What tests are done for female infertility?

Infertility is on the rise and this can be attributed to a lot of different factors. Some couples cannot have a child if the woman or man is infertile,  in  rare  cases  it  could  be  both.  Infertility  is  when  a  woman  can't  get  pregnant  after  a  year  of  marriage  or  keeps  having miscarriages. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery.Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples  will  go  on  to  conceive  a  child  without  treatment.  After  trying  to  get  pregnant  for  two  years,  about  95  percent  of  couples successfully conceive.
Causes of female infertility:
•    Obesity
•    PCOS
•    Hypothalamic dysfunction
•    Ovarian insufficiency
•    Too much prolactin
•    Damage to fallopian tubes
•    Endometriosis
•    Benign polyps or tumors
•    Overweight and underweight women are at risk of ovulation disorders.
•    Smoking , drinking alcohol & caffeine has negative effects on fertility.
•    Stress increases infertility.
Blood test What it is Why is it tested ? What it means Nutritional intervention
Testosterone Hormone High testosterone leads to hyperandrogegism. High testosterone is associated with significant prolongation of the follicular phase of the cycle and increased incidence of amenorrhea or anovulation. •      Diindolylmethane, or DIM, present in  cauliflower and broccoli  is known to reduce androgens.
•      Herbal tea consumption helps reduce testosterone levels.
•      If high testosterone is coupled with high DHEA , ensure adequate B6 & Vitamin C levels.
•      Eat foods that increase oestrogen levels ( as high oestrogen reduces testosterone levels) eg Soy, Flax seeds (contra indicated if DHEA is high).
•      Stop smoking and drinking alcohol.
•      Spear mint & pepper mint tea have anti androgenic effects.
LH Hormone involved in regulating menses Hormone that promotes ovulation. Imbalanced levels of these hormones cause both PCOS and irregular periods.
High levels of LH increases testosterone levels.
•     Manage insulin levels
•     Omega 3 decreases LH levels
•     Inositol decreases LH (citrus fruits, sprouts, capsicum, oats, green leafy vegetables)
Progesterone Hormones involved in regulating menses Progesterone helps prepare the uterine lining for pregnancy.
Low progesterone levels cause PCOS.
Low levels of Progesterone usually indicate that ovulation did not occur and no egg was released.
Low progesterone also causes anxiety, weight gain, cellulite, insomnia, fluid retention, thyroid issues amongst others.
•     Ensure adequate Vit B6 & Vitamin C levels as it boosts progesterone production.
•     Adequate zinc levels ensure ovulation ( lamb, liver, cashew nuts and pumpkin seeds).
•     Magnesium helps maintain progesterone levels ( green leafy vegetables, pumpkin seeds).
•     HDL rich foods help progesterone production.
•     High fibre ensures that oestrogen ( which antagonises progesterone ) is low.
Estradiol / Oestrogen Estradiol is a female sex hormone produced by the ovaries, adrenal gland and also the placenta during pregnancy. Estradiol is the most important hormone during a female’s reproductive years, and is required for reproductive.
Estrogen dominance is a feature of PCOS.
Most women with PCOS are surprised to find that their estrogen levels fall within the normal range (about 25-75 pg/ ml).  This may be due to the fact that the high levels of insulin and testosterone found in women with PCOS are sometimes converted to estrogen. MUFA rich foods: Olive oil, canola oil, avocados, almonds etc Zinc rich foods: wheat germ, chickpeas, oats, kidney beans Magnesium rich foods: banana, raisins, curds
Estrogen rich foods are soya products, flax seeds, sesame seeds, peaches, pista , walnuts, peanuts, olives etc.
Prolactin Hormone secreted by the pituitary gland High prolactin levels causes infertility. High prolactin levels may be due to medications or thyroid issues. Excess production of prolactin (hyperprolactinemia), reduces estrogen production and may cause infertility.
Prolactin  stimulates  the  breast to      produce      milk      during pregnancy.    In    women,    high levels  of  prolactin  in  the  blood often     cause     infertility     and changes in menstruation
•     Higher levels of Vitamin B6 can reduce prolactin levels.
•     Vitamin E naturally prevents rises in prolactin levels.
FSH Follicle stimulating hormone To evaluate fertility issues- function of ovaries   To increase FSH levels:
•     Maintain a healthy weight.
•     Reduce stress levels to boost FSH production.
•     Balance omega 3 and Omega 6 fatty acids.
•     Avoid processed carbs and trans fats.
•     Ensure adequate consumption of essential fatty acids.
Lipid profile It measures cholesterol and triglyceride levels. Dyslipidemia is an important feature  of  infertility  in  both men      and      women.      This increases  lipid  peroxidase  in gametes.Lipid peroxidation is the     oxidative     degradation of lipids.
Dyslipidemia  is  also  present in  thyroid  dysregulation  and PCOS     -     both     of     which contribute to infertility.
  1.    Reducing cholesterol levels :
•     Limit total fat and saturated fat
•     Reduce visceral fat
•     Increase consumption of soluble fibres
•     Decrease alcohol consumption
•     Increase consumption of Omega 3
•     Foods rich in plant sterols and stanols which block cholesterol absorption into the cells eg whole grain, beans, nuts etc
2. Reducing Triglycerides
•     Maintain ideal weight
•     Avoid trans fats
•     Increase consumption of mono and polyunsaturated fats
•     Cut down on smoking
•     Consume soluble fibre
•     Reduce consumption of refined food
Leptin Hormone which is predominatel y responsible for fat gain. Increased levels of leptin is associated with obesity and infertility. There is a strong co relation between serum leptin levels and BMI and unexplained fertility among women. •    High leptin level is linked to high body-fat mass. Maintain healthy weight.
•    Foods containing pectin such as apples improve leptin sensitivity.
DHEA Dehydroepia ndrosterone is a hormone produced by your body's adrenal gland DHEA is involved in the production of oestrogen. Increased levels of DHEA leads to infertility. •     DHEA is a naturally existing hormone that the female body converts into androgens, mainly testosterone.
•     High DHEA levels increase fatigue, weight gain, infertility, baldness etc
•     Increased abdominal obesity
•     Reduce foods containing Omega 3 as it promotes DHEA production.
•     Salmon, tuna, shellfish, mackerel, sardines are fatty fish containing Omega 3
•     Adaptogens like Ashwagandha 500mg -2000mg help reduce androgens. Other adaptogens are thulsi, liquorice, drumstick leaves.
•     Reduce your intake of refined carbs.
Anti- Mullerian Hormone (AMH) Hormone AMH   is   a   member   of   the transforming  growth  factor  β family      of      growth      and differentiation factors In   the   ovary,   AMH   has   an inhibitory  effect  on  primordial follicle recruitment as well as on the  responsiveness  of  growing follicles to FSH •     Ensure healthy Vitamin D levels.
•     Maintain healthy BMI
•     Exercise reduces AMH
Vitamin B Vitamin Deficiency causes reduce fertility. Deficiency causes ovulatory disorders. •     Check for gastritis, pernicious anaemia, GI diseases like Chron’s, celiac or lupus. This effects Vitamin B levels severely.
•     Having a healthy gut with good gut micro biome helps to breakdown Vitamin B from food.
•     Anti biotics and anti seizure drugs decrease Vitamin B levels
Vitamin D Vitamin Vitamin   D   is   an   emerging factor      influencing      female fertility and IVF outcome Healthy Vitamin D levels increases live births. •     In most cases Vitamin D supplementation is needed.
•     Ensure that a source of fat is taken with the Vitamin D supplement.
•     Vitamin D in large quantities can be toxic. Monitor blood levels frequently.
Folate Vitamin B9   Increased progesterone levels and a lower risk of irregular ovulation. Folate rich foods are green leafy vegetables, peas, eggs etc
Zinc Mineral •     DNA        and         protein synthesis,        and        cell division   are   all   related to zinc levels in the body.
•     Adequate    zinc    ensures healthy   ovulation.   Eggs also  need  large  amounts of zinc to reach maturity.
  •     Zinc deficiency is also associated with decreased sense of taste and smell. Check for other nutritional deficiencies.
•     Although  the  cause  in  some  cases  may  be  inadequate dietary  intake  of  zinc,  inhibitors  of  zinc  absorption  are most likely the most common causative factor.
•     Phytate,  which  is  present  in  staple  foods  like  cereals, corn   and   rice,   has   a   strong   negative   effect   on   zinc absorption from composite meals.
•     The amount of protein in a meal has a positive effect on zinc    absorption,    but    individual    proteins    may    act differently; e.g., casein has a modest inhibitory effect of zinc absorption compared with other protein sources.
•     Zinc      and      iron      interact      competitively      during intestinal absorption.
Vitamin E Vitamin It may improve ovulation decline. Vitamin E is another powerful antioxidant and has been shown to increase fertility •     Nuts, seeds, vegetable oils and green leafy vegetables are a good sources of Vitamin E.
•     High doses of vitamin E may increase the body's vitamin K requirement.
•     Increased intake of omega-6 fatty acids may increase vitamin E requirements.
CRP/hsCRP CRP     or      C r  e  a  c  t  i  v  e protein   is   an acute      phase protein. CRP is made by the liver and released into the blood within a few hours after tissue injury or     infection.   It   is   used   to identify     the     presence     of inflammation  and  to  monitor response  to  treatment  for  an inflammatory disorder High CRP levels indicate non specific inflammation.
Implantation failure requires cellular changes in the endometrium and modified expression of different cytokines, growth factors, transcription factors and prostaglandins. Thus , an inflammatory process is involved.
•     Increase consumption of anti inflammatory foods. Foods rich in Vitamin C and E.
•     Reduce refined carbs and processed foods. Aerated drinks should also not be consumed.
•     Ensure adequate hydration.
ESR The          test a c t u a l l y  measures   the rate     of     fall (sedimentatio n   )            o   f erythrocytes (red        blood
cells)     in     a
sample         of blood that has been     placed into     a     tall, thin,    vertical tube
To measure  the degree of inflammation. It is a non specific marker of inflammation. •     Mediterranean diet helps to reduce inflammation.
•     Vitamin E and Vitamin C rich foods decrease inflammation.
•     Anti oxidant rich foods such as amla, oranges etc help reduce inflammation.
Vitamin C Vitamins Vitamin C regulates the catabolism of cholesterol. •      Vitamin   C   helps   improve hormone levels.
•      For women who have luteal phase     defect,     an     issue characterized          by insufficient      progesterone, increased    C    appears    to promote fertility.
•     Vitamin C is heat sensitive and is best taken in the raw form.
•     Smokers need higher doses of vitamin C.
Cortisol Hormone which regulates metabolism, immune response, control sugar level etc Cortisol   is   a   glucocorticoid steroid  hormone  that  plays  a range   of   important   roles   in the body including regulating reproductive function.
Infertility    stress    negatively influences      cortisol      levels which has a negative effect on embryo quality.
High cortisol levels can lead to symptoms such as weight gain, hypertension, high blood sugar, osteoporosis and fragile skin while low levels may cause weight loss, weakening of muscles, fatigue, low blood pressure, vomiting and diarrhea and loss of consciousness. To reduce Cortisol levels:
•      Anti inflammatory diet: whole grains, no processed, nuts , fish, turmeric, ginger, cinnamon
•      DHEA promoting foods: wild yams, soya, flax seeds, salmon, olive oil
•      Vitamin B complex
•      Adaptogens
To increase cortisol levels:
•      Dark chocolate, pro & pre bionics, green tea, banana , pears helps increase cortisol levels.
•      Avoid caffeine,  alcohol, processed food, & refined sugar.
Thyroid panel Hormones that are essential  to regulate growth and metabolism •      In hypothyroidism, the thyroid gland doesn't produce enough of certain important hormones.
•      Low levels
of thyroid hormone can interfere with the release of an egg from the ovary (ovulation), which impairs fertility.
Thyroid dysfunction and associated metabolic imbalance & weight gain. •     Avoid goitrogen rich food like raw broccoli, cabbage, soy etc
•     Thiocynates are sulphur containing compounds- which make it harder for thyroid glad to absorb iodine. Foods that form thiocyanates are Corn, flax seeds. sweet potatoes, broccoli, lima beans, radish , turnip
•     Flavanoids ( like apigenin)present in millets reduce the activity thyroid peroxidase, the enzyme that inserts iodine into thyroid hormone. Apigenin is also present in onions, redwine, beer.
•     Consume at least 150mcg of iodine everyday.
HbA1c Glycated hemoglobin To test for diabetes or /& monitor intervention for diabetes. Higher HbA1c and uncontrolled diabetes leads to increased risk of infertility and PCOS. •     Small frequent meals
•     Low to medium GI foods
•     High fire and high protein foods.
•     Continuous blood sugar monitoring system.
Mercury   High mercury levels can disrupt metabolic processes. Mercury exposure can lead to oxidative stress and decrease detoxification. •     Adequate zinc is needed for mercury elimination.
•     Higher
blood mercury concentratio n is associated with male and female infertility.
•     Higher seafood consumption is associated with elevated blood mercury concentrations.