In Episode 4 of the Fertility Journeys Podcast, Dr. Shala is joined by Lara Adler. Lara is an expert on environmental toxins, an educator, and a health coach.  

Here are some of the highlights of the discussion between Dr. Shala & Lara:

  • Research on environmental toxins and what we now know about this topic.
  • Information suppression by corporate interests, and how US policy around chemicals is different from other countries.
  • Endocrine disruptors and the impact that they have on your hormones.
  • Where to begin if you are experiencing infertility or wanting to get pregnant; how to limit your toxin exposure.
  • Plastics, BPA, and considerations for removing them from your home.
  • How to sort through all of the overwhelming information about toxins and make smart daily choices.

This episode also features a segment on navigating the holiday season while going through fertility treatment.

I hope you will listen to this episode and share it with any family, friends, or colleagues who might find it interesting.  You can listen to the podcast HERE.

In Episode 3 of the Fertility Journeys Podcast, Dr. Shala is joined by Dr. Vivian Chen. Dr. Chen is a UK doctor with over  15 years of clinical experience.  She’s board-certified in the UK in both internal medicine and family practice.    Here in the US, she coaches clients back to health virtually, helping them to identify root causes of illness and implement lifestyle solutions to heal.  

Here are some of the highlights of the discussion between Dr. Shala & Dr. Vivian:

  • Dr. Vivian’s transition from chronic disease management in family practice medicine to focusing on root cause identification for people, to help them understand what is making them ill, versus just treating symptoms.
  • Reducing toxin load as environmental toxins play a role in impacting many chronic conditions.
  • Understanding gut health, and how we now know it’s central to overall health with 70-80% of our immune system in our gut.
  • Dr. Vivian shares her personal journey to heal her gut, and how inflammation, food and nutrition are so impactful for understanding and optimizing health.
  • Leaky gut, and what we now know about the gut lining.  The gut lining should be permeable enough to allow nutrients to come in, the good stuff,  but it shouldn’t be big enough to allow the bad stuff, the bacteria, the endotoxins.
  • Keto and paleo; misconceptions about these diet trends and how they can impact female health.
  • Your microbiome; how to properly feed it and exploring fermented foods!

This episode also features an easy-to-implement breathing technique, 4-7-8 breathing that can be so helpful for managing stress or taking a quick mental break.

I hope you will listen to this episode and share it with any family, friends, or colleagues who might find it interesting.  You can listen to the podcast HERE.

In Episode 2 of the Fertility Journeys Podcast, Dr. Shala is joined by Marilyn Gomez.  She teaches women how to self-advocate on their own fertility and healing journeys.

Here are some of the highlights of the discussion between Dr. Shala & Marilyn:

  • How crystals can be incorporated into your life for everyday healing, empowerment, or inspiration.
  • The need for healing along the fertility journey and how non-traditional tools, when used with therapy or conventional methods, can be an extension of our own power to self-heal.
  • A deep dive into Reiki and how Marilyn used it on her own IVF journey.
  • Marilyn shares her emotional journey through infertility, treatment, and how she had to become her own advocate with her doctors.
  • Using a therapist to help carry the “ebs and flows” of the journey
  • Postpartum realities after having a child
  • The healing powers in being of service to others through volunteering

This episode is will be relatable and likely comforting to anyone who has or is experiencing a fertility rollercoaster.  I hope you’ll listen and share it with anyone that it could help.  You can listen to the podcast HERE

Last week, the Fertility Journeys podcast launched!  This podcast features expert guests from various backgrounds within integrative medicine and real patient stories. Episode 1 features Dr. Loree Johnson and a deep discussion about fertility stress and trauma.  Here is a highlight of some of the discussion between Dr. Shala and Dr. Loree  

  • A natural progression that can take place for many people when they undergo fertility treatments, where it begins to impact mental health.
  • Getting mental health check-ups and support while undergoing fertility treatment isn’t the standard, but maybe it should be.
  • An explanation of the difference between infertility stress and infertility trauma; observing the severity of symptoms. 
  • The value for anybody who’s going through infertility struggles to work with a mental health professional.
  • The stress that men can feel during the fertility journey, and ways that couples can maintain a connection. 
  • EMDR therapy, what it is, and how it can help someone experiencing infertility. 
  • Mindfulness and refocusing attention to the present on the fertility journey

This episode is packed with great information.  I hope you’ll listen and share it with anyone that it could help.  You can listen to the podcast HERE

Trying to bring a new child into the world tends to make us question all aspects of our lives!  Am I eating a well-balanced diet? Am I moving my body enough throughout the day? Is this headache medication safe while trying to conceive? What about my shampoo? Am I getting enough sleep?  Am I stressing out about all of this too much and causing more harm than good?


Nutritional supplements are just one more area of life you might find yourself reevaluating in light of your desire to conceive a child. Adding a prenatal vitamin is a no-brainer. And you might have heard the recommendation from healthcare providers to add a folate supplement as well.


But have you considered adding a powerful antioxidant like coenzyme Q10 to the mix? If so (or even if you’re not!), read on to find out how this could help you!

A Quick Chemistry Crash Course

If you haven’t thought about free radicals and antioxidants since your high school chemistry class, you’re certainly not alone! Here’s a crash course in case you’ve long since packed away your textbooks!

Free Radicals: Building Up in the Body and Causing Chaos

Most molecules contain an even number of electrons, which keeps them stable. Free radicals are different, though. These molecules contain an odd number of electrons.


This makes these unstable free radicals bind easily with other molecules in the body. These molecular combinations can cause very long molecular chains that have the potential to cause quite a bit of damage in the body.


These unstable free radicals, then, can build up to an unhealthy level. This results in oxidative stress, which can cause inflammation and other undesirable side effects. These could include autoimmune disorders, pain, cancer, and metabolic problems. This may also have a negative impact on fertility levels in both males and females.


(It’s important to note that a small number of free radicals in the body isn’t dangerous. In fact, exercise and similar healthy stressors can cause the release of free radicals. It’s a buildup of an excessive number of  free radicals that you want to avoid!)

Antioxidants to the Rescue!

Antioxidants, on the other hand, are able to help balance out free radicals. Antioxidants bind one of their own electrons to bring balance to an unstable free radical. But in doing this, they don’t give up any of their own stability!


In this way, antioxidants help provide a safer environment inside the body. They can also prevent cellular damage from oxidative stress caused by a buildup of free radicals.

Some Potential Benefits of Coenzyme Q10

Coenzyme Q10, or CoQ10, is a very powerful antioxidant. Research on this antioxidant is ongoing, and more studies are needed. But some current studies suggest that coenzyme Q10 could have benefits such as lowering risk of heart disease, migraine, and secondary heart attack after another cardiac event.

Coenzyme Q10 and Its Impact on Female Fertility

Even though more human studies are needed, preliminary studies have shown that supplementation with coenzyme Q10 could promote improved egg count. It may also possibly improve egg quality.


Coenzyme Q10 has also been linked to improved ovulation rates in patients with polycystic ovarian syndrome who are seeking ovulation induction through Clomid. There is also some evidence to suggest that it can contribute to improved ovarian response during IVF cycles.


It’s important to remember that while coenzyme Q10 has shown some promise in improving egg quality, most studies that have shown significance at the statistical level have been studies in animals. Human studies have been limited and have shown a limited benefit. (It may also be possible that the studies are too small to show coenzyme Q10’s full benefit.)

Coenzyme Q10 and Its Impact on Male Fertility

Studies have also shown that supplementation of coenzyme Q10 in males may increase their sperm concentration (number of sperm) and motility (movement of sperm).

Do You Have More Questions About Coenzyme Q10 or Another Supplement?

So the jury is still out on the actual benefits of coenzyme Q10 use in humans. But it appears to have promise, and supplementation with coenzyme Q10 is generally considered safe.


We know that trying to conceive can be a tricky time. So if you’re finding yourself analyzing and reanalyzing everything you put into your body, it might be time to consult with a specialist in the integrative fertility field who can help take some of the guesswork out of the equation for you.

Dr. Salem and her team are experts at finding the right fertility protocol for you. If you’d like to talk about whether or not coenzyme Q10 is appropriate to add to your supplement regimen, reach out today to schedule a consultation!

Maryjane. Cannabis. Reefer. THC. Pot. Marijuana. Dope. CBD. Weed.  No matter how you refer to it, this controversial little plant has gotten a lot of media attention in recent years!  And as more and more states move toward the legalization of recreational marijuana, some may begin to wonder: Can cannabis use affect my fertility?


It seems like so many claims are being made that marijuana can help a wide variety of ailments… Could infertility be one of them? Or is it possible that marijuana could actually decrease your fertility and interfere with your efforts to conceive?

What’s the Difference Between Cannabis, Marijuana, THC, and CBD?

There are a lot of names used for cannabis that all have slightly different meanings. So let’s talk about that!  Cannabis sativa is the Latin name for an herbal plant. The word “marijuana” is typically used to refer to this plant and its many uses.  Marijuana has traditionally been thought of as an inhaled drug (either in a cigarette, cigar, or vape pen). But it can also be eaten in foods, or taken medicinally or recreationally as an extract.


Tetrahydrocannabinol, or THC, is the psychoactive component found in cannabis. It has a slightly shorter growth cycle than CBD. Most cannabis that is used for medicinal or recreational purposes has a high concentration of THC (normally between five and 35 percent). Products that contain THC can be used in foods, topical medications, and tincture oils.


Cannabidiol (often called CBD) is not psychoactive and has a longer growing cycle. Most CBD products have a very low percentage of THC (usually less than 0.3 percent THC). CBD can be used in food, beauty products, and medications.

How Does Marijuana Act in the Body?

People ingest cannabis derivatives for a number of different reasons. Most of these reasons involve an attempt to make their body feel a certain way after they consume cannabis.  Whether they are trying to relax, achieve a high, relieve pain, or increase appetite, marijuana acts in a variety of ways in the body.

Psychological Effects of Marijuana

Cannabis changes the way your brain processes information, so it can cause memory problems, especially with repeated use over time. Cannabis can also slow your reaction time, which can make driving and other tasks that require quick thinking skills more dangerous.


A brain chemical called dopamine is responsible for heightening the senses and causing a feeling of pleasure or euphoria. Dopamine is also one of the hormones responsible for the pain- and inflammation-relieving effects of marijuana use.

Physical Effects of Marijuana

Marijuana and its byproducts affect the physical body in a variety of ways.


  • Immune system: Unfortunately, THC can suppress the immune system, which can make you more immune to infectious illnesses caused by viruses and bacteria. But for those with autoimmune disease, suppressing the immune system can decrease flares of the autoimmune condition.


  • Eyes: Cannabis can lower the pressure in the eyes, which can help glaucoma symptoms.


  • Appetite and digestion: You’ve probably heard of someone who smokes pot getting “the munchies.” That happens because of the appetite increase that comes along with marijuana usage. This can especially help cancer or late-stage AIDS patients who are struggling with their appetites.

  • Respiratory system: Smokers who use traditional tobacco cigarettes know the risks of lung cancer, COPD (chronic obstructive pulmonary disease), and stroke. But it is less commonly known that smoking marijuana can have some of the same negative effects on the respiratory system. Cannabis smoke contains a lot of the same carcinogens and toxins as tobacco smoke.

  • Cardiovascular effects: THC also puts additional stress on the heart.

Can Marijuana Affect Fertility?

Just like cannabis affects all the other body systems, it has some effects upon the endocrine and reproductive systems as well. This is true for both males and females.

The Effect of Cannabis on Female Fertility

Long-term exposure to THC can affect the pituitary gland, slowing luteinizing hormone and prolactin hormone production. Women who smoke marijuana regularly are at risk of not ovulating because high doses of cannabis use can throw a wrench in your menstrual cycle.  Higher doses of cannabis can also interfere with a woman’s sex drive, which makes natural conception less likely.

The Effect of Cannabis on Male Fertility

Marijuana usage has been associated with lower sperm count, sperm quality, and concentration of sperm in the semen. It can also affect sperm morphology (shape), motility (ability to swim and maneuver through the uterus and fallopian tubes),, and viability (ability to successfully fertilize an egg).  Cannabis has been shown to reduce libido in males as well as females. In animal studies, cannabis usage led to atrophy of the testicles as well.

Still Have More Questions About Cannabis and Fertility?

Do you use cannabis medicinally or recreationally? Are you trying to conceive or considering fertility treatments? Be sure to mention your cannabis use to your fertility doctor to receive the best advice for your particular situation.  This is [particularly true if you rely on THC or CBD for your daily functioning. (This might include pain relief, controlling the symptoms of an autoimmune disease, or cannabis dependency.)


At Integrative Fertility M.D., we understand that your medical situation is unique. We would love to chat with you about how we can help you in your journey to conception and parenthood. Get in touch today to book a consultation!

If you follow world news at all, especially since the beginning of 2020, you’ve probably felt the burden of negativity weighing you down.  The same can be true in your personal life, your work life, or anywhere that people are present, if you look for it there is plenty of negativity to go around. 


So how could a little positivity possibly be a bad thing?

The truth is… it’s not! A positive outlook, at its core, is a great asset. In fact, there’s plenty of research backing up the benefits of taking a more upbeat outlook on life.  For example, when medical researchers studied a group of people with a strong family history of cardiac disease, they found that patients with a more positive outlook were a full third less likely to have a heart attack or other cardiac event!

So What Is Toxic Positivity? Can You Be Too Positive?

Dr. Susan David defines toxic positivity as “forced, false positivity. It may sound innocuous on the surface, but when you share something difficult with someone and they insist that you turn it into a positive, what they are really saying is, ‘My comfort is more important than your reality.” 

(This incredible quote from Dr. David was taken from her guest appearance on Brene Brown’s podcast.)

The Consequences of Toxic Positivity

While being overly positive may not seem too destructive on the surface, it has many consequences. This can even be true when we find ourselves speaking with toxic positivity in our own self-talk!

Denying Emotions

Toxic positivity can lead us to deny the reality of the emotions that we’re facing. Depending on your personality type, you may tend to deny your emotions (or at least the ones you deem negative!) in general. This rarely ends well. Usually, it ends up with the negative feelings building and building and building.


In the end, these feelings will be released. It’s only a matter of time. They might “seep out sideways” through passive aggression or snapping at a stranger in the grocery store. Or you might wind up having a major meltdown.  But regardless of how these feelings end up presenting themselves, the fact is this: emotions that you deny and repress never stay repressed.

Guilt for Feeling Negative Emotions

Some people tend to deny or repress emotions they don’t want to feel. Others of us feel that we have no choice but to experience feelings like sadness, fear, and anxiety. But even people who don’t struggle to feel their feelings can have a tendency to feel guilty for them!


And toxic positivity can intensify this guilt. But in reality, feelings are just that: feelings. They don’t define who we are, and we aren’t defined by our fears or worries. And we don’t need to feel guilty for being fearful or worried.


Fertility treatments can be trying, even in the best of circumstances! Worrying about the outcome of a treatment or test is a sign that you’re normal, not that anything is wrong with you!  People who operate in a mindset of toxic positivity will make statements like, “You should just be grateful for the things you have in your life!” “Everything happens for a reason!” “Don’t focus on unwanted test results!”  These kinds of statements are not helpful. In fact, they are dismissive of your true feelings.


But the fact of the matter is that it’s completely possible to feel more than one emotion at a time. The fact that you are disappointed with a negative pregnancy test doesn’t mean you are any less grateful for your friends, family, or all the other wonderful things in your life.

Not Seeking Support

One of the most dangerous things about toxic positivity is this: It can discourage us from seeking emotional support during the very times we need it most!  When we feel shamed for our feelings by others, we tend to shut down and not seek help from them again. No one wants to share their darkest feelings if we know that our supposed source of support is going to encourage us to “think happy thoughts!”

Things To Try Instead

Whether you are tempted to scold yourself or others for feeling sad and downtrodden, resist the urge to act as if life is all rainbows and unicorns.  Acknowledge your feelings, and let them flow through you. Sit with your grief. Acknowledge when you or a loved one has experienced a loss, even a perceived loss.  As painful as it can be, it’s important to acknowledge the possibility of undesirable outcomes.


Possibly the most important part of this process is acknowledging that poor outcomes are a possibility. And, that you can handle whatever comes your way. So much of toxic positivity comes down to a belief that we can’t handle the difficulties that life throws at us!


When you’re supporting others, empathize with them.  Let yourself feel the emotions that they are describing. Ask yourself how you would feel in their situation.  Avoid jumping straight into encouragement. Let them share their feelings without judgment.

Need a Place to Vent Without Being Told to Think Positive?


Life can seem uncertain, and you aren’t sure where this journey will take you. That’s completely normal.  Even though we are generally upbeat and positive at The Integrative Fertility M.D., we understand the road that you are walking during your fertility testing and treatments. We understand the confusion that comes with test results you weren’t expecting.


We empathize with the disappointment you feel when treatments don’t have the outcome you’d been hoping for. Even after pregnancy is achieved, mixed feelings are a normal part of the process! And even in your celebration, you might feel anxious, scared, or ambivalent. It’s okay (and healthy!) to acknowledge these mixed emotions.


If you need a place to turn for support without the toxic positivity, consider The Integrative Fertility M.D. for your fertility consultation, testing, and treatment needs. We are here to help and hold space for you!

Nothing beats getting all your necessary vitamins and minerals from a diet rich in nourishing, whole foods. But unfortunately, it’s just not always possible to achieve this with our modern diets. One day you’ll knock it out of the park with healthy fats, but neglect to eat enough calcium. The next day you cover your calcium and magnesium bases, but hardly get any zinc.

This is the reason you may want to include supplements as a part of your daily life. Though we shouldn’t rely on supplements to give us all the nutrients we need and neglect our eating habits, including some of the best supplements for fertility can help.

Prenatal vitamins

When you’re trying to conceive, one of the most important supplements to include in your routine is a prenatal vitamin. It takes an egg about three months to complete its journey to ovulation. So the nutrients you take in today are actually playing a huge role in healthy egg development and production months down the road!


Not all prenatals are the same, though. Be sure to read labels, and select a prenatal without artificial flavors, dyes, and hydrogenated oils. A lot of supplements on the market are coated with phthalates, which can disrupt your endocrine system in powerful ways.


Look for a prenatal that contains vitamin B12, choline, iron, calcium, selenium, zinc, iodine, and biotin. It should also offer vitamin A, most of which comes from beta carotene. Finally, be sure the brand of prenatal vitamin that you choose contains methylfolate rather than folic acid. Though most prenatals contain folic acid, methylfolate is the more bioavailable, readily-absorbed form. This is especially important if you have an MTHFR (methylenetetrahydrofolate reductase) gene variant.


A lot of the prenatals available at the grocery store contain vitamin D and DHA. These nutrients are both vital during pregnancy and preconception, but prenatals usually contain very little of either of these. Look for separate vitamin D and DHA supplements!

Vitamin D

A vast majority of people in the Western world have low vitamin D levels, despite all the “vitamin D fortified” foods we ingest. This is primarily due to the lack of sunshine that we get, since we spend most of our hours inside. And it’s pretty common for women with PCOS to have very low levels of vitamin D.


Vitamin D is fat-soluble, and it has hormone functionality. It’s actually a vitamin that your body produces in response to sun exposure and foods like eggs, liver, and fatty fish.


It’s incredibly difficult to get enough vitamin D from foods alone. In addition to adding a vitamin D supplement, though, aim to spend at least 20 minutes in direct sunlight every day to encourage vitamin D production. Know your skin type, though, and use caution if you tend to burn easily!


The research surrounding fertility rates and vitamin D levels is a bit mixed. One study concluded that vitamin D deficiency was associated with lower success rates of in-vitro fertilization in non-hispanic White women. But other data don’t show any increase in conception or live birth with vitamin D supplementation.


Levels of vitamin D can be lower due to inflammation, which could possibly be the reason we see lower levels in women with PCOS. Several small studies have suggested that vitamin D supplementation may help regulate the menstrual cycle in PCOS patients. More study is needed in this area, though.


Women with a vitamin D deficiency may also be at increased risk of gestational diabetes, preeclampsia, and premature birth.


There’s some evidence that males who supplement with vitamin D can have improved sperm motility. Higher vitamin D levels were associated with a higher chance of one’s partner conceiving.

Coenzyme Q10

Coenzyme Q10 is a nutrient that naturally occurs in the body. It’s a powerful antioxidant that has been shown to improve ovulation rates in women using Clomid. CoQ10 can also help to support improved egg quality during IVF cycles..


Men taking CoQ10 also showed a possible improvement of sperm concentration and movement.


While we definitely need more human studies on the benefits of CoQ10, it’s considered a safe supplement to take during conception and pregnancy, so most practitioners feel that it is safe and that the possible benefits outweigh the risks.


Myo-inositol is a sugar found in the brain, and it’s part of the group of B-complex vitamins. When studied in women with PCOS, it was shown to decrease insulin resistance and lower levels of serum testosterone. It also improved menstrual irregularities and increased ovulatory frequency! 


Pregnancy rates were increased in PCOS patients after they had taken myo-inositol for three to six months. And myo-inositol has also been shown to possibly improve egg quality during IVF. Gestational diabetes levels were also lowered in women who continued supplementing during pregnancy.


Myo-inositol can be a great supplement to consider if you’ve been diagnosed with PCOS!


N-acetylcysteine is a great antioxidant to add to your supplement routine to protect your cells from the stress caused by oxidation. Oxidation can reduce the body’s ability to produce a healthy egg, and antioxidants can help fight this oxidative process. This is especially helpful to your egg cells!


N-acetylcysteine can also benefit sperm quality. One study showed that men who took selenium supplements along with N-acetylcysteine demonstrated increased semen quality. 


N-acetylcysteine might also benefit women with PCOS by reducing their testosterone and insulin levels. It’s possible that N-acetylcysteine and myo-inositol could be an option for women who can’t tolerate the side effects of Metformin.

Don’t forget to discuss this with your care provider!

When we talk about supplementation, it’s important to remember that each case is different. Your unique history and medical issues may make any of these supplements inadvisable in your case. Be sure to discuss the advisability of adding these supplements to your routine with your fertility doctor.


Dr. Salem is extremely knowledgeable about the benefits and drawbacks of various vitamins and mineral supplements during fertility treatments, conception, and pregnancy. Request a consultation with her to discuss which of these supplements could benefit you!

No one wants to struggle with infertility, regardless of its origins. But if you’ve conceived in the past with no apparent difficulty, infertility can be particularly shocking.

What is secondary infertility?

Secondary infertility is when an individual or a couple has difficulty conceiving or carrying a pregnancy to term, despite having prior biological children with no difficulty.

About ten percent of couples who had no trouble conceiving previously will experience secondary infertility. Though it has many of the same causes as primary infertility, this topic doesn’t seem to receive as much attention in the media or in society.

Unfortunately, many couples struggling with secondary infertility find themselves suffering in silence. Well-meaning family and friends try to convince them that they should be content with the family they already have. Coworkers remind them that they already have one or more children and should just focus on that. Your Great Aunt Sue reminds you to “just relax, and it will happen when you least expect it!”

Sadly, there are even medical providers that fail to take your concerns seriously, not giving your case the attention it deserves simply because you have successfully conceived a child before.

But regardless of whether the desired pregnancy is the first child or the sixth, no one should be shamed by others for their desire to grow their family.

What causes secondary infertility?

There are multiple possible causes of secondary infertility. Many of them are the same factors that cause primary infertility. Unexplained infertility is also a common diagnosis. These difficulties in conception can occur at any point in the early pregnancy process: ovulation, sperm production and travel, fertilization, travel of the fertilized egg, or implantation in the uterus. These problems can originate with either a male or a female partner. Though it would be rare for both partners to have developed problems in the time since the conception of the prior child, this is also a possibility.

Here are a few possible causes of secondary infertility, though of course you’ll need to work with your healthcare provider to determine what specific factors are at play in your case.

  • Change in sperm quality and quantity. As a man ages or changes his lifestyle, the quality and number of sperm in each ejaculation can decline. This can be linked to smoking, alcohol intake,  changing testosterone levels and environmental exposures. Sperm morphology and motility can be checked through a semen analysis.
  • Endometriosis. Endometriosis happens when tissue similar to the uterine lining (“endometrium”) grows outside of the uterus, in places like the ovaries or fallopian tubes. This lining can cause scarring in the pelvis and on the fallopian tubes, making it impossible for the sperm to reach the egg or for a fertilized egg to pass through the fallopian tube to the uterus.
  • Uterine fibroids. Fibroids are noncancerous tumors found in the uterus. Some uterine fibroids occur in the uterine cavity and can make implantation difficult.
  • New medical problems. If you have been diagnosed with a new medical condition since your last pregnancy, this could contribute to secondary infertility. Polycystic ovary syndrome, diabetes, autoimmune concerns, uterine polyps, and pelvic inflammatory disorder are examples of conditions that may make conception more difficult than it has been in the past.
  • New medications. Likewise, if you are taking new prescription or over-the-counter drugs, this may affect fertility. Drugs taken for epilepsy, thyroid, pain medications, some steroids, and chemotherapy have been known to impact fertility.
  • Complications from prior pregnancy. Any uterine scarring can cause difficulty with the implantation process. Talk to your physician about your particular prior pregnancy and birth experiences to see if this could be a factor.
  • Complications from prior surgeries. Complications from prior surgeries can lead to scar tissue in the uterus or pelvis that can impact fertility.
  • Age. It goes without saying that both partners are more advanced in age than they were when the prior pregnancies were conceived. Because female fertility tends to decline in the mid-30s, the more a woman ages, the lower her egg quality tends to be.
  • Lifestyle factors. Habits frequently change after one becomes a parent. There are a few lifestyle factors that can possibly contribute to infertility. It’s harder to round up your child and the stroller and get out the door for a walk than it was when you just had to grab your keys and go. Maybe you’ve returned to a smoking habit you picked up in college. Perhaps you find yourself reaching for the wine bottle more often than you did before. It’s easy to slip back into these methods of coping in the busy years of raising small children. Focusing on eating whole, nutritious foods, moving your body more, stopping smoking, and cutting back on heavy alcohol consumption can contribute to a healthy lifestyle that can support fertility.

What is the treatment for secondary infertility?

Just as the causes of secondary infertility are similar to primary infertility, the treatments can be similar as well. After performing a thorough examination and history, your provider can order lab tests to check your hormone levels. A semen analysis is also commonly ordered to check the number and motility of viable sperm.

There are a number of treatments that can be helpful for secondary infertility. These can include medications such as Clomid or letrozole. Intrauterine insemination (IUI) or IVF may be considered as well.

When should I get help for secondary infertility?

If you’ve been having unprotected sex for more than a year, consider seeking medical help. If you are over the age of 35, this time period can be shortened to six months. And if you are over the age of 40 or you have been experiencing irregular menstrual cycles, contact a fertility specialist right away to get the help you need.

Secondary infertility can be a very unwelcome surprise, but The Integrative Fertility M.D. is here for you. Reach out – we’d love to help you with your family planning goals!

As if infertility isn’t overwhelming enough on its own, keeping track of fertility testing names, schedules, and results can leave you completely befuddled.

“Which tests? Are these blood tests or ultrasounds? This dye goes where, now?”

And how do you keep track of which blood draws need to take place on which days of your menstrual cycle?

We’re here to demystify this process for you!

Why would I need all these tests?

The results of these labs can help your provider determine the reasons that you’ve been struggling to conceive or maintain a pregnancy. And if you’re considering growing your family with fertility treatments, the results can also help determine what your next steps will be.

Important fertility tests

Here are 10 of the most common tests your provider may order when trying to assess the reasons behind your infertility.

  • Anti-mullerian hormone (AMH) level. AMH level is assessed through a blood draw, and it evaluates ovarian function. A low AMH level can indicate a low egg count, which could be the cause of your fertility struggles. But this isn’t always the case! AMH might be most useful in helping your doctor predict how you might respond to certain fertility medications.
  • Prolactin level. Prolactin is a hormone made in the pituitary gland in the brain. It’s the hormone that’s primarily responsible for breast milk production after birth. But unusually high levels of prolactin can be linked with infertility and irregular or absent periods as well, so this level can help pinpoint if that might be causing your difficulties conceiving. A normal prolactin level in a female who is neither pregnant nor lactating is less than 25 ng/mL.
  • Day 3 follicle-stimulating hormone (FSH) level. As its name indicates, FSH stimulates the ovarian follicle to be produced. FSH is the primary hormone responsible for selecting which follicle will be released. This follicle production then proceeds to ovulation. By testing this level very early in the menstrual cycle, your provider can get an idea of how hard the body is trying to stimulate follicle production. Simply put, an elevated FSH level can indicate that the body is having to do extra work to produce a follicle. FSH levels typically increase with age.
  • Day 3 estradiol level. This level is closely related to FSH, so it’s typically drawn along with the FSH test discussed above. If estradiol is elevated but FSH is normal, this can signal problems with the response of the ovary. Estradiol level less than 80 is considered normal at this point in the menstrual cycle.
  • Progesterone level. Progesterone is a hormone that rises in response to ovulation. A rising progesterone level can help confirm that ovulation is occurring, so this test is timed for about a week after suspected ovulation. Your progesterone levels will need to be interpreted by your care provider, of course, but low levels may suggest that ovulation didn’t occur or that post-ovulatory progesterone levels may be too low to sustain a pregnancy.
  • Hysterosalpingogram (HSG). Whereas a lot of these other tests look at your hormone levels, the HSG evaluates the patency (openness) of your fallopian tubes. The physician performing the HSG will pass a very small catheter through the opening of your cervix and insert dye into the uterus. After inserting the dye, a pelvic x-ray is taken. If the uterus fills abnormally, there might be a polyp, fibroid, or malformation of the uterus. If both fallopian tubes are unblocked, the dye will spill out through the fallopian tubes. If there are any blockages in the tubes, the dye will stop at the blockage.
  • Antral follicle count (AFC). This count is performed by vaginal ultrasound. Egg count and quality decrease as women age, and this test evaluates ovarian reserve. Your antral follicle count can give your provider an idea of where your fertility ranks in relation to your age. Because egg count decreases as you age, this number will be lower the closer you come to menopause.
  • Thyroid testing. Hypothyroidism (low levels of thyroid hormones) can prevent the release of the mature egg from the ovary, leading to difficulty conceiving. There are several blood tests that can help evaluate thyroid function, but one of the most common is thyroid-stimulating hormone (commonly referred to as TSH). Healthy levels of TSH can vary based on your specific case.
  • Diabetes testing. Fasting blood sugar levels can help determine if further testing for diabetes is warranted since diabetes can be associated with infertility.
  • Semen analysis. All of the tests above have been primarily performed on the female partner, but semen analysis is vital to the fertility treatment process! This is because male factor infertility can be the cause of up to half of cases of infertility. Semen analysis is normally one of the first fertility tests performed, as it is less invasive than others. Semen analysis is most accurate when it follows 24 to 72 hours of abstinence. It’s also important that the sample be examined within an hour after collection. The semen is examined under a microscope and the number, shape, and movement of the sperm are observed.

You might not need all these tests!

Though these tests are important, every case is different! Not every test on this list will be required before starting treatment for each patient. It’s vital that you discuss the specifics of your situation with a fertility specialist to understand which could benefit you!

Fertility treatments can be confusing, and it’s easy to become overwhelmed with the testing process. We understand the overwhelm and are here to walk you through the process! We also know that you may still have questions about some of these tests.

Regardless of the specifics of your fertility case, we consider it an honor to accompany you on your journey. Contact us today to consult with Dr. Salem about which of these tests would be best for you!