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Many women are told their blood tests are “normal”, yet struggle with fatigue, heavy periods, or difficulty conceiving. One commonly overlooked factor is low iron levels, particularly low iron stores, which may be present even when haemoglobin appears within range.

In my fertility clinic, I regularly see women with subtle signs of iron deficiency that have been missed — sometimes even during fertility investigations. When I suggest they ask their GP to check iron stores, results often show low ferritin, highlighting an important and treatable factor that may be affecting fertility and early pregnancy.

What Do We Mean by “Low Iron Levels”?

When people talk about iron levels, they are often referring to haemoglobin. However, haemoglobin can remain normal even when iron stores are already depleted.

The most useful test is serum ferritin, a protein that reflects how much iron the body has in reserve. Ferritin is the earliest and most sensitive marker of iron deficiency, falling before anaemia develops (1).

Symptoms of Low Iron Stores That Are Often Missed

Even before anaemia develops, low ferritin may be associated with:

• Persistent fatigue

• Hair thinning or shedding

• Brain fog

• Palpitations or breathlessness

• Heavy or prolonged periods (11)

These symptoms are often normalised, yet may reflect depleted iron stores rather than “just stress”.

UK Guidance and Important Cut-Offs

For many years, UK guidance used a ferritin level of around 10 µg/L to define iron deficiency — a level now recognised as far too low for menstruating women.

In July 2025, NICE-aligned guidance was updated so that:

• Ferritin below 30 µg/L is now considered iron deficiency, even if haemoglobin is normal (2,3).

In fertility and preconception care, many clinicians work with higher functional targets:

• <30 µg/L – iron deficient

• 30–50 µg/L – low or borderline for fertility

• ≥50 µg/L – commonly considered a more optimal level when trying to conceive, providing better reserves for ovulation, implantation and early pregnancy (1,4,5)

Why Iron Levels Matter for Fertility

Iron is required for:

• Ovulation and egg development

• Hormone production

• Formation of the uterine lining

• Implantation

• Cellular energy production and stress resilience

Research shows:

• Low ferritin is more common in women with unexplained infertility and recurrent miscarriage (6,7).

• Correction of iron deficiency in fertility patients has been associated with improved conception and live birth rates and reduced miscarriage rates (8).

• Higher dietary and supplemental iron intake is associated with a lower risk of ovulatory infertility (9).

Iron Levels in Pregnancy

Iron requirements increase significantly during pregnancy due to expanding blood volume and fetal iron needs. Starting pregnancy with low ferritin increases the risk of:

• Developing anaemia later in pregnancy

• Significant fatigue

• Low neonatal iron stores

• Preterm birth in some studies (3,10)

Optimising iron stores before conception is therefore preferable and easier than correcting deficiency later in pregnancy.

Acupuncture Support and Fertility Assessment

Acupuncture does not replace medical treatment for iron deficiency, but it can support the body alongside GP-led care.

In my fertility consultations, I take a detailed case history, including:

• Menstrual bleeding and cycle patterns

• Energy levels and history of burnout

• Digestive function and absorption

• Stress, sleep and lifestyle

• Fertility treatment plans (including IVF)

From this wider clinical picture, I may suggest that a patient discusses ferritin or other blood tests with their GP, as nutritional deficiencies and subtle imbalances are sometimes overlooked in standard fertility investigations.

Acupuncture may also support:

• Digestive function and nutrient absorption

• Regulation of menstrual cycles

• Uterine blood flow

• Nervous system balance during fertility treatment and preconception care

Key Takeaways

• Ask your GP to check ferritin, not just haemoglobin, if you are trying to conceive.

• Ferritin <30 µg/L is now recognised as iron deficiency in UK guidance.

• For fertility and preconception health, many practitioners aim for ferritin ≥50 µg/L.

• Identifying and correcting low iron stores before pregnancy may support energy, cycle health, implantation and pregnancy outcomes.

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References

1. World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency. WHO, 2020.

2. NICE. Anaemia – iron deficiency: diagnosis and management. Updated 2025.

3. Pavord S et al. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020.

4. Camaschella C. Iron deficiency: new insights into diagnosis and management. N Engl J Med. 2015.

5. Milman N. Iron and reproduction: a review of clinical importance. Ann Nutr Metab. 2011.

6. Rasmark Roepke E et al. Iron deficiency in women with recurrent pregnancy loss. J Reprod Immunol. 2020.

7. Vaucher P et al. Low ferritin in women with unexplained infertility. Eur J Obstet Gynecol Reprod Biol. 2012.

8. Bencaiova G et al. Correction of iron deficiency improves fertility and pregnancy outcomes. Fertil Steril. 2024.

9. Chavarro JE et al. Iron intake and risk of ovulatory infertility. Am J Clin Nutr. 2006.

10. Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005.

11. Tolkien Z et al. Symptoms of iron deficiency without anaemia. BMJ Open. 2017.