POI and Autoimmunity: What Your Doctor Might Be Missing

Premature Ovarian Insufficiency (POI) is often explained as “early menopause.”
Most women are told that their ovaries have stopped working, that hormone replacement is the only option, and that donor eggs are their best chance at pregnancy.

But new research shows that the story is more complex.

For many, POI begins with an overactive immune system that targets ovarian tissue and disrupts hormone signaling. Understanding this link changes how we approach testing, treatment, and fertility potential.

Looking Beyond the Ovaries

POI affects about 1 percent of women under 40, but recent meta-analyses suggest prevalence may be around 3 – 4 % globally. It’s defined by irregular or absent periods, low estrogen, and elevated FSH.

Yet in many cases, the ovaries aren’t permanently “shut down.” They’re reacting to deeper inflammation or immune dysregulation.

Autoimmune diseases such as Hashimoto’s thyroiditis, celiac disease, type 1 diabetes, and lupus often appear alongside POI.

A 2024 study in Human Reproduction found that women with POI were twice as likely to have autoimmune conditions compared to controls. This supports what we see clinically: immune imbalance plays a major role in ovarian decline.

How the Immune System Affects Fertility

The immune system protects the body, but when it becomes overactive, it can misfire against healthy tissue, including the ovaries.
This immune attack can:

• Damage ovarian follicles and lower AMH

• Disrupt hormone production

• Interfere with ovulation and implantation

Inflammation also affects other systems that are critical for fertility, especially the thyroid and gut.

Thyroid and Gut Health: Hidden Drivers of POI

The thyroid regulates metabolism and reproductive hormones. When thyroid antibodies are present, ovarian signaling can falter, leading to anovulation and irregular cycles.
Optimal functional ranges are:

• TSH below 2 mIU/L

• TPO antibodies < 10 IU/mL

• TBG antibodies < 30 IU/mL

The gut is another key player. About 70 percent of the immune system resides there. If the intestinal lining becomes permeable (“leaky gut”), immune activation can spill over into the bloodstream and affect reproductive organs.
Testing, such as the GI-MAP stool test, helps identify bacteria, parasites, or yeast that can drive chronic inflammation.

Learn more here:
👉 How Gut Health Impacts Egg Quality and Ovarian Reserve

Nutrient and Hormone Balance

Women with POI often show nutrient depletion and metabolic stress.
Common imbalances include:

• Vitamin D (ideal 60–80 ng/mL) for immune and hormone support

• Ferritin (ideal 80–100 ng/mL) for oxygen and egg health

• B12 and folate for DNA synthesis and embryo development

• Homocysteine (< 7 µmol/L) to lower inflammation and clot risk

Low AMH doesn’t mean pregnancy is impossible; it reflects quantity, not quality. By improving nutrient status and immune balance, some women with AMH < 0.1 have conceived naturally.

Reducing Immune Activation

A functional fertility plan for POI focuses on calming inflammation and restoring hormonal communication. Key steps include:

• Following an anti-inflammatory, gluten-free diet

• Healing the gut and supporting detox pathways

• Regulating the nervous system through breathing, movement, and rest

• Replenishing nutrient deficiencies

• Considering bioidentical hormone support when needed

For nervous system regulation ideas:
👉 How the Hypervigilant Stress Pattern Affects Egg Quality

Can You Get Pregnant with POI?

Yes. Studies estimate that up to 10 percent of women with POI can spontaneously ovulate and conceive.

When inflammation, thyroid imbalance, and nutrient depletion are corrected, the ovaries may begin functioning again.

Even for those using IVF, addressing these underlying factors can improve embryo quality and implantation success.

Next Steps in Your Fertility Journey

Subscribe to Get Pregnant Naturally for evidence-based guidance on functional fertility, and share this episode with anyone on their fertility journey.

Not sure where to start? Download our most popular guide:  Ultimate Guide to Getting Pregnant This Year If You Have Low AMH/High FSH it breaks everything down step by step to help you understand your options and take action

For personalized support to improve pregnancy success, book a call here.

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TIMESTAMPS

00:00 – What if POI isn’t just early menopause?
Why many women are misdiagnosed and how autoimmunity can drive premature ovarian insufficiency.

02:00 – Conventional vs. functional fertility approaches to POI
How standard care stops at HRT or donor eggs, while functional fertility looks at what’s really driving ovarian decline.

04:00 – Understanding POI beyond the ovaries
How deeper health issues like immune, thyroid, and gut imbalances can affect ovarian function and fertility potential.

06:00 – The autoimmune patterns seen in women with low AMH and high FSH
How family history, Hashimoto’s, and other immune clues point to systemic dysfunction.

09:00 – Key labs to explore beyond AMH and FSH
Why thyroid, antibodies, and gut testing reveal what routine fertility tests miss.

12:00 – Why you must advocate for deeper testing
How to push for immune and inflammatory markers like ANA and hs-CRP when conventional medicine overlooks them.

15:00 – Gut health, inflammation, and leaky gut in POI
The link between microbiome imbalance, gluten sensitivity, and ovarian autoimmunity.

18:00 – Nutrient and metabolic markers that affect ovarian function
Vitamin D, ferritin, B12, folate, and homocysteine. What optimal levels mean for egg quality and implantation.

21:00 – Understanding HRT and bioidentical hormones for POI
Why bioidentical estrogen and progesterone support heart, bone, and reproductive health more effectively than synthetics.

24:00 – Functional fertility action plan for autoimmune POI
How to test deeper, calm the immune system, and improve fertility outcomes naturally or with IVF.

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TRANSCRIPTION

[00:00:00] What if premature ovarian insufficiency wasn't just about your ovaries, but about your immune system turning against them? So many women with POI are simply told it's early menopause and the conversation usually stops at hormone replacement. And if you want children, you're quickly pointed to donor eggs.

But new research shows that in many women, POI has autoimmune roots. And when that's the case, everything from treatment to pregnancy potential looks different. In this episode, we're going to explore how. The immune system plays a critical and direct role in POI, the red flags. Most doctors miss the labs that can, the labs that can uncover what's really happening.

I'm going to share how functional fertility approach goes beyond symptom management to address the underlying immune balance. So if you ever wondered whether your thyroid, your gut, or your immune system could be tied to your fertility, this episode is for you. Let's go.

Welcome back. I'm Sarah Clark For over a decade, my team and I have helped couples improve their chances of pregnancy success, whether naturally or through [00:01:00] IVF. We specialize in supporting those with low AMH high FSH, diminished ovarian reserve, premature ovarian insufficiency, recurrent pregnancy loss through functional lab testing, and personalized fertility strategies.

This episode is for you as if you've been diagnosed with premature ovarian. Low AMH or high FSH, and you want to understand what's driving it. You have a personal or family history of autoimmune conditions like thyroid disease, celiac type I diabetes or lupus. You have faced irregular cycles, miscarriages or failed IVF transfers, and you feel like you're missing part of the picture.

Thanks so much for listening. I'm so thankful that you're here. Make sure you hit subscribe or follow. If you know someone else who's on the fertility journey, please share this podcast with them.

Okay, so let's get into the episode. POI or premature ovarian insufficiency is not menopause. The loss of function before the age of 40 is premature Ovarian insufficiency. Conventional medicine is basically going to tell you got to protect your heart and your bones and there's nothing you can do.

It's only donor eggs. Today we're going [00:02:00] to talk about some themes that we see, specifically the autoimmune side of things with POI and really why your REI is, trained to do surgeries, trained to give medication. It's not that we're opposed to IVF or PRP or donor eggs, but we always need to work on your health and to see what exactly is driving the premature ovarian insufficiency.

In this case we're going to be talking about is it an autoimmune issue that's driving it? POI is a loss of function of the ovaries before the age of 40. It could be irregular or no cycles, hot flashes, low estrogen, a high FSH. I was diagnosed with POI at 28. Before that I had a heavy periods in my late teens irregular periods in my early twenties. I thought that was great because I didn't want to deal with those heavy periods that made me want pass out and horrible cramps every month. And then they went away and I was like, thank goodness they're gone. Only a couple times a year.

I was so disconnected from my body. I didn't realize that was a [00:03:00] major clue there's something was happening. I went to see my physician and she's let's put you on the pill. So I went on the pill and then my period became regular and I'm like, okay, great. And then I got married at 25 and then at 28 I thought, this is the time I'm going to have my child went off the pill and then I got this diagnosis and went, what the heck is going on?

Didn't get a second opinion. I've done a whole podcast episode talking about my journey with POI and went on to have both my kids with donor eggs and then discovered all these different health issues and now helping couples with low AMH and high FSH get pregnant naturally or improve the chances with IVF or sometimes they need to go to donor eggs, but

we always need to work on their health. And so a lot of times people are just given HRT, so hormone replacement therapy and if you're trying to get pregnant, they tell you donor eggs. I've assembled a team with a functional medicine OB GYN, he's our medical case reviewer.

We have functional nutrition practitioners. They're the ones who can review our testing. We do food sensitivity testing, stool testing, looking at the DNA of the stool. We do genetic testing different from the [00:04:00] karyotyping, really epigenetics. What are the specific diet, lifestyle and supplement recommendations to support your gene variants.

We're going to dig into the autoimmune component that we see. Like literally just before this call, I had someone that had told me that she's got POI with Hashimoto's and no one's dug deeper and her antibodies are at a hundred. So we need to look at the whole body, not just focus myopically on the AMH and the FSH and the low estrogen and think we're doomed because that's not helpful.

We need to see what's driving this? And so for POI, spontaneous ovulation is still possible. And so there's ovarian reserve. It's not always at zero because we think there's nothing we can do. It's so low, but I never want to sugarcoat anything, right? This is a tough diagnosis.

It can impact your health. Impact you emotionally. You may not be feeling great if you're dealing with mood swings or hot flashes or night sweats or insomnia. Sometimes we do need to bring in the bioidentical, so we'll talk a little bit about that. But we don't want synthetic hormones. So before the age of 40, [00:05:00] it's not early menopause. AMH, anti-mullerian hormone, it's misleading. It can really have you circle in the drain of, oh my goodness, what are we going to do? We want to know the AMH, but it does not predict your ability to get pregnant naturally.

It does not look at your uterine receptivity. It does not look at your egg quality. They can't test for that. To see how well you'll do with IVF. They see yours is super low, below 0.1, and they're like, we can't help you. Donor eggs. Off you go. And then no one digs deeper in conventional medicine.

They'll say, HRT or donor eggs and we're just left reeling wondering what we can do. From an autoimmune perspective. So we see this as a theme with Low AMH High FSH. We see autoimmune issues all the time. And then I'll say to people, oh, how's the health of your parents?

It's very interesting either one parent has an autoimmune disease. Either both parents have an autoimmune disease. Either one parent has cancer, either another parent is no longer here, they passed away. So there's typically something going on genetically, [00:06:00] and so rarely is everybody perfect in the family with their health.

Otherwise. Where is this coming from? There is a connection with people getting the Gardasil vaccine and also getting COVID vaccines and having their cycles go away. So we can't ignore that piece. If you've had the vaccines, the whole idea is to be able to boost up your immune system and be able to get the nutrient status back and really look at your health in a targeted manner.

But, today we're talking all about the autoimmune piece. So 2024 human reproductive study. POI patients had a two times higher, greater risk of autoimmune conditions like thyroid, so Hashimoto's, lupus and then also IBD. Such as Crohn's or colitis. And so if you've got digestive issues and you've got loose stools, you're not absorbing any of your nutrients.

And there's also studies talking about Crohn's and colitis making diet and lifestyle changes. We can actually end up reversing that as well as the autoimmune diseases because a lot of times for autoimmune diseases you'll be given, steroids or medication and say that's all you have to do.

But the diet and lifestyle [00:07:00] changes are what can actually help reverse it. And so the immune cells may attack the ovarian tissue, thyroid dysfunction. I literally, I see this all the time, and a lot of times we will see secondary fertility issues where, oh, we had our first child, easy breezy, first try.

This is wonderful that maybe the postpartum was a little tough. Maybe we had a hard time with our milk supply, so it can be an indicator of thyroid issues. And and now all of a sudden out of the blue this low AMH high FSH diagnosis comes along and and we're just left reeling.

And first of all, you just sustained life. Then typically fed that little human. Maybe had some difficult postpartum periods so your hormones could be out of balance. And we need to see what's driving the fact that these things are off.

The fact, you are able to have your child easily the first time and now we're told it's game over and it's donor eggs, but we haven't dug deeper and looking at our how to make a determination of our next steps. And so thyroid dysfunction can disrupt your reproductive hormones if [00:08:00] you've got gut driven autoimmunity.

Creates inflammation, impacts the ovarian reserve. So we see a lot of people with gut infections, so we're just not looking at the ovaries, we're looking at the full immune system, the whole body. If you've got autoimmune driven inflammation, that can accelerate ovarian dysfunction.

People come to me, my health is great. You may feel okay, but you sometimes you don't know how poorly you feel until you feel amazing. You don't want your labs normal. You want optimal. Something is missing. It's not just the AMH and the FSH. And autoimmune such as Hashimoto's, we've had lots of people get pregnant naturally, or with IVF, with Hashimoto's. Celiac is not just about you going gluten-free.

Also one autoimmune disease will predispose you for a second one. So with the celiac piece takes usually, over 10 years to get diagnosed. We see the theme of non-celiac gluten sensitivity. So even if you're like, I don't have celiac, I've gone to test for celiac.

First of all, there's a lot of false negatives of that where there's over 60 proteins and gluten. They're only testing for four. And so then you come back and say, great, I can have [00:09:00] gluten, but we see the theme of non-celiac gluten sensitivities, or we do see celiac, so we must be a hundred percent gluten-free.

And then some of the cross reactors, not forever, potentially gluten. Yes, but the other foods not forever. We need to reduce inflammation in gut, we see type I diabetes, lupus, rheumatoid arthritis. We also do see the irritable bowel disease, though the Crohn's and colitis definitely inflammation in your body and not absorbing those nutrients.

And so the thyroid piece is a huge theme. We see the premature ovarian sufficiency, and people are looking at the TSH, it's below two, and the doctor says, don't worry, your thyroid is totally fine. So typically if it's not hypothyroidism or it's not Hashimoto's, we do see subclinical thyroid issues.

So it's the liver or the gut. So the FREE T4, the FREE T3, if you have antibodies or TPO or the TBG. We like the TPO below 10, the TBG below 30. If those are elevated, 100, 200, [00:10:00] 900, that could be why you've got these low a AMH and high FSH.

As we start to heal the the gut and reduce inflammation, then the thyroid comes back online. So from the conventional side of things, they're just going to focus on ovarian symptoms. Look at the low AMH, the high FSH and the functional side of things, functional fertility. We are looking at symptoms and we want to dig deeper. Like we just said, that family history of autoimmune disease. So I have a thyroid issue, so I've got POI also, I have hypothyroidism. My mom had half her thyroid out. She refuses to take medication and wonders why she's having some symptoms. But cold hands, cold feet and anxiety and nervousness and things like that.

But she doesn't want to take medication, but that would help her. She's also been vegan, but that's a whole other story. So we see many people with POI and they get married to a vegan diet and that no longer serves you. You can be low in your B vitamins. We're not going to force anyone to eat meat, but we need to have an open mind about the diet that's right for you.

It's not about doing these generalized vegan, [00:11:00] paleo, keto carnivore. We need the diet that's right for you based on your genetics. So if you've got a family history, mother, sister, dad with autoimmune disease, that's a clue. If they've got thyroid or lupus or rheumatoid arthritis, I can't tell you how many people that I talk to the same thing where the parents, there's something going on with their health or a cancer diagnosis, that's, 10 years beforehand, that was brewing

It doesn't just appear out of the blue. So your risk is higher of an autoimmune related POI. Family history often shows the terrain that you've inherited. You see the genetics. My mom has rosacea. Also thyroid issues.

My dad, I do believe there's an undiagnosed gluten issue with him. He's got a whole bunch of symptoms that I would correlate . He's got iBS that catchall that tells us nothing. And other skin itching and things like that, which, you know the man's 85, he's not going to be making changes.

My mom's 81. So we need to look at our family history. And it's not just oh wait, I'm doomed. [00:12:00] Okay, they have poor health, or maybe they're okay, but they're, they do have autoimmune issues or they're not in optimal health and we think we're doomed. No, there's specific diet and lifestyle strategies we can do to actually improve our health.

And so the thyroid piece, if you've got fatigue, like you should not be dragging your butt around if you've got unexplained weight gain, or loss. If your hair is changing. For years, my thyroid was 3 or 4 and my hair was falling out and everyone's your thyroid's fine.

It's under 5. You're totally fine. No, it wasn't fine. Have you got sensitivity to hot or cold? You got anxiety, brain fog, thyroid issues and the thyroid autoimmunity. So Hashimoto's, a Graves we regularly see more Hashimotos than the Graves side of things. We need to be able to address that. Sometimes we do bring in the bioidentical hormones if you've got symptoms and you're just not feeling right.

We need to be careful with, with a family history of any kind of cancer. Or estrogen dominance side of things. Also, we don't just bring in the hormones. We need to make sure [00:13:00] your metabolically sound. So if you've got a whole bunch of blood sugar issues going on, your thyroid bouncing all over the place, you've got gut issues and food sensitivities.

Each case is different to decide when we bring in the bioidenticals. So sometimes it can be helpful some progesterone cream, but we look at that individually. So GI issues, so chronic bloating can be common, but not normal. No, you shouldn't look like you're three months pregnant all the time.

I had that, like I'm six foot fairly slim. I'm like, why is my stomach always bloated? My mother always had that, oh, I've got a pot belly. No. And she's 5ft 8' skinny. So that's digestive issues going on. Food sensitivities is there, like we say, that non celiac gluten sensitivity that can.

Impact gut driven autoimmunity. That leaky gut where it allows the immune activation, it can cross-react with the ovarian tissue. So if you've got a whole bunch of parasites or bacterial infections or there's an overgrowth of the bad bacteria, we need to, bring in the good.

Sometimes we do a whole bunch of antibiotics that we wipe out [00:14:00] the good bacteria. Healing the gut is foundational to a functional fertility plan. So if you've got all these infections, fungal overgrowth, you've got yeast infections or toenail infections, and you've got acne or eczema, you've got brain fog and headaches. There's usually something going on, and that can be a clue. People worry, oh, they're not going to find anything on the gut test. That's not the case, otherwise you'd already be pregnant. And we see things going on in the gut infections. We can't do a beautiful, pristine diet and do a parasite cleanse. Just, a random parasite cleanse.

We need to address exactly what's going on in there and develop a specific protocol. Otherwise, you're spending good money after bad. And I can't tell me how many people have gone to functional practitioners. Or naturopaths. Or acupuncturists. And there's nothing against any of those people.

But if they don't specialize in fertility, you can throw good money after bad. So you need someone who specializes in this. This is what we do day in and day out. Either you work with us, but you want to find someone that specializes in this. And we work with people [00:15:00] worldwide as a virtual coaching practice that we have to be able to help using lab testing, the food stool, genetics, looking at your blood work, looking at your partner's blood work.

because we see infections being passed back and forth between you guys. Similar gut microbiomes. And then also looking at his health and his semen and his DNA fragmentation, making sure he's in good shape. because it's not just you over here working all on your health. And he's hasn't even got a semen test done.

We need to do this in conjunction positive ANA. So we've talked about that anti nuclear antibody. We've done a whole podcast episode on that. Maybe it's for you, it's positive. It can be an early sign of immune dysregulation. What is an inflammation in your body? What's firing that up?

Women with a positive ANA are more likely to experience ovarian dysfunction, recurrent pregnancy loss, or difficulty with implantation. So if yours is positive, we need to see what is causing that from food sensitivities to gut infections, from the chronic stress under the blood sugar dysregulation, the thyroid dysregulation.

 It's all connected and like we were just talking about, if you've got skin issues. [00:16:00] Eczema, psoriasis vitiligo. So chronic skin conditions often reflect systemic immune imbalance and increased inflammatory load.

And also the skin is a direct reflection of the health of the gut. You got acne, hives, eczema, psoriasis, vitiligo. You typically don't have all of those, but if you have any of those, you have rosacea. That is a clue. These external signs can mirror what's happening internally, and this can attack the ovaries, skin issues, huge clue.

Type I diabetes. If you've got type I diabetes which is a classic autoimmune condition, it can be strongly linked with premature ovarian insufficiency. It's not just like I have POI and I'm like how's my health? Oh, it's good. Oh. By the way, I also have Hashimoto's. Oh, by the way, yes. I do have type I diabetes.

Oh yes. I was just recently diagnosed with lupus. It is all connected. And then so blood sugar swings are going to then compound hormonal instability and so stabilizing your glucose levels and as we bring in the continuous glucose monitor, pop that on there [00:17:00] and we can see more fats, more proteins, be able to stabilize your blood sugar.

That helps your period. We've helped people in their forties regain their period. After years of not having one. And so we want to have a regular period. It shouldn't be like painful and crampy and obviously not coming all the time. So we need to, work on that. And once we start to to work on these foundational period pieces, the period can come back. Recurrent pregnancy loss or implantation failure.

So when the pregnancy doesn't progress despite embryos being transferred, even like great embryos it's difficult, right? Where we do a retrieval, nothing works. And then we're told to do a PRP and then we haven't really worked on our health and we're injecting inflamed cells into the ovaries.

Working on the immune system can then help improve. If we decide to go to IVF, decide we want to deploy that we can improve the chances of it working. because PRP is the wild west. It's people are selling it in packages of three. I've heard people paying anywhere from 10 K to 2K across the states.

They look oh wait. They've got low AMH or high FSH POI, premature [00:18:00] ovarian sufficiency. It's either donor eggs, but you know what let's make some cash and offer PRP. We're not against the PRP, but we need to decide when to deploy it. Get your body in the best shape so we do fire up the ovaries.

We're going to have better success with that. because I see people that it doesn't work and they're throwing money down the drain. Natural killer cells activity on a whole podcast episode on that. If that's raised for you, that can be an indication of underlying inflammation. And then also clotting factors.

So looking at the thrombophilia panel. So if you've had pregnancy loss, that can interfere with implantation. If you've had IVF. Haven't worked. Is there a clotting issue going on for you? It's a whole body immune system and we need to get some deeper testing and not just think donor eggs, PRP and HRT, that's just a waste of time.

And so we want to know our numbers, like our day three and day 21, FSH. And hormones and look at your follicles. You definitely want to get tested. So there's idiopathic, POI, which we're talking about here, which is not [00:19:00] genetic, but we do want to get tested for Turner syndrome or fragile X. People that we work with don't have that.

We can still work with people with genetics side of things, but we haven't helped anyone get pregnant with the genetic side of things, but we can still work on your health. From a functional standpoint, we need to look at the thyroid, the gut, the methylation pathways. If you're not absorbing all your B vitamins, looking at your thyroid like we just talked about.

So it is key. Okay. So we don't just hang our hat on the AMH and the FSH, the follicle count say that they're, the AMH is so low. We've helped people as low as 0.02 at 44 get pregnant naturally. But I don't want to be sugarcoating the low numbers in a high FSH, but we don't just look at those and go, oh no, there's nothing we can do.

We want to see what's driving it. And so we've had people with FSH is high in the sixties and seventies, have it come down to a seven and go on to get pregnant. The thyroid not just looking at the TSH elevated can suggest [00:20:00] hypothyroidism, but even, normal ranges, your REI is going to want that below 2 mIU/L

If it's higher, they might give you some Synthroid or levothyroxine which can be part of it. But we want to see why it's low. To begin with, we want to look at the FREE T3 and the FREE T4. So really how much hormone is available in the cells. We want to make sure those are in the optimal ranges like we talked about the TPO and the TPG.

We want to make sure those are the TPO is below 10. The TPG thyroid antibody is below 30. Yours are climbing up. That's a huge clue. Or maybe someone looked at your TSH and went, oh, it's perfect, and didn't even look at the whole panel. So we need to look at that. It's not just oh, they said it was normal, unhelpful.

And if your doctor doesn't want to do it, get a new one. and we have a doctor as part of our team. You need to be your own advocate. There's gaslighting here where you're like, oh, there's nothing you can do. And we just throw our hands up and give up. Typically, if you've found this podcast you're not ready to give up.

Something is telling you to dig deeper and it's always our health. We work on our health and we make [00:21:00] decisions along the way that feel right for us. We need to have an open mind of what's going to happen, of how our child is coming in. Is it through naturally? Is it IVF? Is it perhaps donor eggs?

But at every junction, we never skip the health. It's not just running off and saving all our money for IVF people say, oh I'm going to do an IVF. I better save. No, because these, that's just throwing money down the drain. because I see people that are, they're buying IVF and packages of three and 60 K and it still doesn't work because we forgot the health.

And most people have done something on their health, but very generalized, not targeted, not based on testing, not someone that specializes in this. And even though we do the testing, the nervous system dysregulation is typically the elephant in the room that's tilted all your bio markers the wrong way.

The chronic stress, like we said. So looking at the anti-nuclear antibody so you can really see systemic autoimmune activity. Even a low positive a could indicate immune [00:22:00] dysregulation. Looking at for celiac antibodies, be careful about doing some of the celiac testing. And take out gluten and consider that it is non celiac gluten sensitivity.

And and also looking at the high sensitivity C-reactive protein. We like to have that below one. I've done a whole podcast episode on that. I see people with it trending like two, three, even 1.2, like over. There's something driving inflammation in the body and we inject those inflamed cells into the ovaries.

And so looking at your fasting insulin, your glucose shows how well the body is regulating your blood sugar. If the elevated insulin is driving inflammation or hormone disruption, looking at your lipid panel. So we do see that. So women with POI have a higher long-term risk for cardiovascular disease.

A lot of the times the triglycerides are either low or high and that can be an indication of blood sugar issues two to five years in the future. Also sometimes the cholesterol can be low. You don't have enough good healthy fats to even make hormones because we're going on some low fat [00:23:00] diet or we're not absorbing all the nutrients that we need.

And so looking at those markers, so the blood sugar, the lipid, we also see the iron piece here. Looking at your ferritin and your iron. because we see a lot of people that are anemic and then also the gut side of things. We do the stool test, looking at the DNA of your stool and looking for pathogens and yeast and parasites and leaky gut.

We can see if you've got a leaky gut. Looking at your zonulin marker. You get intolerant to your favorite foods. And then the leaky gut just brings in all these parasites and bacterial infections and inflammation. So 70% of the immune system lives in the gut, and if the microbiome is imbalanced, autoimmune activity can worsen and triggering further ovarian dysfunction.

It's all connected. And so with the nutrient status, we see the vitamin D. There's lots of studies with low vitamin D, and I've done a whole podcast episodes on that. Low vitamin D and low AMH. It's essential for ovarian function. Immune balance, implantation and deficiency is [00:24:00] common with POI. Ferritin.

So the marker of iron storage we see low levels impacting egg quality and energy. We see ferritin low all the time. We like it 80 to 100, so very low we see it. B12 and folate's crucial for methylation, DNA, synthesis and embryo development. We see people with that MTHFR gene variant one or two SNPs and the methylation pathway.

So how well are you absorbing your B vitamins? Way more complex than that. But basically how well are you absorbing them? And we can see it on the genetic side of things. And the whole genetic pathway is lit up and you need support there. So it's a theme that we see. Homocysteine did a whole podcast on that, so it's a marker of inflammation and methylation dysfunction, high levels, increased clotting and miscarriage risk.

So looking at those nutrients is going to improve both ovarian immune function, supporting your natural conception. FSH on day three, high level suggest ovarian resistance, but values will fluctuate. So it does fluctuate each cycle. Estradiol.

Day three, it's going to [00:25:00] assess your ovarian activity and feedback to the brain. High levels with high FSH mean the ovaries are overworking. anti-mullerian hormone, like we reflects ovarian reserve. And it does not measure agg quality.

Low AMH does not equal zero fertility potential. People worry about that. Ooh, it's so low. There's nothing I can do. I'm not here to sugarcoat this piece. If it's low. We need to know why. Same with the follicles. So the antral follicle count. So it's a real time

look at the actual follicles that month. Those can change and those can improve. Then also with the HRT. So if you've got symptoms that you're dealing with, insomnia, hot flashes, night sweats mood swings, we can look at some bioidentical hormones. Standard approach is estrogen and progestin, so you don't want synthetic hormones.

With POI, we want to protect your bones, your brain, your heart health. You want to make sure you're using bioidentical hormones, we need to decide when to bring them in based on symptoms and based on your health. And so we have a whole bioidentical checklist that we use when if you [00:26:00] decide to work with us to determine, based on your symptoms, if there's a family history of cardiovascular disease or dementia, osteoporosis.

I feel like I have all that. My parents of osteoporosis my dad's got some dementia that's happening. Which I feel has been brought on by a certain vaccine because he was totally fine before that, there was some health issues going on with him, right? We've got these turbo cancers and things that are happening.

I opted not to get the vaccine, but we do see people that have got it and then all of a sudden their cycle is off and they've got this diagnosis. So it's not that, you're doomed, but we need to see was your health off beforehand? And what can we do to address that? If you did do that?

The bioidentical hormones can be part of it, getting from a co compounding pharmacy. And then but we want to make sure, and sometimes we can bring in progesterone too. That can help with the rine lining, improving sleep, improving mood but synthetic progestins are not offering the same benefits.

So bioidenticals can be part of the [00:27:00] solution by themselves. They're a bandaid. We need to decide when to deploy them. When to bring them in working on your health. We have a team approach on this, and each person is different, but it's not about, I'm going to not take HRT because I'm just worried it's not right for me.

We may need it, but not the synthetic form. The conventional side of things where POI. We're being told that donor eggs are the only path. Natural pregnancy is often dismissed up to five to 10% of women with POI can conceive naturally. But I really do believe it could be more if people understood what was driving the underlying issues with POI.

And so you're going to lower inflammation, support ovarian function, and then you can capture that spontaneous ovulation. So IVF with your own eggs is maybe attempted if some reserve remains. We need to decide when to deploy it. Then donor eggs can be an option, but it shouldn't be presented as the only hope.

We need to work on our health. Then we decide if we need to do IVF decide donor eggs, but we don't just rush into IVF. We don't just rush into donor eggs.

And [00:28:00] I see they've selected donor eggs, so it hasn't worked. We've helped many people with POI, get pregnant naturally or go on to get pregnant with IVF. So POI is multifactorial and we need to be able to work on our health. And so like we said, we've had people with an A AMH.

She was 44 with an AMH of 0.02. For her, it was secondary fertility issues. We worked on her gut and her thyroid and blood sugar, nervous system dysregulation. because she'd had some pregnancy loss before coming to see us. And she went on to conceive. I don't want to sugarcoat anything here, right?

And give false hope. That's not what we're doing. But if we come in with our health. An open mind as to what we wanted to have happen here and not feeling shut down, especially if you just got this diagnosis. People in the beginning, I'm going to tell you right now, people that just get a POI diagnosis, they waste so much time because they get stuck in the conventional side of things, doing hormone treatment, trying to do retrievals, trying to do an IVF maybe.

And meanwhile, they haven't looked at the fact, in this case [00:29:00] we're talking about is there a missed autoimmune issue? And so we've got to do a deep dive into our health and see what is being missed. We have a hundred question health history questions that, if you're asking your doctor, Hey, I've got this eczema, I have a yeast infection, I have a toenail infection, my hair's falling out.

I feel cold, I feel super stressed. Are those related to my POI? And they'll say. No. You just asked the wrong person. because in our book, those are all clues. We got to look to test beyond the ovaries, the immune system, the thyroid, the gut, looking at inflammation, looking at that gluten-free, doing that, that non-celiac gluten sensitivity.

Send me a message at hello@fabfertile.ca, subject line 10 day and we'll send you the elimination diet, takes out the top allergen, systematically reintroducing them, reducing inflammation, and we have people do a five day food diary, do the 10 day elimination diet. And we have you do food sensitivity [00:30:00] testing targeted to your specific situation, optimize your nutrient status.

Looking at the vitamin D, yes, we want to supplement the vitamin D three K two, but we do also want to see why is it low. I got people with it at 14 and we need it 60 to 80. And why is it low? Is there gut infections? Looking at Omegas, bringing some magnesium glycinate, looking at those methyl B vitamins, but really looking at that in a targeted manner.

Where do we need support to reduce inflammation? Working on the gut microbiome address those infections. It's not, you got a parasite, we got to deal with it. If you have h pylori, which we all have, but yours isn't a virulence factor, and you guys are passing it back and forth via saliva, and you're not absorbing all your nutrients.

We need to improve digestion. You need to eliminate one to three times a day and not one to three times a week. So constipation, we see that a lot correlated with thyroid issues. You've got IBS, you're not absorbing all your nutrients. You've got loose stools, burping, bloating, gas, diarrhea. Those are common but not normal.

We dig deeper hormones. We need to look at stress management. Looking at [00:31:00] your sleep. If your sleep is dysregulated, that can be impacting your blood sugar, your hormones, all of this. Decide when or if the bioidentical hormones are right for you. And then we want to keep both natural conception and IVF/PRP.

Those are all on the table. But health is always first. It's not an or, Ooh, I'm going to save my money for IVF and PRP and not do a deep dive into my health. Or, oh, I've already worked with someone, but they didn't specialize in this. And so the elephant in the room with this is the stress that you've been under has tilted everything the wrong way.

We need to nourish it and bring it back into health. That's why we have a whole mindset checklist. We have mindset coaching as part of our program, so you can see from your biomarkers. If you have a bunch of food sensitivities and gut infections and inflammation, stress can be the driver.

So we've got to work on it. It's not just you doing some yoga and some deep breathing. No, like this is deeper. We've got to go deeper and looking at self-sabotaging behavior, looking at you're controlling person or [00:32:00] perfectionist, like all this piece, how this stress. Or maybe you're like, I don't feel stressed, and that was me.

So if you're like, I don't need the mindset stuff, I'm totally good. I'm going to tell you, you probably need it more than anyone because you're just, you just keep going. Your superpower is you feel fine, but the body's like she's yelling to you right now in the form of POI, and if we ignore it, we've got other health issues down the road.

So it's not just about the ovaries shutting down, it's an immune system issue. It can open up for more testing. There we need to under look at the underlying reason for this. So if you've been told you've got POI and you want to dig deeper and see what is being missed, send me a message at hello@fabfertile.ca, subject line FERTILE, and we'll give some options to help take care.

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How to Get Started With Functional Fertility Support

Book your call here to get your personalized plan and options to help improve pregnancy success either naturally or with IVF treatment. 

Check out our Fab Fertile functional fertility program here and learn how to improve AMH levels naturally.  We work with couples that have low AMH, high FSH, diminished ovarian reserve, premature ovarian insufficiency, and recurrent pregnancy loss.

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Frequently Asked Questions

Can POI be reversed?

Not always, but many women see hormone stabilization and occasional ovulation when immune and metabolic issues are addressed.

What tests should I ask for?

Beyond standard fertility labs, include ANA, TPO, Tg, hs-CRP, ferritin, vitamin D, and a full thyroid panel. Consider stool or food sensitivity testing for gut-immune health.

Should I take HRT?

Hormone therapy protects bone, brain, and heart health. Bioidentical estrogen and progesterone may offer a gentler, more physiologic option when used alongside a functional protocol.

Can I still get pregnant naturally with POI?

Yes. If even a few follicles remain and inflammation is controlled, spontaneous ovulation is possible.

Key Takeaways

• POI is often linked to immune, thyroid, and gut imbalances.

• Decreasing inflammation and improving nutrient status may restore ovarian activity.

• Low AMH or high FSH do not automatically mean donor eggs are the only path.

• A functional fertility approach can support both natural conception and better IVF outcomes.

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RESOURCES

Stop Ignoring hsCRP and the Role of Inflammation in Diminished Ovarian Reserve: https://fabfertile.com/blogs/podcasts/stop-ignoring-hscrp-and-the-role-of-inflammation-in-diminished-ovarian-reserve?_pos=1&_sid=82deaccd1&_ss=r

Get Pregnant Naturally with Low AMH, Diminished Ovarian Reserve or POF: (Sarah's Story) https://fabfertile.com/blogs/podcasts/get-pregnant-naturally-with-low-amh-diminished-ovarian-reserve-or-pof?_pos=15&_sid=86a653303&_ss=r

Is Your Thyroid Impacting Egg Health? The Hidden Connection to Low AMH, DOR & Fertility Success: https://fabfertile.com/blogs/podcasts/is-your-thyroid-impacting-egg-health-the-hidden-connection-to-low-amh-dor-fertility-success?_pos=6&_sid=81c11854e&_ss=r

How Iron Deficiency Impacts Fertility, Egg Quality & Low AMH: https://fabfertile.com/blogs/podcasts/ferritin-iron-deficiency-fertility-low-amh-high-fsh?_pos=1&_sid=5bce72a22&_ss=r

Why Addressing Homocysteine Levels Can Boost Egg and Sperm Health: https://fabfertile.com/blogs/podcasts/why-addressing-homocysteine-levels-can-boost-egg-and-sperm-health?_pos=1&_sid=b235d5698&_ss=r

Autoimmune Roadblocks to IVF: How ANA Affects Fertility: https://fabfertile.com/blogs/podcasts/autoimmune-roadblocks-to-ivf-how-ana-affects-fertility?_pos=1&_sid=d10e6427f&_ss=r

The Clotting Connection: Hidden Causes of Implantation Failure and Miscarriage: https://fabfertile.com/blogs/podcasts/the-clotting-connection-hidden-causes-of-implantation-failure-and-miscarriage?_pos=1&_sid=82f26ca56&_ss=r

Our favorite fertility tracker Inito (use code FABFERTILE15 to save 15)