Functional Fertility

Welcome to another edition of the Doctor's Note, where we talk about what's on our minds when it comes to your health.

This week, I had the pleasure of sitting down with Robin Riddle, FNP-C, our West Knoxville nurse practitioner with expertise in functional fertility, to explore a topic impacting more couples than ever before. With fertility challenges now affecting nearly one in six couples, our conversation unpacked the growing why behind the numbers—looking at the physiological, environmental, and lifestyle factors often missed in conventional care. Drawing from her background in labor and delivery and her transition into functional medicine, Robin brings a thoughtful, whole-person, puzzle-solving approach that offers both clarity and hope to couples navigating their fertility journey.

What makes our approach to fertility unique is the lens of functional medicine, where we prioritize identifying root causes and personalized care over quick fixes. As Robin emphasized, infertility is a true 50-50 equation between male and female partners. We discussed how delays in starting a family, exposure to toxins and plastics, rising rates of PCOS and metabolic disorders, and the limitations of traditional treatments like Clomid and IVF are shifting the conversation. Robin stressed the importance of natural interventions—antioxidants, lifestyle changes, and targeted testing—before pursuing more invasive or pharmaceutical approaches. She also highlighted new technologies like the MIRA monitor for at-home hormone tracking and the impact of cutting-edge medications like GLP-1s on fertility, with a focus on preparing the body for a healthy pregnancy.

PODCAST NOTES 

• Infertility is a growing issue now affecting 1 in 6 couples, up from 1 in 8 in previous years. This startling statistic means that more families face challenges on the path to conception than ever before. Robin clarifies that infertility is officially defined as inability to conceive after one year for women under 35, or after six months for women 35 and older—a shift that highlights the increasing need for awareness, early assessment, and intervention.

• The role of both partners in fertility is crucial, with roughly equal responsibility for infertility split between men and women. Despite the tendency for women to internalize blame, the data and our clinical experience underscore that male factors—such as reduced sperm count, poor motility, or hormone imbalances—are involved just as often. Robin emphasizes that it’s essential to evaluate both partners from the start in order to avoid unnecessary frustration and missed diagnoses.

• Widespread exposure to environmental toxins, including plastics, parabens, and phthalates, is having a massive negative impact on fertility rates in both genders. We discussed research, like Dr. Shanna Swan’s work, documenting how these chemicals disrupt hormone balance, reduce sperm counts to the lowest levels ever recorded in the U.S., and damage egg quality—even starting with prenatal exposures in utero. The consequences are profound and underline the need for everyday vigilance in minimizing exposure.

• Societal trends, such as deferring childbirth and focusing on careers, have contributed to older maternal age at first pregnancy, but age is not the whole story. Robin points out that healthy lifestyle habits—diet, exercise, toxin avoidance—can help preserve fertility well into the 30s and 40s. She challenges the idea that all women over 35 are “high risk,” shifting the message toward empowerment and holistic self-care.

• Rising obesity, insulin resistance, and PCOS are intimately linked to increasing infertility rates. We're seeing PCOS and metabolic dysfunction in even younger patients, sometimes as early as 13 or 14 years old—a trend driven by poor diet, sedentary lifestyles, and, again, chemical exposures. Addressing weight management and metabolic health is now considered foundational in any fertility-enhancement plan.

• The functional medicine framework delivers a deeper, more patient-centered approach to fertility testing and care. Instead of only looking at baseline hormones or jumping straight to IUI or IVF, our process involves comprehensive lab panels for both partners, analysis of thyroid, A1C, inflammation markers, and advanced tools like the MIRA monitor for at-home tracking of hormone metabolites. This “detective work” frequently reveals correctable barriers to conception overlooked in standard protocols.

• Natural, supportive interventions take center stage before medication is ever considered. Robin’s protocols commonly include antioxidant therapy (NAC, glutathione, resveratrol, melatonin), reduction of environmental exposures, and sometimes NAD injections to improve overall cell health and egg/sperm quality. This focus on lifestyle provides meaningful benefits and often enhances success rates if medications or assisted reproductive technologies are finally needed.

• While standard fertility treatments such as Clomid, IUI, and IVF do have their place, they are too often used before modifiable underlying causes are addressed. Robin describes the limitations and side effects of common medications—in particular, the drawbacks of Clomid for women—and advocates for gentle, root-cause-oriented therapies, reserving medications (like Letrozole for ovulation induction) and collaboration with reproductive endocrinologists for cases where natural and lifestyle approaches have been fully optimized.

If you or someone you love is on the journey to parenthood and feeling discouraged, know that there’s a better way. The functional medicine approach—comprehensive, targeted, and patient-centered—offers real answers, not just band-aids. Don’t wait until other options have failed. Reach out for thorough evaluation, personalized recommendations, and support that considers the whole picture for both partners. 

Whether it’s a conversation with our team or a direct consultation with Robin, it’s never too early to take charge of your reproductive health.

Stay educated. Stay healthy. 

Till next week.