Root Causes of Infertility and Natural Ways to Boost Fertility

You may have been trying to get pregnant for a couple of months or a couple of years. The wait feels hard, and unanswered questions can stack up alongside frustration and lost hope.

Or, maybe you understand the cause of your infertility. But you go to your OB and they don’t run labs, ask questions, or dig deeper. Instead, doctors jump straight to conversations on IUI or IVF without considering the implications at play—physical, emotional, financial. If this is your story, please know you are not alone. And there may be deeper answers worth exploring.

The statistics are staggering. Infertility is rising alarmingly in the United States, with fertility declining by 1% each year. Male sperm counts are also falling at the same rate, and women are more vulnerable than ever to hormonal dysfunction and imbalance due to modern day lifestyle, diet, environmental toxins, stress, and more. 

So what can you do?!

Root Cause Medicine: A Functional Approach

While it might feel hard to dive head-first into the question of infertility, true hope is found with getting to the bottom of the situation! 

Instead of masking symptoms, it begins to piece the puzzle together behind why conception (or regular cycles, ovulation, being able to sustain a pregnancy, etc.) isn’t happening. 

This approach asks questions like:

• Are hormones being produced and metabolized properly?
• Is ovulation occurring regularly?
• Is inflammation impacting implantation?
• Are nutrients sufficient to support egg quality?
• Could thyroid or autoimmune factors be involved?

Then we can come up with a comprehensive and tailored plan to support natural conception. 

Common Root Causes of Infertility

Before we dive into specific diagnoses, there is one thing you need to understand. 

Many cases of infertility are connected to underlying imbalances, including hormonal, inflammatory, metabolic, or environmental, that are often overlooked. Functional medicine looks at the body as a whole, uncovers the area(s) of imbalance, and supports the body to return to its natural state of optimal health.  

PCOS (Polycystic Ovarian Syndrome)

PCOS is the leading cause of infertility today, affecting up to 13% of reproductive-aged women. (source, source) Research is continuing to expand regarding characteristics and categories of PCOS. 

However, it’s important to know most women with PCOS (up to 70%) also experience insulin resistance. This includes both obese women and women with “lean BMI.” (source) PCOS can largely be categorized as a metabolic disorder, and it is most often a manifestation of insulin resistance in the ovaries. (source)

For this reason, I encourage women with PCOS to start their fertility journey by working on blood sugar balance through diet and lifestyle factors. (source) If you’d like insight into PCOS-specific protocols, check out my article on Healing PCOS Naturally. I have worked with countless women to heal their PCOS and enjoy healthy pregnancies! Though it can be common, it is reversible and there is hope! 

For the small percentage of women suffering from Adrenal PCOS, Autoimmune PCOS, or other PCOS subsets, I suggest working with a functional medicine professional to undergo the specific tests you need, determine your health and hormonal baselines, and tailor a protocol to restore balance and regularity. 

Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus begins to grow outside of the uterus. It can be very painful in addition to causing infertility. 

It isn’t fully understood why endometrial tissue migrates outside of the uterus, but some commonly known contributing factors include:

• Increased inflammation
• Excess estrogen or estrogen dominance
• Imbalances in the microbiome

Irregular or Anovulatory Cycles

Menstrual cycles that are either irregular or do not result in ovulation can be due to:

• Stress
• Prescription medications
• Environmental factors
• Nutritional factors
• Lifestyle factors
• Some combination of all of the above

Fibroids

Fibroids are non-cancerous tumors that grow in or on the uterus. They can grow individually or in groups, and they range in size from a grain of rice to a softball. 

Around 30% of menstruating women will have a fibroid at some point in their lives. They may have no symptoms at all, but other times fibroids can be painful, cause bowel and/or cycle irregularity, and may be associated with infertility. (source) 

Causes of fibroids may be linked to (source, source, source):

• Estrogen dominance
• Stress
• Vitamin D deficiency
• Obesity

Male Factor Infertility

According to most medical sources, roughly one-third of infertility cases can be attributed to male factors. (source) If a couple is struggling with infertility, I always recommend the male also undergo testing to understand whether or not this factors into their difficulty getting pregnant. 

Factors to look at are:

• Sperm quality
• Sperm count
• Motility
• Autoimmune conditions like anti sperm antibodies 

If You’ve Experienced Miscarriage

Miscarriage is far more common than most women realize. And it is never something to blame yourself for. For women with recurrent pregnancy loss, functional medicine may explore contributors such as:

• Thyroid imbalance 
• Autoimmune conditions
• Blood clotting factors
• Progesterone support
• Inflammation
• Nutrient depletion

If this is part of your story, please know you deserve both compassion and deeper answers.

Fertility Testing: Establishing Baselines

I often say “Test, don’t guess!” to my clients. Testing is the best way to obtain concrete information and ultimately a “starting place.”

These are the tests I initially turn to for establishing baselines and uncovering answers when working with clients battling infertility:

• Full Thyroid Panel (including optimal ranges):
  • TSH 1-2 mIU/L
  • Free T4 1.1-1.4 ng/dL
  • Free T3 3.2-3.8 pg/mL
  • Reverse T3 <12 ng/dL
  • Negative Thyroglobulin and TPO antibodies 
• Full Nutrient Panel/Evaluation (see below)
• CBC 
• HgA1c
• Insulin
• CMP
• ANA w/ reflex to titer (complete autoimmune panel) 
• Iron panel w/ ferritin 
• Antiphospholipid antibody
• Cardiolipoprotein antibody

In addition to lab work, I strongly recommend tracking ovulation at home using something as simple as basal body temperature (BBT) and LH strips, or a more in-depth hormone monitor such as Mira or Inito. LH strips help identify your surge window (a 24-48 hour period of increasing hormone activity that triggers ovulation), while a sustained rise in BBT confirms that ovulation has occurred. This knowledge can help ensure proper timing when trying to conceive. 

For deeper insight, Mira provides hormone data to track estrogen rise, LH and FSH peaks, and progesterone production. This real-time tracking allows you to follow hormone patterns throughout your cycle and assess ovulation quality month to month.

While I’m a fan of functional medicine lab testing all of the time, it can be especially important to go deeper into testing when battling infertility for exactly how to tailor a protocol for improved fertility. 

Here are some of my top functional medicine lab tests to run on clients who are struggling with infertility:

• TDW Bloodwork Panel – This basic but comprehensive bloodwork panel will include many of the markers referenced in the sections above. This labwork is available to those in my TDW Community membership. 
• Metabolomix Nutritional Assessment. It allows us to see if/what specific nutrients are lacking and may be playing into infertility. This labwork is available to those in my TDW Community membership. 
• DUTCH Adrenal Test – This provides an in-depth look at stress hormone activity, and it sheds a lot of light on which hormones may need support. While we do not offer this test inside the TDW community, you can contact DUTCH directly to find a qualified provider near you.
• DUTCH Complete + Cycle Mapping – This is a comprehensive dried urine hormone test that evaluates estrogen, progesterone, testosterone, cortisol, and their metabolites. While we do not offer this test inside the TDW community, you can contact DUTCH directly to find a qualified provider near you.

Another Root Cause Option: What is NaPro Technology?

If you’ve been told your only options are IUI or IVF, you may want to know there’s another path that focuses on finding and treating the underlying cause of infertility.

NaPro Technology (Natural Procreative Technology) is a medical approach that works with your natural cycle. Not around it.

Here’s what makes it different:

• It closely tracks your menstrual cycle patterns to identify hormonal imbalances.
• It looks for root causes like low progesterone, thyroid issues, PCOS, endometriosis, or luteal phase defects.
• It supports ovulation and implantation rather than bypassing them.
• It aims to restore normal reproductive function, not replace it.
  

NaPro often uses detailed hormone testing, cycle charting, targeted medications (like bioidentical progesterone), and if necessary, surgery for issues like endometriosis. All with the goal of helping your body conceive naturally. For women who desire a restorative, root-cause approach before moving to assisted reproductive technology, NaPro can be a meaningful option to explore.

Supplements to Support Fertility

After baselines are established via testing, it’s time to tailor supplements for filling in nutritional gaps, targeted detox, hormonal support, and beyond. 

Before diving into common fertility-supportive supplements, I have to reiterate that the best supplement protocols are tailored to your individual needs based on testing, symptoms, genetics, and your unique situation. 

With that said, the following are some of the more commonly beneficial supplements I’ve seen in supporting hormonal balance and ultimately fertility after working with countless women:

• Inositol – Supports hormone signaling and insulin sensitivity, helping improve ovulation and egg quality.
• Vitamin E – Supports uterine lining development and improves blood flow to reproductive tissues.
• Vitamin C – Provides antioxidant support, supports progesterone production, and reduces oxidative stress.
• Pycnogenol – Improves circulation and reduces inflammation, supporting ovarian and uterine health.
• CoQ10 – Supports mitochondrial energy production, which is essential for egg quality and healthy embryo development.

• Probiotic – Strengthens the vaginal and gut microbiomes. As mothers, we “seed” our baby’s microbiome with our own, which is why it’s so important to work on building up our own good bacteria! A healthy gut may also help prevent GBS in pregnancy. 
• Needed Prenatal – A comprehensive prenatal for overall nourishment. These nutrients aid in preparing the uterine lining for pregnancy, support egg quality, fertility, and pregnancy. I recommend starting this ideally, 3 months prior to conception. 

5 Lifestyle Measures to Support Fertility

When restoring balance to the body and preparing any woman for a future pregnancy, I start with five foundational steps. 

These are beneficial across all women, regardless of the reason for their fertility challenges. And only after nailing down on these foundational pieces do we begin to dive into more specific detail work. While these might initially feel unrelated to infertility, that couldn’t be further from the truth. I cannot more strongly advise that you don’t skip these steps!

Ideally, you should start preparing your body and environment for conception as early as possible, and at least 3-6 months beforehand. This will allow you to optimize the baby’s environment for growth and development. 

The goal is to optimize mom’s health now to provide an abundance of nutrients and nourishment throughout pregnancy, delivery, nursing, and postpartum.

1. Address Nutritional Imbalances

Nutrition absolutely affects the regularity of ovulation as well as egg quality (source). Low levels of iron can impair follicle development. Red blood cells deliver oxygen to the ovaries and uterus. If there is an iron deficiency, it may cause egg quality to weaken.

With proper nutritional intake, we can support mitochondrial health and energy production, ovulation regularity, egg quality, insulin sensitivity, and more. 

Here’s what to focus on:

• Cut out all processed and refined foods, at least for a length of time—things that come in a package
• Eat real, whole foods only. Plenty of clean protein, healthy fats, and some complex carbs
• Prioritize antioxidant-rich fruits and veggies, organic if possible
• Eat foods that are high in omega 3s, such as salmon, sardines, anchovies, and flaxseed.
• Up your B6 and folate intake by regularly eating broccoli, Brussels sprouts, leafy greens, eggs, legumes, avocado, salmon, and turkey
• Up your fiber intake to 25-35g per day. This will help detox excess hormones and toxins from the body. Include foods like berries, chia seeds, flaxseeds, avocado, artichokes, lentils, and other high fiber fruits and veggies 

This would also be a great time to undergo a comprehensive nutritional analysis, such as the Metabolomix Nutritional Assessment referenced above. 

2. Reduce Inflammation 

Inflammation can negatively impact the menstrual cycle and sperm quality (source), can cause implantation failure, and increases the risk of endometriosis and miscarriage. 

Support anti-inflammatory habits through: 

• Minimizing processed and refined foods
• Prioritizing antioxidants, omega 3s (fatty fish such as salmon, eggs, flaxseed, etc.) and B vitamins (including folate)
• Stress-reduction practices such as deep breathing, connection with loved ones, journaling and/or reading, prayer, meditation, getting outdoors, grounding, etc. 

3. Heal and Seal the Gut

Healing the gut has downstream effects on nearly every aspect of health, including fertility. Gut health is central to overall wellbeing, and you will definitely want to check out my master gut health resource: All About Gut Health: Master Roundup of Article, Symptoms and Easy Actions to Improve Your Gut Health.

The gut affects so many factors that can be tied into fertility:

• How we metabolize hormones
• Our ability to fight pathogens and bacteria
• How we regulate the body’s inflammation
• Efficiency of nutrient absorption 

Not only that, a mother’s microbiome is passed down to her baby when she does become pregnant. 

In addition to the anti-inflammatory diet outlined above, including highly beneficial fiber and fermented foods will create a robust and diverse microbiome environment. This includes: 

• Leafy greens
• Deeply colored vegetables
• Chia seeds
• Flaxseed
• Sauerkraut
• Kimchi
• Coconut yogurt
• Kefir 

Especially if you suspect gut issues, a stool test via your functional medicine practitioner or through the TDW Community would be my first suggestion. For members of TDW Community, we offer the gold standard GI-MAP stool test, and I also include my Get Your Gut Right program for free to those who purchase the stool test. This program includes the same gut-healing protocols and steps I used in my private practice. 

4. Detox Your Environment

Research shows exposure to various toxins, especially endocrine disruptors like BPA, phthalates, and heavy metals, can significantly contribute to infertility in both females and males by disrupting hormone balance and reproductive cell function. Currently recognized effects of toxic exposure include: decreased sperm count, impaired ovulation, and reduced implantation rates (source). 

Switch out toxic cleaning products, candles, personal care products, makeup, laundry soaps, etc. to non-toxic alternatives. This greatly reduces your body’s toxic load. Did you know that most conventional products including cleaning products, beauty products, personal care products, etc., contain all sorts of endocrine-disrupting chemicals?! 

As a huge bonus, cleaning up your environment also reduces the amount of toxins that you could/would pass onto baby through the placenta or even breastmilk when you do become pregnant. For a master list of my most loved and trusted non-toxic products, you can find it HERE. Finally, the Environmental Working Group (EWG) is a great resource for all things non-toxic living. 

While you can click the guide referenced above in order to receive the master list of all of my favorite swaps, I want to share a few of the common ones to get you started:

• Shampoo/Conditioner: Acure, Innersense – use code TAYLORDUKES
• Body Wash: Aleavia – use code TAYLORDUKES, Primally Pure – use code TAYLORDUKES, Dr. Bronner’s
• Facial Cleansing and Facial Products: Primally Pure – use code TAYLORDUKES
• Laundry Detergent: Branch Basics – use code TAYLORDUKESWELLNESS, Molly’s Suds 
• Cleaning Products: Branch Basics – use code TAYLORDUKESWELLNESS or use vinegar and water

5. Nail Your Healthy Foundations: 

Optimize daily habits that are foundational to overall health. Not only can these help bring the body back into balance and improve fertility, they are also great habits to get into for long-term wellbeing after your baby arrives. 

• Prioritize sleep: Sleep is so healing! It helps to balance blood sugar, balance hormones, improve detoxification, protect the nervous system, and so much more. While sleep after baby can be challenging, be sure to really nail down your sleep routine and get your best rest before baby. 

• Eat real food: Decreasing or significantly reducing your processed food intake and trading them for real food is one of the simplest but most impactful moves you can make for your fertility and health journey in general. Choosing real food helps you deeply nourish your body while decreasing the inflammation and stress that processed foods cause. 

• Move your body: Regular exercise, such as yoga, stretching, and strength training are beneficial on many levels. Staying active will help fertility, but also improve baby’s health after becoming pregnant! A word of caution: Know your body! Over-exercise can cause strain on adrenals and stress the HPA axis, eventually leading to hormonal imbalance. So don’t overdo it. 

• Reduce stress: The body perceives stress in many different ways. We want to not only consider the obvious stressors that we might be experiencing like relationships, job deadlines, life changes, financial strains, or a traumatic event, but also less obvious forms like not eating enough, prolonged fasting, and not getting enough sleep. This is a time to nourish the mind, body, and soul in order to ensure we are in a calm “rest and digest” state.  

Other Helpful Lifestyle Measures to Improve Fertility

• Increasing Cervical Fluid: Increasing cervical fluid will help both fertility and the health of baby after becoming pregnant.
  • Hydration (ideally, with electrolytes!)
  • NAC 
  • Omega 3 Fatty Acids (O3FA)
  • Evening Primrose Oil (EPO)
  • Acupuncture
• Addressing specific findings from testing with personalized protocols including detox measures, lifestyle changes, and supplementation plans. 

A Trusted Guide for Pregnancy

We want to support you through your entire fertility journey! If you haven’t already, you’ll want to check out our Ultimate Prenatal, Pregnancy & Postpartum Guide. This all-in-one digital guide is your essential motherhood companion from preconception through pregnancy to postpartum. Created by functional medicine nurse practitioner and mom of two, Taylor Dukes FNP-BC, APRN, it’s filled with evidence-based suggestions, supplement plans, and protocols to support you and your baby naturally and confidently. 

Final Thoughts

I know this can feel overwhelming. But you need to know this: there is so much you can do. You are not hopeless or broken. And you also don’t need to implement all the things tomorrow. One day at a time. One step at a time. Advocate for answers and a personalized plan. Be patient. Have grace. And allow each little decision you make for your long-term health and fertility to stack up.