Are you drowning in your fertility journey?
I’ve been there personally and have been walking side by side with women who are navigating this same experience for the last 7 years as a naturopathic doctor.
Before we start , I want to be clear that fertility affects both partners and we need both partners to participate in this journey - while most of the emphasis is on a woman’s body, it does not mean your body is inherently the problem. Men account for about 1/3 of infertility cases, and need a proper evaluation before any fertility treatments are started (and especially before we internalize the message that our body is broken). I’ve seen so many women on their very last round of IVF with a partner who never had a sperm analysis. Studies show that male partners of women with recurrent miscarriage show measurably worse sperm motility, morphology, higher DNA fragmentation, and higher oxidative stress. (3-9)
Okay, let’s dig in. I think about fertility in 4 main categories:
Anatomy
Hormones
Immunity
Bacterial environment
Anatomy:
Anatomy refers to the shape of the uterus, whether the uterus is tilted, whether both fallopian tubes are open, the presence of fibroids, endometriosis, polyps, adenomyosis, pelvic infections, etc. This is the most important category to explore early on in the process. A large study by the World Health Organization showed that tubal/pelvic factors account for 34% of female infertility cases. (1, 3) Structural abnormalities can be investigated with hysterosalpingogram (abbreviated as HSG) or saline ultrasound that looks more closely at the uterus and fallopian tubes.
Hormones:
Once you know for sure the structure of the uterus is normal, this is a great time to review your hormones. It is extremely common to find minor abnormalities in a hormone panel for couples struggling with infertility. These types of minor abnormalities might not be a big deal for everyone, but can be disruptive in some bodies that are more sensitive. It is certainly true that people accidentally get pregnant all the time with underlying thyroid conditions, but if you’re not getting pregnant easily or you’re having repeat miscarriages finding a minor thyroid imbalance become the most important thing to correct. As I tell many of my patients, having a hormone lab that is in range only tells me you don’t have overt disease. For fertility, we want to be more nuanced, we want to find your hormonal “shoe size.” Here’s what I mean: Just like a size 7-10 shoe is considered normal for women, if we were to put a size 10 foot into a size 7 shoe - you will get blisters, be in pain, and only be thinking about your feet all day. The moment you place a size 10 foot into the size 10 shoe, all the pain goes away and you don’t think about your feet at all. Both sizes are technically within the normal range for women, but your foot fits into 1 size comfortably - that is what we want to use your hormone panels to find.
Immunity:
There are human studies linking the presence of high auto-antibodies to infertility (Take a look at these here: 12, 13) Think about all that the immune system has to orchestrate in order to help the baby to implant - the immune system has to ramp up very quickly to cause minor inflammation in the wall of the uterus, then suddenly reduce its activity so the body doesn’t accidentally attack the growing baby….the timing must be perfectly orchestrated here. If you are already struggling with an impaired immune system showing up in your labs in the form of mildly elevated antibodies, the immune system at the level of the uterus may also not be functioning at its best. Anti-Phospholipid antibody syndrome, anti ovarian antibodies, clotting disorders, elevated Natural Killer cells are often part of the investigation process for fertility.
Bacterial Environment:
Overgrown bacteria and inflammation in the vagina/uterus alters the vaginal pH, making the environment less easy for sperm to navigate and causing other problems. You lose the protective bacterial species (lactobacillus), this gives space for the non protective species to overgrow resulting in inflammation. This is the perfect environment that can allow the uterine lining to be colonized which can ultimately disrupt implantation. People with persistent Bacterial Vaginosis showed a 43% reduction in prospective preconception, poorer IVF and implantation outcomes, and early pregnancy loss. Around 19% of women pursuing IVF were estimated in 1 study to have vaginal dysbiosis (abnormal vaginal bacteria levels). These dysbiotic organisms can ascend to the endometrium and prohibit implantation. (14-18)
There is compelling emerging evidence that the hormone system is partly orchestrated by the gut.
between the communication pathways of the gut and vaginal microbiome. If you have overgrown bacteria in the gut, this can play into abnormal vaginal baceteria as well, and disrupts hormone signaling across the entire body.
Sources:
1.Diagnosis and Management of Infertility: A Review.
The Journal of the American Medical Association. 2021. Carson SA, Kallen AN.Review
3.Infertility Evaluation and Treatment.
The New England Journal of Medicine. 2025. Santoro N, Polotsky AJ.Review
3.Infertility Evaluation and Treatment.
The New England Journal of Medicine. 2025. Santoro N, Polotsky AJ.Review
7.Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020; Amended 2024).
The Journal of Urology. 2024. American Urological AssociationGuideline
Clinical Chemistry. 2019. Jayasena CN, Radia UK, Figueiredo M, et al.
Advances in Experimental Medicine and Biology. 2026. Chakra MA, Mima M, Niederberger CS, Ohlander S.RecentReview
12.Thyroid Disorders and Female Infertility.
The Journal of Clinical Endocrinology and Metabolism. 2026. Unuane D, Velkeniers B, Poppe KG.RecentReview
BJOG : An International Journal of Obstetrics and Gynaecology. 2022. Dhillon-Smith RK, Boelaert K, Jeve YB, Maheshwari A, Coomarasamy A.
Human Reproduction. 2021. Lokken EM, Manhart LE, Kinuthia J, et al.
Journal of Assisted Reproduction and Genetics. 2024. van den Tweel MM, van den Munckhof EHA, van der Zanden M, et al.Observational
Journal of Reproductive Immunology. 2025. Dubé-Zinatelli E, Cappelletti L, Ismail N.RecentReview
Nature Communications. 2025. Haahr T, Freiesleben NC, Jensen MB, et al.RCT
18.Vaginal and endometrial microbiome dysbiosis associated with adverse embryo transfer outcomes.
Reproductive Biology and Endocrinology : RB&E. 2024. Su W, Gong C, Zhong H, et al.
