Dr. Aumatma Simmons, ND

 

Subheadline

A root-cause fertility case exploring hormonal optimization, vaginal microbiome restoration, luteal phase support, and individualized naturopathic care in advanced reproductive age.

 

Short Description

This case report details the successful restoration of fertility in a 41-year-old woman with diminished ovarian reserve, prior pregnancy loss, luteal phase dysfunction, and recurrent vaginal dysbiosis using an integrative naturopathic approach. Through individualized nutrition, endocrine optimization, microbiome support, and cycle-based interventions, the patient conceived on her first cycle of actively trying and ultimately achieved a healthy pregnancy.

 

Abstract

A 41-year-old woman presented with a history of one early pregnancy loss at 7–8 weeks,
shortened and irregular cycles after miscarriage, low ovarian reserve markers, luteal phase
concerns, recurrent vulvovaginal irritation, and multiple metabolic and endocrine contributors to subfertility.

 

Assessment included cycle day 3 hormone testing, along with basic testing of CBC with
differential, CMP, lipid panel, Hgb A1c, fasting insulin, thyroid panel, and homocysteine. Also, a dried urine hormone evaluation (7 days post ovulation) and vaginal microbiome analysis via next-gen sequencing was conducted.

Naturopathic assessment emphasized hormonal and ovarian support, luteal adequacy, vaginal microbiome restoration, anti-inflammatory nutrition, blood sugar stabilization, stress and sleep regulation, and reduction of inflammatory triggers. Over approximately 6 months, interventions included a structured anti-inflammatory whole foods plan, targeted nutraceutical and botanical support, vaginal antimicrobial and probiotic-based protocols, cycle tracking, and iterative laboratory monitoring. The patient reported reduced premenstrual spotting, clearer ovulatory signs, improved energy and digestion, and reduction in vaginal irritation. She conceived on the first cycle of actively trying in July 2025 and was documented as 7 weeks 2 days pregnant with mild early-pregnancy symptoms in August 2025. This case illustrates how a root-cause naturopathic strategy can support conception in a complex fertility presentation at advanced reproductive age.

It should be noted that her husband was a crucial part of the equation, given his presence of NAFLD, severely depleted sperm count, motility, and morphology. His contribution is not
reviewed in this case report but he needed equal attention and care to optimize his overall
health and fertility. We noted a reversal of NAFLD and significant improvement in his symptoms but never got a repeat semen analysis because they got pregnant before he could submit his sample.

Introduction

Fertility challenges in the late reproductive years often arise from overlapping endocrine,
structural, inflammatory, and lifestyle factors rather than a single diagnosis. This case is
significant because the patient combined low AMH, prior loss, luteal concerns, recurrent vaginal dysbiosis, chronic vulvodynia, and HPV history, yet ultimately conceived following staged naturopathic care. The report is organized according to case report guidance emphasizing etiologic factors, diagnostic reasoning, timeline, interventions, and outcomes.

Case Presentation

The patient was a 41-year-old woman with long-term oral contraceptive use from about age 21 to 39, one prior miscarriage at 7–8 weeks, chronic vulvodynia/vaginismus beginning with early pelvic exams, oral and genital herpes, persistent HPV, recurrent vulvovaginal irritation, insomnia, low libido, and a vegetarian diet with intermittent fast food, processed snacks, sugar, and dairy. She described short cycles with spotting after miscarriage, strong caffeine sensitivity, non-restorative sleep, and difficulty waking, and had been informed of a 1 cm uterine polyp or fibroid.

Etiologic factors included advanced reproductive age, prior pregnancy loss, low AMH, possible luteal insufficiency, elevated estradiol, low DHEA-S, borderline low thyroid function for fertility, elevated homocysteine, low ferritin, high LDL, chronic sleep disruption, high psychosocial stress, vaginal dysbiosis, and the uterine lesion. Chronic pelvic floor pain, a long history of hormonal contraception, and inconsistent adherence to an anti-inflammatory diet further contributed to the fertility picture.

Diagnostic Assessment

Day 3 Labs:

• • AMH 0.516
  • FSH 6.9
  • LH 5.2
  • Estradiol 99

• TSH 2.1 (suboptimal)

• Homocysteine 9.2 (suboptimal)

• Low ferritin

• DHEA-S 68 (low)

• Free testosterone (low)

• Dried urine testing found:

• low-normal cortisol awakening pattern

• Low cortisol throughout the day

• High 4-OH-E

• Normal Estradiol:Progesterone ratio

• Short luteal phase with progesterone decline around Cycle day 23

• Vaginal microbiome testing:
  Presence of Ureaplasma, Gardnerella, Candida (all not conducive to conception)

 

Imaging: 1 cm polyp or fibroid

 

All findings reflected a pattern of multifactorial subfertility rather than a single diagnosis.

Timeline

• • July 2024: the patient experienced pregnancy with subsequent loss at 7–8 weeks, persistent spotting, elevated estradiol, low DHEA-S, sleep disturbance, and identification of a uterine lesion.

  • October–November 2024: Initial naturopathic care started
    – Anti-inflammatory, whole foods diet
    – Optimize hydration
    – Circadian and sleep hygiene
    – Anti-microbials for gut and vagina

• Nov-Dec 2024: Focus on adrenal and thyroid optimization
  She was suggested botanical adaptogens to support both

• Between January and April 2025, the plan focused on HPV and vaginal microbiome protocols, continued dietary tightening, homeopathic post–birth-control support, and cycled luteal and follicular formulas, while tracking symptoms such as nausea with eggs, periovulatory vaginal irritation, low energy, and insomnia. 

• By May–June 2025, the patient reported improved digestion, better sleep, consistent exercise, less premenstrual spotting, and clearer ovulation, and DHEA had risen from 68 to 75 while oocyte-directed support and post-ovulation progesterone testing were added. 

• Cycle tracking documented a positive pregnancy test July 29, 2025, with a follow-up visit on August 26, 2025 noting a viable pregnancy at 7 weeks 2 days, along with mild fatigue, breast tenderness, loose stools, and mild aversions.

Differential Diagnosis

Differential considerations included age-related diminished ovarian reserve, luteal phase defect or insufficient progesterone production, implantation interference from the uterine polyp or fibroid, thyroid-related subfertility, stress-mediated hypothalamic-pituitary-adrenal effects on ovulation and sleep, and recurrent vulvovaginal dysbiosis contributing to inflammation. Polycystic ovary syndrome was less likely because she lacked typical pre-pill features, had relatively short rather than long cycles, and exhibited low rather than high androgens, and primary gastrointestinal disease appeared secondary because digestive symptoms were mild and diet-responsive.

Interventions

Treatment followed a naturopathic systems framework focused on removing obstacles to
conception and optimizing reproductive physiology via diet, lifestyle, microbiome balance,
endocrine support, and individualized supplementation. Nutrition centered on a
fertility-optimized diet, increased vegetables, optimal hydration, stable meal timing, and strong emphasis on eliminating sugar and minimizing dairy, gluten, and eggs, given the clear symptom linkage.

Supplement and botanical care evolved over time and included high-quality prenatal support; B vitamins and methylation support; choline and iodine; fertility-focused multi-ingredient formulas; detox and binder protocols; DHEA and pregnenolone drops; daytime adrenal support; magnesium and vitamin B6; sleep-supporting botanicals such as reishi; thyroid-supportive nutrients; cycle-phase female fertility formulas; oocyte-directed support; phosphatidylcholine in early pregnancy; and oral and vaginal microbiome support pre and during pregnancy. Recurrent vaginal symptoms were managed with vaginal antimicrobial suppositories, a structured vaginal microbiome protocol, boric acid during flares, strategic use of oral probiotics, and avoidance of unprotected intercourse during intensive antimicrobial phases.

Interventions were adjusted based on tolerance and response: when nausea and gastric
pressure followed multiple new products, all but the prenatal were paused and then
reintroduced individually to identify triggers, and eggs were removed as a protein source when they reliably provoked nausea. As DHEA remained low, dosing was revisited and
complemented with oocyte support, while post-ovulatory progesterone testing was ordered to refine luteal support planning.

Outcome and Follow-Up

Over the course of care, the patient reported reduced premenstrual spotting, improved bowel regularity, fewer digestive complaints, better sleep and energy, clearer skin when on plan, reduced vaginal redness and itching, and more obvious signs of ovulation. Laboratory trends showed DHEA rising from 68 to 75, though still suboptimal for fertility goals, and thyroid and vitamin D status were periodically reassessed.

The primary reproductive outcome was conception on the first cycle of actively trying in July 2025, with an ongoing intrauterine pregnancy documented at 7 weeks 2 days in late August 2025. Early pregnancy management emphasized maintaining protein intake, hydration, sugar avoidance, conservative continuation of selective supplements, and lab monitoring of thyroid, HCG, and progesterone.

This patient did send updates throughout her pregnancy and recently shared baby photos after a healthy delivery.

Discussion

This case underscores the utility of a multimodal naturopathic approach when fertility barriers span ovarian reserve, luteal phase optimization, microbiome health, and lifestyle factors. Rather than focusing on a single target, care addressed modifiable contributors in parallel, with symptom trajectories and labs guiding timing and intensity of interventions. Improvements in vaginal symptoms, spotting patterns, ovulatory signs, energy, and sleep supported the working hypothesis that enhancing systemic terrain and hormonal resilience can improve fertility even when AMH is low.

The case has limitations: interventions were layered and cannot be disaggregated. Adding to the complexity, her husband was a significant contributor to their fertility struggles given his oligoteratozoospermia, borderline diabetes, and fatty liver disease with long-term alcohol abuse. This case report does not cover the multi-modal naturopathic care he received to reverse his fatty liver, optimize his blood sugar regulation, and improve his sperm health via his naturopathic fertility plan.

Nonetheless, the sequence from terrain-focused treatment through symptom improvement and successful conception suggests meaningful clinical value for root-cause, naturopathically oriented fertility care in similar patients.

Conclusion

An individualized naturopathic program integrating anti-inflammatory nutrition, microbiome restoration, endocrine optimization, and cycle-based treatment adjustments was associated with conception and early ongoing pregnancy in a 40-year-old woman with prior loss, low ovarian reserve markers, recurrent vaginal dysbiosis, and multiple lifestyle and endocrine contributors to subfertility. This case supports the potential role of holistic, root-cause–based fertility care in complex presentations at advanced reproductive age.

 

Bio:

Dr. Aumatma is a double board-certified Naturopathic Endocrinologist, in practice for close to 20 years. Dr. Aumatma founded the Holistic Fertility Institute to support couples to create the family of their dreams, without drugs, injections, or taking out a second mortgage! In recent years, she has also trained 100s of doctors who want to specialize in fertility. She is the best-selling author of “Fertility Secrets: What Your Doctor Didn’t Tell You About Baby-Making” and host of the award-winning podcast “Egg Meets Sperm.”  Dr. Aumatma is also the co-founder of Madre Fertility, the world’s first Smart Fertility Analysis & individualized guidance app – It’s like having a fertility doctor + coach in your pocket, guiding your fertility journey step by step. Dr. Aumatma has been featured on ABC, FOX, CBS, KTLA, MindBodyGreen, and The Bump as the Holistic Fertility Expert. Her recent Tedx talk “Fertility Secrets: Understanding Your Body’s Wisdom” has received rave reviews. She is on a mission to help bring healthier babies into the world by creating healthier parents and a healthier planet. If you want to join the movement, you can connect with her at https://www.instagram.com/holisticfertilitydoctor