Latest / The Lila Rose Show / E109: Healing Infertility and Period Problems Holistically

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E109: Healing Infertility and Period Problems Holistically · The Lila Rose Show

0:00
I want to get to fertility treatments.
0:01
So what about endometriosis? What about stress?
0:04
How does that impact fertility? What is holistic reproductive
0:07
Women's Health care? What does that mean when we say
0:09
holistic? We are treating women as a whole
0:11
person that we're more than just our physical ailments,
0:14
understanding the root causes and really utilizing all
0:18
modalities, not just conventional treatments.
0:20
In my prior life, no matter if that woman was coming to me for
0:24
painful periods, if they had acne or abnormal hair growth, I
0:27
would tell them to go on the same exact treatment.
0:30
Which was a hormonal contraceptive and it just felt
0:33
very incomplete. This is your own body, this is
0:36
your own journey. This is your life.
0:38
You absolutely deserve to get the full answers, Doctor.
0:45
Lauren Rubel, welcome back to the show.
0:46
Thank you for having me again. You're my favorite.
0:49
Same Lila. We we did.
0:51
We did an episode last year on your story, which is super
0:55
compelling. I mean, people loved it.
0:57
And then we have an episode. I think it's coming out.
0:59
So these are coming out during my maternity leave.
1:01
And the other episode is you're breaking down all of the details
1:04
of IVF because it's a lot of confusion about it.
1:06
Fascinating stuff. Today we're going to talk about
1:09
healthcare for hormones, fertility for women.
1:12
The positive solutions? Yes, exactly.
1:15
I'm excited to get into it. So first of all, you're a
1:18
doctor. You're in OBGYN.
1:20
Why are you so passionate about Women's Holistic Healthcare?
1:23
Oh, oh, that could take another hour.
1:25
Just on and of itself. OK, I am very passionate about
1:28
it because I've first of all, as I shared in my other episodes, I
1:32
felt for so long I was treating ovaries in a vacuum that I
1:36
wasn't able to provide healing and answers to a lot of issues.
1:42
I was giving birth control as band aids in some many ways I
1:46
felt. And so from that perspective, I
1:49
didn't feel like I was doing a full and complete job in helping
1:52
care for the women and girls who are seeing me, number one.
1:55
Number two, I think that a lot of the current treatments that
1:59
are in use are quite honestly the opposite of what our natural
2:05
bodies do, that they are not perfect, that they have
2:09
significant potential for side effects and risks.
2:13
And I think that there's so much more that's a largely still not
2:17
known in conventional medicine. And so for that reason, I feel
2:21
very inspired to, you know, share all of this because it's a
2:25
common condition that many women suffer with is issues with their
2:29
periods or with their fertility. What's so fascinating too is
2:33
you've been on both sides. So you've done the birth control
2:35
prescription route. You were involved in an IVF
2:38
clinic working there and now you're doing holistic fertility.
2:42
You're doing holistic women's healthcare.
2:44
What is holistic reproductive women's healthcare?
2:47
What does that mean when we say holistic?
2:48
Yeah, great question. So we think about it, the terms
2:52
that are very commonly used is restorative reproductive
2:55
medicine or RRM, because we love our acronyms or I also think of
3:00
it as Integrative Gynecology or integrative fertility.
3:03
And so essentially what that means is that we are treating
3:08
women as a whole person that we're more than just our
3:12
physical ailments. And so it's a very patient
3:16
centered approach looking at mind, body, soul, understanding
3:23
the root causes by assessing hormone imbalances,
3:27
inflammation, other organ systems, forming A partnership
3:30
with your physician so that you two can walk alongside each
3:33
other to. Determine the best plan of care
3:35
for that patient. And really utilizing all
3:39
modalities, not just conventional treatments, but
3:41
really other approaches such as foundational lifestyle changes,
3:47
as well as judicious use of nutraceuticals, botanicals, so
3:52
supplements and whatnot as well. And so integrative medicine was
3:56
a fellowship that I did and it was revelatory and I it was
4:04
around that time when I'd left my prior practice and I was
4:07
really searching for how to be able to provide authentic and
4:12
full and holistic women's. Healthcare, that I discovered
4:18
that integrative medicine was this approach, that it really
4:21
was full circle and I also discovered the value of
4:25
fertility. Awareness based methods and you
4:28
know, this was a big deal because I was the purported
4:30
expert in Women's Health and many of these things.
4:32
I felt like I'd never heard about before.
4:34
In all your training before that, before your fellowship,
4:37
you had never really heard about like Fertility awareness methods
4:39
and. It or it had been brushed over
4:42
and it wasn't something that was as focused on as I think.
4:44
It should be. OK, so let's start with the
4:47
landscape of what women are even struggling.
4:51
With with regard to their reproductive health.
4:54
And then walk us through how it's currently typically
4:57
treated. Absolutely.
4:59
Women walk into their doctor's office.
5:00
Yes. And so when I think about it.
5:02
You know of. Course for GYN causes, meaning
5:07
many women are suffering from painful periods and in fact
5:13
about 10% of women worldwide will have a condition called
5:15
endometriosis, which equates to about 190 million women
5:21
globally. 10% of all women endometriosis.
5:24
Correct. So that is a lot.
5:26
When we think about women who have irregular ovulation which
5:30
will lead them to have irregular cycles, so not that monthly
5:34
period that women who ovulate regularly have, again that is a
5:39
significant amount of women. So the most common condition
5:43
that can lead to these irregular ovulatory cycles is called
5:47
Polycystic Ovary Syndrome. And this can also affect about 5
5:53
million women in the US. It's very common, It's about a
5:55
10%, almost 6 to 12% incidence. And so again huge numbers for
6:03
the two most common reasons. I'll see someone who is dealing
6:07
with abnormal periods for fertility.
6:10
We know that there is a new study by the CDC showing that
6:15
17.5% of couples will deal with infertility.
6:19
That's one in six couples, roughly.
6:21
This is worldwide. These are are those numbers up?
6:24
Yes, that is from last year, I think it was published.
6:26
In 20, So the infertility challenges are increasing.
6:29
Correct, yes. And they're all, yes, correct.
6:31
I thought you meant recent, but yeah, they're also increasing it
6:35
seems like overall and again recent studies showing that
6:39
even. For men in the Western
6:42
countries, they did a recent study showing that sperm numbers
6:46
have declined by about 50% over the past 40 years.
6:50
And so we know that that many people are struggling with this.
6:56
Absolutely. And so I'd love to talk next
7:01
about yeah, like you said, what is the typical course when
7:05
someone comes in and presents and?
7:07
So this was part of what was such an issue that I realized
7:11
when when I was practicing in my before in my prior prior life, I
7:16
felt like no matter if that woman was coming to me for
7:20
painful periods, heavy periods, irregular periods.
7:23
Too frequent periods. If they had acne or abnormal
7:27
hair growth, I would tell him to go on the same exact treatment
7:32
which was A. Hormonal contraceptive and it
7:35
just felt very incomplete again. That I wasn't able to determine
7:42
the why as much as I thought I should have.
7:45
And so it wasn't only the sense of not understanding the why and
7:50
the cause of why people were dealing with this.
7:53
It was also the fact that with this same treatment that I very
7:57
commonly prescribed in the past and I put up people on, they
8:01
didn't really seem to be always satisfied with.
8:04
I mean for multiple reasons, but in fact there are studies that
8:07
show. There are a.
8:09
Lot of women on hormonal contraception.
8:11
In fact, 99% of all women in the US have used contraception at
8:18
some point in their life. Out of those 88% of those used
8:23
hormonal contraception, it's huge numbers.
8:27
Currently about 65% I believe of women aged 15 to 40, nine are
8:35
using contraception and so this. Equates to about. 47 million
8:39
women that we're dealing with and that we're talking about.
8:43
It's it just makes me think immediately it's a huge industry
8:46
to have 47 million women on some form of I think it's hormonal
8:49
contraceptive. I mean that's a huge industry
8:52
for the Pharmaceutical industry that creates these pills to have
8:57
that many patients all using they're same drugs.
9:00
Exactly. And I think that number is for
9:02
overall contraception, but certainly it's still tens, 10s
9:06
of millions of women, OK. And why is that an issue?
9:12
Well, I mean, first of all, what does the hormonal contraceptive
9:17
do? We think about it from the.
9:19
Perspective of what our own bodies do.
9:22
The. Hormones that are produced by
9:24
our ovaries and work within throughout our bodies.
9:28
There's this beautiful cyclicity and rhythm and and change and
9:34
variance throughout the course of a cycle.
9:36
And believe it or not, these have effects in every different
9:39
Organism from our brains. There's really interesting
9:41
research looking at that to again, they affect every other
9:45
organ. There are receptors for these
9:46
hormones in our other organs and we contrast that and our what
9:51
should naturally be happening to what for example birth control
9:56
pill does. It creates a flat line.
9:58
It's a mainly what we call progestin which means all types
10:03
of progesterone, progestin based response.
10:06
So progesterone is I think progestation, so that's a pro
10:10
pregnancy hormone. That hormone typically is
10:14
produced naturally after we ovulate, so after the eggs
10:18
release and it really prepares and readies our lining.
10:21
For a baby. To implant.
10:23
And so that's its goal. But it goes down after if if a
10:27
woman doesn't get pregnant and then isn't present the entire
10:30
cycle the way it overall is with the pill.
10:34
And so you're having this like flat line of hormones overall
10:38
compared to that cyclicity. So that's one big issue.
10:42
I mean the second issue that a lot of people have raised as
10:45
well, if we're acting and using this progesterone, this
10:48
pregnancy hormone kind of on a very long term basis, that isn't
10:53
what our bodies are necessarily going to be naturally.
10:57
Used to or should. Be used to OK and so that's
11:00
another question that gets raised.
11:03
And then we think about the actual hormones that are used in
11:07
these contraceptive methods. They are not the same as our
11:12
body's hormones. It's a different chemical
11:16
structure in fact. And because of that, they can
11:20
confer different effects and that's why they can cause
11:22
different effects. What do I mean by that?
11:24
Remember, hormones are just messengers.
11:26
That's the way that our brain communicates to other parts of
11:29
the body and how they talk back. And so they have receptors that
11:33
they will kind of sit in and. These synthetic hormones, they
11:38
actually will sit in the receptor typically longer and
11:42
and stronger. So they have greater potency and
11:46
so this can lead to issues like an increased risk of blood clots
11:51
in the blood vessels. There's a three to five time
11:54
increased. Risk of this and.
11:56
Three to five time increased risk of blood clots in the
11:58
vessels for those on hormonal contraceptives.
12:01
Estrogen containing contraceptives, which are the
12:04
which are good amount of them. Absolutely this can be deadly.
12:08
Unfortunately, women who have clots that can go to their lungs
12:11
1/3 of the time die from them, so it is not insignificant,
12:17
right? Thankfully these numbers are
12:20
low, but as we age, these risks can go up.
12:23
I read a study that said about there was a 2% chance of that
12:27
happening by age 50, just at baseline.
12:29
OK. 2% of the women using. Of just women in general.
12:34
Of women in general. Wow.
12:36
And that's increased three to five times if you're using a
12:39
hormonal contraceptives with estrogen.
12:41
Correct. Estrogen based, correct.
12:44
And so I think another compelling risk that we have to
12:48
be aware of is that these hormones, again, they're done.
12:53
They're being given a stronger type, a more potent type.
12:57
They're beginning in a different way than our body naturally
13:00
produces or uses it. And So what we're finding too is
13:04
that there's an increased risk of mood disorder.
13:06
So what does that mean? That means things like
13:08
depression. And in fact, they did this huge
13:11
study in Denmark, a million women, and they found that there
13:15
was an up to three times increased risks of depression
13:18
and even suicidality. And this may persist even after
13:22
discontinuation of the pill. And so again, this is very
13:28
concerning because we know we're facing a mental health crisis
13:31
already and we also know again how common many teens are on
13:36
this, and it just becomes almost like a perfect storm.
13:39
What are any other risks of hormonal contraceptives of the
13:43
birth control pill? Another one that may be an issue
13:45
is that there's an increased chance for gastrointestinal
13:48
issues. And so I'm hepatic, which means
13:51
liver, liver tumors. It can also increase risk of
13:57
ulcerative colitis or Crohn's which are issues dealing with
14:01
your gut with your colon SO and GI tract SO.
14:05
We know that that can also occur so.
14:09
Any cancer risks. The cancer risks are
14:13
controversial still, and it's not clear.
14:16
However, it does appear there was a recent paper published
14:19
that show that even progesterone only, so not even containing
14:22
estrogen. Hormonal contraceptives may
14:26
increase breast cancer risk and so we do feel like there could
14:31
be increases, although again there are some studies that say
14:34
yes, some studies that say no. So I feel like there there is
14:37
some Gray area there. The Washington Post had this
14:40
article recently. I don't know if we already
14:42
talked about off camera, but the headline was, you know,
14:45
something about the misinformation that is scaring
14:47
women off of birth control and claiming that there's nothing in
14:51
the article that was critical of birth control.
14:54
Or just say that, you know, didn't mention the Denmark study
14:56
about suicidality and mental, you know, depression and
14:59
representing itself. And these women, you know, on
15:02
the pill in in in a disproportionate amount.
15:05
Obviously, it doesn't mention anything about blood clots.
15:07
You know, these are all somehow myth, A myth according to the
15:11
Washington Post. And they kind of focused in on,
15:13
I think right wingers and influencers online who are
15:16
sharing this information. I mean, is this an American
15:19
phenomenon? I don't know if you can answer
15:21
this, but you know, Denmark is doing a study of a million women
15:24
and there this information is available.
15:26
Obviously you can see it in the United States, but why are we
15:29
so? Why is it so?
15:30
Controversial to tell the truth about the harms of birth control
15:34
in the United. States that is.
15:40
I would say that there, as you mentioned, there are probably a
15:46
lot of forces at play that very much are interested in, in women
15:54
being on these modalities, quite honestly.
15:58
But I think also that it's multifactorial because when
16:03
we're in school, of course I to, to to be frank, there's more
16:09
data of course coming out. But I know that I didn't feel
16:13
like I was taught completely about all of these, OK, in the
16:16
sense that again, there's more of a focus on the benefits that
16:20
I can have. And it's it's again, not as
16:24
diverse of opinions in some ways, #1, #2 even when I was
16:28
counseling patients, I'm ashamed to say I don't feel like I fully
16:32
was talking to them about all the potentials, OK.
16:37
And then third of all, I think that there's just this odd kind
16:45
of position that medicine sometimes gets in where it's the
16:50
physician knows all and this patient just has to acquiesce to
16:55
what the recommendations are. I think debate and questions.
17:01
That is the essence of the scientific method and that is
17:03
the essence of being in charge of your own health actually.
17:07
And so I I firmly encourage all women to be their own best
17:13
advocate. I say it every time, and it
17:16
shouldn't be something that is relegated to whatever they said,
17:22
influencers or whatnot. This should be.
17:24
This is your own body. This is your own journey.
17:27
This is your life. You absolutely deserve to get
17:29
the full answers. And unfortunately, if you don't
17:32
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So earlier you were saying the common treatment plan for women
18:49
coming in with these different issues with their periods or
18:53
with, you know, seeking, they have acne, cystic acne, or they
18:57
have these different conditions, they're frequently just.
19:01
Told to go on the pill. Basically, and you're talking
19:04
through the different disadvantages.
19:05
Of that for these? Women #1, they're not addressing
19:08
the underlying condition. And then #2, there's the side
19:11
effects of birth control. Talk more about those underlying
19:14
conditions. So that's where it gets really
19:16
interesting. I mean, obviously birth control,
19:18
we could talk a lot more even about some of its harms.
19:21
I think we've kind of run over some of that.
19:23
But what are these underlying conditions that women have in
19:26
your expertise? And what are the solutions
19:30
instead of just giving them the birth control pill?
19:33
Yes, absolutely. And so I'll go over the more
19:35
common ones as I touched upon earlier.
19:37
So one includes irregular periods and there's actually a
19:41
myriad of causes for this because or there can be more
19:45
than one issue. What that means is a woman isn't
19:49
regularly releasing that egg. And so the most common cause
19:54
about 70% of the time is that condition called polycystic
19:57
ovary syndrome or PCOS. What that is, is essentially an
20:01
imbalance of the male to female hormones in the body.
20:05
We have male hormones. As well as female hormones, but
20:08
there has to be. It's very intricately
20:09
controlled, and if there's a relative increase in male
20:12
hormones, it can either be present and identified in the
20:16
blood when we do lab tests, or it can also be present
20:22
clinically. And so women will deal with a
20:24
lot of unwanted hair in locations like their upper lip
20:29
or their chin, chest and others, or they can also have very
20:33
bothersome acne on their face, chest or back.
20:36
And so it's a condition that causes a lot of suffering, quite
20:42
honestly as well. And so it can be associated.
20:46
And the reason why it can be such an issue is because it also
20:52
has as it's caused many times insulin.
20:55
Issues and so as insulin is the counterpoint to.
20:58
Glucose, which is sugars that insulin can affect, weight
21:04
potentially can affect and increase the risk of developing
21:08
metabolic conditions down the road.
21:10
Like diabetes, it can be involved in even cardiovascular
21:14
issues again down the road and there.
21:20
So therefore, helping to heal these women who are dealing with
21:24
this very common PCs condition is really important because
21:28
we're going to prevent hopefully those downstream issues, OK.
21:32
And So what does that mean? So what that means to me is we
21:36
can employ an integrative approach for PCOS.
21:39
OK. What does that mean?
21:41
What that is? And when we think about those
21:42
pillars, we have the foundational lifestyle factors,
21:46
OK. And some of these things I tell
21:50
people it's like, you know, it's what our mothers told us.
21:52
And so it's not necessarily these fancy complex some
21:56
treatments you. Don't necessarily need drugs,
21:59
yeah. Yeah, but it also does require a
22:02
lot of, you know, ability to stick to something.
22:08
And that's why it's good to have a good plan and to walk
22:11
alongside someone who can help you with this.
22:15
Because it may not. It may feel overwhelming, OK,
22:18
but the lifestyle foundational ones are good.
22:21
Nutrition, Food is medicine is a regular exercise routine is
22:28
sleep and really having restorative sleep.
22:34
It's also the intangibles. So this is you know having the
22:39
the mind body connection, right, being connected to God, to other
22:44
to other humans, things like that right?
22:48
And then on top of that, when we to establish that foundation, we
22:53
can also use our knowledge of how can we limit maybe
22:58
environmental toxins. There's some interesting
23:01
associative studies looking at for example BPA and plastics and
23:05
potentially impacting PCOS development.
23:08
There can be a different supplements that we use that
23:12
have been shown in research and studies that are as effective as
23:19
some of the pharmaceuticals we use.
23:21
And so for me, when I see a patient with PCOS, we want to
23:25
make sure we're working on healing their insulin levels
23:29
again. There's some interesting
23:31
supplements like inositol, berberine and acetylcysteine,
23:35
which is a precursor to the most potent antioxidant in the body.
23:38
We'll be using that in conjunction with other ones that
23:43
help with with antioxidation, which is fighting off those free
23:48
radicals. And so that could be even fish
23:51
oils and Omega threes. So we we develop a plan together
23:55
to help with not only restoring the male female hormones but
24:01
also working on the insulin, working on the inflammation.
24:04
And then we continue watching together.
24:06
I'm happy to report that it works, that really I've.
24:10
Seen amazing things where women have and resume normal cycles
24:16
and they feel better and they have less symptoms.
24:19
So it's very exciting to again from where I came from to now
24:24
where I am and really, truly feel like I'm helping heal
24:27
people. So if you have a patient
24:29
presenting with PCOS symptoms and you diagnose PCOS is part of
24:34
the diagnosis doing a test for their insulin levels, how
24:38
important is the insulin piece and is the insulin piece, is it
24:40
healed by? I think you mentioned different
24:43
supplements or botanicals, but is there is there a nutritional
24:46
plan for that too? Oh, absolutely.
24:48
So that is one of the foundations, right.
24:50
And so what's interesting is, is that not everyone looks at
24:54
insulin specifically. And so Will there are different
24:56
ways to assess for how their sugars have been.
25:01
And I have to say that again, part of restorative reproductive
25:04
medicine is really digging deep immediately because we don't
25:07
want you to get to the point where you're already at a pre
25:10
diabetic stage and we're diagnosing that.
25:12
We want to nip it in the bud prior that when we see an
25:15
elevation in your insulin for example and we say, oh, let's
25:19
work on a nutritional strategy, let's work on potentially.
25:24
Again, exercise is so important and let's focus on how we can
25:28
help with weight, which is in many peace to US women very
25:33
difficult to lose. And again, it's not for lack of
25:35
trying, they're doing their best, but it's also because of
25:38
these metabolic changes including the insulin and so the
25:43
the supplements. I always tell my patients I
25:45
don't want them to be on supplements forever, but I
25:48
actually use it as a bridge as we're changing the foundation
25:54
and and coming up with a new plan.
25:56
Yeah, I am curious. This is a theory.
25:58
Tell me if you think this, this adds up.
26:00
But, you know, if you're presenting with PCOS as a woman,
26:03
you go to your average doctor, they give you a birth control
26:06
pill because that's going to suppress some of these, you
26:09
know, disorders between the male, female hormones that
26:11
they're experiencing. The birth control has its other
26:14
side effects that you're dealing with because of the PCOS.
26:17
If you had been trying to get pregnant at the time, you might
26:19
have had some trouble anyways. And then you go forward to get
26:22
off the pill. At some point you turn 34, you
26:24
want your first baby. You know, I don't know.
26:25
You get married. And this is a story for a lot of
26:28
women, by the way, And then all of a sudden they're like, well,
26:30
I'm off the pill, but I can't get pregnant now.
26:33
Do you think a lot of the fertility issues today, I don't
26:36
know if you can weigh in on this, but how many of the
26:39
fertility issues may be connected to?
26:41
There were underlying conditions and issues the woman had.
26:45
They put the Band-Aid of Birth control on top, which actually
26:47
ended up having its other issues.
26:49
And then they took the Band-Aid off and the underlying issues
26:51
are still there. And now they're like, what's
26:52
wrong with me? Why isn't it working?
26:54
This is so common, Lila. And this is exactly the reason
26:59
behind restorative medicine. Because here's the thing, as we
27:04
talked about last time, you know, even we look at IVF, which
27:09
is you make, if you make the baby with IVF, right, you have
27:14
an embryo. The pregnancy rate with IVF is
27:18
not 100%. The pregnancy rate with IVF is
27:20
not even 50%. And so if we've made the baby,
27:25
so what's the issue here? Well, the issue could be that
27:29
there is something going on with the embryo, with the transfer
27:32
that was done with the uterine environment, with the mom's
27:37
environment, maybe even her immune system, her hormone
27:40
imbalances or inflammation. There's so many different
27:42
factors, right? And so by using restorative
27:48
reproductive medicine instead of putting those band aids on,
27:52
we're trying to heal those causes.
27:54
So when women are young, This is why we should be teaching how to
27:57
chart, because it really is the 5th vital sign that once we see
28:01
there's an issue, we can nip it in the bud, like I said.
28:04
And then when that woman is trying to conceive yours down
28:08
the road, if she deals with infertility, we've we're already
28:11
able, she's able to really understand that and also a lot
28:15
of these issues we talked about PCs and the metabolic
28:18
implications. This may have an impact on the
28:21
health even of her pregnancy, on certainly her future health.
28:25
And so if we want to have healthy moms giving birth to
28:28
healthy babies, it really behooves us to try to understand
28:33
and help them at the root, OK. And so to answer that question
28:38
of, well, now what do we do? I just always feel so sad
28:42
because that happens a lot. And they say, well, I my period
28:45
didn't come back. I didn't.
28:46
I'm not ovulating. And it's like, OK, yes, because
28:49
unfortunately we didn't. Correct the issue.
28:51
We just we just suppressed it. There is, you know, the birth
28:55
control pill does help decrease free levels of testosterone,
28:59
which is a male hormone. So it does help in that regard.
29:04
But again, it's not going to fix PCOS.
29:10
I've actually had patients come to me who said I've been trying
29:12
to get pregnant, but then I was offered a birth control pill
29:15
because I'm not having regular cycles.
29:16
And that just doesn't, That's a lot of dissonance for me because
29:21
that's going to prevent pregnancy, right?
29:22
And so it's like the answer is not delaying time to pregnancy.
29:25
The answer is trying to correct what's going on.
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using the code Lila at checkout. OK, So what about endometriosis?
30:44
Yes, that's also a very common. One what's the what's the
30:47
holistic approach, the restorative reproductive
30:50
approach to healthcare approach to endometriosis?
30:53
Yes. And So what is endometriosis?
30:56
And so endometriosis is the way. The way I explain it is that
31:00
when we think about the endometrium is the inner lining
31:02
of the uterus, that lining responds to the hormones
31:06
produced by the ovaries. That lining is what sheds every
31:08
month in the form of our period, which is fine if it's inside our
31:11
uterus, OK, but with endometriosis.
31:14
And this is an absolute overs simplification, because there
31:17
are many different theories of how endometriosis develops.
31:20
But I just think of those similar types of cells in other
31:25
places of the body, OK, typically in the pelvis.
31:29
But here's the thing, they're still responding to the ovarian
31:32
hormones. And so therefore with all those
31:36
changes in the hormones, they're still potentially like almost
31:39
bleeding into themselves and that can cause a lot of
31:41
inflammation. It can cause, obviously, the
31:44
pain symptoms. It can even cause scarring,
31:47
which is an issue if there's. Endometriosis on the tube for
31:50
example, right? Because it can scar closed
31:53
potentially. And that prevents the egg from
31:56
being able to reach the uterus. That prevents the union of egg
32:00
and sperm and therefore that baby develops and forms in the
32:03
outer part of the tube typically, and then travels from
32:07
there to the uterus. And so yes, it could, it could
32:10
have effects at different places depending on the degree of
32:14
stricture. Degree of is, yeah.
32:16
Stricture and then or blockage, blockage, they wouldn't even be
32:19
able to meet, right. So yes, there can be
32:23
implications for fertility. In fact, that's why 30 to 50% of
32:28
patients with endometriosis may deal with infertility and 30 to
32:33
5050% of patients with infertility may have
32:36
endometriosis. And so it's a condition that has
32:41
a lot of wide implications, again, just similar in that way
32:45
to PCOS, OK. And so the typical way that we
32:50
make a diagnosis of endometriosis is by doing a
32:52
surgery, by looking, by seeing, by visualizing, by biopsy and a
32:57
looking or microscope confirming it.
32:58
OK, for a lot of women, for many reasons, that is not something
33:03
they're interested in, at least immediately.
33:05
And so we can presume sometimes a diagnosis because women will
33:08
very often present with pain, sometimes pain with periods,
33:12
pain with intercourse, pain with bowel movements.
33:16
And so for those women, there are other ways that we can
33:21
presume A diagnosis. But if you said if a woman came
33:25
to me and she said I really just want to try to not invasively
33:30
help my terrible pain with periods, what can I do?
33:34
What I would say is we should look for obviously other causes
33:39
and rule those out, number one. But #2, there is interesting
33:43
data supporting that if we can pursue an anti-inflammatory diet
33:49
in many ways that that will help them with their pain with
33:53
periods. A Mediterranean diet is a great
33:56
one to just use for everything. I mean, their studies show me it
34:00
increases our lifespan by two to three years even.
34:03
So there's a lot of reasons to do that.
34:06
Lots of green leafy vegetables, you know, healthy fats like fish
34:11
that are low in mercury, whole grains, you know, organic olive
34:17
oil, nuts and seeds. That's kind of the Mediterranean
34:19
backbone. And so we'll really start
34:22
talking about how we can have them on a good nutritional plan.
34:29
We also talk through how to limit toxins in the environment.
34:34
OK. Again, this can feel like a
34:35
rabbit hole and it always tell my patients to not be
34:38
overwhelmed because all the data show that small changes can have
34:42
profound impacts and so just decreasing perhaps your
34:46
fragrance exposure or changing. Like perfume fragrance or
34:52
household products that have fragrance.
34:54
Any or any of the. Yeah, yeah, yeah.
34:56
What about scented candles? That one, yes, that one also may
35:01
have impacts but again this is where I also start telling
35:04
people that we have to give ourselves lots of grace and we
35:08
have to many times what I the what I see is that there's this
35:14
propensity to start restricting everything for this future goal
35:17
and I completely understand that.
35:19
But we also have to be able to enjoy the here and now.
35:22
So if I, you know, if women want to have a candle and they're
35:26
they've changed out their laundry detergent to, you know,
35:30
fragrance Fray. So.
35:31
Yeah. Exactly.
35:32
Great. Right.
35:34
So a lot of keep one candle. Yes, exactly.
35:37
Please. Special days you can light that
35:40
candle. So that's what I mean.
35:43
A lot of the data show that as long as we change the quartiles
35:45
of exposure if we bring them from the highest quartile of
35:47
exposure down to the lowest. That can have profound impact.
35:51
So that's that's more the point, but we can also use different
35:59
support in the sense of their interesting studies showing even
36:02
calcium and magnesium by doing this, there's a statistically
36:05
significant. Decrease in pain with periods.
36:08
Well, I remember getting on a supplement that a friend, a
36:10
girlfriend, recommended to me. This was probably a decade ago
36:14
because of painful periods. I didn't have extreme pain, but
36:17
at the time I was looking for solutions.
36:19
She had extreme pain and I took the supplement, which I think
36:21
was heavy in magnesium and calcium and I had pain free
36:25
periods as long as I was on it, which was remarkable to me that
36:29
it it worked that well that quickly.
36:31
So I must have had a deficiency. I didn't know.
36:33
Yes. So there's randomized controlled
36:34
trials looking at this and showing a benefit.
36:36
So you yeah, that I'm so glad that that a decade ago was out
36:40
there, right. Even the B vitamins, there's
36:43
studies showing that that by using those especially a
36:45
methylated I. Think it had that too, and it
36:47
was like kind of a concoction of all the.
36:49
Things that could help you know. Yes, that's exactly right.
36:52
And so Omega threes are great at decreasing inflammation.
36:56
Or again, the natural component to that is I'm really upping
36:59
your intake of organic extra virgin olive oil.
37:02
Or again, the fatty fish like the ones low in mercury,
37:06
includes sardines, mackerel, anchovies, salmon, herring, to
37:10
try to have a couple of servings of those a week, or the nuts and
37:13
seeds. Tree nuts are great as long as
37:16
it's great to store them in a freezer just to prevent them
37:19
from undergoing fat oxidation. And again, I don't want to put a
37:22
lot of rules for everyone, but that would be the ideal way.
37:25
So these can all be helpful and then we can start diving into
37:30
other factors like again that an acetyl cysteine or glutathione,
37:35
which can help with the prevention of free radical
37:40
damage. Like the something called Coq
37:43
10, which is a mitochondrial cofactor.
37:46
And as the mitochondria of the energy powerhouses of our cells,
37:50
this might be beneficial in helping with some of that pain
37:53
so we can really develop. There are I'm usually not
37:55
limited by the amount of supplements that we can start.
37:58
We want to do it again, judiciously remembering that
38:01
that that first of all it's a bridge.
38:03
I don't want to be on all these things forever.
38:05
Second of all, what can this woman do in her daily life that
38:10
won't make her feel overwhelmed or if she hates pills, like
38:13
what? What can we do that that is
38:14
reasonable, but there are a host of different supplements that we
38:19
could put people. On what about cystic?
38:21
Acne. I know that that's a common
38:23
challenge for a lot of especially young girls after
38:26
puberty and that's they present with, you know, yes, heavy
38:29
periods, but also cystic acne. And then they're prescribed
38:32
birth control. Yes.
38:33
And so cystic acne also has different causes behind it,
38:37
right? And so I would be interested in
38:40
assessing their menstrual history and making sure they
38:43
don't have PCOS because it is just so common, but it can
38:46
actually be a reaction or a relation to foods and different
38:50
allergies. And so dairy may be associated
38:52
with this. And so they can try potentially
38:53
different elimination diets to see if that helps them in making
38:58
that and improving it. OK.
39:01
I would say that the gut is the center of everything and there's
39:05
more and more research coming out as the microbiome project
39:08
has showed how important are good guy bacteria which is what
39:13
the microbiome is and how it helps us and has connections to
39:17
different from one organ to the next like the gut to the brain
39:19
for example. And so we really want to support
39:23
healthy microbiome. A lot of girls and women I see
39:27
are dealing with many GI issues, bloating, changing stools,
39:32
reflux, nausea for example. And that can be related to
39:38
several conditions, but it can also be related to what we
39:42
colloquially call leaky gut and what that.
39:46
Why that matters is because our immune system, actually much of
39:51
our immune system resides within the gut.
39:53
It's the GI associated lymphoid tissue and typically the the
39:59
intestinal junctions are what we call tight.
40:01
That means that if if. I'm the immune system.
40:04
I can't see out if the junctions are tight and we think of leaky
40:08
gut, you kind of think of this, the junctions are impaired and
40:12
so that immune system can start kind of recognizing what's
40:15
inside and start becoming sensitized to that.
40:18
That can lead to the development of autoimmune issues.
40:21
What is that? Our immune systems, our defense
40:25
system that protects us from foreign invaders, which is a
40:27
good thing. But I think of autoimmune
40:29
disease as friendly fire, that the immune system mistakenly
40:32
recognizes one of its own as enemy and starts attacking that
40:35
into a common place is thyroid, for example, which I see
40:38
unfortunately commonly as well. But anyway, the gut is so
40:43
central that if if they're dealing with any gut conditions,
40:47
we need to focus and heal that because it might be related to
40:50
their acne. And I would say a probiotic
40:52
might be a very worthwhile approach.
40:56
I know that it's very common to be placed on antibiotics for
41:01
acne. And again, imagine what that's
41:02
going to do to your gut bacteria.
41:04
And so this can start becoming worse and worse because of some
41:11
of the the treatments. And I would say that there's
41:13
interesting data looking at different types of light therapy
41:16
to help with acne. And so blue, light red light
41:20
therapy has some benefits too. So it's something else that they
41:24
could pursue. OK, so fascinating, I want to
41:27
get to fertility treatments. Yeah, but before we do that you
41:31
mentioned earlier, I think the your cycle, our cycle as as
41:35
women as the 5th vital sign. So explain that, because this
41:39
is, I believe, the foundation of fertility awareness based
41:42
methods. Yes, absolutely.
41:44
And so I say that it is the 5th vital sign because a woman's
41:50
again, that natural cyclicity that we should see, it is
41:55
beautifully and very intricately controlled by a lot of different
41:58
feedback loops and a lot of interactions between different
42:01
hormones. And so it results in our period,
42:06
it results in ovulation, OK, which is actually the main, the
42:09
main event. And if there is a disruption to
42:14
any of those factors, it will then manifest as an abnormality
42:19
in the ovulatory cycle. And so again, fertility or
42:25
abnormal cycles, those are still symptoms.
42:28
We need to get at why that is happening.
42:31
And so the vital sign component comes in where if there's an
42:33
abnormality, let's figure out the why.
42:35
And that's where you start undergoing different hormone
42:38
testing. You start looking at the
42:39
structure of the pelvic organs to make to see if there's
42:42
anything that needs to be addressed, for example.
42:46
So when we talk about fertility being a sign of health, is that
42:50
the right way to look at fertility?
42:53
If you're have a healthy cycle, it's regular, you don't have a
42:57
lot of pain associated with it. You are in a position, if you
43:01
wanted to, to be able to get pregnant and it's not some big
43:04
mountain to climb, that's a sign of health.
43:07
And that means that your system is working.
43:10
Well, I think that I think that it shows that all of the factors
43:15
that could be impacting your health and your fertility seem
43:19
to be optimal. OK.
43:20
And so I would say that even that fertility may be impaired
43:26
even in women who have those who's who are ovulating
43:29
regularly, who don't necessarily have pain.
43:31
And that's because dealing with difficulty conceiving can be due
43:37
to a myriad of factors. OK.
43:40
Be it what we think of as factors within the woman like
43:45
ovarian related, tubal related, uterine, the endometriosis,
43:51
those are some causes again even changes in the microbiome versus
43:56
male factors or combination of the two, OK.
44:00
So increasingly, women are struggling with infertility
44:02
today. Yes.
44:04
And why? Why is that?
44:06
What are what are the different kinds of infertility?
44:09
And then how do we treat them holistically?
44:10
Yes. And so I always want to preface
44:13
this by saying that there is always hope.
44:17
You know, out of the couples trying to get pregnant, 85% of
44:21
them will conceive within a year.
44:23
After additional three years, another 50% will conceive.
44:26
And so after four years of trying, 93 to 95% of couples
44:30
will OK and so not only that, but I have seen it all.
44:36
So again, medicine is never an absolute that person, that
44:40
couple, that is the first time that has ever happened for that
44:43
couple. And so things, even when they
44:45
may have a what. We call a.
44:49
Poor prognosis, which is just there may be several factors
44:53
that make it less likely by the numbers to get pregnant.
44:57
Anything can happen. I've absolutely seen that
44:59
before. So for the couples that are
45:02
experiencing infertility, what are some of the common causes of
45:05
infertility and what are the holistic or the reparative
45:09
reproductive healthcare treatment options for them?
45:12
Yes, exactly. That's a great question.
45:14
And so we know that many times it's due to an issue again with
45:19
in the uterus or the ovaries or the tubes that's a female factor
45:24
is what we call. There's another 30 to 40% of the
45:27
time there might be a sperm issue that means either lower
45:33
concentration, lower motility, a lower number of normally shaped
45:38
sperm. And then there can be other
45:41
factors like the endometriosis, as I said, OK, there is a subset
45:46
of couples where it's called unexplained and that can be even
45:50
the numbers say anywhere from 10 to 30% of the time people may be
45:53
given this diagnosis. Again, there could be hormone
45:57
imbalances or endometriosis within that group that is being
46:01
called unexplained that we should try to look into more.
46:06
OK. And do you think that
46:08
unexplained diagnosis is in part not enough care is being taken
46:13
in time to understand why the patient is facing infertility?
46:17
Or is that really it is just unexplained and who knows?
46:20
Well, Lila, I think it just, I think that's depends potentially
46:24
on that specific case, OK. But I will tell you that
46:29
previously decades ago it was very common to do for example,
46:33
laparoscopies to diagnose endometriosis.
46:36
It was more common to do other tests to look for things such as
46:39
what we call a cervical factor. And as more and more roads seem
46:43
to lead towards IVFI, feel like there has also been less of that
46:52
assessment for those factors, for example, and just more of a
46:56
push to, well, let's just try IVF at this point.
47:01
And so I think that again, everyone's trying to do their
47:06
best, but it's what tools do we have in our armamentarium And I
47:10
think that we do need to expand these tools.
47:12
OK. What do I mean by that?
47:13
Well, a very common one that I find in a lot of women is that
47:16
there are still hormone imbalances that are present even
47:20
potentially in women with ovulatory cycles.
47:23
OK, what does that mean? So what that means is there
47:29
could be imbalances in the what we call gonadotropins, which is
47:34
just FSH and LHS, the fuel. I think of it that goes and
47:39
starts a race to ovulation in the ovaries.
47:42
And what I found very commonly in this decade is that these FSH
47:50
and LH maybe not as high as what I would love to see and why
47:57
stressors may impact this. This could be emotional
48:00
stressors, nutritional stressors, physical stressors
48:03
like working out for hours a day for example.
48:06
But regardless of that type of stress, the body can go into a
48:09
survival mode and says OK, I can't support anyone else, I
48:12
have to conserve my resources and part of that conservation is
48:15
not releasing as much. Fuel.
48:17
That's a big deal because I won't bore you with all of the
48:21
details. I mean, I find it fascinating,
48:23
but there's a lot of receptor dynamics that are all designed
48:26
to make that egg that is developing and that's the one
48:29
that will be released the best quality.
48:33
And so that goes from a macro level, from production of male
48:37
hormones, the androgens and estrogens to even a micro level.
48:40
There are these amazing like pull electrical pulses that have
48:42
to go through the egg to help mature it.
48:45
And so any change and lessening of that fuel are going to
48:50
potentially have an impact on the egg.
48:53
So that's one that I see a lot that isn't always evaluated.
48:58
Thyroid is incredibly common relatively in the patient,
49:03
patient population that I see. And then there can be other
49:06
hormone imbalances, like an increase in prolactin.
49:10
That's a hormone that is designed to help us produce milk
49:13
after we give birth and we're nursing.
49:16
But sometimes due to different reasons, it can be elevated and
49:20
this can have a significant impact on fertility and
49:24
ovulation and even progesterone production after the eggs
49:28
released. So remember, progesterone's
49:30
critical for that baby developing.
49:34
And so if there's a decrease in that, there might be therefore
49:39
an impact on the pregnancy. So if you have thyroid issues,
49:44
how would even you know you have thyroid issues if you're
49:47
experiencing infertility? And then what would be the
49:49
treatment for thyroid issues to help you regain your ability to
49:53
get pregnant? So thyroid is a gland in our
49:56
neck and it is involved in everything.
49:58
It's involved in our metabolism, in our energy levels, in our
50:03
cardiovascular system. It's involved even in our hair,
50:07
in our certainly our our fertility and cycles and so
50:12
people may have symptoms very commonly.
50:16
So it's more common to have under active thyroid than it is
50:20
to have overactive thyroid. And so the women who have under
50:23
active thyroid will come in saying I am so fatigued, I wake
50:27
up and I'm tired. I have brain fog, potentially
50:31
cold intolerance, meaning they're freezing and they'll
50:33
have very cold hands and. Feet.
50:35
They, they're losing hair. They're constipated.
50:40
So that's some of the constellation of more common
50:43
symptoms that I'll hear about. The flip side, the overactive
50:47
thyroid is kind of the opposite of all those.
50:49
And So what we'll commonly do is a deep dive in their blood work
50:54
and try to assess for their thyroid testing.
50:58
Again, it's all like I liken reproductive endocrinologists to
51:02
kind of like engineers we had. We love feedback loops.
51:04
And so there's a feedback loop that goes from the brain, the
51:07
TSH, to the gland. The gland then pumps out
51:10
hormones and responds to that signaling from the brain.
51:12
And there are different types of hormones that get released.
51:15
And then those hormones go back up to the brain and says, OK,
51:18
we've, we're good. We don't need any more thyroid
51:20
hormone. You can turn down the signal and
51:22
not only that will look and assess for autoimmune attack on
51:26
that thyroid gland, as I was mentioning earlier, because that
51:30
can also become an issue. There's interesting studies
51:34
actually tying that autoimmune attack marker on the thyroid to
51:38
a potential increase in pregnancy issues including
51:40
miscarriage, including issues later on down the line for
51:44
pregnancy depending on what that woman's current thyroid function
51:48
is. And so that's the start of the
51:51
way we evaluate for thyroid. The treatment for thyroid is
51:55
multifactorial, but it would include the replacement of
51:58
thyroid hormone and then watching and titrating that very
52:01
carefully as well. As you know, it's interesting
52:05
even a lot of cruciferous vegetables, which is typically
52:10
my favorite type of vegetable to recommend because they're full
52:13
of antioxidants. They're anti cancer, they're
52:15
wonderful. But for women who are dealing
52:18
with thyroid, they might be what we call goitrogenic, so it can
52:21
cause a thyroid goiter. So that would be one way as to
52:24
say to someone, if you're eating cabbage or broccoli or kale
52:27
three times a day, maybe we should decrease this for
52:30
example. So that would be a dietary
52:32
change. You want to make sure that your
52:34
iodine levels are appropriate and so that would be some
52:40
nutritional approaches. Certainly there's a lot of
52:45
anecdotal evidence showing that decreasing potentially gluten or
52:49
working on fixing the gut can potentially help with thyroid
52:52
because of that autoimmune connection.
52:54
And then there might be some supplements that could help.
52:57
So one is inositol that is a sugar moiety that also is used
53:06
very commonly in PCOS, and it it's a heavy metal chelator too.
53:10
There's a lot of uses for inositol, but there's some
53:13
interesting studies showing for autoimmune attack on the thyroid
53:16
gland. It can be useful, and so there
53:18
are a few other supplements we can we can start to use to
53:20
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54:16
So what would you say are the top three, I mean I think you've
54:18
mentioned some already but the top three causes for infertility
54:22
and we just you just deep dive thyroid for us, but what are
54:26
the, what is the holistic treatments for those?
54:29
Yes, yes, yes. Yes, we already.
54:31
Covered maybe one at least one of them, but what are we missing
54:34
here? So what is that irregular cycles
54:37
we've really touched upon in different facets of it and this
54:40
one again is very amenable to restorative approach because if
54:45
we can get that woman to ovulate normally, if we can restore her
54:48
hormones and make them optimally balanced, we can hopefully the
54:52
the goal is that she gets pregnant on her own.
54:54
OK. So that's one I would say that
54:56
from that there could be sperm issues, the sperm life cycles
55:01
every few months. And So what that means is that
55:05
if there are lifestyle factors involved, the good news is, is
55:09
that we can try to make some changes in that man's lifestyle
55:14
and perhaps there will be a new group of sperm that have now
55:17
been exposed to these optimized lifestyle factors.
55:21
And so this just, again, is as foundational as having a healthy
55:26
diet. This could be as simple as
55:27
trying to limit our processed foods, trying to eat more
55:30
organic to minimize the amount of pesticides, quite honestly,
55:33
that we're consuming. So those things, pesticides and
55:36
non organic foods could be killing men's sperm count.
55:41
That there seems to be some association.
55:43
Or sperm quality. Yes.
55:44
And we think that you know it's again lots of different reasons,
55:47
but we know that over time we have an increasing rates of
55:52
obesity of metabolic issues of of these environmental toxins.
55:57
And so as we're surmising what is happening and why fertility
56:02
is being affected and sperm counts, these are certainly
56:05
actionable areas where we can, you know, potentially change
56:13
this, right. Of course, the classic toxin.
56:16
So that's like drinking alcohol, smoking is alcohol is a little
56:21
bit more mixed in the data. But I say that we know, you
56:25
know, it's something to consider if someone's dealing with a
56:27
sperm. Issue any alcohol or don't get
56:29
drunk alcohol. So that's what I mean.
56:31
So the data is not as clear. It looks like there you can
56:34
have. It's really more at higher
56:36
amounts that there might be an impact on sperm or in
56:39
association with that. Smoking is 1 where it's it's a
56:44
toxin and it can. Hurt the sperm.
56:47
What about having your phone or your electronics near?
56:50
I mean that's just like there's sort of like the trending on X
56:53
sometimes, you know, things to do for men's fertility and take
56:56
the phones away. Wi-Fi has been called out as a
57:00
potential negative for men's fertility.
57:03
So is there credit to that? So I would say two things.
57:06
First of all, the data to date don't show a clear association
57:10
between this. But the second thing that I want
57:12
to say is just because the study hasn't yet been done or hasn't
57:15
been done on a scale or in a proper design, doesn't
57:18
necessarily that mean that it's not real.
57:20
So again, we have to think about what do we have in our control,
57:24
like fertility is out of our control at the end of the day,
57:27
right? And that can feel very hard.
57:29
And I'm saying it a little bluntly, but at the end of the
57:32
day, we I, we can't say you will have this or you will not.
57:38
Like none of us are in absolute control for me.
57:41
God is the one in control of that.
57:43
But what I would say is that how can we empower ourselves to make
57:49
sure that things that are in our control are as optimized as
57:52
possible? And so even though there may not
57:55
be current data, I think that, you know, there is an impact on
58:02
of electromagnetic fields that we're being exposed to more and
58:05
more. Why not just move it?
58:07
I don't think it's that big of a deal for most people to keep
58:10
that away from their reproductive organs.
58:12
I, you know, I I'm absolutely an advocate for that.
58:15
So. What about stress?
58:17
I've heard, anecdotally, the experience of a lot of women who
58:21
they feel when they're more stressed, it's more difficult to
58:24
conceive. I also want to get into
58:26
miscarriage because that's another aspect of this.
58:29
But I've heard, you know, when I was less stressed, when my
58:32
stress levels went down, my cycle return, you can actually
58:35
miss a period if you're really stressed, you're not sleeping
58:37
enough. How does that impact fertility?
58:40
So again, it's one of those where the data does not support
58:43
a clear association between stress and infertility, OK.
58:49
And I have to emphasize absolutely that for the, for the
58:55
vast majority of my patients, absolutely none of this is their
59:01
fault, which is a very common, common sentiment that they're
59:05
just are looking at everything they did do or didn't do.
59:08
And this is the same with miscarriages, right.
59:10
And they're racking their brains and actually feeling so much
59:13
guilt and so much of it is absolutely not their fault at
59:19
all. OK.
59:21
So I want to put that out there because that's very important.
59:27
I have it's it's good. You mention that because I think
59:29
about, for example, one, one woman that I know that I look up
59:32
to an older woman and she talks sometimes about, we've had
59:35
conversations about miscarriages that she had and she wonders,
59:38
was this miscarriage because I was too stressed out because I
59:42
wasn't, you know, being more more of a gatekeeper with my
59:45
schedule. And you know, there there is
59:47
that common a tendency to just blame oneself for these things
59:52
and wonder what did I do wrong? Yes, And again, I see women all
59:57
the time with this and that is absolutely not the case.
1:00:00
We bring it back though, too. Well, what about the
1:00:03
physiological? Reason that we want to try to
1:00:08
help and try to recenter ourselves on a daily basis, I
1:00:11
think that's more actionable. We all have stress, we all have
1:00:13
stressors. That is that is life, that is
1:00:15
this decade for sure. And so you know, how can we try
1:00:20
to improve our stress levels and why does it matter?
1:00:23
Well, again remember we talked about that FSH and LH and how
1:00:26
important that is and how we know that that can ultimately
1:00:32
impact the ovarian hormones that are being produced.
1:00:35
And so I think it is a good idea again to just get those things
1:00:39
tested to rely upon the fertility awareness based
1:00:42
methods because those can as external signs tell us about how
1:00:47
our hormone balances are And again stress may may have a
1:00:52
downstream effect at changing our estrogens or progesterone
1:00:55
production. OK, that's one.
1:00:58
And I would say that for miscarriages in particular with
1:01:04
that that sense of it, you know there are so many other factors
1:01:08
that can be assessed and improved and I absolutely
1:01:12
encourage women who have had even even 1 miscarriage.
1:01:16
I know many times people feel badly going back to the doctor.
1:01:19
Why not just get a baseline hormone panel?
1:01:23
The best It will give you Peace of Mind moving into trying for
1:01:27
that next pregnancy, or you'll uncover something that you can
1:01:30
then correct. Alongside lifestyle changes and
1:01:36
you mentioned some surgeries to kind of determine if there's
1:01:39
some physical issue, issues, you know, with the anatomy that you
1:01:44
are preventing, you know, preventing you be to be able to
1:01:47
conceive, What are some other concrete things that can be
1:01:50
prescribed or done for a patient who's struggling with
1:01:54
infertility so? Actually.
1:01:58
For example, OK, got it as a, you know, it's a drug that I
1:02:01
think it's can be perfectly more from the moral perspective.
1:02:04
It can be perfectly listed. You know you're not using it
1:02:06
with IVF, you're using it just to try to ensure you have you
1:02:09
ovulate more or you can ovulate. Walk us through some of those
1:02:12
treatments. Sure, absolutely.
1:02:14
I will say also just as another baseline, there's some
1:02:16
interesting studies that show that there are true fat actually
1:02:20
a fertility, a pro fertility diet that I encourage women to
1:02:25
to follow. And so that's again very similar
1:02:29
to a Mediterranean diet, but it actually this surprises some
1:02:32
women, it includes full fats and so people think, wait, why it's
1:02:37
because cholesterol is the building block for all our
1:02:40
hormones for example. And so that's one that people
1:02:43
can look up and and pursue. And then the second one is
1:02:48
actually looking at the amount of exercise.
1:02:50
This again relates to stress in many ways.
1:02:52
So I don't want to have this is where you talk and make a plan
1:02:55
with your doctor. But if your BMI is between 19
1:03:00
and 25, you actually may want to consider not doing as high
1:03:07
intensity of exercise because it may lengthen your time to
1:03:10
conceive potentially. That's been associated in some
1:03:13
studies. If your BMI is 25 or over, which
1:03:15
is a body mass index, you can calculate, you can have any sort
1:03:19
of exercise in any capacity of intensity and it will, it will
1:03:23
help shorten that time to conception.
1:03:25
So those are two other baseline things.
1:03:27
So in terms of the types of fertility treatments that I do
1:03:33
and that others can do, well, it of course.
1:03:36
Depends on the. Cause right.
1:03:38
And so we will consider using surgeries or a different methods
1:03:45
if there seems to be an issue structurally inside the uterus
1:03:49
like a polyp, very pretty common that can cause irregular cycles
1:03:54
or spotting in between. Sorry, not irregular cycles, but
1:03:57
irregular bleeding meaning longer heavier cycles
1:03:59
potentially spotting in between cycles.
1:04:01
OK. This can also prevent
1:04:05
implantation or increase risk of miscarriage so that one can be
1:04:08
corrected very easily. Again, endometriosis.
1:04:11
There are some studies supporting that there can be an
1:04:13
improvement in pregnancy rates after surgery for and removal of
1:04:18
endometriosis. So there are those foundational
1:04:21
issues for these specific causes.
1:04:24
If a woman's having irregular ovulation, a very commonly
1:04:30
prescribed medication is what we call oral ovulation induction
1:04:34
agents. OK, that's a fancy way of just
1:04:36
saying that we can give medications to provoke ovulation
1:04:39
to occur. OK, Clomid is absolutely one of
1:04:42
them. It's it's actually not as
1:04:46
commonly in use anymore. There's another agent called
1:04:50
letrozole. They both function in a very
1:04:53
similar fashion, even though they're different classes of
1:04:56
medications. But essentially what it does is
1:04:58
it almost like causes the brain not to realize that estrogens
1:05:05
rising. And so as a result, the brain
1:05:08
puts out more FSH and LH where we talked about that fuel.
1:05:13
And so the way I think about it is that every month in a woman
1:05:17
who is ovulating regularly, there's a group of follicles
1:05:21
each having one egg in it. And I think of The Focal as a
1:05:24
car, and I think of the egg as a driver in that car.
1:05:27
And they're all at the starting line of this race.
1:05:29
And it's just like any other race.
1:05:31
There can only be 1 winner. Typically only one egg can cross
1:05:35
that finish line and be released.
1:05:37
And unfortunately, the rest of them, they don't get to race
1:05:39
again, they dissolve away. And so the signal, that fuel
1:05:42
source that I'm saying, that starts that race, it comes from
1:05:45
the brain, it's FSH, it's LH, just fuel.
1:05:48
It goes to the ovaries, starts the race.
1:05:49
They're all madly racing. They want to win.
1:05:52
Their exhaust as they race is estrogen.
1:05:54
Lots of effects, including going to the lining and thickening it
1:05:57
up. And then once that winning egg
1:06:01
crosses the finish line, that empty car, so to speak, starts
1:06:04
pumping out progesterone, which goes to the lining and makes it
1:06:08
really receptive for an embryo to implant there.
1:06:11
OK, and so that's the basics. What do these I love?
1:06:14
The way you describe. Them I usually draw it out for
1:06:18
prescription. I've ever heard of egg.
1:06:21
Release it. Gets like I can go way more into
1:06:24
it. Actually I'm trying to keep it
1:06:25
short, but every picture I've ever seen knows my upside down
1:06:29
draw. I love that.
1:06:31
Thanks Lila. And so you know when we think
1:06:36
about, well how does Clomid or electrozole work?
1:06:38
What it does is it ramps up your body's own fuel, and so the goal
1:06:42
is either to make that race happen if it's not.
1:06:45
Or. Sometimes we want to get two or
1:06:48
three eggs to run that race maybe to try to increase
1:06:51
probability of pregnancy. And so you're going to have more
1:06:55
fuel, therefore potentially more winners.
1:06:57
OK, if you will. And so again, letrozole is an
1:07:02
aromatase inhibitor and it does that same function.
1:07:06
It is not FDA approved for this as unlike Clomid which is OK,
1:07:12
but there have it's used very commonly.
1:07:15
I mean that's because there are some studies comparing the two
1:07:18
and it seems like letrozole improves ovulation rates and
1:07:20
pregnancy rates, OK. And so that is a great option.
1:07:24
It's overall very well tolerated and I can go into side effects
1:07:28
and risks and whatnot, but I think that that is a licit way,
1:07:35
absolutely that has been shown in studies to help optimize and
1:07:40
improve pregnancy rates. Another support that can be used
1:07:44
is even just watching that cycle more closely.
1:07:47
So monitoring with ultrasounds, it's actually amazing.
1:07:50
If you could watch the follicle, you watch that race happen in
1:07:54
real time. And we know that for certain
1:07:57
follicle sizes, the chance of maturity of that egg increases.
1:08:02
And so for example, at 14mm diameter of a follicle, since we
1:08:07
can't see the egg inside right on ultrasound, that that
1:08:11
follicle may contain a mature egg.
1:08:13
OK, we know that around 20mm it's very likely to contain a
1:08:16
mature egg and around 25mm that's the average size at the
1:08:21
time of spontaneous ovulation that a woman will release that
1:08:24
egg. And so we can track all of that.
1:08:26
We can track the thickness of the lining.
1:08:28
And so we have a lot of ability to see and try to again optimize
1:08:31
and potentially intervene if it appears that that process isn't
1:08:37
occurring as it should. Another type of of intervention
1:08:43
that might optimize pregnancy would be giving progesterone
1:08:47
supplementation after after ovulation.
1:08:53
There is. It's interesting because there's
1:08:56
actually divide between restorative reproductive
1:08:58
medicine and kind of conventional REI in regards.
1:09:01
To this. And conventional area has really
1:09:04
decreased the use of luteal progesterone.
1:09:08
There are some studies that were done that didn't seem to support
1:09:13
improvements and pregnancy and and then the the argument is
1:09:17
that well progesterone's released in a pulsatile manner
1:09:19
and so if you do measurements looking at progesterone in your
1:09:22
blood, you might be catching at its through for example.
1:09:26
And there's other other studies that are quoted with that being
1:09:29
said, again, I actually have seen a lot of women who have
1:09:36
progesterone issues. Again, it might be tied into
1:09:38
that stress and the FSH and LH response.
1:09:41
OK, #1, #2, we'll see it reflected in their fertility
1:09:45
awareness based method. So they're charting, you can
1:09:48
actually see their progesterones, their cycles not
1:09:52
as optimal. And #3 progesterone,
1:09:56
bioidentical progesterone overall is very well tolerated.
1:10:01
There are a large series looking at it when we use bioidentical
1:10:05
that supported to see even in pregnancy.
1:10:08
And so that is certainly an intervention that that I use for
1:10:12
patients. Fascinating stuff.
1:10:15
All such important information. I know we've got a wrap here
1:10:18
soon. What is?
1:10:19
Is there anything more that you think?
1:10:21
I mean, there's probably a lot more, but any other thoughts on
1:10:26
the holistic approach to infertility?
1:10:29
Anything else that people you you think people really should
1:10:32
know? Yes, I would say that again,
1:10:35
just to throw back to what I was saying earlier, this is not
1:10:38
simply about this acute assessment, acute fix, acute
1:10:44
solution. This is something that will help
1:10:48
that woman's overall health. We help that woman and her.
1:10:52
Wellness. We are going to be helping with
1:10:55
that pregnancy. We're going to be helping
1:10:58
potentially with that baby, right?
1:11:02
Of course. You know, prematurity can affect
1:11:05
babies. There's a Barker hypothesis that
1:11:07
says that whatever happens in the womb can affect baby
1:11:09
throughout his or her whole life.
1:11:12
And so it's just a great strategy to ensure Wellness for
1:11:17
all. And not only that it is an
1:11:21
effective there, there are studies showing that restorative
1:11:25
reproductive medicine has similar and comparable live
1:11:30
birth rates compared to these cycle of IVF.
1:11:34
OK, So it's effective. That's incredible.
1:11:37
So you're saying that there's studies that show that if you
1:11:40
approach the restorative, yeah, if you use the restorative
1:11:43
approach to to infertility versus just going for IVF, the
1:11:48
results are similar. That it appears the results are
1:11:50
similar in these prospective cohort studies that were done.
1:11:53
So it is effective, it may take some more time, right?
1:11:57
But ultimately there are similar efficacy #1 #2 from a financial
1:12:05
perspective, from a medication perspective, it's a lot less
1:12:09
intensive than something like an in vitro fertilization cycle.
1:12:13
OK, #3, there is a less risks. We already kind of went through
1:12:19
the the maternal risks, the risks of the children risk of
1:12:22
multiples is so much lower with it. #4 it's a moral, illicit way
1:12:29
to try to conceive. And so I think that again, we
1:12:34
should start with that. We shouldn't necessarily start
1:12:37
with these Uber aggressive treatments.
1:12:39
I think that there's a lot of reason to to be focused on the
1:12:45
why and to help heal that. Such good stuff.
1:12:49
Thank you so much, Lauren. OK, where can people find your
1:12:52
work? And you're practicing?
1:12:53
So I know we. I know that when I did the first
1:12:58
episode, I had a lot of people say I'm so excited.
1:13:00
I need to. I wish I lived where she lived.
1:13:02
Or can I reach out? Can I do a Zoom call with her?
1:13:04
How can people find you? So they can find me on my
1:13:08
website. solaurenrubalmd.com would be a great way to start.
1:13:12
And yes, I am happy to help. Thank you so much.
1:13:16
Yes, thank you for having me.