Like many, I sought answers beyond conventional treatments, which led me to the transformative power of functional medicine. Functional medicine not only helped me to achieve conception but is giving me the energy to be the kind of mom I want to be. In this post, I’ll share how functional medicine addresses fertility challenges from a holistic perspective, looking at the root causes of imbalances and giving way to support your reproductive health naturally. 

Conventional medicine often treats symptoms in isolation, whereas, functional medicine takes a comprehensive view of your body’s core systems. It identifies and addresses the root causes of issues like hormonal disarray, gut health, and stress. Root causes can include gut dysbiosis, food intolerance, leaky gut, nutritional deficiencies, medication impacts, environmental toxins, detoxification overload, stress, immune system dysfunction, mitochondrial dysfunction, and genetics/epigenetics. Specific laboratory testing can find the individual root causes affecting a woman's or man’s fertility. It is important to assess both the man and woman’s fertility factors. Based on the root cause analysis, a personalized treatment plan can be introduced. 

My own fertility journey started with a struggle against endometriosis, which led to years of infertility and deep emotional challenges. I initially tried conventional medical treatments like clomiphene, letrozole, intrauterine insemination, and even invitro fertilization (IVF). I did become pregnant with IVF but then had a stillbirth at six months due to inflammation in my body. As conventional medicine failed to provide positive results, I spent a year coping with my grief over my daughter and working on my health through functional medicine. Through this holistic approach, which focussed on addressing the root cause of my inflammation and health issues, I was able to put my endometriosis and irritable bowel syndrome (IBS) into remission. This health transformation helped me to achieve a natural pregnancy. Inspired by my personal healing, I now usee functional medicine to help other women overcome fertility challenges, addressing the mind, body, and soul on their pathway to wellness.

The term hormonal imbalance is a misnomer because hormones always shift in levels. But hormones must be at a range of normal and in range with one another. For example, thyroid hormones have normal ranges for the laboratory performing them but a tighter range for fertility benefits and to prevent miscarriages. Also, estrogen may be in the range of what’s considered normal, but due to lower amounts of progesterone, there can be an estrogen excess in the body. These are just a few examples of how hormones may be assessed using functional medicine labs and any derangements can then be stabilized using plant-based herbs which have milder side effects and are easily tolerated compared to conventional hormonal treatments. Hormonal imbalances are a major roadblock to fertility, often linked to PCOS, thyroid issues, or endometriosis. In functional medicine, we dive deeper into hormone testing to uncover imbalances and address them with personalized protocols, including diet, supplements, and lifestyle changes.

One of the most challenging journeys a woman can face in her lifetime can be the struggle of infertility.

The estrogen-gut axis involves the breakdown and recycling of estrogen by gut bacteria. These collective gut bacteria involved in estrogen breakdown are called the estrobolome. A rich estrobolome helps in the metabolism and excretion of excess estrogens, thus stabilizing hormonal balance. 




Dysbiosis, gut inflammation, or poor digestion can lead to a relative estrogen excess, also termed estrogen dominance. In this condition, the estrogen levels are too high compared to the progesterone levels and this can affect ovulation and implantation of the embryo. It can cause or worsen conditions like PCOS, endometriosis, and an-ovulation, which is the absence of ovulation. Dysbiosis can also affect the gut-brain axis, which is a bidirectional communication system between the gut and the brain, largely mediated by the gut microbiome, lymphoid tissue, and the vagus nerve. Imbalance gut microbiome can contribute to mental health illness es like anxiety and depression, which can increase stress levels. Research is showing that men’s gut health can also impact fertility by influencing sperm quality.

A microbiome that is balanced supports proper testosterone production and reduces oxidative stress (stress and inflammation at the cellular level), thus improving sperm motility and morphology. Gut health can be achieved using prebiotics, probiotics, eating a nutrient-dense, anti-inflammatory diet rich in fiber, leafy greens, fermented foods, and omega-3s; reducing toxin exposure by switching to natural personal care products and avoiding plastics and nonstick cooking vessels, and stress reduction techniques like meditation, yoga, breathwork, and adequate sleep.

Approximately 70% of the immune system lives in the gut.

Hormones are constantly shifting and can
never truly be in balance. 

Dysbiosis is an imbalance of gut bacteria with not enough
beneficial bacteria and excess pathogenic bacteria.

Gut health is foundational to optimal fertility as it regulates hormone balance, immune function, nutrient absorption, and stress response. 

A healthy gut lining prevents toxins, undigested food particles, and harmful bacteria from entering the blood stream. When the gut lining is damaged, it can lead to leaky gut or intestinal permeability which can trigger widespread inflammation and immune response. Such chronic inflammation can trigger the body into feeling unsafe for fertility and implantation of an embryo. It can disrupt ovulation, impair egg quality, and create a chemically inflamed environment that is too hostile for implantation. Autoimmune conditions and endometriosis are examples of chronic inflammation and linked to gut health. The gut is also responsible for the absorption of vital nutrients from the diet like folate, iron, zinc, selenium, ane omega-3 fatty acids. Poor gut health can lead to malabsorption and nutrient deficiencies, which can then negatively affect egg quality, hormone production, and overall reproductive function, 

 Stress can negatively impact fertility. Stress can include internal factors like gut dysbiosis or autoimmune conditions. It can also include external factors like environmental toxins and work/personal relationships. Endocrine disrupting chemicals (EDCs) like polychlorinated bisphenols (PCBs), phthalates, dioxins, and bisphenol A and its analogs are some of many environmental chemicals that can impact fertility. Ways to reduce exposure include avoiding plastics in food preparation, nonstick pans and pots, and eating organically as much as financially possible. Stress can be improved by using mind/body techniques, learning to prioritize tasks, and meditation practices. Herbal supplements and treating gut dysbiosis can also help to improve stress levels. 

- Dr. Sushma Sadula