The biggest gap in fertility care is the lack of investigation into the underlying drivers of suboptimal outcomes. Many are told everything looks “normal,” yet they’re struggling to conceive, experiencing loss or not getting the results they hoped for with IVF. The missing piece is often this: We’re not asking why.

Hormones are a clear example. Progesterone is commonly supplemented, but rarely is there a deeper look at why the body isn’t producing enough. Chronic stress, blood sugar dysregulation, inflammation and nutrient deficiencies all impact hormone production. The same applies to thyroid health—levels may fall within a conventional range, yet still be insufficient to support ovulation, implantation and early pregnancy.

At the foundation is metabolic and GI health. Blood sugar imbalances and insulin resistance can impair egg quality, mitochondrial function and hormone production—even without a diagnosis like PCOS. At the same time, GI dysfunction affects nutrient absorption, inflammation and hormone metabolism. If the foundation isn’t strong, the downstream effects often show up in fertility and cycle health.

We also have to consider the environment an embryo is implanting into. Endometrial receptivity is not just about thickness—it involves inflammation, immune signaling and microbial balance. The vaginal microbiome plays a role as well, influencing sperm survival, fertilization and implantation in ways that are often overlooked.

Immune regulation is another critical piece. The body must shift in a very specific way to recognize and support pregnancy. When that communication is off, it can prevent implantation or contribute to recurrent loss.

While much of the focus is on egg quality, sperm health is often evaluated using ranges that reflect what is common, not optimal. Subtle changes in motility, morphology and DNA integrity can significantly impact fertility, pregnancy outcomes and the health of a baby.

IVF and ART can be powerful tools, but they don’t address these underlying factors—they work around them. Without supporting the whole system, we miss opportunities to improve success rates and long-term outcomes.

This is where preconception preparation becomes essential. By supporting thyroid function, metabolic health, gut integrity, immune balance and both egg and sperm quality, we’re creating the conditions for a healthy pregnancy, healthy mom and healthy baby.

Dr. Arculeo and Dr. Heaney-Burcher provide individualized, root-cause-focused care through Root & Restore, 24 Wilkins Ave., Haddonfield, NJ. Arculeo also owns the Natural Life Wellness Store, 480 E. Evesham Rd., Unit 103, Cherry Hill, NJ. Call or text 732-641-2217 to learn more.