When “One Blocked Tube” Isn’t the Whole Story: Inflammation, Metabolic Health, and Fertility

Ravi and Priya came to see me to talk about weight loss. That’s how the appointment was booked, and that’s what I expected to discuss. But within the first ten minutes, it was clear their story was about something much bigger than the number on the scale.

Ravi was 42, working as a retail manager for a large textile firm. In his youth, he’d been a serious footballer — fit, fast, athletic. Priya worked as a school administrator. She’d been a competitive swimmer and something of an athletics star at school. Neither of them had ever thought of themselves as “unfit.” But in the eight years since they’d married, the weight had crept on — two to three kilograms a year, quietly, the way it does for so many couples juggling careers and life. Both were now largely sedentary.

They’d been trying to conceive, without contraception, for over six years. Four rounds of IUI hadn’t worked. They were now on their third cycle of IVF.

I asked them a simple question: did they understand why conception kept failing?

Priya’s answer was: “My one tube is blocked.” That was it. No further explanation had ever been offered. Ravi, remarkably, had not been investigated at all.

That gap — a couple spending years and a small fortune on fertility treatment without ever being asked about their sleep, their energy, their diet, or their metabolic health — is far more common than it should be. And it’s exactly why I want to talk about the connection between chronic inflammation, metabolic health, and fertility, using Ravi and Priya’s story as the thread that ties it all together.

What Their Bodies Were Actually Telling Us

Once I started asking broader questions, a much fuller picture emerged. Both Ravi and Priya were loud, habitual snorers. Both described low energy and poor concentration that dogged them through the day. Both were carrying significant abdominal fat, despite the fact that neither had ever been what most people would call “overweight” in their younger years.

On examination, Priya had acanthosis nigricans — the velvety, darkened patches of skin, often at the neck or in skin folds, that are a classic visible marker of insulin resistance — along with deep, dark stretch marks. Ravi had multiple skin tags (another common insulin-resistance marker) and eczema in the creases of his elbows and behind his knees.

Their blood work told the rest of the story, and it was sobering:

Marker	Ravi	Priya
Glucose/insulin status	Pre-diabetic, insulin-resistant	Pre-diabetic, insulin-resistant
Inflammation	CRP 8.1 (elevated)	CRP 12.6 (markedly elevated), ESR 37 (markedly elevated)
Lipids	Very elevated triglycerides, deranged liver function	Very low HDL (good cholesterol)
Uric acid	Elevated	—
Vitamin D	Low	Low

Neither of them had any idea their bodies were in this state. They’d come in worried about a few extra kilos. What they actually had was a textbook picture of metabolic syndrome with significant systemic inflammation — in both partners simultaneously — sitting quietly underneath years of unexplained fertility treatment.

What Chronic Inflammation Actually Is

It’s worth pausing here to explain what we mean by “inflammation” in this context, because it’s a word that gets used loosely.

Acute inflammation is the kind you already know — the redness and swelling around a cut, or the fever that comes with an infection. It’s protective, short-lived, and resolves once the threat is dealt with.

Chronic, low-grade inflammation is different. It’s a smouldering, background immune activation that doesn’t resolve — driven not by an infection or injury, but by ongoing signals from excess visceral fat, insulin resistance, poor sleep, gut imbalance, and lifestyle factors, including stress. It doesn’t announce itself with fever or pain. It shows up in blood markers like CRP and ESR, in skin changes like acanthosis nigricans, and — critically for couples like Ravi and Priya — in the organs and tissues that reproduction depends on.

How Inflammation Sabotages Fertility — In Both Partners

This is the part most fertility conversations skip entirely, because fertility investigations tend to focus narrowly on the reproductive organs themselves: tubes, ovaries, sperm counts. But the reproductive system doesn’t operate in isolation from the rest of the body’s metabolic state.

In women: Chronic low-grade inflammation, closely intertwined with insulin resistance, is now understood to be a unifying mechanism disrupting fertility. Excess inflammatory cytokines and oxidative stress impair the quality of the eggs themselves, disrupt the delicate hormonal signalling needed for ovulation, and reduce the endometrium’s receptivity — its ability to accept and support an implanting embryo. In women with PCOS specifically, insulin resistance has been shown to directly affect fertilisation outcomes and embryo development during IVF, with obesity-related inflammation compounding oxidative stress that damages the machinery inside the egg cell responsible for healthy cell division.

In men: The same processes work against sperm. Insulin resistance suppresses a protein called SHBG (sex hormone-binding globulin), which reduces the amount of usable testosterone in circulation. At the same time, insulin resistance switches on inflammatory pathways that flood the testes with inflammatory messengers, impairing the mitochondria inside sperm cells, disrupting the protective blood-testis barrier, and ultimately compromising sperm maturation and quality. This is precisely why Ravi’s lack of investigation was such a missed opportunity — male metabolic health is just as relevant to a couple’s fertility outcomes as female reproductive anatomy, and it’s assessed far less often.

In both partners — sleep apnoea: This is an underappreciated piece of the puzzle, and it mattered enormously for Ravi and Priya, who were both loud snorers with daytime fatigue and poor concentration — classic red flags. Obstructive sleep apnoea causes repeated overnight drops in oxygen levels, and this intermittent hypoxia is itself a driver of oxidative stress and systemic inflammation, independent of weight. In women, sleep apnoea is strikingly common in PCOS — found in nearly 44% of women with PCOS in one study, against just 5% of controls — and it worsens insulin resistance, inflammation, and the hormonal disruption of ovulation. In men, the same hypoxic stress correlates with increased oxidative damage in the testes and reduced sperm motility, largely through the same endocrine and inflammatory pathways. Sleep apnoea isn’t just a fertility bystander sitting alongside obesity — it’s an active contributor to the inflammatory load undermining conception in its own right.

What Was Actually Driving Their Inflammation

Once we mapped it out, Ravi and Priya’s daily eating pattern explained a great deal:

• Breakfast: Coffee with sugar, toast with margarine and jam
• Mid-morning: Cookies and coffee
• Lunch: Sandwiches, noodles, or pasta salad
• Afternoon: Fruit with fruit juice
• Dinner: A home-cooked but high-carbohydrate meal — usually rice, a potato bake, or oven chips, with chicken or fish and salad
• Evening: Chocolate-coated shortbread
• Weekends: Whiskey and Coke for Ravi

Nothing here looks extreme or obviously “unhealthy” at a glance — this is an ordinary, busy-family way of eating. But it’s relentlessly high in refined carbohydrate and sugar, low in protein and fibre relative to need, built around margarine and processed fats rather than anti-inflammatory fats, and largely absent of the polyphenol-rich vegetables and oily fish that help keep inflammation in check. Combine that pattern with sedentary days, undiagnosed sleep apnoea disrupting sleep quality every night, and the chronic low-grade stress of years of fertility treatment, and you have a near-complete picture of what drives chronic inflammation in modern life:

• Diet — excess refined carbohydrate and added sugar, ultra-processed food, poor-quality industrial fats (particularly margarine and refined vegetable oils high in omega-6), and insufficient fibre, protein, and polyphenols
• Visceral fat — abdominal fat is metabolically active tissue that itself secretes inflammatory cytokines
• Poor sleep and undiagnosed sleep apnoea — both a cause and a consequence of the same metabolic disturbance
• Sedentary behaviour — physical inactivity independently promotes insulin resistance and inflammation
• Chronic stress — sustained cortisol elevation disrupts glucose regulation and immune signalling
• Gut dysbiosis — an imbalanced gut microbiome increases intestinal permeability and low-grade endotoxaemia, a recognised driver of systemic inflammation
• Alcohol — regular intake, even at moderate levels, adds to the inflammatory and metabolic burden
• Micronutrient deficiency — low vitamin D, seen in both Ravi and Priya, is consistently associated with higher inflammatory markers and, separately, with poorer fertility outcomes
• Environmental toxin exposure — endocrine-disrupting chemicals from plastics, pesticides, and certain personal care products are increasingly recognised as contributors to both metabolic dysfunction and reduced fertility

Avoiding Toxins and Environmental Triggers

There’s one driver of inflammation that rarely comes up in a routine consultation, yet it sits quietly in the background of almost every modern home: endocrine-disrupting chemicals, or EDCs.

These are substances that interfere directly with your hormone system — some mimic natural hormones like oestrogen and bind to their receptors instead, some block hormone receptors so your body’s own signals can’t get through, and others interfere with how hormones are made or broken down. The practical effect, for a couple trying to conceive, is a system-wide disruption of the same delicate feedback loops that govern ovulation, sperm production, and implantation — layered on top of whatever metabolic inflammation is already present.

The chemicals worth knowing about:

• BPA and its replacements (BPS, BPF) — found in hard plastics, the lining of tinned food, and till receipts. BPA acts as a synthetic oestrogen and has been linked to lower ovarian reserve and reduced sperm quality. Worth knowing: “BPA-free” doesn’t mean disruptor-free — the common replacements BPS and BPF appear to carry similar effects, so glass and stainless steel remain the genuinely safer choice.
• Phthalates — used to soften plastics and stabilise fragrance in everything from food packaging to perfume and cosmetics. Linked to lower testosterone and sperm count in men, and to cycle irregularity, higher miscarriage risk, and worse IVF outcomes in women.
• PFAS (“forever chemicals”) — found in non-stick cookware, water-resistant fabrics, and some packaging. These persist in the body for years rather than clearing quickly, and are linked to thyroid disruption, which has its own downstream effects on metabolism and fertility.
• Parabens and synthetic fragrance — common preservatives in personal care products, associated in population studies with adverse fertility outcomes.
• Pesticide residue — particularly relevant for anyone buying fresh produce at the supermarket, or from suppliers that are not the farmers themselves.

Practical, low-effort swaps that make a genuine difference:

Area	Swap
Food storage	Plastic containers → glass, stainless steel, or ceramic
Heating food	Never microwave in plastic → use glass or ceramic
Drinking water	Single-use plastic bottles → filtered water in glass or steel
Cookware	Non-stick (PFAS-containing) → stainless steel or cast iron
Personal care	Standard shampoos, lotions, perfumes → fragrance-free, paraben-free, phthalate-free alternatives
Cleaning products	Synthetic sprays and air fresheners → simple, fragrance-free alternatives with good ventilation
Receipts	Frequent handling → decline where possible, or wash hands after

A reassuring point worth sharing if all of this makes you feel anxious: you don’t need to overhaul your entire home overnight, and you can’t eliminate every exposure — these chemicals are genuinely everywhere. But some of the most-studied EDCs, like BPA and phthalates, clear from the body relatively quickly once exposure drops, often within days to weeks. That means starting these swaps even a few months before a planned conception attempt or fertility treatment cycle gives the body real time to lower its overall burden before it matters most.

For Ravi and Priya, this fitted naturally alongside the dietary changes and sleep apnoea treatment they were already implementing — small, sustainable swaps rather than one more overwhelming list of restrictions on top of everything else.

📋 A closer look at pesticides — particularly relevant here in Mauritius

Pesticide residue deserves its own mention for folks living in Mauritius, because the local data is rather striking. A 2021 FAO report found Mauritius to be the world’s largest consumer of pesticides per square kilometre. Government testing in 2019 found that 20% of agricultural produce samples — collected from farm gates, supermarkets, and importers — exceeded the legally permitted maximum residue levels, and many of these were pesticides not even legally approved for use. This followed an earlier 2016 investigative report that first exposed excessive pesticide residues across most locally grown vegetables. A dedicated law, the Use of Pesticides Act, was introduced to address the problem, but the gap between legislation and farming practice on the ground reportedly remains wide.

Why it matters for fertility: several of the pesticides most commonly implicated in these residue surveys are recognised endocrine disruptors, meaning they interfere directly with the same hormonal signalling pathways that govern ovulation, sperm production, and implantation.

What helps, practically:

• Wash produce thoroughly under running water with gentle scrubbing
• Peel produce where pesticide residue tends to concentrate on the skin (e.g. cucumbers, apples)
• Buy from a diversified mix of sources, including growers known to use lower-input methods where possible
• Prioritise organic for the highest-risk, most frequently eaten items where it’s affordable, rather than trying to buy an entirely organic shop
• Grow a few herbs or vegetables at home if you can — even a small patch removes some regularly-eaten items from the equation
• Don’t let this create food fear — the goal is reducing cumulative exposure over months and years, not achieving a “zero-pesticide” plate. The fibre, polyphenol, and micronutrient benefits of vegetables and fruit far outweigh the residue risk for the vast majority of produce, most of the time.

What Actually Lowers Inflammation — The Evidence-Based Toolkit

This is the toolkit we built for Ravi and Priya, and it’s the same evidence-based framework I use with any patient carrying this pattern of metabolic and inflammatory disruption:

Intervention	Why it matters
Low-carb Mediterranean-style diet	Reduces the glycaemic load driving insulin resistance while increasing anti-inflammatory fats (olive oil, oily fish), fibre, and polyphenols from vegetables and legumes
Regular exercise (3–4x/week)	Improves insulin sensitivity independently of weight loss and directly reduces circulating inflammatory markers
CPAP for sleep apnoea	Treating OSA has been shown to lower inflammatory cytokines like IL-6, TNF, and CRP, and improves the hormonal disruption driving both ovulatory and sperm dysfunction
Vitamin D repletion	Corrects a deficiency consistently linked to both higher inflammation and poorer reproductive outcomes
Gut health focus (pre- and probiotic foods)	Supports a healthier gut barrier, reducing the low-grade endotoxaemia that feeds systemic inflammation
Sleep hygiene	Restorative sleep is itself anti-inflammatory and supports healthy hormone regulation
Stress management	Lowers chronically elevated cortisol, which otherwise disrupts both glucose control and reproductive hormone signalling
Reducing environmental toxin exposure	Limits additional endocrine-disrupting burden on an already stressed metabolic system

None of this is exotic. It’s the same foundation of lifestyle medicine I talk about constantly — but applied with real precision and urgency to a couple whose fertility outcomes depended on it.

What Happened Next

Seven months later, Ravi had lost 14kg. His metabolic panel had essentially normalised, with only mildly elevated triglycerides remaining. Priya had lost 11kg, and her inflammatory markers — that CRP of 12.6, that ESR of 37 — were back within the normal range.

Their next IVF cycle succeeded.

If you have read this far, then it’s clear you are interested in the effects of inflammation on your body.  Download your free guide to reducing inflammation here.

An Honest Note on the Evidence

I want to be careful here, because it would be easy — and tempting — to present this as “lifestyle change fixed their fertility.” I don’t think that would be honest, and it’s not what the research actually shows.

The evidence on preconception weight loss and IVF outcomes specifically is mixed. Several systematic reviews and meta-analyses show that weight loss interventions before fertility treatment do increase overall pregnancy rates — and interestingly, the strongest effect is on unassisted, natural conception, not IVF-specific live birth rates, where the evidence remains uncertain. Professional bodies like the American Society for Reproductive Medicine have been clear that there isn’t sufficient evidence to justify routinely delaying IVF to achieve weight loss first.

So what do I take from Ravi and Priya’s story, honestly? Not that their weight loss “caused” the IVF success — we can’t know that with certainty, and it may well have happened regardless. What I do know is that they went into that cycle with normalised insulin sensitivity, resolved systemic inflammation, treated sleep apnoea, and replete vitamin D — a body, by every measurable marker, in a fundamentally better state to support conception and a healthy pregnancy than it had been for years. That’s not a guarantee. It’s stacking the cards in your favour, in every way the evidence actually supports, before or alongside fertility treatment rather than instead of it.

My Take

Fertility investigations, in my experience, too often stop at the reproductive organs and never ask the bigger question: what state is this person’s whole body in? Ravi and Priya spent years and a great deal of money moving through IUI and IVF cycles while carrying pre-diabetes, marked systemic inflammation, deranged lipids, and undiagnosed sleep apnoea — in both partners — without a single conversation connecting those dots to their fertility struggles.

If you’re navigating fertility challenges, my advice is this: before — or alongside — your next round of treatment, ask your doctor to look at the whole picture. Metabolic health. Inflammation. Sleep. Both partners, not just one. It costs far less than another IVF cycle, and whatever the outcome of that next cycle, you’ll be building the foundation your body needs regardless.

If you recognise any part of Ravi and Priya’s story — the creeping weight gain, the fatigue, the snoring, the sense that something metabolic is going on beneath the surface — my Nutrition Basics PLUS programme is exactly where I’d suggest starting. It’s built around the same evidence-based, anti-inflammatory foundations we used with them, so you can start addressing this before your next appointment, not after. Learn more about Nutrition Basics PLUS here.