Get Pregnant Naturally

The fertilization report looked good. You had eggs. They fertilized. Day three looked fine. Then came the call. Nothing made it past day five, or one did, and it was graded poor, and the cycle was over. You were told it was egg quality, or it was a numbers game, or that you have to try again.
Here is what that explanation leaves out. An embryo does not run on one engine the whole way. For the first two to three days it runs almost entirely on the egg, on the proteins, the messenger molecules, and the energy the egg packed during its final growth phase. Then, around the four to eight cell stage on day three, the embryo activates its own genome and takes over, and the paternal contribution comes online.
That handover changes where you look. If development stalls in the first three days, you start with the egg and its energy supply. If it looked strong on day three and stalled before the blastocyst, you start with the sperm and its DNA. Same line in the report. Two completely different first moves. Most workups examine neither. They adjust the protocol and go again.
In this episode, I walk through the seven factors that shape whether an embryo keeps dividing, and what most clinics never review before they tell you it was your eggs. Pull it up, take notes, and bring it to your next appointment.
TIMESTAMPS
00:00 The day five call and what the explanation leaves out
00:55 If this show has helped you, leave a review
01:05 Who reviews your case at Fab Fertile
03:50 Number one: the day three handover and where to look first
06:10 Number two: the egg's energy supply was built before the cycle
08:05 Number three: sperm DNA fragmentation and the standard semen analysis
09:20 Number four: the full thyroid panel, including antibodies
10:20 The Embryo Audit Checklist
10:40 Number five: blood sugar and insulin, for both of you
11:45 Number six: inflammation, the gut microbiome, oxidative stress
12:40 Number seven: the ninety day window and why repeating a cycle repeats the result
13:45 Why the data driven approach works for left brain people
14:30 Chromosomal quality is information, not a verdict
14:55 The Functional Fertility Second Opinion
WHAT THE RESEARCH SHOWS
A standard semen analysis measures count, motility, and shape. It does not measure the integrity of the DNA inside the sperm. Sperm carrying damaged DNA can still fertilize an egg and produce a normal-looking embryo on day two or three, and development can stall after the genome handover.
In a 2025 retrospective analysis of 870 fresh single blastocyst ICSI cycles, each one percent increase in sperm DNA fragmentation was associated with roughly 2.5 percent lower odds of obtaining a top quality blastocyst on day five. The same analysis found that fragmentation was not predictive of clinical pregnancy outcomes. It speaks to why an embryo stalled, not to whether a pregnancy will happen.
Thyroid autoantibodies have been detected in follicular fluid at concentrations that correlate with blood levels, which is one reason a complete thyroid panel may include Free T3, Free T4, Reverse T3, TPO antibodies, and thyroglobulin antibodies rather than TSH alone. These are not established diagnostic tests for embryo arrest. They can provide context that a single TSH result cannot.
THE EMBRYO AUDIT CHECKLIST
If your embryos have arrested and you want to walk through what to review before the next cycle repeats the same result, we built the Embryo Audit Checklist for exactly this.
Download it at https://fabfertile.com/pages/embryo-audit-checklist
Or email hello@fabfertile.ca, subject line CHECKLIST.
FUNCTIONAL FERTILITY SECOND OPINION
This is a call where I review your cycle, your labs, your history, and your partner's picture together in one place. You leave knowing what your embryos may be telling you and what the next cycle would be built on, instead of repeating the same outcome. Whatever you decide afterward is yours, but it gets made with information your workup did not give you.
Book at https://fabfertile.com/pages/book
Or email hello@fabfertile.ca, subject line FERTILE.
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. Subscribe to Get Pregnant Naturally for weekly episodes on fertility optimization, IVF preparation, and the lab work your doctor probably isn't running.
Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile.
If this episode helped you make sense of your own numbers, leave a review wherever you listen. It is how another woman, being told the same thing, finds her way here.
REFERENCES
Machałowski T, Machałowska J, Gill K, et al. Sperm DNA Fragmentation Impairs Early Embryo Development but Is Not Predictive of Pregnancy Outcomes: Insights from 870 ICSI Cycles. International Journal of Molecular Sciences. 2025. doi:10.3390/ijms26167923
Monteleone P, Parrini D, Faviana P, et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. American Journal of Reproductive Immunology. 2011.
American Urological Association and American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. 2020.

You were told your AMH is low, and maybe that IVF was your only option. Maybe you went through it, and it did not work. Maybe you already have one child and have been told this time is different. And some part of you has been wondering whether that number is really the whole story.
Here is what most women are never told. AMH reflects egg quantity, not egg quality, and not your ability to conceive. It predicts how your ovaries respond to medication. It does not explain why a cycle failed, why embryos stopped developing, or why outcomes have not changed despite every protocol adjustment.
In this episode, I walk through a real case. Her AMH was 0.27 ng/mL. She had a failed IVF cycle behind her and was navigating secondary infertility. One pattern that stood out was inflammation. Her hs-CRP was 1.3 mg/L, read as normal by conventional ranges but not optimal, and something was driving it. She conceived naturally, not because the number changed, but because the systems shaping egg development were finally looked at.
This is not about avoiding IVF or chasing a better lab value. It is about reading what your body has already shown you, so your next decision is an informed one.
CHAPTERS
00:00 What your AMH actually tells you, and what it does not
01:00 Why a failed IVF cycle can be more informative than the number
02:00 This was not unexplained, age, or bad luck
03:00 The patterns we see, inflammation, nutrient absorption, brain, and hormone signaling
04:00 Addressing systems in sequence, not a random checklist
05:00 What it looked like when the body started responding
06:00 Natural conception at AMH 0.27, and why the number was not the point
07:00 Pausing before the next cycle, readiness over urgency
07:30 The Functional Fertility Second Opinion
WHAT YOUR CLINIC MISSED
The companion guide walks through the patterns a standard fertility workup tends to miss, with the markers behind each one, 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 bloodwork, 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: https://fabfertile.com/pages/book
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.

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