Get Pregnant Naturally

Low AMH, failed IVF, or told donor eggs, and still no real explanation for why? This episode looks at the system a standard fertility workup rarely checks: the nervous system, and how chronic stress affects egg quality, progesterone, thyroid function, and ovulation.
If you are a high-achieving, Type A woman who has been told your stress is handled and your thyroid is fine, this is the seven things behind low AMH, diminished ovarian reserve, and recurrent pregnancy loss that rarely get investigated, including the cortisol pattern, the full thyroid panel, blood sugar, prolactin, and the stress nerves that run directly through the ovary.
This episode covers: low AMH and high FSH, the cortisol curve, a single blood draw misses, thyroid antibodies and reverse T3 behind a "normal" TSH, how stress pulls raw material away from progesterone, blood sugar, and the 3 am wake-up, elevated prolactin, and the nervous system inside the ovary affecting egg quality.
This episode is for you if you have low AMH, diminished ovarian reserve, a failed or cancelled IVF cycle, or recurrent miscarriage, and you have been told donor eggs are your only option, and no one has explained why this is happening.
CHAPTERS
00:00 Why the woman who handles everything is the one who needs this
03:00 The seven things, and why this is physiology, not mindset
03:40 One: survival first, and reproduction turned down
05:00 Two: why a single cortisol draw misses the pattern
06:00 Three: thyroid antibodies and reverse T3 behind a normal TSH
06:50 Four: how stress competes with progesterone
07:50 Five: the 3am wake-up is blood sugar, not anxiety
09:00 Six: the prolactin that got flagged, then dropped
09:30 Seven: the nervous system inside the ovary
11:00 What you can actually change
12:30 The Functional Fertility Second Opinion
NEXT STEPS
What Your Clinic Missed guide: the lab markers behind each of the seven, in writing. Email hello@fabfertile.ca, subject MISSED.
Functional Fertility Second Opinion: a call where I review your full picture, your labs, your blood sugar, and your partner's results, and help you make an informed next decision. Email hello@fabfertile.ca, subject FERTILE, or book a call with your partner here.
I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My functional fertility team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.
Subscribe to Get Pregnant Naturally for weekly episodes on fertility optimization, IVF preparation, and the lab work your doctor probably isn't running.
Get Pregnant Naturally: A Functional Fertility Second Opinion.
If this show has helped you make sense of your numbers, please leave a review. It helps other women find the show and be their own advocate.

You were told to try again. Maybe you were told it was bad luck, or to wait until it happened a third time before anyone would look.
Here is what changed this year. In 2026, the American Society for Reproductive Medicine updated its definition of recurrent pregnancy loss for the first time since 2012. Two losses now meet the definition, not three, and a positive test that ended early counts. The old number kept women waiting for a third loss before the investigation even started.
Here is the part no one tells you. Meeting the definition gets you a workup. It does not guarantee the workup is complete. After two or more losses, up to half of couples are told the same word. Unexplained. The losses are real. What gets called a complete workup is the question.
This episode is the 9 specific things we most often find that are rarely checked before a woman is told her losses were unexplained or simply bad luck. Pull it up. Take notes. Bring it to your next appointment.
The 9 patterns:
Thyroid, the full panel and antibodies, not just TSH
Antiphospholipid antibodies, tested correctly
Chronic endometritis
The reproductive microbiome, vaginal and seminal
The gut, hidden gluten, and inflammation
Sperm DNA fragmentation
The male partner's full bloodwork
Blood sugar and metabolic patterns
The nervous system and progesterone
These are the areas that sit outside a standard miscarriage workup. A 2012 meta-analysis in Human Reproduction, pooling sixteen studies and nearly three thousand couples, found miscarriage rates rose with sperm DNA damage, with about twice the relative risk. Unexplained rarely means there is nothing to find. It usually means the search stopped at the karyotype, one antiphospholipid test, the anatomy, and a TSH.
For the full breakdown of every pattern, read the companion article, Recurrent Pregnancy Loss: The Functional Fertility Approach, at https://fabfertile.com/blogs/learn/recurrent-pregnancy-loss
WHAT YOUR CLINIC MISSED
The companion guide walks through all 9 of these patterns in more detail, so you can take it to your next appointment and ask the questions.
Email hello@fabfertile.ca, subject line MISSED, and we will send you the guide.
FUNCTIONAL FERTILITY SECOND OPINION
A free 45-minute call where I review your labs, your history, your losses, and your partner's results with you. You leave knowing what your biology has been telling you and what your next decision could be.
Email hello@fabfertile.ca, subject line FERTILE, or book here.
ABOUT THE HOST
I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My functional fertility team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.
Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile.
If this episode helped, leave a review on Apple Podcasts. It is how other women find this work.
TIMESTAMPS
00:00 What "Unexplained" Means and What the 2026 Guideline Changed
01:30 Who's Reviewing Your Case at Fab Fertile
04:00 Thyroid: The Full Panel, Not Just TSH
05:50 Antiphospholipid Antibodies, Tested Correctly
06:30 Chronic Endometritis
07:30 The Reproductive Microbiome
08:30 The Gut, Hidden Gluten, and Inflammation
10:30 What Your Clinic Missed Guide
11:00 Sperm DNA Fragmentation
12:30 The Male Partner's Full Bloodwork
13:50 Blood Sugar and Metabolic Patterns
15:20 The Nervous System and Progesterone
16:30 What "Unexplained" Really Means
17:20 The Functional Fertility Second Opinion

For most people, donor eggs is at the bottom of the list. It is not where you wanted to land. And if your clinic is recommending it, something in you is saying there has to be more to look at first.
Here is what we see every week. The donor egg recommendation rarely arrives after a complete workup. It arrives after looking at the AMH, the FSH, the follicle count, maybe a basic semen analysis, and maybe being told your TSH is normal.
Those numbers are real. The diagnosis is real. What gets called complete is the question.
This episode is the 11 specific things we most often find skipped before the recommendation gets made. Pull it up. Take notes. Bring it to your next appointment.
The 11 patterns:
1. Thyroid, the full panel, not just TSH
2. The gut, including H. pylori
3. Hidden food sensitivities
4. Medications you are already on that affect fertility
5. The vaginal microbiome
6. The seminal microbiome
7. The male partner's full bloodwork
8. Sperm DNA fragmentation
9. Vaginal and seminal cross-contamination between partners
10. The nervous system and HPA axis
11. Liver function and hormone clearance
These are the tests that sit outside the standard fertility workup. A 2024 study in Archives of Gynecology and Obstetrics found that ovarian reserve markers like AMH do not significantly predict natural conception in women with regular cycles. The donor egg recommendation comes from one snapshot, not the full investigation.
If this is the first episode you have landed on in this series, go back and listen to "Told Donor Eggs Are Your Only Option? Ask This First," then "How Long Should I Try With My Own Eggs Before Donor Eggs?" then "The Gut Findings Your Clinic Did Not Look For," and "Multiple Failed IVF And Told Donor Eggs?" This episode brings all of it together.
WHAT YOUR CLINIC MISSED
The companion guide walks through all 11 of these patterns in more detail, so you can take it to your next appointment and ask the questions.
Email hello@fabfertile.ca, subject line MISSED, and we will send you the guide.
FUNCTIONAL FERTILITY SECOND OPINION
A free 45-minute call where I review your labs, your history, and your partner's results with you. You leave knowing what your biology has been telling you and what your next decision could be.
Email hello@fabfertile.ca, subject line FERTILE, or book here.
ABOUT THE HOST
I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My functional fertility team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.
Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile.
If this episode helped, leave a review on Apple Podcasts. It is how other women find this work.
TIMESTAMPS
00:00 The Donor Egg Recommendation and What Gets Called Complete
01:00 Who's Reviewing Your Case at Fab Fertile
02:00 Thyroid: The Full Panel, Not Just TSH
03:00 The Gut and H. pylori
04:00 Hidden Food Sensitivities
05:00 Medications That Affect Fertility
06:30 The Vaginal Microbiome
08:00 The Seminal Microbiome
08:30 The Male Partner's Full Bloodwork
09:00 Sperm DNA Fragmentation
09:30 Cross-Contamination Between Partners
11:00 The Nervous System and HPA Axis
11:30 Liver Function and Hormone Clearance
13:00 The Functional Fertility Second Opinion

You have done IVF more than once. Maybe twice. Maybe three times. Maybe more.
Each cycle they tweaked the protocol. Higher dose. Lower dose. Different stimulation drug. Different trigger. Added growth hormone. Added DHEA. Mini IVF. Dual stim.
Each cycle the protocol changed.
And now they are telling you donor eggs.
Here is the question this episode is about. They changed the protocol every time. Did anyone look at what was already in your body when each of those protocols arrived?
That is what this episode is about. The layer underneath every protocol.
In this episode:
- Protocol vs system: what your clinic was trained to adjust, and what nobody adjusted across any of your cycles
- Why the donor egg conversation arrives after the only variable your clinic was trained to address has been exhausted, not after a full review of your body
- The thyroid, iron, B12, vitamin D, inflammation, gut, cortisol, mineral, vaginal microbiome, and blood sugar markers that did not change between cycle 1 and cycle 5
- Why we look at ferritin against 80 to 100 going into IVF, not the lab reference of 15
- What a 2024 study in Archives of Gynecology and Obstetrics found about ovarian reserve markers and natural conception — and why donor eggs gets recommended on markers the literature itself does not support
If this is the first episode you have landed on in this series, go back and listen to "Told Donor Eggs Are Your Only Option? Ask This First," then "How Long Should I Try With My Own Eggs Before Donor Eggs?" and "The Gut Findings Your Clinic Did Not Look For." This episode builds on all three.
———
WHAT YOUR CLINIC MISSED
The full thyroid panel, not just a TSH. The iron panel that flags ferritin against the fertility target. The gut microbiome testing your REI does not order. The inflammatory markers they tell you are normal. And the male side that almost nobody investigates.
Email hello@fabfertile.ca, subject line MISSED, and we will send you the guide.
———
FUNCTIONAL FERTILITY SECOND OPINION
A free 45-minute call where I review your labs, your history, and your partner's results with you. You leave knowing what your biology has been telling you and what your next decision could be.
Email hello@fabfertile.ca, subject line FERTILE, or book here.
———
ABOUT THE HOST
I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My functional fertility team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.
Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile.
———
If this episode helped, leave a review on Apple Podcasts. It is how other women find this work.
———
TIMESTAMPS
00:00 The Protocol Changed Every Time. Did Anyone Change You?
01:00 Who's Reviewing Your Case at Fab Fertile
02:00 Protocol vs System: The Layer Underneath Every IVF
03:00 What Your Body Brought to Every Cycle
04:30 What the 2024 Research Says About AMH
06:00 The Markers That Did Not Change Between Cycles
07:30 Why Multiple Tests Are Not One Test
09:00 The Donor Egg Recommendation With Half the Data
10:30 The Functional Fertility Second Opinion

Your clinic told you donor eggs. You walked out wondering how much time you actually have left. Whether waiting six months means missing your window. Whether trying with your own eggs one more time is brave or stupid.
The honest answer is longer than your clinic implied. And the window is not your AMH number.
In this episode:
- Why a 2024 study in Archives of Gynecology and Obstetrics found that ovarian reserve markers like AMH do not significantly predict natural conception in women with regular cycles
- What the 90-day window before ovulation actually is, and why the eggs you work with six months from now are not the eggs you are working with today
- The inputs your clinic's timeline assumed would not change: mitochondrial function, inflammation, iron, B12, zinc, vitamin D, cortisol patterns, toxic load
- The clinical pattern we see over more than a decade of cases: month zero to six is where the picture comes into view, twelve to eighteen months is where it can start to move substantially
- Why some pictures do not move, and why that is still a reason to look before you decide
If this is the first episode you have landed on in this series, go back and listen to "Told Donor Eggs Are Your Only Option? Ask This First" and then "The Gut Findings Your Clinic Did Not Look For." This episode builds on both.
———
WHAT YOUR CLINIC MISSED
The full thyroid panel, not just a TSH. The iron panel that flags ferritin. The gut microbiome testing that your REI does not order. The inflammatory markers no one notices. The male side that almost no one investigates.
Email hello@fabfertile.ca, subject line MISSED, and we will send you the guide.
———
FUNCTIONAL FERTILITY SECOND OPINION
A free 45-minute call where I review your labs, your history, and your partner's results with you. You leave knowing what your biology has been telling you and what your next decision could be.
Email hello@fabfertile.ca, subject line FERTILE, or book here.
———
ABOUT THE HOST
Now in its eighth year, Get Pregnant Naturally was one of the first podcasts dedicated to the functional fertility approach for low AMH and failed IVF. Hosted by Sarah Clark, founder of Fab Fertile, author of Fabulously Fertile, and host of a podcast with over one million downloads. Fab Fertile is a functional fertility team that works with couples to review the lab work most fertility clinics do not run: gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, full thyroid panel, the iron panel, and inflammation markers, alongside nervous system work. Each week Sarah brings you what the team sees across more than a decade of cases.
Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile.
———

If this episode helped, leave a review on Apple Podcasts. It is how other women find this work.
———
TIMESTAMPS
00:00 The Donor Egg Recommendation and the Real Question
01:00 Who's Reviewing Your Case at Fab Fertile
01:30 AMH Is Not the Countdown Clock
03:00 The 90-Day Window Before Ovulation
04:30 What Actually Changes In 90 Days
07:00 The Fab Fertile Method: What We Investigate
08:30 Why Some Cases Do Not Shift
09:30 The Functional Fertility Second Opinion