Gut Health

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

Written by: Lauren Chamberlain 

Edited and Reviewed By: Anabelle Clebaner MS, RDN 

Did you know that your gut health could impact more than just digestion? From immunity to mental clarity, a healthy gut plays a pivotal role in overall well-being—and even fertility. Emerging research suggests that a balanced gut microbiome influences hormone regulation, immune function, and inflammation, all of which are crucial for reproductive health. Whether you’re looking to optimize fertility or improve general health, supporting your gut can be a game-changer for both your body and mind.

The Basic Functions of the Gut

Before diving into the more intricate details of gut health, it’s essential to understand the basic functions of the gut and why it plays such a crucial role in your overall health.

1. Digestion

The gut is responsible for breaking down the food we eat, allowing nutrients to be absorbed into the bloodstream. This process starts in the mouth and continues through the stomach and small intestine. Enzymes and acids help break down food into smaller molecules for absorption.

2. Nutrient Absorption

Once food is broken down, the small intestine absorbs essential nutrients—like vitamins, minerals, and amino acids—into the bloodstream. These nutrients are then transported throughout the body to fuel our cells and organs.

3. Immune Function

A large portion of the body’s immune system resides in the gut. It acts as a barrier to harmful pathogens, such as bacteria and viruses. A healthy gut microbiome— the community of beneficial bacteria—supports immune function and helps protect the body from infections and inflammation.

4. Detoxification

The gut plays a vital role in detoxifying the body by processing and eliminating waste. The liver, bile, and gut work together to filter out toxins, which are then excreted through the stool. This process helps maintain a clean internal environment.

5. Hormone Regulation

The gut is involved in hormone production and regulation. It helps control hormones related to digestion, hunger, and metabolism. Additionally, the gut microbiome can influence hormonal balance, which is vital for reproductive health.

6. Gut-Brain Connection

The gut and brain communicate through the gut-brain axis, a direct link between the two. This connection influences mood, mental clarity, and stress levels. Research suggests that an imbalance in the gut microbiome can impact mental health conditions like anxiety and depression.

By understanding these basic functions, we can see why maintaining a healthy gut is essential for overall well-being and fertility. Now, let’s dive deeper into how to support these functions for optimal health.

Understanding Gut Permeability and Leaky Gut

Leaky gut occurs when the intestinal barrier becomes compromised, allowing undigested food particles, toxins, and microbes to enter the bloodstream. This process can trigger systemic inflammation and is implicated in conditions like autoimmune diseases, irritable bowel syndrome (IBS), and even neuroinflammation. The protein zonulin regulates tight junctions in the gut lining, and its overproduction is associated with increased gut permeability.

Dietary choices, stress, and environmental toxins all influence this delicate balance.

The Role of Diet in Gut Health

Diet plays a crucial role in shaping gut microbiota and maintaining a strong intestinal barrier. Research suggests that:

• High-fiber foods (e.g., fruits, vegetables, whole grains) support beneficial bacteria and help regulate gut permeability.
• Healthy fats, such as omega-3s, promote anti-inflammatory gut conditions, whereas excessive saturated fat intake can negatively impact gut flora.
• Akkermansia muciniphila, a beneficial bacterium, is linked to improved gut barrier function, reduced inflammation, and better metabolic health.
• Bovine colostrum supplementation has been shown to decrease intestinal permeability and lower zonulin levels, particularly in athletes.

Small Intestinal Bacterial Overgrowth (SIBO) and Gut Dysfunction

SIBO occurs when there’s an overgrowth of bacteria in the small intestine. This can lead to bloating, malabsorption, and digestive discomfort. It’s often associated with IBS, celiac disease, and metabolic syndrome.

Managing SIBO:

• Get proper testing to identify SIBO.
• Modify your diet, focusing on low FODMAP foods.
• Consider probiotics to restore balance.
• Work with a healthcare provider to determine if antibiotics are necessary.

Gut Health and Systemic Wellness

Emerging research highlights the gut-brain connection, linking gut health to cognitive function, mood regulation, and neurological diseases like Alzheimer’s. The gut microbiome also plays a role in cardiovascular health, obesity, and diabetes. Fecal microbiota transplants (FMT) have even been explored as potential treatments for age-related cognitive decline and metabolic disorders.

Gut Health and Fertility

Emerging research suggests that gut health plays a crucial role in reproductive health. The gut microbiome influences hormone regulation, immune function, and inflammation, all of which impact fertility outcomes. Dysbiosis, or an imbalance of gut bacteria, has been linked to conditions like polycystic ovary syndrome (PCOS), endometriosis, and unexplained infertility.

• Hormonal Balance: The gut microbiome helps regulate estrogen levels through the estrobolome, a collection of bacteria involved in estrogen metabolism. An imbalance can lead to estrogen dominance, which is associated with infertility and conditions like PCOS.
• Inflammation and Immune Function: Chronic inflammation, often driven by poor gut health, has been implicated in endometriosis and implantation failure. A healthy gut barrier helps regulate immune responses and supports a favorable reproductive environment.
• Microbiome and Pregnancy Outcomes: Research suggests that a balanced gut microbiome contributes to healthy pregnancy outcomes, reducing the risk of gestational diabetes, preeclampsia, and preterm birth.

Supporting Digestion

Efficient digestion breaks down food properly, allowing for optimal nutrient absorption and minimizing digestive distress.

Ways to enhance digestion include:

• Incorporating bitter foods: Foods like arugula, artichoke, bitter melon, dandelion greens, Brussels sprouts, coffee, and grapefruit stimulate stomach acid and bile production.
• Using digestive aids: Digestive enzymes, HCl supplements, apple cider vinegar, or digestive bitters may be beneficial.
• Relaxing at meals: Stress can negatively impact digestion, so mindful eating practices are essential.
• Consuming adequate minerals: Sodium (from sea salt) and zinc (from oysters and red meat) support stomach acid production.

Supporting Healthy Bile Flow

Bile is critical for fat digestion and detoxification. Signs of inadequate bile include bloating, floating stools, nausea after eating fats, and vitamin deficiencies. To support bile production:

• Consume fiber-rich foods: Legumes, beans, and avocados help bind to excess bile.
• Eat bitter foods: These naturally promote bile flow.
• Use cholagogue herbs: Globe artichoke, dandelion, burdock, and Oregon grape enhance bile movement.
• Ensure adequate taurine intake: Meat, fish, shellfish, and eggs aid in bile salt production.

Supporting Beneficial Bacteria

A balanced gut microbiome is essential for digestion, immunity, and gut barrier integrity. To nurture beneficial bacteria:

• Prioritize digestion first: Ensuring proper food breakdown is key before increasing fiber intake.
• Incorporate prebiotic foods: Apples, asparagus, garlic, onions, oats, and legumes serve as fuel for gut bacteria.
• Limit excessive alcohol intake: Alcohol can cause dysbiosis and inflammation.

Supporting Liver Detoxification

The liver plays a crucial role in gut health through bile production and detox processes. To support liver function:

• Include Phase 1 detox foods: Magnesium (leafy greens, avocado), B vitamins (liver, eggs, seafood), vitamin C (citrus, bell peppers), and zinc (oysters, beef).
• Incorporate Phase 2 detox foods: Glycine (bone broth), glutamine (beef, spinach), cysteine (broccoli, eggs), and taurine (meat, fish).

Strengthening the Gut Lining

A strong intestinal barrier prevents harmful substances from entering the bloodstream. Factors that contribute to a leaky gut include stress, poor digestion, processed foods, overuse of medications, and imbalanced gut bacteria. To support gut integrity:

• Limit inflammatory foods: Avoid heavily processed and inflammatory oils.
• Boost beneficial fibers: Prebiotic and resistant starch-rich foods enhance gut lining health.
• Consume gut-supportive nutrients: Glutamine (cabbage, fish), zinc (beef, crab), and colostrum aid in healing the gut lining.
• Use gut-healing herbs: Marshmallow root, slippery elm, aloe vera, and licorice can be beneficial.

Strengthening the Immune System

A well-functioning immune system relies on strong digestion and a balanced gut microbiome. Factors that deplete immunity include poor digestion, chronic stress, hormonal imbalances, and long-term medication use. To support immune health:

• Improve digestion and gut microbiome health
• Incorporate immune-boosting foods: Colostrum, mushrooms (reishi, shiitake), and vitamin C-rich foods (citrus, mango, papaya) support immune function.
• Use supportive herbs: Andrographis, elderberry, echinacea, and astragalus help strengthen immunity.

Prebiotics & Resistant Starch

Prebiotics are fibers that feed beneficial bacteria and help produce short-chain fatty acids, which support gut integrity and immunity.

• Prebiotic foods: Apples, asparagus, garlic, onions, oats, and legumes.
• Resistant starch sources: Cooked and cooled potatoes, green bananas, and legumes.

By focusing on these key areas, you can create a solid foundation for optimal gut health and overall well-being. Making small, sustainable changes to your diet and lifestyle can have lasting positive effects on digestion, immunity, and energy levels.

Conclusion

Maintaining gut health is essential for overall well-being, from digestion and immunity to mental clarity and chronic disease prevention. By making mindful dietary and lifestyle choices, you can support a resilient gut microbiome and improve long-term health outcomes. The science is clear: a healthy gut is a foundation for a thriving body and mind.

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