Get Pregnant Naturally

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision → fabfertile.com

After a failed cycle, the pressure to decide arrives fast. Another retrieval. A different protocol. A different clinic. Donor eggs. And underneath all of it, the question of what to do next.

This episode is not an argument against IVF. It is the opposite. It is about walking into the next cycle having looked at the whole picture rather than only the protocol.

These are the five questions I would ask if we were sitting together reviewing your case.

What your last cycle actually told us, and why stimulation works with the eggs your body has already been developing rather than creating egg quality. What has genuinely changed since the last cycle beyond the medication. Whether investigating costs you time, or whether the two can run in parallel. Whether both partners have been evaluated, or only one. And what information would let you feel settled about the decision either way.

I also share what I would do differently. I was 28 when I was told donor eggs were my only option. I did not know there were other questions to ask.

CHAPTERS

00:00 The pressure to decide after a failed cycle 00:52 Review ask 01:00 What our team reviews and how we work 02:30 The type A pattern, and the tracking data that still has not answered it 03:10 Question 1. What did your IVF cycle actually tell us 03:40 Stimulation does not create egg quality 03:55 Question 2. What has actually changed since your last cycle 04:30 His full workup, beyond count and motility 05:00 Question 3. Will investigating cost me time 05:50 What is happening to your eggs while you gather information 06:15 Running functional work and IVF in parallel 06:50 Question 4. Have we looked at both partners 07:20 The 70 to 80 day window before conception 07:35 Question 5. What would help you feel confident either way 08:05 Medical gaslighting, and the symptoms nobody connected 08:30 I was 28 and I did not know what to ask 09:15 The Functional Fertility Second Opinion, and how parallel timing works

FUNCTIONAL FERTILITY SECOND OPINION

A free 45-minute call. Upload your bloodwork and IVF records to the portal beforehand and we go through what has already been investigated, where the gaps are, and whether our approach is a fit. If you have a retrieval scheduled we can still work with you. Email [email protected], subject line FERTILE, or book at fabfertile.com

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.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

You knew before the nurse called. You had been checking the portal, and there it was. FSH, flagged high. You read the range beside it several times, then searched the number late at night hoping it would tell you what it meant for your future. What came back was not an explanation. It felt like a verdict. Diminished ovarian reserve. Poor responder. Consider donor eggs.

A high FSH is a real finding, and this episode does not pretend otherwise. But a number tells you where you are standing. It does not tell you how you got there, and it does not decide for you.

In this episode, I walk through what a high FSH does tell us, what it does not, and the questions I would want answered before making another fertility decision. That includes the cycle day the sample was drawn on, whether estradiol was measured alongside it, whether the result has ever been repeated, and the layer of health that sits underneath the number and rarely gets examined.

I also share the outcomes I have seen across ten years. Some couples conceive naturally. Some go on to IVF, and it works. Some choose donor eggs. Some choose adoption. Some decide not to pursue children and feel better than they have in years. The goal of this work is clarity, not a promise.

CHAPTERS

00:00 The portal, the result, and what it felt like

01:00 What our team reviews and why it looks different

02:00 Both partners, and why this is multifactorial

03:00 What FSH is actually telling us

04:00 Cycle day, estradiol, and whether the test was repeated

05:00 What could be contributing to the bigger picture

06:00 Thyroid, ferritin, vitamin D, blood sugar, inflammation

07:00 Autoimmunity, gut health, endometriosis, sleep, nutrition

08:00 Under-fueling, chronic stress, and what the DUTCH test shows

09:00 The pattern I see in type A women, and my own diagnosis at 28

11:00 Every path we have helped couples take

12:00 What Your Clinic Missed

12:30 Three questions before your next decision

13:30 The Functional Fertility Second Opinion

WHAT YOUR CLINIC MISSED

The companion guide walks through the markers worth reviewing before a donor egg decision, so you can go through your own results and see what is there. Email [email protected], subject line MISSED, and we will send you the guide.

FUNCTIONAL FERTILITY SECOND OPINION

A free 45-minute call. Before we speak, I review your bloodwork, your history, your previous treatment, and both partners' health, so the conversation focuses on what has been explored and what questions remain. Email [email protected], 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.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

You have the appointment booked. Maybe it is a second opinion with a different clinic. Maybe it is a consult after a cycle that did not go the way you expected. You have your lab work, your partner is ready to join, and you have your questions ready. And some part of you is wondering whether the whole picture will actually be looked at this time.

Here is what most women are never told. A diagnosis names where you are. It does not always explain why you are there. "We did not find anything" and "we looked for these specific things and ruled them out" are not the same sentence. One is the absence of an investigation. The other is the result of one.

In this episode, I walk through exactly what to bring and what to ask: the records that tell the real story of your cycle, the symptom history most workups leave out, your partner's complete evaluation, and the three questions that move the conversation from what happened to why. Pull it up and take notes.

This is not about avoiding IVF or distrusting your doctor. It is about walking into your next decision having asked every reasonable question, so the decision is an informed one.

CHAPTERS 00:00 What to bring to a fertility second opinion 01:00 Why functional testing looks upstream, not just one more test 02:00 Your bloodwork and IVF cycle records, and how to get them 03:00 Your symptom history, and why every symptom is a clue 04:00 His records, including sperm DNA fragmentation 05:00 The first question, what has actually been ruled out 06:00 What would explain your numbers 07:00 What happens if you change nothing 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 [email protected], 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 [email protected], 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.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

IVF stimulation doesn't create egg quality. It reveals it.

Most people think an IVF cycle starts on day one of stimulation. Biologically, that's already too late.

You were told the protocol would be adjusted. Maybe the dose went up. Maybe they switched you to a different one entirely. And the result was the same, or close enough that nobody could explain the difference. Somewhere in it, you started wondering whether the cycle was ever really the variable.

The follicles recruited in your cycle have been developing for weeks to months. They reflect the metabolic and inflammatory conditions that were present during that window. Stimulation doesn't override those conditions. It asks the system to perform under them.

The same applies to sperm. His semen analysis came back normal, he got a high five from the REI, and nobody looked at DNA integrity or fragmentation.

In this episode, I walk through three patterns we see with clients and why repeating a cycle without reassessing readiness often produces the same result.

CHAPTERS

00:00 Why the cycle was decided before day one 01:00 Pattern one: egg and sperm quality are set before stimulation begins 02:00 The sperm side nobody looked at, and why stimulation amplifies what is already there 03:00 Pattern two: why pre-IVF prep fails when it is just supplements and timelines 04:00 Blood sugar, gut and immune signaling, and stress physiology 05:00 Pattern three: preparing for IVF versus auditing whether you are ready 06:00 The hierarchy, and whether now is the time to push the system 07:00 The reframe: clarity protects your time, energy, and biology

EMBRYO AUDIT CHECKLIST

If you're preparing for IVF or considering another cycle, the free Embryo Audit Checklist walks through the key systems that influence egg quality, embryo development, and implantation, so you can have a more informed conversation before moving forward.

Download it here: https://fabfertile.com/pages/embryo-audit-checklist

FUNCTIONAL FERTILITY SECOND OPINION

A free 45-minute call where I review your labs, your history, and your patterns with you. This is a diagnostic review, not coaching on a protocol. You leave knowing what your biology has been telling you and what your next decision could be.

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.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

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 [email protected], 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 [email protected], 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

1. 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
2. Monteleone P, Parrini D, Faviana P, et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. American Journal of Reproductive Immunology. 2011.
3. American Urological Association and American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. 2020.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

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 [email protected], 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 [email protected], 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.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

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 [email protected], 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 [email protected], 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.

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

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:

1. Thyroid, the full panel and antibodies, not just TSH
2. Antiphospholipid antibodies, tested correctly
3. Chronic endometritis
4. The reproductive microbiome, vaginal and seminal
5. The gut, hidden gluten, and inflammation
6. Sperm DNA fragmentation
7. The male partner's full bloodwork
8. Blood sugar and metabolic patterns
9. 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 [email protected], 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 [email protected], 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

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

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 [email protected], 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 [email protected], 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

Failed IVF? Low AMH? High FSH? Told donor eggs? Book a free Functional Fertility Second Opinion before your next fertility decision.→ fabfertile.com

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 [email protected], subject line MISSED, and we will send you the guide.

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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 [email protected], subject line FERTILE, or book here.

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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.

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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