Fertility is a continuum.

National Infertility Awareness Week ends this Saturday, April 25. For more information, please visit: http://www.resolve.org

More than a decade ago, a 31-year-old woman named Helen walked into my clinic.

She told me she had been trying to get pregnant for three years and that she had been recently been diagnosed with “unexplained infertility.” For many women, unexplained fertility is a common utterance at the end of a long and frustrating process. It even has its own Wikipedia page and boasts enough NIH research to deter even the most determined among us.

Helen said that her doctor had no idea why she wasn’t getting pregnant. Everything looked fine from his perspective. His clinical efforts stopped there, with no suggested recourse.

The stress of not getting pregnant was really starting to affect Helen’s marriage, I learned. If nothing was wrong, why she wasn’t getting pregnant?

My job was to try to be the first person to actually look at the whole picture: her health history, her menstrual cycle, her BBTs (Basal Body Temperature), and perhaps most importantly, her diet and lifestyle, in order to figure out how all of the pieces fit together. My job was also to create a plan to untangle these factors and get them all functioning again.

If nothing was wrong, why she wasn’t getting pregnant?

One of the most prominent themes in American culture is the mentality that we can do whatever we want, whenever we want. Often, this idea often falls flat in the face of science, reason, and better judgement. The more we buy into the idea of modern convenience and technology-enabled entitlement, the more we start to lose track of reality.

For example, it’s not true that you you can just freeze your eggs and get pregnant later, on your own schedule.  Earlier this year, singer Sophie B. Hawkins made the news when she shared her positive pregnancy test at age 50. This and countless other examples leads women to think they can easily get pregnant at 50, too (which is possible, but unlikely).

Similarly when Facebook, Apple, and other companies offer to freeze eggs for employees who want to wait to have babies, it’s again easy to assume that preserving fertility is as easy as pushing pause on your iPod.

There are a lot of people, in fact, who would prefer that women remain in the dark about what fertility is and is not. Fertility and infertility are big business. I think all companies should be very careful about what they promise to women in their zeal to recruit and retain.

But the flip side of this also holds true. For women like Helen, who are told that there is no chance of getting pregnant, there often is a chance, and a better one than they typically realize.

One third of women who are infertile are diagnosed with “unexplained infertility.” Unexplained infertility is a collection of symptoms and lifestyle problems that together form a syndrome that can only be addressed by a highly specialized program that addresses not only a woman’s root biology, but also the specific dietary, environmental, and behavioral factors that gave rise to the problem in the first place.

One of the most prominent themes in American culture is the mentality that we can do whatever we want, whenever we want. 

So there it is. Inasmuch as there is a population of American women who seem to want to believe that fertility is a cinch, there is an equal population of American women to whom we have little or nothing to offer. Fertility and infertility in this country are a study in extremes.

The truth is that fertility is a continuum, which is inconvenient for those who would prefer a black-and-white diagnosis. I repeat: Fertility is a continuum. If you take nothing else away from the article, remember: Fertility is a continuum.

And as such, it is high time that women understand the reality of their own biology and the reality of their natural ability to get and stay pregnant. I am always startled to learn how little women know about how these things actually work.

Around the time I met Helen, I started to notice that the menstrual cycle was an excellent barometer of a woman’s overall health. This was an unconventional thought in any traditional hall of medicine. To a degree, it remains unconventional today.

In our lab and in the clinic alike, we slowly realized that if you successfully regulated a woman’s menstrual cycle, almost everything else would also in turn self-correct. I became fascinated with the menstrual cycle. My friends have grown used to me talking incessantly about it, but not everyone is as comfortable with the topic as I am.

Still, I was obsessed with how each and every part of the cycle from the length to the color of blood and absence or presence of clotting or pain told a story about a woman’s health and, more importantly, how to help her. I was desperate to learn more for the women who were suffering all around me.

We started to notice a very strong correlation between a woman’s BBTs and diagnoses like high FSH (follicle-stimulating hormone, link), or recurrent miscarriage. I began to compulsively look at as many BBT charts as I could—250,000 of them, in fact.

The truth is that fertility is a continuum.

We correlated BBTs with these diagnoses, looking for patterns. And we found lots of patterns. There is a very specific set of profiles of symptoms and lifestyle traits of the women who come into the clinic looking for help trying to get pregnant.

More importantly, we also see an even more distinct profile of the women who are now able to get and stay pregnant. (A detailed run-down of these factors can be found here and related FAQ’s are here.) Suffice it to say that an incredibly wide variety of factors influence a woman’s cycle. The good news is that the underlying biology is possible to reverse-engineer.

I have now seen over 7,000 women in my clinical career. I run one of the largest and most respected reproductive wellness centers in America, and I am the CEO of a company that developed a program called Conceivable that puts a “fertility clinic in your pocket.”

We have had the chance to test everything, thousands of times. We have spent about 10 years defining and redefining what it means to be fertile or infertile, and I can tell you with complete confidence that there are infinite degrees of each. I’ve seen women at every place along the fertility spectrum.

I’m not making a recommendation about when a woman should get pregnant or how. That is each woman’s choice. We as medical professionals are here to support those choices in the best way we possibly we can. But I believe, based on science and in my heart, that the best way to improve fertility is simply to improve health.

I’ve seen it over and over. Women who change their health status change their fertility status in turn. You cannot successfully diagnose or treat infertility as an isolated biological truth. I think that is a beautiful thing. A woman’s cycle isn’t a single function; it is rather an articulation of all function.

 A woman’s cycle isn’t a single function; it is rather an articulation of all function.

As we close out National Infertility Awareness Week, please help me spread the word to the millions of women, like you and like Helen, who believe that fertility is either automatic or near-impossible.

Ladies, the truth is somewhere in the middle. Fertility is a scientific marker of overall well-being. If you make your body healthier, your body will naturally want to do what you want it to do. Your ability to get and stay pregnant increases and decreases alongside a myriad of choices you make each day, week, and month. 

A fertile or infertile diagnosis is never so simple. We’re all always somewhere in between.

Kirsten Karchmer is the founder and CEO of Conceivable, a step-by-step modern fertility program that improves a woman’s ability to get and stay pregnant. She runs one of the largest and most-respected reproductive centers in North America, and has worked with more than 7 thousand couples over the last 15 years.

Photo via harinaivoteza/Flickr (CC BY SA 2.0)