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Lab tests and fertility

Hi John,
I ran this lab for one of my fertility patients.  She is female, 42 years, never been pregnant, tried for 3 years actively but has not been using contraception for 7 years.  Wants to give it another shot.  This is the first test. Wondering about her pH and Thyroid specifically.  Everything else looks good to me.
Your time is appreciated!
SF Acupuncturist

Dear SF Acupuncturist,
These are some of the healthiest labs that I have ever seen.  None of the things that I would  consider at all a potential problem are here.
– Blood sugars are perfect
– Thyroid is perfect ( on the surface at least – could do a reverse T3 to confirm)
– No signs of allergy or inflammation
-uric acid low
-CRP low
-eosinophils normal
– liver enzymes great.
– No signs of infection
– since no pregnancies, vs miscarriage, not too likely to be antibody problem

It’s great , which is of course a problem.  So the next most likely problems would be:
1. male problems – up to 40% of fertility issues are male problems
2. Healthy uterine cyclical hormonal development
3. Healthy cycle – luteal phase defects or ovarian defect
4. patency of fallopian tubes.
5. Healthy uterine structure

My personal next steps, to minimize cost with maximum effectiveness, would be in this order:

1. Test the male.
a. complete sperm work up is not expensive
b. STD testing – a very high percentage ( maybe 40%) of male sperm problems are from occult chlamydia infections
2-3. Cycle
a. Continue Basal Body Temp chart to be certain of 12 day high temp luteal phase with sharp rise and fall
b. Check LH:FSH ratio just to make certain no polycystic ovarian problems (very unlikely with the labs and glucose levels, but..)
c. Check day 21 progesterone levels for evidence of good luteal phase Pg levels
d. Have her check the amount of stretch to her Spinnbarkeit, mid cycle cervical mucus.
e. Ultrasound of ovaries to check follicular development during follicular phase
4. Have her MD test Fallopian tubes
a. ultrasound helpful
b. Hysterosalpingogram; much more accurate
c. STD testing and history; primarily for Chlamydial fallopian damage. This is particularly important with the high urine pH. (occult infections by certain STD’s can settle in the kidneys.  These bacteria  split urea which creates ammonia which will raise the pH.  This also puts her at higher risk for kidney stones so should be followed up on at any rate.  Since the specific gravity was moderately high, it might have just been a very concentrated urine sample however).  At any rate, I would have her hydrate normally and then do another urine test.
5. Uterine issues – her MD
a. View uterus to see that it is structurally sound and properly shaped
b. View uterine lining to be sure she is developing good uterine lining.

Be Happy!

– Dr. John Nieters, L.Ac. DAOM, FABORM

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