Two patients brought this Chatelaine article to my attention today. If you haven't read it, the gist of the article is that Monika Schnarre had a number of miscarriages, failed IUI's, failed IVF's and was dealing with age related fertility problems when she and her husband finally conceived and maintained a successful pregnancy with the help of a naturopath. The patients who showed me this article were, of course, wondering if perhaps their thyroid was a little off just like Monika Schnarre's was and should they be tested for this. I give all of my fertility patients a list of tests that would be helpful to request from their fertility clinic or that we can run. Unfortunately, OHIP will not cover the cost of the tests if I run them and although we only charge what the lab charges us for them, they can amount to hundreds of dollars worth of tests.
So, we are often dependent on the cooperation of the fertility clinics to have these vital tests done. You would be surprised how many fertility related tests are never run by a fertility clinic. Wouldn't they be the experts? Shouldn't they be the most thorough at testing? Sadly they are not, as demonstrated by Monika Schnarre's article. She struggled with fertility for years and was being treated at a fertility clinic and yet, hadn't had these fairly basic and routine tests done. T3 and T4 are on my list of "must have" tests for fertility patients, particularly if their TSH level is above 2.00. In my experience, fertility clinic testing is often very cursory. They'll test estrogen (estradiol), FSH, LH and progesterone and for many women I've seen, that's about it and that is nowhere near enough. What about testing for androgens or male hormones like testosterone, DHEAs, androstenedione since they present the most likely impediment to successful ovulation? What about testing the thyroid thoroughly with T3 and T4? What about checking the adrenal glands since they help produce building blocks or precursors to sex hormones and work in conjunction with the ovaries and thyroid?
What about looking at autoimmune issues like anti-cardiolipin antibodies, anti-phospholipid antibodies and anti-thyroglobulin antibodies? What about checking for MTHFR, a somewhat common genetic mutation that can mean a greater risk of infertility, miscarriage and birth defects? How about blood sugar and insulin issues by testing fasting blood sugar AND fasting insulin, HbA1c and maybe even a glucose tolerance test WITH insulin levels, since insulin has a significant impact on hormone balance and therefore healthy egg development. The glucose tolerance test with insulin levels is the only method of assessing insulin resistance. If a woman is insulin resistant, it means that every time her blood sugar level rises, she needs extra insulin to get that blood sugar back down. Extra or frequent insulin production alters hormone balance and increases male hormones or androgens. A developing egg bathed in androgens, will not develop normally and will make for a poor quality egg and poor response to fertility treatments. Why wouldn't a fertility clinic want to know this going into such an expense treatment as IVF?
Most of the women I have seen who are being treated at a fertility clinic, have never had any of this checked, but because these doctors are supposed to be the experts, they don't know to question how thoroughly their infertility has been investigated. They trust that these "experts" would test thoroughly, and they don't. In my 14 years of experience, I have never seen a woman who was tested for all of these things without us requesting that it be done, never, no matter what the reputation of the fertility clinic.
What I take away from Monika Schnarre's article is this, not necessarily that every fertility patient needs to have their T3 and T4 checked, but that they should all be thoroughly checked for any factor that might be affecting their fertility BEFORE initiating any kind of treatment, since the success or failure of that treatment hinges on the knowledge derived from all of the above testing. For a more thorough, all encompassing and holistic approach, it's probably best to have a naturopathic doctor who specializes in fertility on your team if you are trying to conceive and are having difficulty.
To read Monika Schnarre's article in Chatelaine, click here: http://www.chatelaine.com/health/wellness/how-i-got-pregnant-against-the-odds/
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