10 important tips for overcoming infertility and recurrent pregnancy loss

A client asked me the other day "what are my most important tips for overcoming infertility and recurrent pregnancy loss?" so I thought I would explore my thoughts on this in a blog post. There are obviously many more than 10 important things to know, but these 10 are what I feel is the most important as a practitioner who has worked with clients over the last 7 years and also from my own journey with unexplained secondary infertility and recurrent pregnancy loss.

Stress is the biggest disruptor of fertility

It is hard not to feel stressed when you are experiencing infertility. It is an emotional rollercoaster filled with hope at the start of your cycle and very often crushing disappointment at the end of your monthly cycle if your period shows up. Then there will be a few days of sadness until you bounce back and start all over again with the next cycle. You have to put on a smile and hope that this next cycle is the one.  

The unfortunate reality about stress is that it messes with every single hormone, especially progesterone, which is important for maintaining a pregnancy. 

The corpus luteum of the ovary produces progesterone from approximately day 14–28 of your cycle. As well as this, a percentage of progesterone is also produced by the adrenal glands, which are two small glands located on top of both kidneys that regulate the stress response. This means that if you are under a lot of stress, then your adrenal glands may have shut down your production of progesterone in favour of stress hormones such as cortisol and adrenaline. I really believe this was a huge factor in my fertility journey and is likely to be the case with many women in this day and age. Stress literally shuts down our reproductive system, since getting pregnant is not considered essential for our survival, unlike our heart and circulation. 

The problem is that many women experiencing infertility are stuck in a permanent state of high alert, and their bodies remain in survival mode long-term, which is not the ideal environment to conceive and maintain a healthy pregnancy.  

Stress also leads to an increase in the production of the stress hormone cortisol from the adrenal glands, which inhibits GnRH (gonadotropin-releasing hormone). The role of GnRH is to trigger the pituitary gland to secrete luteinising hormone (LH) and follicle-stimulating hormone (FSH), so if stress suppresses these hormones, ovulation may not occur. In men, stress can have a negative effect on sperm health. 

Chronic stress can lead to HPA axis dysfunction, which can downregulate your thyroid gland and lead to an underactive thyroid. Having thyroid issues can negatively affect your fertility, as well as your energy levels and sense of well-being.

Stress is more than just being busy. If you have an injury, infection, gut issue, or food intolerance that is causing inflammation and uncomfortable symptoms, this is stressful for your body as well. These situations can weaken the immune system and can become a form of stress that affects your whole glandular system. 

To support your adrenal health, you can take adaptogenic herbs like ashwagandha and rhodiola, B vitamins and vitamin C, but unless you actively take the time to reduce your stress or practice self-care and stress management techniques, supplements alone won’t do much.

Progesterone is very important, but it doesn’t fix everything

Progesterone is extremely important, but it is not the “quick fix all” if you are not addressing the root cause of your infertility issues. You can be taking or enhancing progesterone and still find it difficult to get pregnant or maintain a pregnancy.  I have noticed there is a lot of “you just need to take progesterone, and you will be fine” in fertility forums. This is true if low progesterone is the only cause of your infertility and pregnancy loss, but for most people this is not the sole reason, and a deeper investigation into your reproductive hormones and glandular system health in general (e.g. adrenals and thyroid) is warranted. For example, with myself, I was on prescribed progesterone cream for about 2 years with my hormones being monitored, and it didn’t make a difference to my recurrent pregnancy loss. When my IVF also ended in a miscarriage at 6 weeks, I was on progesterone pessaries and my levels were good. Looking at the complete picture of what is going on with your hormones, egg quality, organ function (e/g adrenals, thyroid, liver, gut), stress, diet, nutritional deficiencies, and lifestyle will help to create an idea of the root cause and the actions that are needed, whether it is dietary adjustments or targeted supplements. This is what I do with my clients in my holistic fertility nutrition consultations.   

MTFHR gene mutations – get tested if you can.

It is more widely recognized today that supplementing with natural methyl folate is superior to synthetic folic acid, especially for individuals with either of the MTHFR gene mutations, which is great news.  Rather than guessing though and taking a prenatal multi with around 800mcg of methyl folate just in case, it is best to have a simple blood test to test to see if you have the two most common gene mutations that can affect folate metabolism. This is because the type of gene mutation you have and whether you have a one (heterozygous) or two copies (homozygous – inherited from both parents) will determine how many micrograms of methyl folate you will need to take to optimise fertility and reduce the risk of miscarriages. As an example, a positive test for a double mutation on the C677T gene suggests a 70% decrease in the enzyme responsible for folate conversion, meaning you'll require more methyl folate than someone who tests negative and this could be as much as 2000 mcg a day. The dose will also depend on your age and health history, so it is best to work with a practitioner.

I usually test most clients who come to see me, especially clients with unexplained infertility.  I would say over the last 7 years of testing clients, only 1 has tested negative for any of the MTHFR mutations, which is interesting. It seems to be a common factor with unexplained infertility and often requires just taking the right dose of methyl folate and supporting the methylation cycle with other important methyl donors such as B12, B6 and choline.   For more information on this, check out my MTHFR blog post

If you have a MTHFR gene mutation – you would also benefit from taking vitamin B12

If you have one or more MTHFR gene mutations, you will also benefit from taking at least 1,000mcg of activated vitamin B12 daily, either as methylcobalamin or adenosylcobalamin, but not cyanocobalamin, the synthetic form.  I have noticed this seems to be a sweet spot dose with clients, and it was my own experience with needing B12 to overcome my infertility issues that brought this to my attention. Most of my clients who have struggled with infertility and recurrent miscarriage and have taken a personalised folate dose plus activated vitamin B12 have gone on to have a successful pregnancy, so I think this is important.

Doctors often overlook vitamin B12 because they do not test for it or tell patients it is fine due to a high plasma blood test, which can be misleading. The truth is that if you have a MTHFR gene mutation, you can get a false high B12 reading in a blood test. What I see often in my clinic, (especially with fertility) is elevated B12 levels on a blood test even when a functional B12 deficiency exists, particularly with the MTHFR C677T homozygous (double) mutation. Here are the reasons this might be the case:

Having a double C677T mutation significantly reduces your body's ability to convert folic acid and food folate into the active form (5-MTHF) (often by about 70%). This creates a bottleneck in the methylation cycle. Because B12 and folate work as partners in this cycle, the following can occur:

Failure of Cellular Uptake: Cells cannot effectively utilize B12 if the methylation cycle stalls due to insufficient active folate. It essentially "backs up" in the bloodstream because it has nowhere to go.

The Folate Trap: Without sufficient methyl-folate, B12 stays trapped in its transport form in the serum. Your blood test measures the circulating B12, but it doesn't reflect how much is actually entering your cells or performing its biological duties.

Synthetic supplementation overload: If you are taking non-methylated forms of B12 (like cyanocobalamin), your body may struggle to convert it into an active form, leading to high serum levels of unusable B12. This shouldn't be an issue if you take a prenatal multi with methylated B vitamins. 

To get a more accurate assessment of B12 levels when serum B12 seems unusually high, I will often check homocysteine levels, as this is often a sign that the cells are not getting the B12 they need. If B12 and folate aren't working well together; homocysteine levels usually rise.

If my client is doing a DUTCH hormone test, I will also check Methylmalonic Acid (MMA) which is part of the DUTCH test. MMA is a highly specific marker for B12 activity. If MMA elevates, it signals cellular B12 deficiency, irrespective of your serum B12 levels.

At the end of the day if you are unable to access testing, it won’t do you any harm to take activated B12 alongside your folate, either every day or every second day, as it can often be the missing link in the methylation puzzle.

We must not forget the importance of a healthy endometrial lining

Endometrial receptivity is just as important as egg quality but is often overlooked when investigating infertility and recurrent pregnancy loss. There are many things that can affect how receptive your endometrial lining is to a fertilised embryo, such as low progesterone, elevated thyroid antibodies, inflammation, fibroids, endometriosis, immune dysregulation, and the endometrial microbiome. This is such an important area that needs more recognition, as if the embryo fails to implant then the pregnancy won’t be able to continue, as even if the embryo was viable, it was unable to find a comfy home. I would recommend checking out this blog post I wrote last year about endometrial receptivity and implantation, and if it resonates with you, I would be grateful if you could share it to spread the word.

Thyroid dysfunction in the very first instance needs nutritional therapy.

Thyroid dysfunction, (most commonly an underactive thyroid) is a common cause of infertility. Nutritional deficiencies can be a cause of an underactive thyroid, as nutrients such as iodine, tyrosine, selenium, zinc, iron, and vitamin D are essential for manufacturing thyroid hormones and the conversion of the inactive thyroid hormone T4 to the active T3 hormone.

 The trace mineral iodine is essential for the production of thyroid hormones, along with the amino acid tyrosine. Good food sources of iodine are seafood, seaweed such as kelp and bladderwrack, kombu, nori, and iodised salt. Eating protein with each meal is your best source of tyrosine, such as dairy foods, poultry, fish, red meat, eggs, almonds, avocados, and bananas.

The trace mineral selenium is an essential component of the enzyme that converts T4 to T3 in the liver.  Good food sources are Brazil nuts, salmon, chicken, brown rice, beef, and walnuts.  The mineral zinc is also involved in the production and conversion of thyroid hormones, T4 to T3. Good food sources are oysters, beef, chicken, dairy, cashews, almonds, and pumpkin seeds.

Iron is another mineral that is very important for healthy thyroid function, as it is involved in the production of TSH and the conversion of T4 to T3. Good food sources are beef, lamb, pork, and liver. Animal sources contain haem iron, which has higher absorption. Beetroot, spinach, kale, beans, lentils, tofu, molasses, and dried fruit are all non-haem plant-based sources with lower absorption. Eating foods rich in vitamin C with iron food sources can help improve absorption. Citrus fruits, strawberries, broccoli, capsicum, and potatoes are all rich sources of vitamin C.

Optimising vitamin D is important if you have an autoimmune thyroid condition such as Hashimoto's or Graves' disease, as it can help to lower thyroid antibodies. Studies have also found that people with autoimmune thyroid conditions have lower vitamin D levels than the general population. As a general rule, I will recommend a minimum of 2,000iu per day, as most people are deficient, but I will test if I suspect they might need more.

I often recommend a personalised nutritional supplement protocol in clinic for clients who have thyroid dysfunction in the first instance. This protocol will consist of these important nutritional building blocks for thyroid hormone production and conversion. With many of my clients, optimising these key nutrients (as well as stress management and a gluten-free diet) is enough to bring their thyroid into a healthy balance.

Most people would benefit from taking vitamin D

As well as for autoimmune thyroid it is beneficial to consider vitamin D as a general supplement for fertility, as vitamin D is important for your whole glandular system and approximately one fifth of the global population is deficient in vitamin D. Taking around 2,000iu daily is a general recommendation for thyroid support and fertility, but testing is a good idea as you may need require more than this.

Vitamin D functions like a prohormone rather than a vitamin, playing such a crucial role in reproductive health, especially as most people don’t get enough daily vitamin D from sunlight exposure. As well as supporting the entire endocrine system, it modulates the immune system, influences gene expression, regulates anti-Müllerian hormone (AMH) and supports implantation.  Researchers have linked vitamin D deficiency to poor egg quality, reduced ovarian reserve, and lower success rates with procedures like IVF.  

DIM isn’t suitable for everyone

DIM (diindolylmethane) is a concentrated compound found in cruciferous vegetables that can help to support estrogen metabolism and detoxification.

I wouldn’t recommend experimenting with DIM supplements unless you really need it. I have seen many clients who have self-diagnosed themselves with estrogen dominance and have taken DIM long term and it has lowered their estrogen too far. Healthy levels of estradiol (E2) are important for fertility and pregnancy, and without healthy levels of estrogen, you will struggle to conceive. If you start to get hot flushes, then this is a sign you have lowered your estrogen too far. I do use DIM in clinic if needed, though, but usually after we have investigated hormones with either a DUTCH test or a salivary hormone test. If there is a time to test and not guess, it is in the preconception period.  I like to recommend a daily serving of brassica vegetables and broccoli sprouts for their rich source of sulforaphane as a general support for estrogen detoxification, especially if you haven’t had any testing done and are unsure how your hormones are tracking.

Going gluten-free is the most important dietary change I would recommend

If you have or suspect you have an inflammatory or autoimmune condition of any kind, I recommend going 100% gluten-free whilst trying to conceive. There is so much research on the connection between gluten and infertility (even if you don’t have coeliac disease) that it is absolutely worth a try. See my blog on gluten and infertility. Gluten can trigger an inflammatory response in the body (which you may not realise is happening), which can cause the immune system to become overreactive and dysregulated.  Silent low-grade inflammation can be an underlying cause of infertility. I explore this in more detail in my blog on silent, low-grade inflammation. Of course, there is more to silent low-grade inflammation that just eating gluten, but taking gluten out of your diet can be a good place to start if you have struggled with infertility and recurrent pregnancy loss.

Fasting and low-carbohydrate diets can be problematic for some people when trying to conceive.

Prolonged periods of fasting and low-carbohydrate diets have many health benefits; however, these dietary approaches are not supportive of fertility when continued long term, especially if you are trying to conceive and have hormonal imbalances or thyroid issues. This is because we need healthy, nourishing carbohydrates from vegetables, fruits, fibre, legumes, and whole grains to support and fuel the production of our reproductive hormones and support the function of our thyroid and adrenal glands. The best time to do a fast is in the follicular phase of our cycle (day 1–14 approximately) as from ovulation onwards we need nourishing carbohydrates to support progesterone levels naturally.

Feeling overwhelmed and don’t know what to do or try next? I can help and I am available for consultations online and in my clinic at the Gate Pa Health Shop in Tauranga. You can book online here or email me for my Tauranga clinic availability. Or if you are experiencing unexplained secondary infertility, then you may wish to check out my book that I published last year called Healing from Unexplained Secondary Infertility, as this was my journey for so long.  My book is available on Amazon or globally on many retail sites.