Failed IVF 4 Times: What They Changed Before Getting Pregnant Naturally [EP 80]
After five years of fertility challenges, multiple pregnancy losses, and four failed IVF outcomes, Sarah and James were exhausted. They had been told to try another IVF cycle, but they still didn't understand why they were struggling to get pregnant or stay pregnant. Instead of immediately repeating the same treatment, they decided to pause IVF and take a deeper look at both partners' health.
Five months later, they were pregnant naturally. This isn't a story about being anti-IVF. IVF can be an incredible fertility tool, and many couples absolutely need it. But treatment and investigation are not the same thing. In this episode, I'm walking you through what we discovered when we looked beyond the standard fertility workup — including sperm DNA fragmentation, insulin, thyroid health, gut health, inflammation, nutrient status, minerals, and the reproductive environment as a whole.
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“Sometimes taking a few months to prepare is the fastest path forward.”
What You’ll Learn:
Why repeated IVF cycles should not replace investigating why implantation or pregnancy is failing
Why both partners need a comprehensive fertility evaluation after failed IVF or recurrent miscarriage
How sperm DNA fragmentation can reveal an important piece of male fertility that a basic semen analysis may miss
Why fasting insulin can tell you something very different from glucose and A1C
How gut health, inflammation, immune health, thyroid function, and nutrient status can influence the reproductive environment
Why minerals matter for energy production, hormone function, and egg maturation
What the three-to-four-month preconception window can do for egg and sperm health
Why individualized fertility care is more useful than adding more supplements or following another generic fertility diet
Why sometimes taking a few months to investigate and prepare can be a more strategic step than immediately starting another IVF cycle
“You don’t necessarily need another random supplement or another fertility diet from Instagram. You need to understand what your fertility barriers are.”
Testing Mentioned:
Comprehensive blood testing
Fasting insulin, blood glucose, and hemoglobin A1C
Thyroid testing
Inflammatory markers
Nutrient status
Hormone testing
Ovulation and menstrual cycle signs
Gut health testing
Mineral status
Semen analysis and sperm DNA fragmentation
Links Mentioned:
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“More information wasn’t going to solve that. They needed the right information.”
Transcript:
Welcome back to the Fertility Dietitian Podcast.
Today I want to walk you through a real case that I think so many couples struggling with fertility really need to hear.
Not because I think everyone should stop IVF or that getting pregnant naturally and avoiding IVF is the only way, but because this couple had been through five years of fertility challenges.
Multiple IVF losses, and they just kept hearing essentially the same recommendation to try another cycle.
And they were tired.
They were so tired. Tired of treatments, tired of losses. They were tired of trying to piece together their own fertility plan from Google and podcasts and supplements on social media and whatever information they could get from their fertility clinic.
Most of all, they were tired of feeling like nobody was asking why this kept happening.
So they made a decision that felt very scary at the time.
They paused IVF.
We agreed to give their bodies at least four months to dig deeper.
And five months later, they were pregnant without IVF.
And there's a lot we can learn from their story.
So let's dive in.
Meet Sarah and James
When we first spoke, I'm changing their name, so we'll call her Sarah.
Sarah was 38 and James was 40.
They had been trying to have a baby for five years, and at this point, they weren't new to fertility treatment.
They had experienced a blighted ovum. They'd had two miscarriages before eight weeks, and two embryo transfers that failed to implant.
She had also been diagnosed with PCOS and Hashimoto's thyroiditis.
After everything they had been through, they asked about additional testing and they were told it wasn't necessary.
They were told to just try another IVF cycle.
And this is where I have such a problem with how fertility care can sometimes be approached.
IVF is an amazing tool, but another IVF cycle is not an investigation.
If you have repeated implantation failure or repeated pregnancy loss, I want to know why.
Because IVF can't bypass those things.
IVF doesn't change egg quality. It doesn't change sperm quality. It doesn't change how safe your body feels supporting your entire reproductive process.
And we may not always find one neat, clean answer. We typically don't.
Fertility rarely really works like that.
But after multiple losses and failed transfers, that information alone gives me a lot of guidance as to where to go next.
I don't want to keep doing the exact same thing without asking whether there are modifiable factors that we have missed.
Because there typically are at least two. Most often, there's more than that.
And in this couple's case, there were many.
There were a lot of them.
Why They Paused IVF
The decision to pause IVF was a difficult one.
But when they came to work with me, we agreed to take IVF off the table for at least four months.
Not forever.
This wasn't an anti-IVF decision.
It was a decision to stop throwing medications and treatments at the body that we didn't fully understand — how they were impacting their bodies and how they were changing their fertility outcomes as a whole.
And I know how difficult that can feel, especially when the female is 38.
Sarah was 38 at the time that we started this discussion.
There is enormous pressure around age and fertility. Every month can feel like you're just losing time.
But a lot of the time, rushing into another cycle without addressing what went wrong during the previous cycles isn't actually saving time.
We can actually get to a healthy baby faster if we take this pause and learn how to work with your body better.
Zooming Out Beyond the Ovaries
Instead of asking what else we can do to make her ovaries work, we zoomed way out.
Because fertility does not happen in isolation from the rest of the body.
Your ovaries need energy.
Your thyroid matters.
Your immune system matters.
Your gut matters.
Your metabolic health matters.
Your nutrient status matters.
Your partner's sperm matters.
And your reproductive system is constantly receiving information from all of those systems.
So we started there.
We started investigating all of these systems.
What We Tested
We did comprehensive blood testing.
The conventional fertility approach just scratches the surface, and we can learn so much more with better testing, even if it is just blood testing.
We evaluated blood sugar and insulin at a much deeper level.
We did a deeper dive into thyroid health, more inflammatory markers, and nutrient status, which typically isn't considered at all in a conventional fertility workup.
We looked at hormones too because we want to make sure that we're looking at how the body is responding.
Hormones are never the root cause, but they definitely give us insight and information.
We looked at Sarah's ovulation and menstrual cycle signs instead of just assuming that having a period meant everything about ovulation was fine.
And even though they're considering going back to IVF, all of this cycle information tells us a lot about what's happening with follicle maturation and the health of that follicle — just the health of the overall reproductive environment as well.
We tested the gut.
The gut is so important for how you're getting the nutrients out of the foods and the supplements that you're taking.
And we can have many barriers involved in fertility popping up in the gut.
Our immune system is heavily involved with what's happening with the bacterial environment in the gut.
Inflammatory markers impact the overall reproductive system and overall health that are coming from the gut too.
So we need to see what is happening in the gut.
We also evaluated mineral status.
Minerals are so important because they are required in every single cell in our body to create energy.
And because fertility is such an energy-intensive process, we need to know what's happening with minerals.
The Missing Piece of Male Fertility
Of course, we also evaluated James.
After five years of infertility and four IVF losses, we had never had sperm DNA fragmentation tested.
That is insane to me.
Let that sink in.
This couple had gone through years of fertility treatments, and we were still missing a major piece of male fertility.
His DNA fragmentation came back at 40%.
His morphology was 3%.
This is a big deal.
Even though in an IVF setting, you're trying to choose which sperm look the healthiest and are swimming well, you can't see DNA fragmentation under that microscope.
They potentially could have been picking sperm that had high levels of DNA fragmentation.
Morphology can be worked around a little bit more, but it definitely still speaks to the quality of the sperm.
And these factors definitely heavily impact natural conception, of course.
So they're ones that we want to focus on because they're also information about how the body is able to support fertility.
He was also low in vitamin D and B12.
And just with this information, suddenly that sentence that male fertility is fine wasn't the whole story.
It wasn't even part of the story because male fertility was absolutely an important factor playing a big role in all of the fertility outcomes.
As it always is.
Why Sperm DNA Fragmentation Matters
Here's a little bit more about why DNA fragmentation matters.
A basic semen analysis gives us important information, but it does not tell us everything about the health of your sperm.
DNA fragmentation looks at damage to the genetic material carried inside the sperm.
And this matters because the sperm isn't just responsible for getting to the egg.
It contributes to half of the DNA required to build that embryo.
As those cells continue to divide, that DNA information is very, very important for successful pregnancy and a healthy baby.
Sperm quality can influence fertilization, embryo development, implantation, and pregnancy.
This is why I get so frustrated when the entire conversation after a miscarriage becomes egg quality.
Especially if the woman is over 35.
And yes, of course, egg quality matters. Age does make a difference.
But sperm contributes half of the DNA.
And we cannot call fertility a couple's health issue and then investigate only one half of the couple.
His results gave us something actionable.
Instead of simply saying, "Take some CoQ10 and try again”, we looked at why his sperm environment might be struggling.
We looked at nutrient status.
For instance, the vitamin D and B12 were absolutely playing a role here.
We addressed lifestyle factors that were contributing to oxidative stress.
We supported metabolic health, antioxidant capacity, sleep, of course, which is always a huge foundation, and the nutrients required for spermatogenesis, which is that whole sperm production process.
And then we gave his body time because sperm takes time to develop.
You aren't changing the sperm that already exists.
You're changing the environment in which the next generation of sperm develops.
And that is why the preconception window matters for men too.
What We Found on Sarah's Side
All right, let's talk about what we found on Sarah's side.
Her results told another story.
First, her minerals were significantly imbalanced.
And I know minerals aren't nearly as exciting as talking about AMH or estrogen, but minerals are involved in energy production, glucose regulation, thyroid function, antioxidant defense, and cellular communication.
They are a big deal.
Your reproductive system requires a tremendous amount of energy.
Egg maturation requires so much energy, as does ovulation.
Hormone production requires a lot of energy.
Early embryo development requires a lot of energy.
Also, you get the point, right?
So when I look at fertility, I want to know where the basic machinery required to make that energy is and what it needs.
Where is it now?
What do we need to support it to get it to function the way that we want it to, to improve every step of the fertility puzzle?
We also found H. pylori and significant gut inflammation.
This is especially important because she had Hashimoto's, and the gut and the immune system are not separate systems.
They are very intricately involved.
A huge amount of immune activity is happening around the gut and, really, the bacteria or that microbiome environment.
When there's an infection or an overgrowth like H. pylori, intestinal inflammation, or altered gut function, I want to understand whether that is adding to the inflammatory and immune burden that we're already dealing with.
So we worked on the H. pylori, we worked on rebuilding the gut environment, we supported digestion and nutrient absorption, and we addressed the nutrient deficiencies that we found rather than blindly adding more fertility supplements.
The Blood Sugar Clue We Almost Missed
Then there was her blood sugar.
And this is one of the biggest missed clues.
Remember that I mentioned that she has PCOS?
I have a whole podcast on this topic if you want to dive more into that.
But her hemoglobin A1C was within a standard range.
And that's typically where that conventional workup stops.
So she thought her blood sugar was fine because of this.
But it wasn't.
When we tested fasting insulin, we saw a very different picture.
And this is why I talk so much about fasting insulin.
Hemoglobin A1C and fasting glucose can look perfectly acceptable while insulin is working overtime behind the scenes to keep glucose where it needs to go.
Your body may be producing more and more insulin to maintain that normal blood sugar and that normal A1C.
And that creates inflammation and a lot of hormone chaos and instability — lack of safety around reproduction because we need that balance for energy creation.
And remember how important energy creation is.
This can be happening for years, even a decade, before glucose or A1C finally moves outside of the standard range.
And then when we're throwing IVF medications in, that's putting even more stress on this process too.
When we're talking about PCOS, ovulation, egg quality, and fertility, all of this matters a lot because of the energy.
Insulin is not just a blood sugar hormone.
It communicates with your ovaries.
Chronically elevated insulin can actually influence androgen production, follicular development, and ovulatory function.
So of course we had to address it.
Not with anything crazy.
I am not about restrictive diets.
We didn't eliminate every carb that she loved, and definitely not by undereating because we need plenty of food to support all of the energy pieces.
We focused on building meals that supported stable glucose and insulin.
That meant adequate protein, fiber-rich carbohydrates, healthy fats, movement, muscle, sleep, and meal timing.
It's not just about what you eat.
It's about how you eat, as well as how you live your life, that is going to impact insulin response too.
Light exposure is also a really big piece of the puzzle when we're talking about insulin response.
But ultimately, we're making sure that her body was actually getting enough nutrition to support reproduction while managing the inflammation and insulin response.
Individualized Fertility Support
The protocol was different for each of them.
Of course, there's overlap because they're living together, and I want them to be able to eat and live together.
The goal is not to add more stress to the fertility journey.
It's to help make it realistic and sustainable by helping them really understand how to better work with their bodies to get the ultimate goal of that healthy baby.
This is a really important part of their story.
They didn't just get a fertility protocol.
They got individualized guidance based on their labs and their stories.
Sarah's plan was a little different because her barriers were different.
On James's side, we were working on sperm DNA integrity, oxidative stress, nutrients, and the environment in which sperm were developing.
On Sarah's side, more specifically, we were working on medical health, inflammation, gut health, immune regulation, minerals, thyroid support, and of course ovulatory health and overall egg quality.
Why DIY Fertility Wasn't Working
This is exactly why they had reached the point where DIY wasn't working anymore.
They had already tried all the things.
All the supplements.
They ate pretty well.
They listened to podcasts.
They researched.
They had gone through multiple rounds of IVF.
They were absolutely not lacking effort or trying to research and find the best options for themselves.
They were lacking a clear understanding of what their individual bodies needed.
More information wasn't going to solve that.
They needed the right information and somebody to connect it together for them to make it actionable.
What Happened Next
Over the next several months, we worked through their individual plans.
This part is not exciting.
It's not fancy.
There wasn't a magic supplement.
There wasn't a food that fixed everything.
There wasn't any big fertility hack other than individualization.
It was consistent work.
Meals that supported their metabolic health.
Correcting deficiencies.
Supporting gut health.
Addressing the H. pylori.
Working on inflammation.
Improving the environment that the egg and the sperm are developing in.
We had to make sure that we were paying attention to how their bodies were responding.
Cycle signs.
Making sure that they're feeling rested.
And really just allowing time for their biology to respond.
Five months after they paused IVF, they got their BFP.
They were pregnant naturally.
After five years of fertility challenges.
After a blighted ovum and two early miscarriages.
After two failed embryo transfers.
After being told that there wasn't more testing that they needed.
They were pregnant without another IVF cycle.
What I Want You to Take From This
I don't want you listening to this episode thinking Brooke says I shouldn't do IVF.
That is not at all what I'm trying to say.
IVF can be an incredible tool.
I have clients who absolutely need IVF, and I want them going into treatment with the strongest biology that we can create because that means less IVF, which is ultimately the goal.
You don't want to have to go through multiple rounds and losses, right?
The lesson is that treatment and investigation are not the same thing.
IVF can help egg and sperm meet.
It can allow us to grow embryos in a laboratory.
It can allow us to genetically test embryos.
It can bypass certain barriers to conception, like blocked tubes.
But it does not automatically tell us why you are struggling to get pregnant or to stay pregnant.
And when you've experienced repeated loss or repeated failed transfers, I think you deserve to ask deeper questions before automatically repeating the same treatment.
Questions to Ask After Failed IVF
Ask what has actually been evaluated.
Have you really looked at metabolic health beyond glucose and A1C?
Have you looked at fasting insulin?
Has thyroid been fully evaluated?
What does overall inflammation and nutrient status look like?
Are there signs that gut health or infection could be contributing?
What about the immune system?
And then what do all your cycle signs really look like?
What information are they providing you?
Has the male partner had a comprehensive workup for metabolic health and semen or sperm health as well?
DNA fragmentation should be included in this.
If you have had failed IVF cycles, failed transfers, or recurrent miscarriage, I want you to resist the urge to immediately assume that you need to do more.
First, ask whether you need to know more.
You don't necessarily need another random supplement or another fertility diet from Instagram.
You don't need to eliminate 12 more foods.
You need to understand what your fertility barriers are.
We have to look at both partners.
We have to look at the whole body and the full metabolic picture.
And look carefully at ovulation and reproductive health.
And please evaluate sperm beyond whether the count happens to fall inside a laboratory reference range.
Then give your body enough time to respond to what you find.
For most couples I work with, I want at very minimum three to four months of focused preconception work.
Not because you're waiting.
You are actively changing.
Changing the environment in which eggs mature and sperm develop.
And pregnancy really begins during that preconception period.
Sometimes taking a few months to prepare is the fastest path forward.
And sometimes, like this couple, the plan changes completely.
The Bigger Lesson
This couple came to me thinking that their next option was another IVF cycle.
What they actually needed was someone to zoom out.
They didn't need more effort.
They needed direction.
They needed someone to connect the dots between sperm health, metabolic health, gut health, immune function, thyroid health, nutrient status, minerals, and reproduction.
And they needed a plan that treated fertility like the whole-body process that it is.
Five years of infertility did not mean that their bodies were incapable of pregnancy.
Four IVF losses did not mean another IVF cycle was automatically the answer.
And being 38 and 40 did not mean that there was nothing left to investigate.
There were modifiable barriers.
We found them, we worked on them, and five months later they were pregnant naturally.
And this is why I will continue to say this:
You deserve more than “everything looks normal.”
You deserve more than “just try another cycle.”
And you deserve a fertility plan that looks at both halves of the DNA required to make your baby.
When You Need More Than More Information:
If you're listening to this and thinking, "This sounds exactly like us.”
We've done everything we know how to do, and we still don't understand what we're missing.
This is exactly the kind of work we do here inside The Fertility Dietitian and specifically the Master Your Fertility private coaching program.
We look deeper, we test both partners, we connect the dots, and we build an individualized plan based on what your body's results are telling us.
Because you shouldn't have to keep guessing your way through fertility.
If you found this episode helpful, please share it, like it, comment below, and I hope to see you at the next episode of the Fertility Dietitian Podcast.