Most people never think they’ll be the one dealing with infertility but if it happens to you it can be completely overwhelming. Conception doesn’t “just happen” for 1 in 7 couples and 1 in 8 women seek help for infertility. If you’re concerned about conceiving, make sure you’re covering all of your basics and read this.  Then consider hormone testing for both partners. 

DUTCH (Dried Urine Test for Comprehensive Hormones) is the most comprehensive way of assessing adrenal and sex hormonal imbalances. By using dried urine instead of serum (blood) like a conventional medical professional would, we can look at the hormones and their metabolites instead of just the hormone levels in the blood at the time of the test. By looking at the hormone metabolites, we can see how your body is making and processing the hormones. 

Why is this important? Let’s take estrogen dominance as an example. Heavy periods, PMS, breast tenderness, and fibroids are all signs of having too much estrogen. However, there can be multiple causes. Estrogen dominance symptoms can be caused by high estrogen production by the ovaries, impaired metabolism or detoxification of estrogen, or too little progesterone to balance out the effects of estrogen. All of these causes would impact fertility differently.

The treatment could then be specific to the cause once it is found. Doing the DUTCH hormone testing will give us a clear picture of how much estrogen is being produced, how it is being metabolized and detoxified, and how much progesterone is being produced. A serum, or blood, estrogen test with an additional progesterone test wouldn’t give us those answers. 

“If a woman does not ovulate or does not ovulate very well, her progesterone levels will not be healthy, thus reducing her chances of implantation and increasing her risk for miscarriage. If her estrogen is not healthy, she may not stimulate the LH surge to stimulate ovulation, thus not releasing an egg. A woman with high levels of estrogen may experience common ‘estrogen dominant’ symptoms such as breast tenderness, mood swings, and heavy bleeding. If her phase 2 estrogen detoxification is not appropriate, this may indicate a bigger issue with folate which is so critical to fetal development. Low levels of metabolized cortisol may be due to a subclinical (or overt) hypothyroid issue that needs to be addressed as a low functioning thyroid reduces the ability to become pregnant. The hormone pattern throughout the month of the Cycle Mapping test may show rises, falls, or flat-line levels that are abnormal.” Newman, M. (2016, Sept 22). Fertility and The DUTCH Test [Blog post].

Fertility is not a female problem.

Infertility in males is at least partly responsible in about half of all infertility cases. 

DUTCH hormone testing can be hugely helpful for the male partner as well. Average testosterone concentrations in males has reduced about 1% each year since the 1980’s. Low testosterone may lead to altered sperm production, leading to potential fertility issues. Similar to the female estrogen dominance scenario, it is not enough to simply get a serum testosterone test to assess testosterone health. How the body is metabolizing testosterone, the amount of estrogen being produced and metabolized, and how the adrenal glands are acting all matter and impact fertility. DUTCH testing looks at all of that. 

Hormonal Profile for Infertility

It’s important to look at not only the sex hormones, but the adrenal hormones as well for fertility. There is a connection between the sex organs, adrenal glands, and the thyroid. Thyroid hormones are best tested via serum and I suggest getting a full thyroid panel while preparing your body for conception. 

DUTCH looks at the following measures

  • Progesterone and progesterone metabolites
  • Estrogen and estrogen metabolites
  • Androgens and androgen metabolites (testosterone and DHEA)
  • Cortisol, cortisol metabolites, and cortisol daily pattern
  • Melatonin
  • Neurotransmitter (mood) markers
  • Nutritional organic acids for vitamin B12, B6, and glutathione status

Each of these measures impact fertility.

For females, I suggest doing the DUTCH Cycle Map because it looks at estrogen and progesterone levels at several different points of the month. This is great for women with irregular cycles, when you’re not sure when or if ovulation is occurring, or if you have mid-cycle spotting. The balance, or dance, between estrogen and progesterone during the menstrual cycle is critical for fertility and allows us to see how your ovaries are functioning. 

Because timing is so important for fertility, knowing when estrogen and progesterone surge is extremely helpful. The quantity of those hormones is important as well. Without enough progesterone after the LH surge occurs following ovulation, the pregnancy can be lost.

As a bonus, DUTCH is extra helpful for fertility because it measures melatonin and glutathione. 

Melatonin is commonly known as a sleep aid but it is a hormone that has many effects in addition to improving sleep quality. Melatonin has been shown to boost egg quality and increase IVF success rates. These positive effects likely come from its antioxidant action which is critical to protecting the egg (and sperm) as they mature. 

Melatonin is also critical for fetal development and can activate certain important genes that are essential from conception to birth. Not producing enough melatonin? Fertility will suffer. 

Melatonin is a driver of the circadian rhythm and the circadian rhythm regulates reproductive hormones!

Glutathione is also involved in the oxidative balance and in fact, is considered the body’s “master antioxidant”. Oxidative stress occurs during energy intensive processes in the body. Both formation of sperm and maturation of an egg are very energy intensive and thus produce oxidative stress. This process is normal and healthy but the important piece is making sure you have enough antioxidants around to avoid damage from the oxidation. Research has shown that eggs with higher intracellular glutathione levels produce stronger embryos. 

We mentioned melatonin is one antioxidant and glutathione is another. If you have low glutathione, supporting the antioxidant system will be critical in your journey to conception. Luckily, we can accomplish this  through nutrition!

Glutathione status will also be very important for those women with PCOS. Women with PCOS typically have much lower glutathione levels which is associated with higher testosterone levels. In PCOS, testosterone is typically elevated so by improving glutathione we may help decrease testosterone. 

What can be done?

Specific nutrition and lifestyle interventions can 

  • Increase testosterone when low in males
  • Decrease testosterone when high in females
  • Balance estrogen and progesterone
  • Improve progesterone level
  • Improve estrogen detoxification
  • Reduce cortisol to appropriate levels
  • Improve circadian rhythm which regulates reproductive hormone production
  • Ensure adequate B vitamin status
  • Improve antioxidant system
  • Regulate irregular menstrual cycles

Nutrition and lifestyle changes are more powerful than we are typically led to believe. If we find that lifestyle interventions aren’t enough in your case, we’ll be able to seek out the specific medical care you need much more clearly knowing your hormone profile. 

Reach out with your questions about DUTCH testing here. The best part is, it can all be done at home and telehealth appointments are available for those unable to come to my office. Book an appointment. 

Best,

Alyssa