Fertility and the DUTCH Test®

by Mark Newman, MS

Please read this exceptionally informative article written by our Clinical Director, Dr. Carrie Jones, ND, MPH, as she discusses the importance of proper hormonal balance as it relates to women’s fertility.

Whether you’re thinking about trying, actively trying, or struggling to become pregnant, understanding your hormones is critically important. The first half of a woman’s cycle is known as the follicular phase; this is where follicles in the egg are starting to grow because estrogen is starting to rise. Just before ovulation, estrogen spikes causing luteinizing hormone (LH) to release from the pituitary stimulating the primary follicle to release the egg. This release is known as ovulation and typically occurs mid-way in the cycle. The second half of the cycle is known as the luteal phase and in this half, progesterone starts to rise from the leftover primary follicle now known as the corpus luteum. If implantation does not occur, the hormones fall and a woman has her menstrual period.

Statistics show that the average couple trying to conceive without assisted reproductive technology (ART) become pregnant in 3-4 months. In fact, only about 30% of women become pregnant on their first try, yet 80% become pregnant by the sixth month (if trying for six consecutive months). Of course, this does not take into account the health of the egg, sperm, or the hormones involved. This is where the DUTCH test can make a huge difference as part of a preconception program and for those who might be currently struggling. The DUTCH Complete test is typically done on days 19, 20, or 21 of a 28-day cycle in order to properly assess luteal phase progesterone levels plus estrogen, estrogen metabolism, DHEAs and DHEA metabolites, testosterone, melatonin, metabolized cortisol and free cortisol (with the free cortisol pattern). The DUTCH Cycle Mapping test is collected throughout the month in order to graph progesterone and estrogen pattern from the follicular phase to the luteal phase.

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.

For those women looking to become pregnant, the DUTCH Complete test and/or DUTCH Cycle Mapping test should be part of a comprehensive fertility work-up in order to help improve her health and her chances!