For many women and couples, being told they have “unexplained infertility” can feel both confusing and deeply frustrating. On paper, everything looks normal. Hormone levels fall within range, ovulation appears to be happening, and there are no obvious structural issues. Yet month after month, pregnancy doesn’t occur.

All too often, patients given this diagnosis are not told why they’re not conceiving, or in some cases, why they’re unable to sustain a pregnancy. And that’s why “unexplained infertility” shouldn’t be accepted as a diagnosis, because it’s not. It’s a “we don’t know.” And where does that leave the patient? Often a year down the line, thousands of pounds out of pocket and none the wiser.

In many cases, the root cause of infertility simply hasn’t been explored deeply enough.

Within NHS and private clinics, fertility assessments typically include blood tests to assess hormone levels, pelvic ultrasound scans to check for structural issues, and a basic semen analysis for males. These are all essential and incredibly valuable tests. However, they don’t always assess how the body is functioning on a deeper level. And it’s often within this space that we find the missing pieces of the client’s fertility jigsaw.

Take thyroid function, for example. The thyroid plays a pivotal role in regulating ovulation, hormone balance and early pregnancy outcomes and even subtle dysfunction can significantly impact fertility.

It’s not uncommon for women to be told their thyroid results are “normal,” but this is often based on measuring a single marker (TSH), rather than looking at the full spectrum of thyroid hormones and how they’re interacting with each other. When we assess this more comprehensively, we often uncover imbalances that may be affecting ovulation, implantation or early pregnancy outcomes.

Another key area that is frequently overlooked is metabolic health, particularly blood sugar balance. Even in women who appear outwardly healthy, subtle disruptions in blood glucose regulation and insulin sensitivity can have a meaningful impact on fertility. When blood sugar levels rise and fall rapidly (often driven by long gaps between meals, under-eating, high intake of refined carbohydrates or chronic stress), the body is required to produce more insulin to keep levels stable.

Over time, cells can become less responsive to insulin, meaning the body needs to produce even more. This matters because insulin is not just a blood sugar hormone; it also acts as a powerful signalling hormone within the reproductive system. Elevated insulin levels can stimulate the ovaries to produce more androgens (i.e., testosterone), which can disrupt follicle development, delay or prevent ovulation and impact egg quality.

Importantly, these imbalances don’t always show up on standard blood tests. Fasting glucose may sit comfortably within range, while underlying insulin dynamics remain unaddressed. This is why looking beyond basic markers and considering how the body is functioning day-to-day is so valuable.

Gut health is another critical, yet often ignored, factor. The gut microbiome plays a central role in regulating inflammation, supporting immune function and influencing how hormones such as oestrogen are processed in the body. Imbalances here can create an internal environment that is less supportive of conception, yet this is rarely investigated as part of routine fertility care.

It’s also important to acknowledge the role of male fertility. Around 40–50% of fertility challenges involve a male factor, yet investigation often stops at a basic semen analysis. While useful, this doesn’t always tell us the full story. Sperm quality can be influenced by nutrition, inflammation, oxidative stress and lifestyle factors, all areas where targeted support can make a meaningful difference.

What becomes clear when you look at fertility through this wider lens is that it is rarely governed by a single factor. Instead, it reflects how well the body is functioning as a whole. Small imbalances across multiple systems, thyroid, metabolic, nutritional, digestive and lifestyle, can collectively create a significant barrier to conception.

The good news is that these are all imbalances we can do something about. Through a more personalised and investigative approach, it becomes possible to identify and address these imbalances using proven nutrition, supplementation and lifestyle strategies. This doesn’t replace medical care but works alongside it, helping to create the best possible conditions for conception, whether naturally or through IVF/ART.

Being told your infertility is “unexplained” can feel like a dead end. But in many cases, it simply means it hasn’t been explored in enough detail yet. And when we take the time to look more closely, ask better questions and dig a little deeper, there is often a reason and, more importantly, a clear path forward.

Laura Naylor

Laura is a Yorkshire-based registered nutritional therapist specialising in fertility, IVF and pregnancy. Her goal is to first help clients discover & understand the root cause of their health issue, then support them in overcoming this using bespoke, evidence-based nutrition & lifestyle strategies.

Think of her as your fertility detective, using the latest research & functional tests to help you understand what imbalances are affecting your fertility & what you can do about it. Laura offers a range of services, including one-off consultations, functional tests & in-depth 3-month programmes.

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