVF. Too many couples that I see who have had unsuccessful IVF cycles find out that they were dealing with high sperm DNA fragmentation – and an IVF cycle is a very expensive way to find that out.
Again, if sperm DNA fragmentation is high, it is likely to be a big contributor to infertility and can often be improved (restoring natural fertility, or making IVF more likely to succeed) so if sperm DNA fragmentation is high, I refer on to some amazing urologists for further investigation. If no specific cause can be found, then I get stuck in (literally) with my acupuncture needles – acupuncture has a great reputation for improving sperm health, but I like to be sure there is nothing structural or a hidden infection in play before we assume it will be something I can improve with acupuncture.
And We Also Check The Basics
There are some simple things that can be checked in the name of hunting down things that can lower fertility. Some basic blood tests are a useful place to start, including the day 2/3 hormones, Prolactin, Thyroid (a full panel, including the thyroid antibodies), Vitamin D, Vitamin B12 and Ferritin.
All of these can give us clues about possible causes of infertility, of early losses or IVF failures. Some of these tests can be run through a GP practice, but if that proves awkward, then we turn to Medichecks to get the tests we need done.
Who Am I?
I’m a Fertility Support Trained Acupuncturist and we are trained to look at infertility through a very integrated lens – combining Western medical knowledge with Chinese acupuncture for fertility. This isn’t an exhaustive dive into the way I work, but it does give you some idea of how I may approach a case of unexplained infertility. Unexplained infertility is a non-diagnosis, it is a diagnosis given when someone hasn't found the reason. I hunt for signs and symptoms to inform me what to suspect could be a reason, what could be a cause, what needs testing, what symptoms have been ignored. Alongside any of these tests, we work with a combination of Chinese Acupuncture (myself) and visceral osteopathy (Gill Hind or Kirstie Cousins) to improve the menstrual cycle, ease pain symptoms, sooth the soul and gently improve fertility. If you would like to work with me, please get in touch.
Kind regards
Alex