I did not think that infertility would be part of my story. But my experience with infertility spanned four years, and I experienced a profound inner journey. I learned significant life lessons, including how to relinquish control, surrender to the process, and—perhaps most importantly— navigate the world of both conventional and integrative medicine.  

Infertility is a complex issue that can affect anyone unable to conceive a child. In this article, I will share evidence-based approaches to addressing infertility, including ways an integrative primary care provider can support you on your journey. Topics will include mental health, nutrition, exercise, and endocrine imbalances. 

Before we explore those topics, you should know that a medical concern is not required to start the discussion on optimizing the body and mind for pregnancy. Family planning discussions can begin with your integrative primary care provider and may provide essential knowledge and insight. For example, utilizing over-the-counter urine LH strips or a basal body thermometer to track your ovulation can offer data for optimal ovulation time and improve the chances of conception. Also, studies show that starting a prenatal vitamin at least three months before conception is beneficial. It reduces the risks of neural tube defects by providing adequate folic acid levels (2). In general, those of reproductive age—whether desiring to conceive or not—are recommended to take a prenatal vitamin with adequate levels of folic acid (400-800 mcg), iodine (150mcg), iron, and other important vitamins and minerals (3,4). Other preventative care measures for optimal health include routine pap smears (if applicable), STI screening, and vaccine updates.

 Integrative medicine evaluates one’s lifestyle, genetics, and environment to understand the underlying factors that might play a role in infertility. We will explore lifestyle factors below, and discussing genetic risk factors with your family can be helpful. Regarding the environment, endocrine-disrupting chemicals like plastics, BPA, and phthalates are known to impact fertility. To reduce endocrine disruptors, making simple changes like using glass containers and avoiding BPA-lined cans or plastics could be beneficial in improving fertility (5-8).

Mental Health:
I cannot overstate the importance of mental health. Those who look forward to having a child each month as they eagerly (or anxiously) await to see if they are pregnant can feel disheartened, devastated, or even ashamed. Finding healthy coping strategies, including, but not limited to: breath work, meditation, movement, counseling, or support groups, can play a pivotal role in navigating this process. 

I have used heart-centered meditation to focus on the deep emotions that have shown up for me. Starting in January, I will be virtually hosting a heart-centered meditation twice per week until March 16, 2023. I invite you to join the group no matter what health concern shows up as a way of self-exploration at the heart center. 

Support groups can offer a voice to the feelings that arise and help you create connections with other individuals who may be going through a similar experience (fertilityoutloud.com). As social beings, building community in challenging circumstances can help alleviate stress. 

Nutrition recommendations around fertility suggest a Mediterranean, plant-forward lifestyle. Eating fish a couple of times per week adds Omega-3s to the diet, and eliminating alcohol is generally beneficial. This eating strategy also involves limiting processed foods and incorporating fermented foods. Fermented foods are rich in probiotics (beneficial bacteria). Previously thought to be sterile, we now know that the uterus has a microbiota – bacteria, viruses, and other organisms that help balance the uterine environment. This microbiota can become imbalanced, factoring into infertility (3).  

I tried several different nutrition plans throughout my journey: low carb, Whole30, elimination diets, paleo, and eating kimchi daily at different intervals. As an overachiever, I would try the newest diet plan I was researching (indeed, this would be the change I needed to conceive!). 

“Eat food. Not too much. Mostly plants.”
– Michael Pollan, in his book In Defense of Food

In hindsight, I realized the value of a balanced nutrition plan rather than a prescribed one that sometimes felt like a chore to follow. I realized that it is not about “fixing infertility” but being aware of my longing for motherhood. Nutritional exploration was just one piece of the puzzle in navigating this journey. 

A well-balanced, diverse diet emphasizing local, in-season foods, eaten with joy and appreciation, can be the simple shift needed. At Integrative Family Medicine, our medical providers and nutritionists can guide you in making conscious choices around food. Our integrative health coach, Ariana, provides coaching sessions for individuals and Community Health Challenges involving nutrition and other lifestyle modifications. These Community Health Challenges occur quarterly, so look for the next one! 

Developing a balanced exercise program is essential. Extreme exercise can negatively impact hormones and even suppress the hypothalamic-pituitary-adrenal (HPA) axis, which assists with balancing hormones. A variety of cardio, strength, and balance training with restorative practices helps regulate hormones involved in conception. The most important thing, however, is to create an exercise plan that works for you.

Endocrine imbalances:
Hormone evaluation has its place in the journey to conception. There is value in trusting the body’s experience. After giving the body enough time to conceive during the ovulation window, further evaluation may be warranted. A primary care provider can evaluate for and manage various hormone imbalances. These include diabetes and insulin resistance, polycystic ovarian syndrome (PCOS), thyroid disease, and others. 

The next step would be working with a reproductive endocrinologist and infertility specialist (REI). Their role is imperative for a comprehensive evaluation and treatment plan. If it applies to your situation, the male partner should also perform a semen analysis. This test takes place after one year of failed conception. It can provide information to help develop a modified treatment plan if needed.

Of note, I scheduled regular acupuncture treatments while going through in-vitro fertilization (IVF). Those getting acupuncture during the IVF process experience increased implantation (10). I also received abdominal massages to optimize the uterus and experienced regular social and support groups to process the intense emotional shifts. This balance allowed me to create the optimal space I needed. 

Ultimately, by working with REI using in-vitro fertilization (IVF), my husband and I can invite our child into this world. Being pregnant is a journey that I may discuss in future blog posts. The reverence and awe for modern reproductive technology and medical science are deeply humbling as I hold the space for both alternative and conventional modalities. Going through this process has taught me the value of resistance and the process of surrendering. The unfolding that has occurred feels like a miracle every day. 

If this topic resonates with you, our Integrative Family Medicine of Asheville providers can assist you on your journey to creating a family. 

I hope this article helps navigate you to a happier, healthier you!

This blog post was written by Dr. Aneela Cox, one of the physicians on the Integrative Family Medicine of Asheville team. You can learn more about Dr. Cox in her bio!


  1. Gnoth C, Godehardt D, Godehardt E, et al. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 2003; 18:1959.
  1. Hull MG, Glazener CM, Kelly NJ, et al. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed) 1985; 291:1693.
  1. Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can 2006; 28:680.
  1. Nilsen RM, Vollset SE, Rasmussen SA, et al. Folic acid and multivitamin supplement use and risk of placental abruption: a population-based registry study. Am J Epidemiol 2008; 167:867.
  1. Peretz J, Vrooman L, Ricke WA, et al. Bisphenol a and reproductive health: update of experimental and human evidence, 2007-2013. Environ Health Perspect 2014; 122:775.
  1. Bhattacharya P, Keating AF. Impact of environmental exposures on ovarian function and role of xenobiotic metabolism during ovotoxicity. Toxicol Appl Pharmacol 2012; 261:227.
  1. Foster WG. Fetal and early postnatal environmental contaminant exposures and reproductive health effects in the female. Fertil Steril 2008; 89:e53.
  1. Hannon PR, Flaws JA. The effects of phthalates on the ovary. Front Endocrinol (Lausanne) 2015; 6:8.
  1. Benner, M., Ferwerda, G., Joosten, I., Molen, R. How uterine microbiota might be responsible for a receptive, fertile endometrium. 2018;  23 393-415 
  1. Dehghani, A,. Homayouni, K., Kannennejad., Z,. Kanannejadm Z. The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT. Int J Reprod Biomed 2020 Mar; 18(3): 209-214.