When patients are educated about fertility, healthcare providers often focus on things like hormone levels, ovulation tracking, or age. But one often-overlooked piece of the puzzle is metabolic health—the way our bodies manage energy, blood sugar, the storage and breakdown of fat, and inflammation. It turns out, metabolic health is crucial when it comes to reproductive health.

If you have ever been told to “just lose weight” to improve your fertility, you are not alone. That message has been repeated for generations, often oversimplifying what is, in truth, a very complex relationship between the body, hormones, and the environment in which reproduction happens.

Let’s explore a more whole-person, science-informed way to think about this connection—one that supports your health and your fertility, without reducing your story to a number on a scale.

What Is Metabolic Health?

Metabolic health refers to how well your body manages key processes like blood sugar regulation, fat storage and breakdown, blood pressure, and inflammation. You don’t need to have a diagnosed condition like diabetes or Polycystic Ovary Syndrome (PCOS) for metabolic issues to affect you. Even subtle imbalances can influence reproductive function.

When metabolic health is out of balance, the body may produce more insulin or inflammatory chemicals, which can disrupt normal ovulation and hormone production. This can make it harder to conceive or carry a pregnancy, even in people who otherwise feel healthy.

Why Metabolism Matters for Fertility

Fertility is a delicate dance of hormones, that work in feedback loops.  Those hormones are deeply influenced by the way your body processes nutrients and responds to stress.

Here's how:

• Insulin Resistance: When the body doesn’t respond efficiently to insulin, it can lead to higher levels of circulating insulin. This stimulates higher levels of androgens (such as testosterone), which causes a communication upset between the ovaries and the brain. As a result, this process may lead to irregular cycles, dysfunctional ovulation, and conditions like PCOS.

• Chronic Inflammation: Low-grade inflammation can affect the uterus, ovaries, and the chemical communications (signal) system needed to maintain a healthy pregnancy. It can also impact the quality of eggs and sperm.

• Hormonal Imbalances: Estrogen and progesterone, two hormones central to the menstrual cycle, are closely tied to other systems—especially the adrenal and thyroid glands, both of which are impacted by metabolic stress.

The Misconception About “Weight” and Fertility

You may have heard that a higher body size can lower fertility. While it is true that people with a larger body size may have a higher risk of metabolic conditions, it is not the size itself that’s the problem, it’s how the body is functioning overall.

In other words, two people with the same weight on a scale can have very different individual metabolic health profiles! One person in a smaller body may have insulin resistance or inflammation, while another in a larger body may be metabolically healthy.

So instead of focusing on weight alone, it is more helpful—and far more accurate—to focus on how your body is functioning, and what can be done to support it.

What Can Support Metabolic Health and Fertility?

Improving fertility is about improving overall health, not just hitting a target weight. Here are evidence-based ways to support your metabolism and reproductive health, no matter your body size:

Nourish Your Body Consistently

Skipping meals or following restrictive diets can backfire by increasing stress hormones and reducing ovulation. Eating regular, balanced meals that include protein, healthy fats, vegetables, and fibre-rich carbohydrates helps maintain blood sugar stability and supports hormone production.

Tip: Try including whole grains, beans/legumes, colourful veggies, nuts, and seeds to your diet!  You don’t have to be perfect, just try to be consistent.

Move in a Way That Feels Good

Physical activity can help the body use insulin more effectively, reduce inflammation, and boost mood by increasing endorphins! Burning calories does help with weight management, but the main goal is to support your whole-body metabolic health!  

Tip: Find movement you enjoy and are excited to return to!  Some examples may include dancing, walking, yoga, Ppilates, pickleball, or swimming. You don’t have to push to extremes for it to be beneficial.

Sleep and Stress Matter More Than You Think

Stress and poor sleep can raise cortisol levels, which can interfere with ovulation and hormone balance. They also impact insulin sensitivity, making it harder for the body to regulate blood sugar.

Tip: Aim for 7–9 hours of sleep a night and find moments to rest and restore throughout your day. Breathing exercises, meditation, or simply unplugging for a bit can go a long way.

Consider Other Measures of Health, Not Just Your BMI

Ask your healthcare provider about lab markers like fasting insulin, Hemoglobin A1C, CRP (a marker of inflammation), and reproductive hormones like Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), and progesterone. These offer a much clearer picture of your health than just BMI alone.

It would also be beneficial to include body composition scale measurements to assess your health.  A SECA Medical Body Composition Analyzer is one way we can do this at knownwell. This tool can measure details about body fat mass and skeletal muscle mass to help provide more information about health.

If You’re Navigating Fertility Challenges…

It’s okay to feel frustrated, overwhelmed, or even angry if your body isn’t doing what you hoped it would. But remember: your worth is not defined by your fertility, or by how your body looks.

You deserve compassionate care that looks beyond assumptions and treats the whole you. If a provider only talks about weight, it’s okay to ask questions or seek another opinion. There are many providers who will support your health journey with compassion, respect, and science-based evidence.

The Bottom Line

Your reproductive health is deeply connected to your metabolic health, but that connection is about function, not size. During Women’s Health Month, we want to celebrate the full spectrum of what health looks like. Supporting women’s reproductive health means offering a weight-inclusive approach with respectful, individualized care that focuses on overall well-being, not just a number on the scale.

You are more than a number. Every person, at every size, deserves care that respects their whole story. Your body is powerful, intricate, and capable of amazing transformation!   With the right care and support, you can be empowered to take charge of your health and an optimistic fertility journey ahead!