Semen analysis is the first-line test for male fertility, but it has a major blind spot: it doesn’t measure sperm DNA fragmentation — a crucial marker that influences fertilisation, embryo development and miscarriage risk.

For many couples, everything on paper appears normal, yet pregnancy doesn’t progress. DNA fragmentation is often the part of the story that hasn’t been checked, and the consequences can be significant.

When you understand what’s happening inside the sperm rather than just what they look like, so much of the confusion around unexplained infertility and early loss begins to make sense.

What is sperm DNA fragmentation?

Sperm DNA fragmentation refers to breaks, nicks or structural damage in the genetic material inside sperm.
While semen analysis looks at visible characteristics — count, motility and morphology — fragmentation reflects the integrity of what sperm are actually carrying.

High fragmentation can affect:

• fertilisation
• early embryo development
• progression to blastocyst
• implantation
• early pregnancy stability

Oxidative stress, inflammation, heat exposure (hot tubs, saunas, laptops on laps), smoking, alcohol, illness, intense exercise, toxins and disrupted sleep are some of the most common contributors.

How is DNA fragmentation measured?

Different laboratories use different methods (SCSA, TUNEL, SCD/Halo, Comet Assay).
Thresholds vary slightly between tests, but widely used WHO-aligned reference ranges include:

DFI < 15%
• Low fragmentation
• Typically favourable fertility potential

DFI 15–25%
• Mild to moderate fragmentation
• Can influence natural conception and miscarriage risk

DFI > 25%
• High fragmentation
• Associated with lower embryo development, failed implantation and higher miscarriage rates, even with IVF or ICSI

Some clinics use >30% depending on the assay, but the interpretation remains the same: higher fragmentation reduces reproductive potential.

A normal semen analysis doesn’t rule it out

This is one of the most important — and most misunderstood — aspects of male fertility.

A standard semen analysis measures:

• volume
• count
• motility
• morphology

It does not assess DNA integrity.

This means someone can be told their semen analysis is “fine” while a significant proportion of sperm carry DNA damage.
This gap often explains:

• recurrent miscarriage
• unexplained infertility
• poor embryo development
• failed IVF or ICSI cycles

Understanding this disconnect helps people make sense of why conception isn’t happening despite “normal” results.

Why DNA fragmentation matters for fertility

DNA fragmentation affects every stage of the early developmental journey:

• fertilisation may still occur, but embryos may arrest early
• fewer embryos progress to blastocyst
• implantation rates may be lower
• early losses may be more common

Eggs do have the ability to repair sperm DNA damage, but this ability naturally declines with age.
For couples in their late 30s or 40s, DNA fragmentation can therefore have an even stronger influence. Couples in their forties often face both egg and sperm considerations

What causes sperm DNA fragmentation?

Common contributors include:

• smoking or vaping
• alcohol (especially binge patterns)
• heat exposure (saunas, hot tubs, cycling, heated car seats, laptops on lap)
• obesity and visceral fat
• chronic inflammation
• infections
• high-intensity training without recovery
• sleep disruption or shift work
• environmental toxins
• oxidative stress

Many of these factors are modifiable within a single 74-day sperm development cycle.

Improving sperm DNA fragmentation

The reassuring part is how responsive sperm are to positive change.

Within 8–12 weeks, significant improvements can occur when focusing on:

• antioxidant-rich, anti-inflammatory nutrition
• optimising sleep
• improving metabolic health
• reducing heat exposure
• moderating alcohol
• addressing inflammation
• reducing environmental toxin load
• correcting nutrient deficiencies
• supporting healthy testosterone and thyroid function
• balancing training load with recovery

These changes often lower DNA fragmentation and improve traditional semen parameters simultaneously.

How this fits into the HSE fertility hub pathway

For those navigating the public fertility system, it’s important to know that sperm DNA fragmentation is not included in HSE fertility hub investigations.
Only standard semen analysis is provided.

This means DNA fragmentation can remain undetected even in cases of:

• recurrent miscarriage
• unexplained infertility
• failed IVF or ICSI
• older male partners
• borderline semen parameters

Many couples only learn about DNA fragmentation after private testing — often following failed cycles or prolonged uncertainty.

Understanding this gap helps you advocate for a more complete picture of male fertility.

If DNA fragmentation concerns you

If you’ve been told everything looks “normal” but pregnancy still isn’t happening — or if you’re preparing for IVF and want to optimise both egg and sperm quality — DNA fragmentation is worth exploring.

A Fertility Consultation can help you understand what has (and hasn’t) been tested so far, identify contributing factors, and outline practical steps that support healthier sperm over the next 8–12 weeks.

You’re Not IVF-Ready Until Your Body Is: How Nutrition Shapes Your Response to Treatment

Most couples enter IVF assuming the clinic will take care of everything. The medication, the monitoring, the scans — it all feels so medical, so controlled, that it’s easy to forget one vital truth: your body is still doing the work.

IVF can only work with what your body provides. Hormones can be injected, but the response — the eggs, the lining, the implantation — all depend on the metabolic health, nutrient stores, gut environment, and hormonal balance you bring into treatment.

At Now Baby, we see it every day: you’re not IVF-ready until your body is.

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The Missing Piece in IVF Preparation

Clinics measure follicles, AMH, and hormone levels. They talk about protocols. They schedule retrieval.

Very few talk about:

• blood-sugar regulation

• inflammation

• microbiome health (vaginal, endometrial, gut)

• nutrient sufficiency

• stress load and sleep

Those are not “nice to have.” They are the landscape IVF has to work inside.

Too many couples are pushed into IVF quickly — often after years of waiting — without being told that lack of preparation is one of the main reasons for repeated cycles.
Studies consistently show that fewer than half of first IVF cycles result in a live birth, yet couples who eat a Mediterranean diet before treatment have a 40% higher chance of pregnancy.

When those foundations aren’t supported, you’re more likely to see:

• an unpredictable response to stimulation

• thin or inflamed uterine lining

• fragmented embryos

• implantation that “should have worked” but didn’t

This is the gap we work in. Not replacing IVF. Completing it.

IVF can only work with what your body provides.

You’re not IVF-ready until your body is.

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Blood-Sugar Balance: The Ground Floor of Hormone Stability

Your hormonal system is exquisitely sensitive to blood-sugar swings. When glucose spikes and crashes, insulin follows — and high insulin can interfere with ovulation, lower progesterone, and inflame the uterine environment.

Even mild insulin resistance can affect egg quality and implantation. This is one of the reasons some women feel like they’re “doing everything right medically,” but still getting results that don’t match the effort.

So IVF preparation does not start with supplements. It starts with stabilising meals.

The three anchors we use again and again:

1. Eat breakfast within one hour of rising
2. Include at least 15 g of protein
3. Don’t go longer than three hours without eating

This is about keeping your system steady while you move through injections, scans, and that feeling of being “on call” every day.

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Micronutrients That Influence Egg and Sperm Quality

Eggs and sperm are not created in a single moment. They are built gradually. That means nutrition still matters in the final weeks before treatment, not just months ago.

Key players include:

• CoQ10 for mitochondrial energy and egg competence

• Omega-3 fats to calm inflammation and support uterine blood flow

• Folate, B-vitamins, and iron for cell formation

• Vitamin D for hormone receptor and immune balance

• Antioxidants (vitamin C, selenium, zinc) to protect DNA

When these are low, embryo quality suffers; when they’re supported, the body becomes more resilient — especially under stimulation.

The IVF Preparation Programme includes tailored nutrition and targeted supplementation so you’re not guessing, not overdosing, and not leaving gaps that silently matter.

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Sperm Still Matters — Even in IVF

Clinics often say: “Semen analysis looks fine.”

What that usually means is: count and motility are in range.
What it does not tell you:

• Are the sperm well-formed (morphology)?

• Is there DNA fragmentation?

• Is oxidative stress damaging the genetic material that will become half of the embryo?

Sperm quality influences fertilisation, embryo development, and miscarriage risk — even with ICSI.

In our work with couples, we address both sides: nutrition, inflammation, lifestyle, and heat exposure. Better male fertility support creates better embryos before transfer ever happens.

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The Microbiome and the Uterine Environment

This part is almost never discussed in clinic consultations, and it matters.

Your vaginal and endometrial microbiome — the balance of bacteria — influence cervical fluid, uterine inflammation, and the environment an embryo meets at implantation.

Your gut microbiome affects nutrient absorption, oestrogen recycling, and immune regulation. An overactive immune response in the uterus can make implantation more difficult, even with a chromosomally normal embryo.

Nutrition in the weeks before transfer helps to:

• create a calm, receptive uterine lining

• improve blood flow

• lower inflammatory signaling

• restore microbial balance

These adjustments are subtle but powerful — shaping the internal environment that determines how well the body receives and sustains a pregnancy.

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Calming the Nervous System (So Your Body Can Receive Support)

IVF is not only physically demanding — it’s emotionally invasive. You’re waiting for phone calls that decide your next 24 hours. You’re injecting hormones into a body you’re not sure you trust anymore. You’re told to “relax,” but no one shows you how.

Cortisol and adrenaline don’t just affect mood; they alter blood sugar, progesterone, uterine lining, and sleep.

So nervous-system care isn’t indulgence — it’s implantation support.

In the IVF Preparation Programme we build in:

• circadian-rhythm routines for restorative sleep

• food patterns that blunt cortisol spikes

• gentle movement and breathwork to discharge tension

• emotional containment through guided practices — not forced positivity

Your body accepts support when it feels safe. Safety isn’t mindset; it’s physiology.

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IVF Doesn’t End at Transfer: The Two-Week Wait

Most people are told: “After transfer, just rest and hope.”

But those two weeks are alive.

What you eat and how you regulate stress and blood sugar during the two-week wait directly shape implantation and early development. This phase is part of preparation, not an afterthought.

That’s why our work continues beyond transfer — supporting lining health, progesterone balance, anti-inflammatory nutrition, and nervous-system steadiness while you wait.

The goal isn’t to hover anxiously over every detail. The goal is to feel held while your body does something sacred and exquisitely complex.

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When to Begin IVF Preparation

The best time to start is just before your clinic protocol begins — soon enough to design your personalised plan, yet close enough that the changes flow straight into treatment.

You’ll complete your consultation ahead of stimulation so supplements, meal planning, and nervous-system supports are in place. Then, as medications begin, nutrition and lifestyle support continue alongside your IVF cycle, stabilising blood sugar, calming inflammation, supporting the microbiome, and maintaining a receptive uterine environment through to embryo transfer and beyond.

Preparation isn’t something you finish before IVF; it’s a thread that runs through every stage — pre-stimulation, stimulation, transfer, and the two-week wait.

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What Support Looks Like

If your next cycle is approaching, the IVF Preparation Programme is designed to sit alongside your medical plan and fill the gaps clinics don’t have scope to cover.

You’ll begin with a joint consultation to create your tailored plan, followed by weekly calls for guidance and reassurance as you move through:

• IVF-specific nutrition

• meal plans supporting blood sugar, inflammation, and microbiome balance

• lifestyle adjustments that protect egg and sperm quality

• nervous-system support from stimulation through the two-week wait

This isn’t about doing everything. It’s about doing the right things, at the right time, so your body is truly ready to respond to IVF.

 Learn more about the IVF Preparation Programme and how it supports you through every stage of treatment.

Optimizing IVF success begins long before egg collection. While clinics focus on stimulation, retrieval and transfer, the biology behind egg quality, sperm health, embryo development and implantation starts much earlier. Understanding the normal IVF attrition funnel — and the factors that influence it — helps you move through your cycle with clarity rather than shock, self-blame or confusion.

IVF today

According to the European Society for Human Reproduction and Embryology (ESHRE), the average IVF success rate is 36%, falling to approximately 5% after age 40. These percentages reflect a clinical pathway that focuses mainly on medical protocols – stimulation, retrieval, fertilisation, transfer – but rarely on the environment that eggs, sperm, and implantation actually depend on.

IVF may be recommended because of PCOS, morphology concerns, diminished ovarian response, recurrent pregnancy loss, unexplained infertility (around 25% of cases), or for structural reasons including same-sex couples and those missing reproductive organs. No matter how you arrived here – GP referral, fertility hub, or self-referral – your clinic will guide the medical steps. What they cannot offer is the holistic metabolic preparation that significantly influences success.

Why preparation matters

In nature, an egg takes ~90 days to mature. In IVF, the ovaries are hyper-stimulated and multiple follicles are collected after less than one month. Some of these follicles were never given the metabolic time or environment they needed to develop healthily.

The same is true for sperm. Although production happens daily, sperm only reach fertilising maturity after ~86 days. Every semen analysis reflects a single snapshot — not the true potential of the next 74‑day cohort.

We also know:

• A Mediterranean-style diet has been shown to increase the chance of pregnancy after IVF by 40%.
• Endocrine-disrupting chemicals alter egg competence and sperm DNA integrity
• Smoking impairs mitochondrial function in sperm
• Chronic stress is linked to lower mitochondrial energy production
• Obesity, insulin resistance, and inflammation directly affect stimulation response and implantation.

Your clinic manages the protocol.

You influence the biology the protocol depends on.

IVF is an event you can prepare for

If you had an event that would affect the rest of your life and cost thousands, you would prepare for it. IVF works in the same way: preparing your internal environment supports the cycle you are about to undergo.

Preparation does not replace IVF — it strengthens egg quality, sperm health, hormones, and implantation conditions so the medical protocol can do its job. This applies equally to IVF, ICSI, IUI, and FET.

Many couples I work with were never told that these physiological foundations matter, or that meaningful improvements are possible within a short window.

What I see every day

Many couples arrive in IVF clinics because that is the medical model:

GP → Specialist → Medical solution.

Most doctors receive minimal training in nutrition and metabolic health, and are rarely in a position to guide the shifts that optimise success. As a result, people often move into IVF earlier than necessary — or repeat cycles without ever supporting the underlying biology.

I have supported people through:

• IVF cycles that previously did not progress in other clinics
• FET cycles following recurrent loss
• Donor egg journeys where couples wanted the strongest possible implantation environment
• HSE-supported IVF, NHS cycles, and private clinic protocols
• Natural conceptions after previously needing IVF — only when appropriate and aligned with physiology

The common thread is this:

When the body is supported, the whole pathway changes.

Your next step: The IVF Preparation Programme

A 30-day, deeply supportive protocol designed to elevate your IVF readiness — physiologically and emotionally.

Includes:

• 90-minute online joint consultation via video call
• Four-week IVF-specific nutrition and lifestyle plan
• Four-week batch-friendly meal plan tailored for stimulation
• 2-week wait meal plan
• A grounded, embodied rhythm to support calmness, clarity, and resilience throughout the process

A container of preparation so you enter your cycle feeling supported, nourished, and ready.

If you are preparing for IVF — or repeating a cycle — this programme is for you.

Whether this is your first cycle, a frozen embryo transfer, or a repeat round after heartbreak… you do not need to walk into it unprepared.

 Learn more about the IVF Preparation Programme

The IVF Attrition Funnel

Why the numbers fall at every step — and why it’s not your fault

One of the biggest shocks in IVF is how many eggs and embryos are lost along the way. Patients rarely see the normal, expected attrition that happens between each stage.

This is what the science shows across ESHRE, ASRM and HFEA‑aligned data.

 

 

 

 

 

 

 

1. Follicles → Retrieved Eggs

During stimulation, your scan might show a good number of follicles — but not every follicle contains a retrievable egg.

Clinically typical:

60–80% of follicles yield an egg

If 12 follicles are visible, you might reasonably expect 7–10 eggs.

2. Retrieved Eggs → Mature Eggs (MII)

Not every retrieved egg is mature enough to be fertilised.

Clinically typical:

70–85% of retrieved eggs are mature (MII) – possibly 7 eggs.

This is influenced by trigger timing, hormonal response, inflammation and metabolic environment.

3. Mature Eggs → Fertilised Embryos (2PN)

Even when eggs are mature, fertilisation is not guaranteed.

Clinically typical:

60–75% of mature eggs fertilise normally – possibly 5 embryos

This depends on sperm DNA integrity, egg competence, fertilisation method, and lab conditions.

Fertilised Embryos → Blastocysts (Day 5/6)

The biggest drop-off — and the most shocking for patients.

Clinically typical:

30–50% of fertilised embryos reach the blastocyst stage ~ 2

Age has a strong influence.

Why this attrition happens

At each stage, the embryo must meet specific developmental milestones:

• competent egg development
• complete and timely maturation
• healthy sperm DNA and motility
• correct fertilisation
• sufficient mitochondrial energy
• chromosomal normality
• supportive culture conditions
• receptive uterine environment

These are biological processes — not indicators of personal failure.

What this means for IVF preparation

Because numbers drop at every stage, improving your starting point can influence the entire cycle:

• Better egg quality = higher proportion of mature eggs
• Better sperm quality = higher fertilisation rates
• Optimised metabolic environment = improved embryo development
• Lower inflammation & steadier hormones = better stimulation response
• Improved mitochondrial function = stronger blastocyst development

Your clinic manages the protocol.

You influence the biology the protocol depends on.

The IVF Preparation Programme strengthens the foundations your clinic cannot see — the internal environment eggs, sperm, embryos and implantation rely on.

You may have one embryo that reached the blastocyst stage on Day 5 and another that reached it on Day 6. If your clinic has placed the Day 5 blastocyst first on your transfer list, the difference of a single day can feel like a verdict on which embryo is more likely to become your baby.

It isn’t that simple.

Day 5 and Day 6 state when each embryo reached the blastocyst stage. Day 5 blastocysts generally have higher success rates across large groups, but development speed is only one part of an individual embryo’s transfer priority. PGT-A result, embryo grade, whether the transfer is fresh or frozen and your clinic’s own laboratory data can all change the comparison.

If you have embryos from both days, the decision is not whether Day 5 is always better than Day 6. It is which of your embryos has the strongest combination of features for transfer first.

What Day 5 and Day 6 Blastocyst Status Actually Means

The day refers to how long the embryo took to develop from fertilisation to the blastocyst stage.

A Day 5 blastocyst reached the stage required for transfer, freezing or biopsy five days after fertilisation. A Day 6 blastocyst reached that stage one day later. Both completed the same developmental transition, but at different speeds.

During this transition, the embryo develops a fluid-filled cavity and two distinct groups of cells. The inner cell mass will form the baby, while the trophectoderm will contribute to the placenta. The blastocyst must also expand and begin preparing to hatch from its outer shell before implantation can begin.

Reaching the blastocyst stage on Day 6 does not mean the embryo stopped developing or developed incorrectly. It means it needed more time to reach the point at which your clinic could assess, freeze, biopsy or transfer it. That extra day may carry information about developmental potential, but it does not determine the outcome on its own.

Do Day 5 Blastocysts Have Higher Success Rates Than Day 6 Blastocysts?

Across large groups of transfers, Day 5 blastocysts generally have higher implantation, clinical pregnancy and live birth rates than Day 6 blastocysts.

That difference does not mean every Day 5 embryo has greater potential than every Day 6 embryo. The figures combine embryos with different grades, chromosome results, freezing methods and transfer circumstances. They describe what happened across a population rather than predict the outcome of either embryo in front of you.

Implantation rate is usually calculated from the number of gestational sacs seen on ultrasound relative to the number of embryos transferred. Clinical pregnancy rate reports how many cycles or transfers resulted in a pregnancy confirmed on ultrasound. Live birth is the outcome that shows how many transfers resulted in a baby, so it carries more weight when comparing success rates.

Development on Day 5 is therefore a favourable feature, but not a complete transfer decision. A Day 6 blastocyst may still be the stronger embryo once its PGT-A result and grade are considered.

Why Blastocyst Development Speed May Affect Transfer Priority

Day 5 blastocysts are often placed ahead of otherwise comparable Day 6 blastocysts because transfers of Day 5 embryos have produced higher live birth rates across large study populations.

The research shows an association. It has not established that reaching the blastocyst stage on Day 5 causes the higher live birth rate or that taking until Day 6 makes an individual embryo biologically inferior.

Development day may be connected with other differences between the embryos being compared. Day 5 blastocysts are more likely, as a group, to be euploid and may also differ in grade. Laboratory procedures, embryo selection and whether the embryos were transferred fresh or frozen can influence the outcomes recorded in each group.

Development day can help estimate which embryo may have the higher chance of success, but it does not explain why one embryo will or will not result in a live birth. If two blastocysts have the same PGT-A result and a comparable grade, the population-level advantage associated with Day 5 development may be used as a practical reason to transfer that embryo first.

Day 5 vs Day 6 Success Rates When Both Embryos Are Euploid

PGT-A changes the comparison because both embryos have been reported to contain the expected number of chromosomes in the cells sampled. This removes one major reason untested Day 5 and Day 6 groups may have different success rates.

Individual studies have reported mixed results. However, the latest meta-analysis found higher clinical pregnancy and live birth rates after transfer of PGT-A-tested Day 5 blastocysts than Day 6 blastocysts. Because the studies were observational, this shows an association rather than proving that reaching blastocyst on Day 5 causes the better outcome.

This uncertainty matters when your embryos are being ranked. A Day 5 euploid blastocyst may still be prioritised when both embryos have a comparable grade because it belongs to the group associated with higher live birth rates in the pooled evidence. That is a population-based transfer decision, not proof that your Day 5 embryo is biologically stronger than your Day 6 embryo.

PGT-A result and embryo grade therefore need to remain part of the comparison. Day 5 status can help separate two otherwise similar euploid embryos, but it cannot determine which individual embryo will become a baby.

Does Embryo Grade Matter More Than Day 5 or Day 6?

Embryo grade and development day measure different features.

Day 5 or Day 6 records when the embryo reached the blastocyst stage. The grade describes how expanded the blastocyst was and how the inner cell mass and trophectoderm appeared under the microscope at the time of assessment.

Neither can identify with certainty which embryo will result in a live birth. Both are associated with transfer outcomes across large groups, but neither provides a direct measurement of everything happening inside the embryo.

There is no universal rule that grade always matters more than development day. Clinics may rank the same embryos differently because grading is subjective, laboratory protocols vary and studies have not established one transfer order for every combination of day and grade.

The comparison is simplest when both embryos have the same PGT-A result and a similar grade. Day 5 status may then be used to decide which embryo is transferred first. When a higher-graded Day 6 embryo is being compared with a lower-graded Day 5 embryo, the priority is less straightforward and should be based on the clinic’s complete ranking criteria rather than either feature alone.

A Lower-Grade Day 5 Embryo vs a Higher-Grade Day 6 Embryo

This is where a simple preference for Day 5 blastocysts stops being enough.

A lower-grade Day 5 embryo reached the blastocyst stage sooner, but its inner cell mass, trophectoderm or degree of expansion received a less favourable assessment. A higher-grade Day 6 embryo took another day to reach the blastocyst stage, but its visible structure appeared stronger when it was graded.

If both embryos have the same PGT-A result, your clinic must decide how much weight to give each feature. Some laboratories may prioritise the higher-grade Day 6 embryo. Others may place greater weight on Day 5 development, particularly when the difference in grade is small.

The grading system cannot settle this comparison on its own. Embryo grading is a visual assessment, and the same embryo may not receive an identical grade from every embryologist or laboratory. Development day is recorded more objectively, but it is still associated with outcomes across groups rather than proving the potential of your individual embryo.

Ask your clinic which embryo it recommends transferring first, what feature determined that order and whether the recommendation is supported by its own live birth outcomes for comparable embryos. That gives you the reasoning behind the ranking rather than a decision based on Day 5, Day 6 or embryo grade in isolation.

Why Fresh and Frozen Transfer Data Can Give Different Answers

A Day 6 blastocyst transferred during the egg collection cycle reaches the uterus later than a Day 5 blastocyst. By then, the endometrium has also had an additional day of exposure to progesterone and may be moving beyond the most receptive part of the implantation window.

This means lower success rates after fresh Day 6 transfer cannot automatically be attributed to the embryo. They may also reflect the timing between the embryo and the endometrium.

Frozen transfer separates the embryo transfer from the egg collection cycle. In most frozen transfer protocols, Day 5 and Day 6 blastocysts are transferred after the same duration of progesterone exposure.

For that reason, fresh and frozen transfer results should not be combined as though they are measuring the same circumstances. Frozen transfer data provide a clearer comparison of Day 5 and Day 6 embryos because the lining can be prepared to receive each embryo at the intended point in the transfer cycle. Even then, differences in PGT-A result, embryo grade and laboratory practice remain.

What a Day 6 Blastocyst Means When It Is Your Best or Only Embryo

If your Day 6 blastocyst is the highest-ranked embryo you have, the comparison with Day 5 statistics no longer determines which embryo should be transferred first. Your decision is whether to proceed with this embryo or consider creating more embryos before transfer.

Its chance of success should be estimated from its own PGT-A result, grade and your clinic’s outcomes with comparable Day 6 blastocysts. A lower average live birth rate across all Day 6 transfers cannot tell you whether this individual embryo will implant.

Your age when the egg was collected may affect the likelihood that an untested Day 6 embryo is euploid. If it has already received a euploid PGT-A result, that removes much of the age-related chromosome uncertainty from the transfer decision.

A Day 6 blastocyst has completed the development required to be selected for freezing or transfer. Its status provides useful context for estimating success, but it is not a reason to dismiss an embryo that may still result in a live birth.

Once this is the embryo being transferred, the focus moves beyond how long it took to reach the blastocyst stage. Day 6 describes its development before transfer. Implantation follows transfer, and while your blastocyst development stage is currently fixed, there is ample opportunity to support what happens next.

Once the Embryo Is Chosen, Implantation Still Has to Unfold

Implantation has 5 distinct phases and each has to complete successfully for pregnancy to continue.

 

 

5 Ways Cortisol Affects Fertility

Cortisol and fertility are deeply interconnected — often in ways that aren’t explained during standard fertility care. Many of my clients arrive feeling wired, depleted, and unsure why their body isn’t responding the way they expected. When we look closely at stress physiology, the missing link usually becomes clear.
If you’ve been doing “all the right things” yet still feel stuck, stressed, or unable to switch off, it’s possible your stress hormones are quietly influencing your reproductive hormones behind the scenes.

And this is one of the reasons addressing stress physiology can make such a meaningful difference when you’re trying to conceive.

What is cortisol?

Cortisol is one of the body’s primary stress hormones. It’s produced through the HPA axis — a sensitive feedback loop between your brain and your adrenal glands. When your brain senses a threat, real or perceived, cortisol is released to help you respond.

Once the threat passes, the body should return to homeostasis:
rest, digest, feed and breed — the physiological baseline in which fertility thrives.

Many people never fully come back to this baseline.

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Everyday stressors that activate cortisol

Stress is not limited to dramatic or traumatic events. Daily life can activate cortisol through:

Diet (refined sugar, caffeine, skipped meals)
Blood sugar swings
High-intensity exercise
Insufficient sleep
Long working hours
Financial pressure
Relationship strain
Health worries
Infertility stress itself

Your senses — sound, sight, smell, taste, touch — can all activate the stress response. When this activation happens repeatedly without a full reset, cortisol essentially becomes the “dominant” hormone in the hierarchy.

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5 ways cortisol affects fertility

Your hormone hierarchy graphic shows the order clearly:
Cortisol sits above the reproductive hormones.
When cortisol rises, it pushes fertility hormones down the priority list.

Below are the five most common ways this shows up in clinic.

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1. Chronic stress keeps the body out of ‘feed and breed’ mode

Acute stress is short and temporary.
Chronic stress is when alerts stack up, your nervous system never fully resets, and cortisol remains elevated day after day.

This can lead to:

• Irregular or delayed ovulation
• Cycle disruptions
• Difficulty reaching deep rest
• Anovulatory cycles
• Reduced cervical mucus
• Suppressed libido

The body will always prioritise survival over conception.

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2. Cortisol disrupts sleep — and poor sleep raises cortisol

Cortisol and sleep form a self-reinforcing loop.

When your nervous system doesn’t feel safe, your brain resists deep sleep. Poor sleep raises cortisol further. And because cortisol is a fat-storage hormone, sleep disruption affects metabolic balance for both partners.

Men often subconsciously sleep closest to the bedroom door — a leftover protective instinct from a time when “threats” were physical. Today, modern stressors activate the same physiology.

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3. Cortisol drives inflammation — and inflammation affects implantation

Cortisol prepares the body for injury by increasing inflammation.
But modern life creates repeated perceived threats, not real ones.

Chronic low-grade inflammation can:

• Interfere with egg maturation
• Reduce sperm quality
• Affect endometrial receptivity
• Disrupt implantation
• Accelerate cellular aging

This is one of the most overlooked connections in fertility care.

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4. Cortisol lowers testosterone and sperm production in men

Testosterone production is downstream of cortisol in the hormone hierarchy.

When cortisol is chronically elevated:

• Testosterone drops
• Sperm count decreases
• Motility declines
• Testicular volume can reduce
• Libido falls

Men who sleep less than six hours per night typically show significantly lower testosterone — and sleep loss itself raises cortisol. It’s a double hit.

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5. Cortisol diverts progesterone in women

Progesterone is essential for:

• Luteal phase stability

• Endometrial receptivity & implantation

• Immune modulation in early pregnancy

• Holding the uterine lining in place

Chronic stress lowers progesterone output because the body prioritises cortisol regulation.

This can lead to:

• Short luteal phases
• Brown spotting before periods
• Difficulty conceiving
• Early losses

Hormone tests may appear “normal,” even when functionally suboptimal.

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Supporting your fertility means supporting your stress hormones

This doesn’t require eliminating stress — only helping your nervous system shift more often into the rest–digest–feed–and–breed state.

Key areas include:

• Blood sugar stability (insulin + cortisol pairing)
• Anti-inflammatory nutrition
• Gentle movement
• Predictable routines
• Sleep support
• Reducing stimulants
• Nervous-system calming practices

Your hormone hierarchy graphic is a powerful way to visualise this interaction.

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When you’re trying to conceive, personalised support matters

 

A grounded next step

If cortisol has been influencing your cycles or your partner’s sperm health, personalised support can make a significant difference. Understanding your stress physiology, blood sugar patterns, inflammation markers, and hormonal rhythm gives you a clearer picture of where to focus — without overwhelm.

A Fertility Consultation brings all of this together into a structured, personalised plan for both partners.

Egg reserve is often spoken about as if it were a fixed store of eggs that can be counted, measured, and predicted.

In reality, what we are trying to understand is ovarian activity — how many follicles are present, how many have left dormancy, and how many are actively growing at a given point in time.

Anti-Müllerian Hormone (AMH) is one of several markers used to describe ovarian activity, but confusion arises when it is treated as a measure of egg reserve or as a prediction of fertility.

To understand what AMH can and cannot tell us, it helps to return to basic follicle biology.

What egg reserve actually describes

Egg reserve refers to the number of follicles within the ovaries that are capable of entering development.

These follicles exist at different stages, from dormant primordial follicles to those that are actively growing. At any given time, only a small proportion of follicles are metabolically active.

Egg reserve describes quantity — how many follicles are available to be recruited into development — not how well an individual egg will mature within its follicle.

Primordial follicles and AMH

Primordial (dormant) follicles do not produce AMH.

AMH only appears once follicles leave dormancy and enter early growth. This distinction is essential for understanding what AMH represents — and what it does not.

A person can have a large number of primordial follicles that are not contributing to AMH at all.

What AMH reflects

AMH is produced by granulosa cells in small, developing follicles.

Its presence reflects how many follicles have left dormancy and are actively growing at that point in time.

AMH is therefore a snapshot of current follicle activity, not a measure of total eggs remaining and not a measure of egg quality.

Because it is a snapshot, AMH can change over time. It can fluctuate, rise, or fall as ovarian activity changes.

The other number linked to egg reserve: antral follicle count

Alongside AMH, antral follicle count (AFC) is commonly used when discussing egg reserve.

AFC is a visual count of small follicles seen on ultrasound. It reflects how many follicles are recruitable at that moment in time.

AFC and AMH often move in the same direction, but they are not the same measurement. AFC describes what can be seen. AMH reflects which follicles are active.

Why AMH is not an egg-quality number

Egg quality is shaped over months within the follicle.

It reflects the environment the egg develops in — cellular support, metabolic conditions, and structural continuity as the follicle grows and ovulates.

AMH does not assess these processes.

A low AMH result does not automatically imply poor egg quality. A higher AMH result does not guarantee it. AMH tells us how many follicles are active, not how well an individual egg has developed.

Quantity and function are not the same

Markers such as AMH and AFC answer a narrow question:
How many follicles are active or visible right now?

They do not tell us:
• how resilient those follicles are
• how effectively they support egg development
• how consistent ovarian activity may be over time

This is why two people with similar AMH levels can have very different reproductive experiences.

Premature Ovarian Insufficiency (POI) and AMH

Premature Ovarian Insufficiency (POI) describes a pattern of reduced ovarian activity before the age of 40.

It is associated with irregular or absent menstrual cycles, altered ovarian hormone patterns, and reduced follicular activity compared with what is typical for age.

POI is sometimes referred to as premature ovarian failure, but this language is misleading.

In POI, ovarian activity is not usually absent. It is often intermittent, with periods of low activity followed by periods of follicular growth and, at times, ovulation.

AMH is often low in POI because fewer follicles are actively growing at that point in time — not because the ovaries have permanently stopped functioning.

For this reason, AMH cannot confirm ovarian failure or predict permanent loss of ovarian activity. It reflects current activity, not final capacity.

Placing the numbers back in context

AMH and AFC can be useful when they are used for what they measure:
current follicle activity and availability at a point in time.

Problems arise when these numbers are treated as a verdict, a countdown, a trigger to implement interventions or a substitute for understanding follicle biology.

When placed back into context, they become what they were always meant to be — limited markers, not definitions of fertility.

Egg reserve is about quantity.
AMH is about current activity.
Egg quality is shaped elsewhere, over months.

That is precisely where nutrition works.

Follicles are metabolically active structures providing the energy and nutrients your egg needs while it is maturing, ready for fertilization. Even after ovulation, their role continues as they produce the progesterone needed to sustain the pregnancy. An egg maturing towards ovulation develops over several months, including approximately 90 days in which your meals, nutrient intake, sleep and metabolic health contribute to the environment in which that egg develops Your partner’s sperm follows a similar cycle.

Targeted nutrition can support that process for both of you.

The Now Baby 90-Day Low AMH Nutrition Protocol is professionally designed around that window — nutrient-dense, blood sugar-balancing, and deliberately constructed to support the cellular conditions that egg and sperm quality depend on.

Is Your Fertility Being Impacted by Everyday Toxins?

When people think about fertility challenges, it’s easy to focus on the “big things”: irregular cycles, PCOS, low AMH, endometriosis, or age-related fertility decline. But everyday habits and products can also influence reproductive health in quieter, less obvious ways.

These exposures add up over time — a concept often called toxic load. Our liver and detox pathways work hard to keep the body in balance, but constant low-level exposure to chemicals can place extra demand on those systems.

This doesn’t mean you need to fear your environment. Instead, it’s about becoming aware of common sources of exposure and making practical choices that reduce unnecessary load.

In this post, we’ll explore three main routes toxins enter the body — ingestion, inhalation, and absorption — and how to make simple swaps that lighten the load.

 

Ingestion: What Goes In Through Food and Drink

Food is nourishment, but it can also carry substances you didn’t ask for.

• Pesticides and fertilisers can remain as residues on crops.

• Food packaging and cookware may introduce chemicals such as PFOAs, sometimes called “forever chemicals,” that persist in the body and may influence hormone balance.

• Burnt or heavily processed foods form compounds that add to toxic load.

• Chewing gum releases ingredients that are absorbed along with saliva.

• Water can contain halogens such as chlorine or fluoride. Reboiling water repeatedly may also concentrate minerals.

• Microplastics are now so widespread that they have been detected in human placentas, highlighting just how pervasive environmental exposure has become. While the full impact is still being studied, their presence raises important questions for fertility and pregnancy.

💡 Practical step: Wash produce thoroughly, use fresh water for boiling, consider stainless steel or cast-iron cookware over scratched non-stick pans, and reduce reliance on single-use plastics where possible.

Inhalation: The Air You Breathe

Breathing seems simple, but the air indoors can carry more than just oxygen.

• Fragrance products such as air fresheners, scented candles, and sprays often contain phthalates — chemicals that make scents last longer.

• Volatile Organic Compounds (VOCs) are also released from fire-retardant finishes on sofas, mattresses, and even some pillows.

Phthalates, Implantation, and Early Miscarriage

Phthalates are of particular concern when trying to conceive. Research has found higher levels of certain phthalates associated with reduced implantation success and a higher likelihood of very early miscarriage sometimes called a chemical pregnancy.

💡 Powerful stat: Women undergoing IVF with the highest DEHP phthalate exposure had a 38% chance of clinical pregnancy per cycle, compared with 57% for those with the lowest exposure.

While studies don’t prove cause and effect, they highlight how everyday inhaled exposures can accumulate and affect reproductive outcomes.

💡 Practical step: Choose fragrance-free personal care and cleaning products, and ventilate indoor spaces regularly.

Absorption: What Touches Your Skin

What goes onto the skin doesn’t always stay there — ingredients can enter the bloodstream within seconds.

• Hand sanitisers and soaps may contain triclosan, a chemical with potential hormonal effects.

• Till receipts are often coated with BPA, an oestrogen-mimicking compound that transfers to the skin on contact. Casual handling of receipts here and there may not seem like much — but for retail workers handling them all day, exposure is far greater. This highlights how your job itself can sometimes be part of the fertility problem landscape, adding to the overall toxic load.

• Disposable period products can contain bleach residues, dioxins, or plastics — factors worth considering for women with endometriosis or painful periods, where reducing inflammatory load is especially important.

• Shampoos and shower gels often use preservatives like sodium benzoate, another compound with oestrogen-like activity.

 

💡 Eye-catching study: BPA has been detected in the urine of over 90% of people tested in US, showing just how universal exposure has become.

💡 Practical steps:

• Opt for BPA-free or digital receipts where possible.

• Explore reusable menstrual products such as cups or period underwear.

• Look for personal care items labelled “fragrance-free” or “BPA-free.”

Reducing Toxic Load on the Fertility Journey

It isn’t possible to avoid every chemical — and that’s not the goal. Normally, we’re told “the dose makes the poison” — meaning a substance only becomes harmful if you’re exposed to a large enough amount. But endocrine-disrupting chemicals don’t behave that way. They act like hormones, and hormones work in tiny, whisper-small amounts. This means even low levels of exposure can influence the signals your reproductive system relies on.The real aim is to make small, mindful choices that reduce unnecessary exposures so your body can use its energy and nutrients for healthy function.

For women with PCOS, endometriosis, low AMH, or recurrent miscarriage, this can be an important part of creating a more supportive environment for conception (see personalised pre-conception support options).

Ready for clarity about what actually matters for your fertility — without overwhelm?

Bring your questions, leave with clarity – Book your Fertility Focus Hour here

 

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Key Takeaway

Toxic load isn’t about a single product or one bad habit. It’s the accumulation of many small exposures over time. By making thoughtful swaps — from cookware to candles to shampoo — you can reduce that load and support your body’s natural balance when trying to conceive.

 

Publicly funded assisted human reproduction (AHR) has been live in Ireland since 2023. Fertility treatment that was once entirely private is now partially funded through the HSE and delivered through the public fertility pathway.

During this same period, fertility legislation has been enacted and the Assisted Human Reproduction Regulatory Authority (AHRRA) has been formally established.

However, while funding is live and treatment is being delivered, system-level outcome regulation has not yet been embedded. In particular, live birth is not measured as a tracked outcome across the publicly funded fertility pathway.

 

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How publicly funded fertility care currently operates

The State allocates approximately €30 million annually to Ireland’s public fertility Model of Care, as defined by the HSE and the Department of Health.

This funding supports a multi-stage pathway. Patients enter through primary care, progress to HSE fertility hubs for assessment and management, and for a subset of patients, are referred onward for Assisted Human Reproduction (AHR).

AHR treatment — including IUI, IVF, and ICSI — is publicly funded but delivered by private fertility clinics under HSE funding arrangements.

According to the HSE’s most recently published figures, approximately one third of patients referred through the public fertility pathway progress to AHR.

The remaining majority complete the pathway without achieving a live birth. HSE-published data indicates that approximately 70% of patients entering the publicly funded fertility pathway do not achieve a live birth, regardless of whether they progress to AHR

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Regulation: established in law, limited in operation

The Health (Assisted Human Reproduction) Act 2024 provides the statutory framework for fertility regulation in Ireland. Under this Act, the Assisted Human Reproduction Regulatory Authority (AHRRA) has been formally established.

The Authority is intended to license fertility clinics, set enforceable standards of practice, oversee compliance, and regulate donor-assisted conception and surrogacy.

However, while the Authority exists in statute, system-level regulatory functions are not yet fully operational across publicly funded fertility care. In particular:

• fertility clinics delivering publicly funded AHR are not yet operating under a mature, inspection-led regulatory regime
• there is no established system of routine, regulator-verified clinic inspections specific to fertility care
• there is no mandatory, system-wide public reporting of outcomes across the publicly funded fertility pathway

Publicly funded fertility treatment is therefore being delivered through outsourced private providers without an established framework for system-level accountability.

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Live birth: the outcome patients are seeking

Patients enter the HSE fertility pathway seeking a live birth. That outcome — not access, referral, or treatment initiation — is the measure that matters to those using the system.

At present, live birth is not tracked as a system-level outcome across the publicly funded fertility pathway, including outsourced AHR provision.

This means that neither patients nor the State can evaluate whether publicly funded fertility care is delivering the outcome it is designed to achieve.

Without live birth as a tracked system outcome:

• patients cannot assess the likelihood of success when entering the pathway
• performance cannot be compared across providers or stages of care
• improvement cannot be measured over time
• accountability remains diffuse

This is not a judgement on individual clinicians or clinics. It is a structural observation about what the system measures — and what it does not.

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Why outcome measurement matters in a funded system

Public funding creates obligations beyond eligibility criteria. It requires the ability to assess whether the system is functioning effectively.

In the absence of outcome measurement, patients are asked to enter the publicly funded fertility pathway without visibility on the likelihood of achieving a live birth.

At a policy level, decisions about access and funding are therefore made without reference to verified outcome data.

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How the UK system differs

The UK offers a useful comparison.

Fertility clinics in the UK are regulated by the Human Fertilisation and Embryology Authority (HFEA), an independent statutory regulator with operational oversight.

The HFEA licenses clinics, conducts inspections, and publishes verified clinic-level data, including treatment volumes, pregnancy rates, live birth outcomes, and inspection findings.

This data is publicly accessible and updated on a routine basis.

The difference between the Irish and UK systems is not funding alone. It is the presence of operational regulation, outcome transparency, and system-wide visibility.

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Final reflection

Publicly funded fertility care represents an important shift in Irish healthcare.

That does not make scrutiny premature. It makes it necessary.

Live birth is the outcome patients enter the HSE fertility pathway seeking.
It must also be the outcome the system is designed to measure.

In the absence of system-level live birth measurement,  evidence-based preparation becomes the primary mechanism through which outcomes can still be positively influenced. Preparation is not about adapting to system constraints. It is about shaping the biological conditions that determine whether fertility treatment has the capacity to succeed — including metabolic health, inflammatory load, nutrient sufficiency, sperm quality, and cycle function — before eligibility thresholds, waiting times, and treatment decisions narrow what is possible. In a system that emphasises assessment and triage rather than preparation for success, this phase becomes the primary opportunity for influencing outcome.

GLP-1 drugs and fertility are becoming closely linked as more women are advised to lose weight in order to have the baby they’re hoping for.

Body mass index (BMI) is a blunt screening tool, yet both the HSE and the NHS use it to restrict access to fertility treatment, narrowing women’s options long before individual physiology is properly assessed.

As a result, some women begin to consider GLP-1 medications not as a weight-loss choice, but as a means of regaining access to care and moving closer to the baby they are trying to bring home.

This decision is rarely taken lightly and often arises after months or years of being told that treatment cannot proceed until a BMI threshold is met.

What is less often explained is how GLP-1 drugs work inside the body — and how those same mechanisms intersect with egg development, implantation, and early pregnancy stability.

GLP-1 drugs and fertility: what changes inside the body

GLP-1 drugs work by amplifying satiety signals in the gut and brain, reducing appetite, slowing gastric emptying, and altering insulin and glucose signalling.

In doing so, they change how much food is eaten, how nutrients are absorbed, and how energy is made available at a cellular level.

These effects can be helpful for weight loss, but fertility relies on those same systems to support egg maturation, embryo growth, and implantation.

In fertility physiology, metabolic support matters more than weight alone.

Weight change is often a downstream reflection of eating patterns, insulin signalling, and inflammatory load, rather than a driver of reproductive function in its own right.

In some cases, higher body weight is itself a consequence of conditions such as insulin resistance or polycystic ovary syndrome (PCOS), rather than evidence of poor habits or inadequate effort.

Why appetite suppression affects nutrients as well as energy

Fertility is supported by a steady supply of both energy and nutrients over time, not by short-term restriction or rapid metabolic shifts.

Long before ovulation occurs, eggs are already maturing inside the ovary, drawing on a wide range of nutrients to support development, fertilisation, and early embryo growth.

When appetite is suppressed, overall food intake often falls, reducing not just calories but the vitamins, minerals, fats, and proteins needed for reproductive tissues to function well.

One practical example is vitamin D. Nutritional deficiencies have been reported during GLP-1 therapy, with vitamin D deficiency noted as the most common pattern.

Because vitamin D supports immune balance and inflammatory regulation, low vitamin D can quietly reduce the steadiness needed for ovulation and implantation, even when weight loss appears clinically “successful”.

Slower digestion can further limit how efficiently nutrients are absorbed and delivered where they are needed.

Over time, this can leave eggs and the uterine lining under-supported, even when body weight changes in the intended direction and standard blood tests remain within range.

This is one reason fertility can feel confusing in BMI-restricted systems: weight can change while the deeper resource picture remains unchanged.

Lean tissue loss and why muscle matters for metabolic stability

One of the less visible effects of GLP-1 drugs is how quickly the body can lose lean tissue alongside fat.

Research has shown that a significant proportion of weight lost on some GLP-1 medications may come from lean mass, including muscle, particularly when protein intake falls.

This matters for fertility because muscle is not just structural — it plays an active role in blood sugar regulation, insulin sensitivity, and metabolic stability.

When lean tissue is lost, the body can become less efficient at handling glucose and distributing nutrients evenly.

This can increase reliance on stress pathways to maintain blood sugar, subtly raising cortisol and inflammatory signalling.

For reproductive tissues, which are highly sensitive to metabolic stress, this shift can reduce the resources available for egg development and endometrial receptivity.

Inflammation, brain signalling, and fertility timing

Alongside changes in intake and lean tissue, GLP-1 drugs also influence inflammatory signalling in the body.

These medications have been associated with reductions in certain inflammatory markers, and many people describe improvements in pain and metabolic symptoms.

In fertility work, inflammation is never only a number — it is a signalling environment.

One area that is especially sensitive is the hypothalamus — a small but critical region of the brain that helps regulate appetite, blood sugar, stress hormones, and reproductive signalling.

When the body experiences rapid changes in intake, digestion, or metabolic balance, the hypothalamus can become inflamed or dysregulated, even in the absence of obvious symptoms.

This can interfere with how hunger cues, insulin signals, and reproductive hormones are coordinated over the cycle.

Ovulation, luteal function, and implantation depend on stable communication between the brain, ovaries, uterus, and metabolic tissues.

When inflammatory or stress signals dominate, the body may subtly down-regulate reproductive processes in favour of maintaining short-term balance.

These shifts do not always show up on routine tests, but they can influence cycle regularity, egg quality, implantation, and early pregnancy stability.

Gut inflammation: the missing link many women feel but are not told to name

Gut inflammation is another important part of this picture, particularly when appetite suppression and slower digestion are involved.

When food intake drops or gastric emptying slows, the balance of bacteria in the gut can shift, and the protective lining of the intestine may become less robust over time.

This can allow inflammatory compounds from the gut to enter the bloodstream more easily, a process often described as metabolic endotoxemia.

Low-grade gut-derived inflammation places an additional burden on the immune and hormonal systems.

For fertility, this matters because implantation and early pregnancy rely on a finely tuned immune response — active enough to support tissue remodelling, yet tolerant enough to accept an embryo.

When inflammatory signals are elevated, even subtly, the uterine environment can become less receptive.

For some women, these gut changes show up as very tangible digestive symptoms.

Flatulence, bloating, and altered bowel habits are commonly reported with GLP-1 drugs and can be a sign that digestion has slowed and the balance of gut bacteria has shifted.

While often dismissed as minor side effects, these symptoms can indicate changes in fermentation patterns and gut transit that affect the microbiome more broadly.

The gut microbiome plays an important role in shaping immune responses throughout the body, including in the uterus.

During implantation, the immune system must strike a precise balance — supportive enough to allow tissue remodelling, yet tolerant enough to accept an embryo.

Signals originating in the gut help regulate this balance through microbial metabolites, inflammatory mediators, and communication with immune cells.

When the microbiome is disrupted or gut inflammation is present, these signals can become less stable.

This may reduce endometrial receptivity and increase the risk of implantation difficulties, even when ovulation and hormone levels appear adequate.

In this way, digestive symptoms can act as early, real-world indicators that the internal environment needed for implantation may be under strain.

What GLP-1 physiology reveals about a fertility-safe pathway

This is where the body’s own GLP-1 signalling pathway becomes important to understand.

GLP-1 is not only a drug target — it is also a hormone the body naturally produces in response to certain foods, particularly fermentable fibres.

When specific fibres and plant compounds reach the lower gut, they are fermented by bacteria into short-chain fatty acids.

These short-chain fatty acids act as signalling molecules.

They support the gut lining, help regulate immune responses, and stimulate natural GLP-1 and related satiety hormones in a way that is slower, more distributed, and more physiologically contained.

For fertility, this matters because this pathway supports nutrient absorption, metabolic stability, and immune balance at the same time — rather than prioritising appetite suppression alone.

This broader physiological context can be especially important when fertility treatment access is tied to BMI thresholds.

Understanding how gut signalling, nutrient availability, inflammation, and metabolic stability interact allows fertility decisions to be made with more clarity, rather than pressure alone.

Fertility Focus Hour

If you’re considering GLP-1 medication because fertility treatment access is being restricted by BMI, a Fertility Focus Hour allows us to assess what is actually happening in your body before you make that decision.

In this one-to-one session, we examine your cycle history, metabolic and inflammatory patterns, gut function, and nutrient sufficiency to understand how your current physiology may be influencing ovulation, implantation, or early pregnancy stability.

The aim is targeted advice to identify what is most likely to move your fertility forward — and what carries risk — so decisions are made with precision rather than pressure.

This is a focused, clinical hour designed to replace guesswork with clarity.

When pregnancy is the goal, timing and physiological readiness matter just as much as access or eligibility.

At Now Baby, we support fertility through physiology-led nourishment, translating complex biology into everyday food.

PCOS and Fertility: Understanding and Managing a Complex Condition

Poly cystic ovaries (PCO)and Poly Cystic Ovarian Syndrome (PCOS) are conditions affecting people with ovaries during their reproductive years.

While these conditions are known for their affect on menstrual cycles, they originate as metabolic disorders affecting insulin sensitivity, which spills into menstruation due to it’s impact on oestrogen.

PCOS is a multifaceted condition, and your experience with it is unique. In this article, we will explore the causes, symptoms, diagnosis methods, the spectrum of PCOS experiences from lean to mean, its impact on fertility and pregnancy, and how to manage PCOS naturally. We’ll also discuss why the birth control pill isn’t a one-size-fits-all solution.

What Causes PCOS? (Genetic, Hormonal & Environmental Factors)

Polycystic Ovary Syndrome (PCOS) is a complex condition with a variety of contributing factors:

• Genetic Factors: There is evidence that PCOS can run in families. If your mother or sister has PCOS, you may be at a higher risk.
• Hormonal Imbalances: PCOS is characterized by an excess of androgens (male hormones) in the body, which can lead to irregular menstrual cycles and other symptoms.
• Insulin Resistance: Many women with PCOS have insulin resistance, a condition where the body’s cells don’t respond effectively to insulin. This can lead to elevated insulin levels and increased androgen production.
• Environmental Factors: Exposure to certain environmental pollutants and endocrine-disrupting chemicals may also play a role in the development of PCOS.

 

Common PCOS Symptoms and Their Impact

PCOS can manifest in various ways, and not all women will experience the same symptoms:

• Irregular Menstrual Cycles: Missed periods or unpredictable menstrual cycles are common.
• Anovulatory cycles: Due to oestrogen dominance ovulation may be suppressed.
• Miscarriages: PCOS sufferers may experience a higher rate of miscarriage than average.
• Hirsutism: Excessive hair growth in places like the face, chest, and back.
• Acne and Oily Skin: Increased androgens can lead to acne and oily skin.
• Weight Gain, especially around the middle: Many women with PCOS struggle with weight management.
• Cravings: Poor insulin sensitivity can lead to cravings and binge eating.
• Mood Swings and Depression: Hormonal imbalances can affect mood.
• Hair Loss (Alopecia): Thinning hair or hair loss on the scalp.

How PCOS Is Diagnosed

The Rotterdam criteria, established in 2003 by the Rotterdam Consensus Group, are used in Western medicine to diagnose PCOS and require the presence of at least two out of three of the following features:

1. Oligo-ovulation or anovulation: This refers to irregular or absent menstrual periods, which may manifest as infrequent periods or complete absence of menstruation (amenorrhea).
2. Clinical and/or biochemical signs of hyperandrogenism: Clinical signs include hirsutism (excessive hair growth in a male pattern), acne, or male-pattern balding. Biochemical signs involve elevated levels of androgens, such as testosterone, in the blood.
3. Polycystic ovaries on ultrasound: This criterion is met when an ultrasound examination reveals the presence of polycystic ovaries. Polycystic ovaries typically exhibit multiple small follicles (cysts) in the ovaries.

So you don’t necessarily need to have actual multiple cysts in order to have this condition and not having multiple cysts does not exclude this diagnosis. I like to add the Functional medicine approach of using the LH/FSH ratio from Day 2 blood tests. A typical LH/FSH ratio in women without PCOS is around 1:1. In PCOS, the ratio may be higher, often greater than 2:1.Using this criteria I prefer to factor PCOS in as a possibility rather than rule it out. The women I work with are mostly trying to conceive, so they don’t want to waste time trying things that don’t work so it is best to get to the root of the problem as quickly as possible.

Why Weight Management Is Harder with PCOS

PCOS can affect women of all body types. It’s not solely related to weight. Lean PCO refers to women with a normal or lower body mass index (BMI) who still experience PCO symptoms. This highlights the diversity of the condition.

Frustration with Weight Management:

• Many women with PCOS experience significant challenges when it comes to weight management. The hormonal imbalances associated with PCOS can make it harder to lose weight and easier to gain it.
• Despite their best efforts, including calorie restriction and regular exercise, some individuals may see limited progress or no weight loss at all.

Feeling Misunderstood:

• One of the most significant frustrations for people with PCOS is the feeling of being misunderstood by healthcare providers, friends, and even family members. Some may hear insensitive comments like “just eat less and exercise more” without recognition of the unique challenges posed by PCOS. The weight gain is not always a result of consuming additional calories, but in the body processing insulin ineffectively.
• The struggle to lose weight is often perceived as a lack of willpower, which can be disheartening and isolating.

3. Emotional Impact:

• PCOS can have a profound emotional impact, leading to feelings of frustration, sadness, and even depression. The constant struggle with weight can erode self-esteem and body image.
• The emotional toll of PCOS can affect relationships, work, and daily life.

While the frustration of weight management is significant, it’s vital to remember that PCOS is more than just a weight issue. It’s a complex hormonal condition that affects various aspects of your health, including menstrual cycles, fertility, and metabolism. Embracing a holistic approach to health, one that focuses on overall well-being rather than just weight loss, can empower you.

PCOS and Fertility: What You Can Do

PCOS can complicate the path to fertility due to irregular ovulation. But remember, you’re not alone. There are options such as lifestyle changes, medications, and assisted reproductive technologies to help you realize your dream of parenthood. In women with PCOS, a low-GI diet for example, more than tripled the number of ovulatory cycles.

PCOS and Pregnancy: Reducing Risks

During pregnancy, women with PCOS may face an increased risk of complications such as gestational diabetes and preeclampsia. Maternal age and obesity can also add to these risks, so ideally whatever can be addressed prior to conception will make for a healthier pregnancy with fewer necessary interventions.

Managing PCOS Naturally with Nutrition & Lifestyle

Taking control of your health naturally is empowering. Consider:

• Diet: A balanced, low glycemic index diet can be beneficial. This may switch off fat storage, reduce cravings and restart ovulation or menstruation.
• Exercise: Regular physical activity helps manage symptoms. Simple walking can improve insulin sensitivity.
• Stress Management: Techniques like yoga, reflexology and meditation can improve well-being.
• Supplements: Inositol supplements may help regulate menstrual cycles, while Vitamin D may improve insulin sensitivity.
• Gut health: A balanced and healthy gut microbiome can aid in regulating hormones and reducing inflammation, both of which are key factors in PCOS. Research suggests that a healthy gut can help improve insulin sensitivity, leading to better blood sugar control. Additionally, a well-functioning gut can support the body in processing and eliminating excess hormones, potentially alleviating some PCOS symptoms. Therefore, focusing on gut health through a balanced diet, probiotics, and lifestyle changes may complement PCOS management strategies and promote overall well-being.

Feeling ready to take control of your hormones?

The Fertility Focus Hour is designed for women with PCOS who want to understand what’s driving their symptoms and create a clear, personalised plan.

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Xenoestrogens and PCOS: What You Need to Know

Xenoestrogens are synthetic or naturally occurring chemicals that can mimic the effects of estrogen in the body. Exposure to these compounds has raised concerns about their potential impact on hormone-related conditions like PCOS (Polycystic Ovary Syndrome).

Understanding Xenoestrogens and Their Sources: Xenoestrogens, also known as environmental oestrogens, are substances found in the environment that can disrupt the endocrine system by mimicking the actions of oestrogen. They can be natural or synthetic and are commonly found in various products and pollutants, including:

1. Pesticides: Many pesticides used in agriculture contain xenoestrogens, which can end up in the food supply.
2. Plastics: Bisphenol A (BPA) and phthalates, found in some plastics, can leach into food and beverages, especially when exposed to heat.
3. Personal Care Products: Some cosmetics, lotions, and shampoos may contain xenoestrogens, like sodium benzoate, which can be absorbed through the skin.
4. Processed Foods: Some processed foods contain additives and preservatives that may have xenoestrogenic properties.

The Link Between Xenoestrogens and PCOS: While research on the direct relationship between xenoestrogens and PCOS is ongoing, there are several concerns about how exposure to these compounds may contribute to the development or exacerbation of PCOS:

1. Hormonal Imbalance: Xenoestrogens can disrupt the body’s hormonal balance by binding to oestrogen receptors, potentially leading to hormonal imbalances associated with PCOS.
2. Insulin Resistance: Some studies suggest that xenoestrogens may contribute to insulin resistance, a key factor in PCOS development.
3. Ovulatory Dysfunction: Exposure to xenoestrogens may interfere with normal ovulation, exacerbating fertility issues common in PCOS.
4. Inflammation: Xenoestrogens may promote inflammation, which is often observed in women with PCOS.

Reducing Xenoestrogen Exposure: To minimize potential risks associated with xenoestrogens, individuals with PCOS and those at risk should consider taking the following precautions:

1. Choose Organic Foods: Opt for organic produce and meats to reduce exposure to pesticides and hormones commonly used in conventional farming.
2. Avoid Plastics: Use glass or stainless steel containers for food and beverages instead of plastic containers, especially when heating food.
3. Check Product Labels: Read product labels for ingredients like parabens, phthalates, and BPA, and choose products that are free of these substances.
4. Limit Processed Foods: Reduce your intake of heavily processed foods, which may contain additives and preservatives.
5. Support Detoxification: Improving gut health and reducing gut permeability can set up a positive chain reaction.

While the relationship between xenoestrogens and PCOS is an area of ongoing research, taking steps to reduce exposure to these substances can be a proactive approach to managing the condition and supporting your overall health.

Why the Pill Doesn’t Fix PCOS

While birth control pills can provide temporary relief for some PCOS symptoms, they don’t address the underlying causes. The bleed experienced between pill packs is not a period, it is a response to the withdrawal from medication. The Birth Control Pill does not regulate your cycle.

Long-term use may also have side effects that impact your journey, particularly in relation to heart and bone health as well as gut integrity.  It’s essential to explore alternatives tailored to your unique needs and goals.

Ready to start balancing your hormones through food?

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From Struggle to Strength

You are not defined by PCOS. With the right support, your hormones, cycles, and fertility can thrive again. Now Baby offers compassionate, evidence-based fertility nutrition and coaching online worldwide.

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