Why Are My Hormones Normal but I Still Can’t Get Pregnant?

If you’ve ever been told “everything looks normal”-yet nothing feels normal at all- you know how deeply frustrating those words can be.

You watch friends, coworkers, even strangers announce pregnancies that seemed to happen effortlessly. Meanwhile, you’re tracking, testing, timing and doing everything under the sun… and still, nothing. It’s exhausting. It’s isolating. It can make you feel like you’re somehow missing something obvious.

You’re not.

So many couples reach this same breaking point after hearing that familiar line, “everything looks fine.” It can feel like the end of the road- like the doctors have checked their boxes and moved on, even though your gut tells you something isn’t adding up. Because if everything were truly fine, this wouldn’t feel so hard.

Hormone testing can be incredibly helpful. It gives us a valuable snapshot of what’s happening beneath the surface, at the microscopic level. But here’s the truth, hormones don’t tell the whole story.

Fertility isn’t controlled by a single switch or dictated by hormones alone. It’s a complex, multi-factorial system influenced by far more than any one lab result can capture. When something feels off, it’s worth looking deeper- because “normal” doesn’t always mean optimal, and it certainly doesn’t mean your experience isn’t valid.

What does “normal” hormone blood work actually mean?

When it comes to fertility, hormones are the behind-the-scenes directors calling the shots. But which hormones actually matter- and when should they be tested? Let’s break it down.

Key players we look at for fertility include follicle-stimulating hormone (FSH), luteinizing hormone
(LH), estradiol (E2), anti-Müllerian hormone (AMH), and Progesterone. Together, these hormones
help paint a clear picture of ovarian reserve and overall reproductive function. Most of these labs are checked on day 3 of your menstrual cycle, and that timing isn’t random. Day 3 of your cycle is when many of these hormones are at their lowest, or most baseline, levels. Testing consistently on this day allows us to compare apples to apples each month. Without that consistency, hormone levels can jump all over the chart, making us compare apples to oranges

As mentioned earlier, the cornerstone hormones assessed in routine fertility testing include
follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Müllerian
hormone (AMH), and Progesterone. These labs are undeniably important and offer valuable insight into reproductive function. But fertility is far more nuanced than a handful of numbers on a lab report- and there are critical factors these values simply can’t capture.

Blood sugar regulation plays a foundational role in fertility. When blood sugar is poorly controlled,
insulin levels can remain chronically elevated, disrupting hormonal balance. High insulin has been shown to impair egg maturation in women and reduce both sperm count and quality in men. In other words, stable blood sugar isn’t just about energy- it’s about creating the right hormonal environment for conception.

Another major, yet often overlooked, factor is chronic inflammation. Persistent inflammation interferes with hormone signaling, which can lead to irregular ovulation and compromised egg quality. Over time, it may even contribute to structural issues such as uterine scar tissue resulting from chronic pelvic inflammation. For men, chronic inflammation creates a hostile environment for sperm, increasing oxidative stress and impairing healthy sperm development.

Nutrient status is equally essential. Both undernutrition and overnutrition can negatively impact fertility. Undernutrition- often associated with calorie restriction and vitamin deficiencies- is typically more commonly recognized. However, overnutrition- frequently linked to obesity- can coexist with significant micronutrient deficiencies as well. Evaluating and correcting nutrient imbalances is critical not only for conception but also for supporting a healthy pregnancy and baby.

Then there’s gut health, a keystone in hormone balance and nutrient absorption. The gut is far more than just the stomach- it’s an intricate system extending from the mouth to the anus, housing trillions of beneficial bacteria. These microbes play a vital role in extracting, absorbing, and even synthesizing key nutrients. When the gut microbiome is out of balance, nutrient deficiencies and poor digestion often follow. Even more importantly, the gut actively interacts with sex hormones like estrogen, testosterone, and estradiol. When gut function is compromised, hormone imbalances- and fertility challenges- often follow.

By now, a clear theme may be emerging: fertility is deeply interconnected with nearly every aspect of our physiology. This is especially true when it comes to stress. Stress isn’t just an uncomfortable mental state-it triggers real, measurable physiological changes. Chronic stress activates the release of “fight or flight” hormones like cortisol and adrenaline. These can disrupt our overall hormonal balance and negatively affect fertility. Stress can also impair gut health and increase unhealthful coping behaviors such as overeating, excessive alcohol consumption, or smoking-all of which further hinder reproductive health.

To make a long story short, optimizing fertility requires looking beyond hormone labs alone. It means supporting the body as a whole. Balancing blood sugar, calming inflammation, replenishing nutrient stores, healing the gut, and managing stress- so our sex hormones can have the space to do what they need to do.

Can you ovulate and still have hormone dysfunction?

While ovulation is a crucial milestone for fertility, it’s only one piece of a much larger hormonal puzzle. A healthy pregnancy depends not just on releasing an egg, but on creating the ideal environment for that egg to implant and thrive. One of the most critical factors here is the uterine lining. For an embryo to successfully implant, the uterine wall must be thick, nourished, and stable. The hormone responsible for maintaining this environment is progesterone. If progesterone isn’t operating in sufficient amounts, the uterine lining will not be thick enough to sustain a successful implantation.

Timing matters just as much as hormone levels themselves. A well-orchestrated menstrual cycle requires precise communication between hormones. It is critical that the luteal phase, the phase of the menstrual cycle after ovulation, is at least 10 days long. Any time shorter than this is not enough time for progesterone to thicken the uterine wall to sufficient amounts.

Conditions like polycystic ovarian syndrome (PCOS) illustrate this clearly. Some women with PCOS do ovulate regularly, yet continue to experience hormonal imbalance with elevated testosterone levels. Symptoms like acne, excess hair growth, and weight gain can persist despite ovulation, signaling that the underlying hormonal landscape is still out of balance.

The same holds true for thyroid disorders. Both hypothyroidism and hyperthyroidism can disrupt
menstrual cycles and make conception more challenging. And yet, regular ovulation can still occur in both conditions. Once again, ovulation alone doesn’t guarantee optimal fertility.

So in short, Yes- it’s absolutely possible to ovulate and still have hormonal imbalances.

What tests look deeper than standard OB labs?

To gain meaningful insight into fertility, we need to look beyond a single lab panel and take a more
comprehensive, whole-body approach. Utilizing a range of advanced and functional laboratory tests allows us to better understand what’s happening at the microscopic level.

These assessments may include functional blood work, gut testing, mineral analysis, and hormone
metabolism testing. Each test adds another layer of clarity which can help to reveal hidden imbalances that standard testing often misses.

What should I focus on if my labs are “normal”, but I’m not pregnant?

Sometimes all the tests come back “normal”, yet the outcome you’re hoping for still doesn’t happen. If you’ve been there, you know how deeply frustrating- and confusing- that can feel.

When this happens, the next step is often to return to the foundations of health. Supporting fertility starts with making sure your body has enough fuel to run a full, healthy menstrual cycle. That means eating enough- especially the nutrients your hormones rely on to function and communicate effectively.

Nutrition plays a powerful role here. Focusing on gut-supportive foods like fiber-rich beans, whole
grains, and produce. Alongside probiotics like fermented foods can help to nourish the beneficial bacteria within our GI tract. At the same time, reducing artificial sugars supports blood sugar balance and helps to prevent the overgrowth of less-than-healful gut microbes.

Stress management is another key piece of the puzzle. Finding healthy ways to cope during stressful seasons allows your body to spend less time stuck in “fight or flight” mode and more time in a calm, hormonally optimized state. Fertility thrives in an environment of safety and balance.

Finally, this is not a journey meant to be navigated alone. Working with a practitioner who looks at the entire picture, not just a single lab value or isolated symptom, makes all the difference. Fertility is complex, and having someone who understands how all the pieces connect is often the missing link.

Want to learn more?

If you like what you read here, want to know more, but don’t have the time to sit down and read through all our blogs, check out our free private podcast where we break down fertility root causes in more detail. Perfect for those who want to learn more about their hormones and bodies all while still keeping up their busy schedule.

Sources

https://www.stonybrookmedicine.edu/islandfertility/news/sugar
https://rep.bioscientifica.com/view/journals/rep/169/4/REP-24-0197.xml
https://pmc.ncbi.nlm.nih.gov/articles/PMC10097215/
https://azgyn.com/blog/fertility-gut-health