Told Donor Eggs Were Your Only Option? Sarah's POI Story and What Her REI Never Tested For
What This Article Is About
Premature ovarian insufficiency at 28. An IVF brochure pulled off the shelf. Donor eggs for you. No second opinion. No workup. No investigation into what was actually driving the diagnosis.
This article is not about dismissing a POI or diminished ovarian reserve diagnosis. The numbers are real. What was not evaluated is what this post is about, and what this rebroadcast episode gets into with Monica Cox turning the mic around and interviewing me about the clues my body was giving me for years before the POI diagnosis nobody connected to any of it.
I was 28 years old when I was told donor eggs were my only option.
My OB/GYN pulled an IVF brochure off her shelf in the appointment. Donor eggs for you, Sarah. That was the conversation. I did not get a second opinion. I did not ask why. I went to the REI, got on the donor egg list, and had both my children through IVF with donor eggs. I considered myself lucky that it worked.
What my OB/GYN did not ask about, and what the REI did not ask about, was the rest of the picture. I had been getting my period twice a year for years and had been told that was nothing to worry about. I had cystic acne on a chin that had been clear through my teens. I had a fungal rash on my chest. I had chronic yeast infections in my twenties. I had dark circles under my eyes I remember seeing in the mirror at 12. Every one of those was a signal. Nobody connected any of them to my fertility. I did not connect them either.
It was not until after my children were born that my health started falling apart, that I began putting the picture together. Chronic sinus infections. Chronic bladder infections. Vertigo. Dandruff. Toenail infections. Multiple antibiotic allergies. Eczema. Year after year, symptom after symptom, each one getting managed in isolation while the pattern underneath went unaddressed.
Years later I discovered what had been driving it. Non-celiac gluten sensitivity. A food sensitivity to dairy and corn. And a gut infection with H. pylori, streptococcus, fungal overgrowth, and chronic stress. By the time I found it, I was already fully in menopause. The window had closed. What I found did not change my outcome. But it changed everything about how I understand fertility, and it is the reason Fab Fertile exists.
This post is for women who have just been told donor eggs are their only option, and for women who accepted that diagnosis years ago and have been putting the pieces together since. If you want to read the fuller version of my story,
What the Episode Covers
In this rebroadcast, Monica Cox interviews me about the clues in my twenties that nobody connected to fertility, the post-pregnancy health crash that finally forced the investigation, the food sensitivities and gut infections I discovered too late, why partners have to be in the protocol from day one, why IVF should be the last choice not the first, and where to actually start if you are just diagnosed versus one failed cycle versus multiple failures behind you.
Listen to the episode. Then come back for what the workup should have looked like and what that looks like in practice for the women we work with today.
What Was Never Tested Before Donor Eggs
A POI diagnosis and a donor egg recommendation can both be real without being the full picture. In my case, neither my OB/GYN nor my REI ordered any of the following before the donor egg conversation started. These are the categories that sit outside a standard POI workup and that we look at in every Functional Fertility Second Opinion today.
Full thyroid panel. Not TSH alone. Free T3, Free T4, Reverse T3, TPO antibodies, TGAb, TBG. Hashimoto's is the most common autoimmune condition in women with POI, and TPO antibodies can be elevated while TSH sits in a range that gets called normal. Thyroid antibodies have been found in follicular fluid. The immune system is inside the follicle.
Autoimmune markers beyond thyroid. ANA. Adrenal antibodies when a polyglandular pattern is suspected. Celiac panel, understanding that standard celiac testing requires active gluten consumption to be accurate and carries false positives and false negative risk, which is why we use it as one input among many rather than a standalone diagnostic. Research estimates that between 4 and 30 percent of POI cases have autoimmune origins, and population-level data from a Finnish registry study of 3,972 women with POI found they had hospital-treated autoimmune disorders 2.6 times more often than matched controls before their POI diagnosis.
Gut testing. Comprehensive stool analysis that looks at the DNA of the stool for H. pylori, parasites, bacterial infections, fungal overgrowth, dysbiosis, and markers of gut inflammation and permeability. Not the stool test your GP runs, looking for obvious pathogens. The gut and the ovary are not considered related in a standard fertility workup. They are inseparable.
Food sensitivities. Not celiac testing alone. Non-celiac gluten sensitivity drives immune activation, thyroid dysfunction, and inflammatory load in a way that standard labs miss. In cases we review, it is one of the most consistently underdiagnosed contributors.
Iron and nutrient status. Ferritin, not just hemoglobin. Iron stores can be depleted while hemoglobin reads normal. H. pylori directly impairs iron, B12, and zinc absorption, which are foundational to egg quality, thyroid function, and hormone production. Vitamin D. B12. Homocysteine.
MTHFR and methylation. Present in over 60 percent of the population. The C677T variant reduces enzyme activity that converts folate into its active form by up to 70 percent. Most prenatal vitamins contain folic acid rather than methylfolate. Women with MTHFR variants taking high-dose folic acid may be getting less support than they think.
DUTCH cycle mapping. Cortisol across the diurnal curve. DHEA-S. Reverse T3. The downstream sex hormone picture including progesterone and estrogen metabolites. The HPA axis is upstream of the HPO axis. A depleted adrenal system suppresses reproductive signaling whether or not the person feels stressed.
Partner workup. Semen analysis including morphology, count, and motility. Sperm DNA fragmentation when there has been pregnancy loss, embryo arrest, or failed transfer. Partner stool testing, because H. pylori passes between partners through saliva. Partner food sensitivities. His health is not separate from the picture.
Functional Medicine vs Your REI: Different Scopes, Same Team
Your REI is not wrong. A fertility clinic is built to assess ovulation, tubes, uterus, sperm parameters, hormone baselines, and to deliver assisted reproductive technology when those systems are not producing a pregnancy. That scope is defined, appropriate, and necessary. Karyotyping, fragile X screening, baseline FSH and AMH, antral follicle count, HSG, semen analysis. These are the right tools for what they are designed to find.
Functional medicine sits outside that scope. It is not a replacement. It addresses the questions a fertility workup is not built to answer. What is driving the low AMH. Why the period disappeared. What is creating the inflammatory, autoimmune, or metabolic environment the follicles are developing in. These are questions the clinic does not ask because its role is not to ask them. It is our role.
We work alongside your medical team, not instead of them. Your REI runs the standard workup. We run the one that sits outside it. Both matter, and a real second opinion combines both.
The Nervous System and the Type A Pattern
This is the pattern nobody recognizes in themselves. Not because it is subtle, but because the women who have it are the ones who feel fine. They are high achievers. They have demanding careers. They train hard. They get things done. And their bodies have been running on cortisol reserve for years, while they called it productivity.
I did not feel stressed at 28. I had a demanding job, I was pushing hard, and I considered that normal. That is exactly the pattern. The body was under enormous load while the mind was telling me everything was under control. Chronic stress does not always feel like distress. It feels like a full schedule that you are managing. It feels like being the person who gets it done.
When the HPA axis has been under chronic load for long enough, it suppresses the HPO axis, the communication network governing FSH, LH, estrogen, and progesterone. The body deprioritizes reproduction to keep the high achiever going. The ovarian environment deteriorates not because the eggs have run out, but because the system supporting them has been depleted.
This is a pattern we see consistently in women with POI and DOR who describe themselves as healthy, functional, and not particularly stressed. The DUTCH test tells a story; their sense of themselves does not. A flatlined cortisol curve. Depleted DHEA-S. Elevated Reverse T3. The full picture of a system that has been running on empty.
High-intensity exercise is one of the most common unrecognized contributors. Running marathons, daily intense training on an already depleted adrenal system, these drive cortisol higher rather than releasing it. They accelerate follicle loss. The woman who is proud of her fitness and her discipline is sometimes the woman whose exercise pattern is one of the key drivers of her fertility picture. We are not opposed to movement. We are specific about what type of movement supports a depleted system and what type compounds the load.
The nervous system work is not optional for this population. It is foundational. Addressing diet, gut health, thyroid, and hormones in a body still running on fight-or-flight produces partial results at best. The nervous system has to come down for the reproductive system to come online.
Amanda's Story
Amanda came to us with an AMH of 0.08 ng/mL, a POI diagnosis, irregular cycles, low energy, and a miscarriage behind her. Like me, she had been told a version of "this is what your body can do now." Unlike me, she found the functional approach before the window closed.
In the Fab Fertile Method, we looked at what her standard workup had not covered. Personalized testing. A protocol built around what her body actually needed. Inflammation, hormone balance, and gut health are all evaluated as part of the same biological picture rather than three separate problems managed in isolation.
The shifts came over time. Her cycles became more predictable. Her energy returned. Her body felt more balanced. And she conceived naturally. Her daughter is here.
An AMH of 0.08 ng/mL. A POI diagnosis. A miscarriage behind her. A natural conception. None of these are contradictions. They are what becomes possible when the biological environment in which the AMH number is sitting inside of gets evaluated before donor eggs is presented as the only option.
Her full story: Amanda's success video
What the Research Shows
The research on POI and DOR is usually cited in one direction, to close doors. What rarely gets communicated in a clinic setting is that the biological environment driving the numbers is modifiable, and that modification changes outcomes.
Spontaneous pregnancy in POI. A systematic review of pregnancy outcomes in idiopathic POI reported spontaneous conception rates of approximately 5 to 10 percent. Up to 10 percent of women with spontaneous POI may have a recovery of ovarian function, sometimes resulting in pregnancy. That is not a reason to delay treatment. It is a reason to run a real workup before being routed to donor eggs as the only option.
POI and autoimmunity. In a Finnish population-based registry study of 3,972 women with spontaneous POI and 15,708 controls, women with POI had at least one hospital-treated autoimmune disorder preceding diagnosis 2.6 times more often than matched controls, and a 2 to 3-fold risk for these diseases for years after diagnosis. The autoimmune conditions most commonly overlapping with POI include Hashimoto's thyroiditis, Graves' disease, adrenal autoimmunity including Addison's disease, lupus, rheumatoid arthritis, inflammatory bowel disease, and celiac disease. This is not a fringe association. It is population-level epidemiology.
POI and celiac disease. A 2-sample Mendelian randomization analysis found that genetically predicted celiac disease increases the risk of premature ovarian failure by 16 percent. A Cleveland Clinic study of 9,368 women with celiac disease found they have a six times higher risk for ovarian dysfunction compared to controls. NICE guidelines in the UK already recommend celiac screening for women with unexplained reduced fertility or recurrent miscarriage. US guidelines have not caught up.
Gut microbiota and ovarian reserve. A 2024 study from Dr. Berenice Benayoun's lab at USC found that transferring gut microbiota from post-reproductive mice to young adult mice improved ovarian reserve markers and reduced ovarian inflammatory signals, demonstrating a direct gut-to-ovary pathway through immune signaling that operates independently of hormone levels. The gut is not separate from the ovary.
Donor egg outcomes and the recipient's environment. Thyroid autoimmunity, vitamin D insufficiency, progesterone insufficiency, and endometrial microbiome imbalance all affect implantation and early pregnancy maintenance in donor egg cycles. The egg quality question is removed with donor eggs. The recipient's biological environment is not. Functional preparation before a donor egg cycle is not optional if the goal is a live birth.
Where the science is less settled, we say so. A 2025 systematic review noted that intraovarian platelet-rich plasma injection and mesenchymal stem cell therapy have shown some effect on fertility restoration in POI, but robust studies are lacking. We are not recommending those interventions. We are pointing out that the research community is not treating POI as a closed case, and neither should patients be asked to.
FAQs
I have been told donor eggs are my only option. Do I have to accept that?
You are not obligated to accept donor eggs as your only path. A donor egg recommendation is a clinical suggestion based on the data your REI had in front of them. If that data did not include a full autoimmune screen, gut testing, food sensitivity assessment, full thyroid panel, nutrient status, MTHFR and methylation, or a DUTCH map of your HPA axis, the recommendation was made on an incomplete picture. You can take time to complete the picture before making a decision that closes a door.
What are the risks of a donor egg pregnancy?
Donor egg pregnancies carry higher rates of certain complications than pregnancies using your own eggs. Research consistently shows elevated rates of pre-eclampsia, hypertensive disorders, gestational diabetes, and preterm birth. One review of singleton IVF pregnancies found that pre-eclampsia occurred in 11.2 percent of donor egg pregnancies compared to 3.9 percent of own-egg pregnancies.
These risks are real. We agree with the recommendations. What is less often said is that many of these complications have underlying drivers that can be identified and addressed before the cycle. Thyroid autoimmunity, vitamin D insufficiency, inflammatory load, gut dysbiosis, blood sugar and insulin instability, low progesterone, and nutrient depletion all affect implantation, placental development, and pregnancy maintenance. These are the same patterns that frequently went unevaluated before the POI or DOR diagnosis was made.
This is where the GrowBaby test becomes important. GrowBaby is a nutrigenomic panel that looks at 42 SNPs across 11 biological processes linked to maternal and baby health during pregnancy, including genetic variants that influence risk of pre-eclampsia, gestational diabetes, preterm birth, and miscarriage. When we identify those variants before conception, we can tailor diet, supplementation, and lifestyle to the specific biology, reducing the risks the research describes rather than waiting for them to appear mid-pregnancy.
Donor eggs can be the right path. Functional preparation, including GrowBaby testing alongside the full gut, thyroid, hormone, and nutrient workup, is how we reduce the complication risks. Health matters regardless of which path you choose.
Has anyone actually gotten pregnant naturally after being told donor eggs were their only option?
Yes. Research estimates 5 to 10 percent of women with POI conceive naturally. Among women with DOR who still have some ovarian function, natural conception rates are higher when underlying drivers are addressed. Our own clients include women who were told donor eggs were their only option and went on to conceive naturally after functional preparation.
Amanda came to us with an AMH of 0.08 ng/mL, a POI diagnosis, irregular cycles, low energy, and a miscarriage behind her. After the functional work, she conceived naturally and had her daughter. Amanda's story.
Rebecca was 27 when she was told donor eggs were her only option, with an AMH among the lowest we see. When functional testing identified gut infections, food sensitivities, and adrenal and thyroid imbalances, she and her partner addressed them together. Her REI was stunned by her improved labs and recommended she start IVF immediately. She and her partner chose to try naturally that month instead. She conceived. Rebecca's story.
These are not outliers. They are what becomes possible when the biological environment behind the AMH number gets evaluated before donor eggs are presented as the only option.
What tests should I get before agreeing to donor eggs?
The tests that sit outside a standard fertility workup are often the ones that change the picture. These are the categories we look at in every Functional Fertility Second Opinion:
- Comprehensive stool analysis (GI-MAP) for H. pylori, parasites, bacterial and fungal overgrowth, dysbiosis, gut inflammation, and intestinal permeability
- Full thyroid panel: Free T3, Free T4, Reverse T3, TSH, TPO and TGAb antibodies
- Autoimmune markers, including ANA, adrenal antibodies if indicated, and celiac panel (understanding that standard celiac testing requires active gluten consumption to be accurate)
- Food sensitivity testing
- Ferritin, vitamin D, B12, homocysteine, and full iron panel
- MTHFR and methylation markers
- DUTCH cycle mapping for cortisol, DHEA-S, progesterone, and estrogen metabolites
- GrowBaby nutrigenomic panel to identify genetic variants linked to pregnancy complications before conception
- Sperm DNA fragmentation and stool testing for your partner
These are not replacements for your REI's workup. They are what sits outside it. A real second opinion combines both.
What if my REI disagrees with functional testing?
Functional testing is not standard-of-care for POI, and your REI is not wrong to say so. Standard-of-care is built around a defined scope. Functional testing addresses questions outside that scope. We work alongside your medical team, not instead of them.
My TSH is normal. Do I still need a full thyroid panel?
If POI or low AMH is on the table, yes. TSH alone does not tell you whether you have Hashimoto's, which is the most common autoimmune condition overlapping with POI. A full panel means Free T3, Free T4, Reverse T3, TPO antibodies, and TGAb. A single TSH reading is not a thyroid evaluation.
I don't have digestive symptoms. Can gluten or a gut infection still be part of my picture?
Yes. Women with gut infections and gluten sensitivity driving reproductive symptoms often have no obvious digestive complaints. The presentation includes fatigue, brain fog, skin conditions, recurring infections, and irregular cycles. All of those get managed individually while the driver goes unaddressed. Non-celiac gluten sensitivity is common in the low AMH and high FSH population we see.
Is it too late to run this workup if I am already cycling with donor eggs?
No. This information changes how you manage pregnancy, postpartum health, and any subsequent cycles. It also changes the health baseline you bring into pregnancy, which affects both maternal and infant outcomes. The value of the workup does not expire when the treatment path is chosen.
Stories From the Fab Fertile Community
Amanda, POI, AMH 0.08 ng/mL, miscarriage, conceived naturally,
Rebecca, POI at 27, AMH 0.04 ng/mL, told donor eggs only option, conceived naturally
Stefanie, FSH from 18-60 mIU/mL down to 7 mIU/mL in seven months, successful IVF with own eggs
Timestamps
00:00 Why this episode is for you if you have low AMH, high FSH, DOR, or POI
02:00 Diagnosed at 28 with premature ovarian failure, handed an IVF brochure, no second opinion
03:00 The clues in her twenties: irregular periods, acne, fungal rash, yeast infections
07:00 Post-kids health crash: chronic sinus infections, bladder infections, vertigo, antibiotic damage 08:00 Discovering food sensitivities (dairy, gluten, corn) and gut infections (H. pylori, strep, fungal overgrowth)
13:00 Connecting the dots: why every "unrelated" symptom was related
15:00 Why partners must be in the protocol, because infections pass between couples
21:00 Multiple failed IUIs and IVFs: burnout, cortisol, and the case for a pause
24:00 The four foundational tests: food sensitivity, DUTCH, GI-MAP, HTMA
35:00 Where to start: just diagnosed vs. one failed cycle vs. multiple failures
The Case for a Second Opinion
If you have been told donor eggs are your only option, the question worth asking before you accept that is whether the full picture has been evaluated.
In most of the cases we review, the diagnosis is real. The AMH is genuinely low. The cycles are genuinely absent or irregular. But the biological environment driving those numbers, across multiple systems, over time, has not been looked at. And when it is, there are things to work with.
A Functional Fertility Second Opinion is not about disputing your diagnosis. It is about finding what has not been looked for yet, before the next decision gets made.
Start with a Functional Fertility Second Opinion.
Or begin with the Embryo Audit Checklist to review the variables that may be influencing your fertility before the next decision.
Related Reading
Low AMH and Regular Periods: What the Cycle Is Telling You
The Shocking Truth About POI and Autoimmune Diseases
Gut Health, Hormone Balance, and Fertility
Why Adrenal Insufficiency Can Be a Factor With Low AMH and High FSH
The Impact of Gluten on Embryo Implantation, Pregnancy Loss, NK Cells, and AMH/FSH Levels
MTHFR and Methylation: What It Means for Low AMH and High FSH Fertility
Hope for POI: Functional Medicine and Lifestyle Solutions for Pregnancy Success
About the Host
I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.
Subscribe to Get Pregnant Naturally for weekly episodes on fertility optimization, IVF preparation, and the lab work your doctor probably isn't running.
By Sarah Clark, Founder, Fab Fertile | Host of Get Pregnant Naturally Podcast
Last Reviewed April 2026
