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Mitochondrial Nutrients in Fertility- Practical Applications with Amanda Haberecht · Wellness by Designs - Practitioner Podcast

• 0:20
  Speaker 1: This is Wellness By Designed, and I'm your host, andrew, at FieldCook.
• 0:24
  Speaker 1: Today, we're joined by Amanda Harbright, a naturopath with a long career in helping women indeed couples with their hormonal health and their fertility.
• 0:34
  Speaker 1: Today, we're going to be discussing mitochondrial nutrients in male and female fertility.
• 0:39
  Speaker 1: Welcome to Wellness By Designed, amanda.
• 0:42
  Speaker 1: How are you?
• 0:44
  Speaker 2: I'm great.
• 0:44
  Speaker 2: Thank you so much for having me, andrew.
• 0:46
  Speaker 2: It's great to be here.
• 0:49
  Speaker 1: It is so great to have you on the show Now, amanda.
• 0:53
  Speaker 1: I've known you for years.
• 0:55
  Speaker 1: we need to just let everybody else know who, those few people who may not know you Can you tell us a little bit about your career?
• 1:03
  Speaker 1: who you learned under, what sort of drew you into specialising in fertility?
• 1:13
  Speaker 2: Like most of us who are naturopathic clinicians, we follow our interests and a lot of our own personal health history.
• 1:21
  Speaker 2: For me, andrew, i was just so blessed because I got to train and learn with Francesca Naitz, who was definitely considered the foremother of preconception care.
• 1:36
  Speaker 2: When we were doing preconception care back in the 1990s.
• 1:40
  Speaker 2: It was definitely an incredibly radical idea, very much based on one study coming out of the UK from the foresight group.
• 1:50
  Speaker 2: Francesca was incredibly passionate and she definitely ignited that passion in me for studying, looking at nutritional intervention and how we can optimise fertility outcomes, both with male and female fertility.
• 2:09
  Speaker 2: After working with her for 10 years, i started Darling Health about 16 years ago, which has had several iterations and several addresses and a lot of great clinicians.
• 2:23
  Speaker 2: Now I still have a great team of clinicians, associates and staff who share my passion for both reproductive health and family health.
• 2:38
  Speaker 2: We're still rolling 26 years down the track.
• 2:45
  Speaker 1: Wow, you hit the nail on the head with the term.
• 2:47
  Speaker 1: I did this, i segmented that thing and said fertility, but it's family health that you're into, because it's not just females, it's males and it's couples, and then it's the kids.
• 2:59
  Speaker 1: It's an interesting differential, if you like, of how we turn things.
• 3:05
  Speaker 1: Can I just ask you I know this is a broad brush, i get it, but can we just talk a little bit about patient presentation?
• 3:16
  Speaker 1: Who are the types of patients who come to see you?
• 3:19
  Speaker 1: Have they already been through the mill and not been successful?
• 3:22
  Speaker 1: Or are they those people that are just going?
• 3:25
  Speaker 1: no, this is my choice to go the natural way, if you like, and I'll seek that support first.
• 3:34
  Speaker 2: Look, Andrew, I would love to say that they are all committed preconception patients, but those preconception patients were seeing me before they actually even start to try and conceive.
• 3:45
  Speaker 2: Unfortunately, that has changed over the last kind of 25 years and they actually are a very small cohort of my practice.
• 3:53
  Speaker 2: Most of my practice are definitely patients who have done a few laps through IVF or they've already had quite a complicated history before they kind of landed my rooms kind of tragically, And I think it's not necessarily just about the patient group.
• 4:11
  Speaker 2: I think that's very much a reflection of the prevalence of fertility that we are actually seeing these days too, so that it's becoming, you know, definitely much more commonplace.
• 4:25
  Speaker 1: And are you seeing things worsen in this arena?
• 4:27
  Speaker 1: Are you seeing dramatic changes over the course of your career?
• 4:32
  Speaker 2: Absolutely.
• 4:33
  Speaker 2: I mean, that's one of the things.
• 4:34
  Speaker 2: You know I'm a bit long in the 2000,.
• 4:36
  Speaker 2: But you know, i've kind of seen a generation now I've been in practice for 27 years.
• 4:40
  Speaker 2: I really have.
• 4:40
  Speaker 2: I mean, i've actually got my son's friends, you know, starting to see me, which is incredibly interesting, you know, and they have a naughty, you know, kids, teenagers, in my household.
• 4:51
  Speaker 2: But yeah, i mean, you know, i mean, and this is, you know, part of the kind of tragedy as well that we do see, but like, even semen analysis is obviously a very good example And it's, you know, very much, just, you know, discussed it in a generation.
• 5:07
  Speaker 2: You know, like, you know, you know this current generation, their sperm counts are probably 50% of their grandfathers.
• 5:13
  Speaker 2: And you know, back when I started out in fertility, you know, to see it, sperm count of 100 million was incredibly common And now it's justifies a high five If you see a guy come in with a sperm count of 100 million.
• 5:29
  Speaker 2: It's very rare for me to actually see that.
• 5:32
  Speaker 2: Unfortunately it's and becoming rarer, absolutely.
• 5:37
  Speaker 1: Right, it's a tragedy.
• 5:37
  Speaker 1: And and women with their presenting conditions?
• 5:42
  Speaker 1: No, i know this is a little bit worse, but let's say, egg quality, egg, egg number.
• 5:47
  Speaker 1: Do you find dramatic changes in that over the course of your career as well?
• 5:53
  Speaker 2: Well, yes, i mean I think egg quality is a bit more difficult to actually kind of measure because I only kind of for measurement is actually with IVF, so but obviously that language, egg quality, is very kind of widespread And it's often the reason you know it can be a bit lazy medicine.
• 6:13
  Speaker 2: I have a little bit of a bit of an offense to that kind of label because the amount of couples who turn up at my door and they're just being told by their specialist that it's in quality, so sometimes that diagnosis is just a bit by exclusion as well.
• 6:27
  Speaker 2: But what we do see an increasing prevalence of without any question, is polycystic ovaries and Demetriosis.
• 6:35
  Speaker 2: Hashimoto's is wild.
• 6:36
  Speaker 2: You know, like I remember, looking back years ago, you might see one Hashimoto's patient a week and I would have, you know, four or five every single day in my practice without any kind of question.
• 6:48
  Speaker 2: I mean it might not be their presentation but it's just a definitely part of their picture.
• 6:53
  Speaker 2: So that's a trajectory, that's also a tragedy And I think you know we need to, you know we need to be having these kind of conversations because you know our reproductive health, i mean health is in decline.
• 7:08
  Speaker 2: I mean it's all kind of these increasing prevalence of these conditions, you know, do kind of actually echo that really.
• 7:17
  Speaker 1: Yeah, yeah.
• 7:17
  Speaker 1: But what's also springing to mind is that we need to revisit the prevalence of these conditions.
• 7:26
  Speaker 1: We need to teach differently, so we're going to need the expertise of people like yourself who are on the coal face to be giving us this information, because what we are learning from is so old and outdated that we've got these outdated specs prevalence stats data in its entirety.
• 7:47
  Speaker 1: It's not reflective of current day.
• 7:51
  Speaker 2: Oh, absolutely, and it's been normalized.
• 7:56
  Speaker 2: And that's the thing that really upsets me as a clinician just to be like, oh, you've got thyroid disease, you're on thyroxin for the rest of your life, and you're like, and I can see amongst my generation of friends versus amongst my daughter's generation of friends, just watching them all being diagnosed with thyroid disease, it's kind of outrageous that we're not kind of yelling from the rooftops about what is kind of going on here.
• 8:24
  Speaker 2: So and all of those things, whether it's polycystic ovaries, endometriosis, you know elevated levels of obviously oxidative stress, thyroid disease, all of those things can affect egg quality.
• 8:37
  Speaker 2: So sorry, that was a very long detour to come back to answer you that the you know and that all of those conditions are of course, that you know oxidative stress is really part of their kind of pathophysiology why we're and why we're seeing the kind of prevalence of them.
• 8:57
  Speaker 2: So they will also affect kind of egg quality.
• 8:59
  Speaker 2: But you know women who are going through IVF you get that information because you can see the cohort of their eggs, how many of their eggs are kind of getting to embryos.
• 9:10
  Speaker 2: You know the percentage that are getting to blastocyst, how healthy they are, etc.
• 9:15
  Speaker 1: Right, so so changing my vernacular.
• 9:18
  Speaker 1: rather than saying egg quality, should we instead be looking at numbers of eggs that are able to be harvested?
• 9:24
  Speaker 1: Would that be more appropriate?
• 9:29
  Speaker 2: Yeah, I definitely think egg quality is part of the picture, but it doesn't really tell us the root cause.
• 9:37
  Speaker 2: And no, for a lot of, for a lot of couples, they end up having egg quality.
• 9:40
  Speaker 2: They're having to make urgent decisions about going to, you know, oocyte, just donors, or you know, when they're specialists we'll just be like we can't do much else because it's coming back to your egg quality And when we're not really finding the root cause of that.
• 9:55
  Speaker 2: You know, is that environmental toxins, is that endometriosis, is that poor nutrients very likely as part of that picture?
• 10:04
  Speaker 2: And if those things aren't being investigated, yes, the outcome can be egg quality, but it doesn't really tell us about the cause.
• 10:13
  Speaker 2: Hormonal reasons, of course, you know.
• 10:15
  Speaker 2: I mean, if they've got very elevated, you know pro lactin levels, or you know definitely there's some disturbances to their adrenal hormone profile, you know, we know that all of those things can affect egg quality.
• 10:29
  Speaker 2: So it just comes back to the way that we practice, that we want to always be making sure that we just don't kind of stay with the oh well, you've got an egg quality issue without really finding the particular pathways that has led to that diagnosis.
• 10:45
  Speaker 1: Okay, so I said broad brush stroke before.
• 10:47
  Speaker 1: Here's a rabbit hole in 20 words or less.
• 10:49
  Speaker 1: What assessments and investigations do you do?
• 10:53
  Speaker 2: It is a total rabbit hole.
• 10:55
  Speaker 2: But again, i'm going to just leave with you.
• 10:59
  Speaker 2: We practice personalized medicine So we are going to do those tests.
• 11:04
  Speaker 2: That is going to help us understand about the presentation.
• 11:08
  Speaker 2: A lot of my couples are fairly worked up by the time they arrive So I often will see you know all their hormones But you know, if they're having implantation failure Andrew, we've got a recurrent miscarriage history.
• 11:20
  Speaker 2: You know we've got to go down looking at a lot of their immune profiles, looking at their antibodies.
• 11:27
  Speaker 2: We need to be looking at methylation profiles if we're seeing chromosomal error in their embryos or, you know, long history of infertility without even a positive pregnancy.
• 11:42
  Speaker 2: I of course test a lot of their nutritional So I'm trying to find the gaps in their work up, so what hasn't been tested a lot of the time.
• 11:50
  Speaker 2: So I'm doing a lot of their nutritionals And you also want to make sure that they've, you know, had a tube or check that you know anything anatomical or obstructive has been ruled out.
• 12:03
  Speaker 2: And the gold standard with the guys.
• 12:04
  Speaker 2: I test nutrients on the guys.
• 12:06
  Speaker 2: I'm looking at a lot of methylation influences as well, but the gold standard is, of course we do a semen analysis which also looks at DNA fragmentation as well, which is an indicator of how healthy the DNA is in the head of the sperm and its ability to kind of pass on healthy chromosomes to the embryo as well.
• 12:29
  Speaker 2: And a semen analysis gives us a lot of information that we can kind of extrapolate whether there is a toxic load, poor antioxidant load as well, based on, you know, the percentage of abnormal to normal forms, how well that's burns, moving, et cetera.
• 12:46
  Speaker 2: So you know there's good tests.
• 12:48
  Speaker 2: We've just got to make sure that we extrapolate the key information from these investigations to design their treatment plan.
• 12:58
  Speaker 1: Yeah, yeah, and that part of that's managing cost as well.
• 13:01
  Speaker 1: Can I ask, though, do you ever question hormonal assessment as a snapshot versus hormonal assessment over a cycle?
• 13:13
  Speaker 2: Oh yeah, absolutely.
• 13:13
  Speaker 2: And look, you just get a lot more experienced with this.
• 13:16
  Speaker 2: So you know, i'll have patients turn up and say, oh, my hormones are okay And they've been done at a ridiculous time in their cycle That's not reflecting ovulation, or it's not reflecting baseline at day two or three.
• 13:27
  Speaker 2: So and it's their dance of their hormones.
• 13:31
  Speaker 2: It's always the kind of the pituitary versus the ovarian dance, you know, and so a lot of you know there's a lot of great doctors I mean obviously fertility specialists are very experienced at this area but sometimes GPs will be a bit kind of confused about the dance between the pituitary and the ovarian hormone.
• 13:51
  Speaker 2: So you know, our aim is to test some of baseline, which is around day two, day three.
• 13:59
  Speaker 2: But also I do a lot of Dutch tests with women too, andrew, because you not only can you know, understand what's going on hormonally, you can see those hormonal metabolites and their impact And you get great methylation markers.
• 14:15
  Speaker 2: Like it's not entirely comprehensive but for one test that gives me a lot of information for this group.
• 14:21
  Speaker 2: you know, i'm seeing cortisol metabolites.
• 14:25
  Speaker 2: I'm seeing, you know, the ovarian hormone metabolites.
• 14:29
  Speaker 2: We're seeing how well she's ovulating.
• 14:31
  Speaker 2: We also have markers for oxidative stress, you know, and a lot of the B vitamin and neurotransmitter markers.
• 14:38
  Speaker 2: So it can help pull a lot of information together just to kind of really understand that kind of matrix of what's happening hormonally for her.
• 14:51
  Speaker 1: And we have to obviously talk about therapies.
• 14:53
  Speaker 1: Now, obviously this is going to be a very personalized approach.
• 14:57
  Speaker 1: I get it, so it's very hard and very dangerous sometimes to say yes, i use this all the time.
• 15:03
  Speaker 1: But can I ask about some hints and tips about therapies that you might find, let's say, advantageous in many you know, in most of a cohort suffering from a condition?
• 15:20
  Speaker 2: Yeah, absolutely.
• 15:21
  Speaker 2: So.
• 15:21
  Speaker 2: I mean, if we're talking about our more kind of complex fertility cases, which is definitely my patient cohort as well, you know it's really.
• 15:31
  Speaker 2: I mean, the mitochondria is really where it's at, you know, and all the things that are kind of impacting the health of the mitochondria, andrew, and look gratefully, even in the last, you know, five years, there has been a lot of further research and evidence into the role of antioxidants and to the impact of oxidative stress And, as we know, you know it's, there's so much kind of published data and the impact on environmental factors, heavy metals, endocrine disrupting chemicals, the plastics, et cetera, et cetera.
• 16:06
  Speaker 2: So it's great that research that's where kind of the research dollars are going and the researchers are really looking And there's a great test which will soon be and it's incredibly, equally exciting for us clinicians who work in this space of antioxidant nutrition infertility.
• 16:27
  Speaker 2: But it's also equally kind of a tragic reflection of where the trajectory again of where male health is going.
• 16:35
  Speaker 2: And there's a emerging test which will absolutely be the gold standard, that is called myoxys test, which basically measures oxidative stress in the, in semen or plasma, and it basically takes four minutes to gather all this information And it's been spearheaded by the world kind of andrology forum and by a researcher called Ashok Agarwal, who any of my fellow fertility naturopaths will, like me, have just spent our careers reading his research.
• 17:13
  Speaker 2: He's been around as long as I have been Andrew.
• 17:15
  Speaker 2: I feel quite familiar with him because he has been just absolutely spearheading this area of research And I remember working in Francesca's clinic back in the days where we would photocopy the journals and take them home to read them at night when we were still working off paper.
• 17:36
  Speaker 2: But he's, this test is going to really help all of us really again, just really help our treatment plans be a lot more kind of focused And, i think, really help the communication with integrated practitioners and IVF, because it's going to.
• 17:59
  Speaker 2: It's going to kind of revolutionize kind of and andrology really.
• 18:03
  Speaker 2: So it's interesting And he's also and his group are definitely proposing that we actually need a change to the nomenclature because, as we mentioned before, you know, male fertility is an incredibly sharp decline, and especially in this last generation.
• 18:23
  Speaker 2: And they are now proposing that, you know, because 50% of male infertility has been basically, you know, recorded as being kind of idiopathic Again, another area of kind of like laziness with diagnosis And so when you kind of rule out trauma infection, you know anatomical kind of reasons, they will describe the rest of male fertility as kind of idiopathic, whereas 80% of idiopathic male infertility is now being deemed to be associated with high rates of oxidative stress, and so there will be a new name for male infertility called MOSI, which is MOSI, which basically stands for male oxidative stress infertility.
• 19:11
  Speaker 2: So I think we're going to a whole new paradigm with male fertility And I think it'll be a really kind of interesting space to watch, with increasing acceptance of some of the nutrients that we use.
• 19:26
  Speaker 2: So it's very, you know, it's fascinating.
• 19:30
  Speaker 2: But yes, but some of those things that we are that are key to my protocols I mean definitely nicotine and riboside is totally the new kid on the block And I'm embracing it and just as excited by a lot of other kind of practitioners out there.
• 19:50
  Speaker 2: I've probably been using it in the clinic for the last kind of, you know, 12, 18 months or so and been watching the research on it, which still is majority kind of animal studies but incredibly convincing male studies where they've been able to reverse aging in the oocyte and, you know, definitely seeing great outcomes in the off.
• 20:15
  Speaker 2: I mean it really, it really.
• 20:17
  Speaker 2: Yeah, I'm hesitated to use the term anti-aging and reverse aging historically, but nicotine and riboside is really one of those kind of key nutrients.
• 20:28
  Speaker 2: We need more human studies on it, but the animal studies are incredibly convincing, even some of the human studies that's been added to the embryo culture of embryos as they're being grown again, with very, very positive outcomes as far as embryo quality and the grading of the embryos.
• 20:51
  Speaker 1: Can I just ask about differentiating it between just normal, everyday B3, whether it be nicotinamide, the amide form, or nicotinic acid or niocinic.
• 21:00
  Speaker 1: Do you find a great difference, like in activity here?
• 21:07
  Speaker 1: And forgive me, what I want to explain for our viewers, our listeners, is if you can visualise a clock from 12 to 6, then that's the B3 side, if you like, of the Krebs cycle, and from 6 back to 12, that's the B2 side of the Krebs cycle.
• 21:31
  Speaker 1: Forgive me, brain fight there.
• 21:32
  Speaker 1: And then that goes into oxidative phosphorylation and the electron transfer chain.
• 21:37
  Speaker 1: So do you find a great benefit of NR, nicotinic ribosite NR?
• 21:48
  Speaker 2: Yes, i'm stumbling over my words.
• 21:50
  Speaker 1: Do you find a real difference here, like way more than just using B3?
• 21:57
  Speaker 2: Look, i am definitely kind of seeing that clinically.
• 22:00
  Speaker 2: I've used a lot of B3.
• 22:02
  Speaker 2: I've used a lot of B3 historically, especially where there's been a history of recurrent miscarriage And I suppose for a lot of those methylating kind of pathways.
• 22:10
  Speaker 2: B3 and B2, if we're seeing a lot of blocks on those with our patients.
• 22:15
  Speaker 2: Where I see a bit of a difference with NR is it it's role in insulin sensitivity, andrew.
• 22:23
  Speaker 2: It seems like it's got much more anti-inflammatory effects.
• 22:28
  Speaker 2: I definitely see a difference with embryo quality with women who've been taking it for four to six months.
• 22:39
  Speaker 2: You know I'm obviously I'm not gonna explain to you the structure of it, i am just a lowly clinician and not necessarily a researcher, but it's obviously got the nicotinamide and the ribose sugar.
• 22:54
  Speaker 2: You know it seems to be what is kind of key to it.
• 22:58
  Speaker 2: But as far as egg health outcomes, like definitely B3, i've seen a lot with recurrent miscarriage, implantation failure.
• 23:07
  Speaker 2: We use I've used it a lot and had had good results with that.
• 23:10
  Speaker 2: Historically I still use B3 for different patients for different reasons.
• 23:15
  Speaker 2: But the NR and look, you know I mean we're still it's all very kind of empirical use But I'm definitely seeing it with the health of the egg and the embryos And look, definitely I'm sure it's got a role in implantation.
• 23:32
  Speaker 2: There's definitely discussion about that, but it's that's where I'm noticing it absolutely.
• 23:37
  Speaker 1: But I felt like you've just given me a knock over the head with a piece of 4B2.
• 23:41
  Speaker 1: Of course, why didn't I realize this?
• 23:43
  Speaker 1: Of course, the inclusion of the ribose sugar, which, of course, is used as an energy fuel.
• 23:50
  Speaker 2: ATP absolutely.
• 23:52
  Speaker 1: Yeah, wake up.
• 23:57
  Speaker 2: All of us.
• 23:57
  Speaker 2: Andrew, there's sometimes, you know, things can be plain as day, but I think we also have to be kind of careful.
• 24:04
  Speaker 2: There's definitely some conflict about dosing in the research.
• 24:08
  Speaker 2: So I'm watching that And it does seem that it can be potentially a bit of a bell curve.
• 24:14
  Speaker 2: You know they've done, and these are tiny studies where people actually take the NR in 100 milligrams sorry, 100 milligrams, 1,000 milligrams and they measure the amount of NAD in that person's bloodstream And it seems there is a bit of a sweet spot.
• 24:31
  Speaker 2: So I think we have to still be kind of careful.
• 24:34
  Speaker 2: We just don't have that kind of research around dosing.
• 24:40
  Speaker 1: But yes, I'm a convertible.
• 24:41
  Speaker 1: What do you find in that?
• 24:44
  Speaker 2: I'm just trying to be kind of bang average at the moment because I don't like to really kind of experiment with my patients, So I'm just trying to be really kind of mis-average with that.
• 24:55
  Speaker 1: But yeah, but sometimes we're, so we're talking around the 300 milligrams.
• 24:58
  Speaker 2: Around the 300 to 400 kind of milligrams is the kind of dose, yeah, but you know, sometimes their IVF doctor might be prescribing at really kind of very elevated doses.
• 25:09
  Speaker 2: But I do think it's one of those nutrients that potentially, you know, we might see the future that less is a bit more with it.
• 25:17
  Speaker 1: So I think we're going to be careful.
• 25:19
  Speaker 1: Yeah, and what about when we go back to sperm motility and function and indeed quality in this issue?
• 25:30
  Speaker 1: the merits of CoQ10, you biquinone, you biquinol, what's your preference, what's your dose?
• 25:37
  Speaker 2: Yes, same thing.
• 25:38
  Speaker 2: I'm a total devotee to a biquinol.
• 25:41
  Speaker 2: I mean a lot of the researchers with a biquinone historically.
• 25:46
  Speaker 2: But you know, definitely emerging research and definitely research that's funded by certain producers of a biquinol is kind of coming to the market.
• 25:54
  Speaker 2: So we will see that.
• 25:55
  Speaker 2: But absolutely, i mean a biquinol is a fantastic nutrient both in male and female fertility.
• 26:04
  Speaker 2: You know, and any of my patients who've had a history or we're looking at aging being a role or, you know, declining AMH or if there's a lot of kind of sperm parameters that are definitely compromised.
• 26:17
  Speaker 2: So, look, it depends, but definitely that it's that 300 to 600 range.
• 26:23
  Speaker 2: Sometimes I have to go higher towards 900 if we're seeing really severe compromise.
• 26:30
  Speaker 2: And again, it's very dependent on the commitment of that patient as well.
• 26:34
  Speaker 2: I mean it's very different if they're 45 or 35, andrew.
• 26:40
  Speaker 2: So and it also depends on the male kind of sperm DNA fragmentation rate too.
• 26:47
  Speaker 2: So if I'm seeing a very elevated fragmentation rate and they all want to be pregnant yesterday, as you understand, andrew, so you have to kind of counsel them around that.
• 26:59
  Speaker 2: You know I'm often saying to my patients I don't want you to be seeing me in two years time and us just kind of bumbling through with, you know, a bit of a kind of vague protocol.
• 27:08
  Speaker 2: I'd rather us be putting on our therapeutic boots.
• 27:11
  Speaker 2: This is what we're doing for the next six months.
• 27:14
  Speaker 2: You know is how that I often kind of counsel a lot of my patients definitely.
• 27:19
  Speaker 1: Now I know that we can spend all day going through each different nutrients, but just thinking about some star players that we know are so important in fertility Iron, iodine phylates Can you give us some little clinical pearls?
• 27:36
  Speaker 2: Look, absolutely they are all star players.
• 27:39
  Speaker 2: I measure them too, you know.
• 27:40
  Speaker 2: So I'm just kind of measuring them because I'm always trying to consolidate what I'm prescribing for people.
• 27:47
  Speaker 2: So I will measure their ID levels Again.
• 27:50
  Speaker 2: If they've had quite a long road to fertility and they're still having very kind of disastrous outcomes, we will often prescribe higher and folate And definitely B12.
• 28:02
  Speaker 2: I'm seeing way more deficiencies in B12.
• 28:04
  Speaker 2: B12, i'm way more kind of concerned around than folate And again, such a crucial nutrient of genetic expression often found to be low in both seminal plasma and follicular fluid.
• 28:17
  Speaker 2: So there's a lot of great research and you'll often see that correlate with high home-assisting levels in follicular fluid and seminal plasma.
• 28:26
  Speaker 2: So B12 is a total go-to And just definitely I'm testing the hollow transcombalamin levels just to make sure we're on top of that.
• 28:35
  Speaker 2: And everyone's got gut issues, andrew.
• 28:37
  Speaker 2: So you'll often see that they're just low in B12 just because of you know if they've got Crohn's disease or ulcerative colitis or Celiac disease or something you know, that will again direct you to ensure that.
• 28:51
  Speaker 2: You know we're definitely seeing replete levels with those nutrients And the other two I use a lot when I'm kind of just going.
• 28:58
  Speaker 2: My absolute favorites and heavy hitters is definitely Enosetol-cysteine, for both men and women, and Enosatol as well, and I compound a lot of these up together.
• 29:11
  Speaker 2: So we regularly have NAC and Enosatol and NR going out for the women and definitely men, you know, enosetol-cysteine definitely, sometimes with the carnitine, arginine, nr for the guys as well.
• 29:27
  Speaker 2: So, and just to limit the amount they're taking, i'm often kind of compounding these nutrients up together But my dear blessed staff just pour off those combinations like 20 a day, like it's just constant.
• 29:43
  Speaker 2: We have them compounded on our shelves, you know, because we have so many patients who are actually kind of taking versions of those compounded formulas definitely.
• 29:54
  Speaker 1: Yeah, i need to ask you a conundrum which you'll face, and that is that you're seeing a heck of a lot more Hashimoto's, yet we have guidelines of 150 micrograms for every pregnant woman by the NHMRC.
• 30:06
  Speaker 1: How do you navigate that one?
• 30:11
  Speaker 2: Well, I mean, I definitely kind of follow that protocol of trying to get their selenium up initially And thank you.
• 30:22
  Speaker 2: Which you often kind of go in with first and then you can introduce iodine.
• 30:27
  Speaker 2: I suppose again that I'm also very careful about being very kind of reductionist on all of this.
• 30:33
  Speaker 2: There's a whole lot of reasons for thyroid antibodies And thyroid antibodies are often the canary in the coal mine of a lot of other autoimmune mechanisms that are going on.
• 30:43
  Speaker 2: So iodine is definitely part of the picture.
• 30:46
  Speaker 2: And again, if I've got a woman with Hashimoto's and she's got fibrocystic breasts and sub fertility and she's been miscarrying and she's got a goiter and everything, she's gonna probably need iodine.
• 30:58
  Speaker 2: I'm gonna bet my house on it.
• 30:59
  Speaker 2: She's gonna come back with low iodine.
• 31:01
  Speaker 2: So we might have to do a preload with selenium.
• 31:04
  Speaker 2: But I test their antibodies all the time And look, you definitely can catch women's antibodies going up at some points.
• 31:12
  Speaker 2: But I don't think that's just related to iodine, andrew, that can be a whole lot of causes.
• 31:18
  Speaker 2: Yeah, so, and cortisol, you will see it definitely associated with cortisol and stress.
• 31:23
  Speaker 2: or if she's having, even if her inflammatory markers, like we're seeing, crp or ESR or ANA antibodies are going up, you can see this kind of soup of inflammation, this kind of swamp of inflammation that's happening for her And we need to quiet and down that tendency, just for her own health, before we kind of pursue fertility.
• 31:53
  Speaker 1: Okay.
• 31:53
  Speaker 1: So again, i'm doing this.
• 31:55
  Speaker 1: I'm so sorry to do this to you because we're talking about this many conditions and we're trying to get you to deliver this in 40 odd minutes and I get it's a rush.
• 32:05
  Speaker 1: So please forgive me and everybody listening or watching this is just a wet your appetite.
• 32:11
  Speaker 1: Please don't think this is a therapy.
• 32:13
  Speaker 1: Please do your due diligence and learn more from Amanda and people like her.
• 32:18
  Speaker 1: So the question is some case histories where have you found these nutrients?
• 32:24
  Speaker 1: just shine and make a real difference to people's lives The linchpin, if you like.
• 32:30
  Speaker 2: Yes.
• 32:31
  Speaker 2: So I mean, obviously we practice polypharmacy and we practice kind of personalized medicine, So I always like to kind of preface it with that.
• 32:38
  Speaker 2: But one couple that kind of came to mind when I was kind of thinking about this this morning and they were just kind of front of mind because they've just sent me photos of their baby And again, just a real indicator that a lot of us who work in this space really kind of struggle to recruit the blokes in.
• 32:57
  Speaker 2: We can really kind of struggle to recruit the blokes, and that can also be because a lot of the conversation with their specialists is like, oh, it's an equality issue.
• 33:05
  Speaker 2: It's an equality issue especially if they're having IVF failure And it is never 100% one member of the couple unless their only reason is some sort of obstructive like a block tube or that man is totally not producing sperm or something, and there's obviously there can be quite a difference in the share causative mechanisms going on amongst both members of the couple.
• 33:31
  Speaker 2: But One couple you know and they just kind of had I mean, this is just they're a typical example of a couple that I see where you know They turned up and they've had like five miscarriages in, including miscarriages of Two perfect kind of chromosomal kind of embryos, you know, and they were that couple that turns up, who are just, who are just so gun shy and so Flattened by their fertility journey that they're major.
• 33:59
  Speaker 2: Stress is their fertility, without any kind of question, and their case was incredibly Multifactorial.
• 34:06
  Speaker 2: But they also turned up going we cannot go through another miscarriage and we cannot go through IVF again And this is it and we're throwing all our eggs in this basket.
• 34:15
  Speaker 2: But and they had a bit of everything.
• 34:17
  Speaker 2: I mean they were both homozygous.
• 34:19
  Speaker 2: For the MTHFR, jean, he had Extremely elevated DNA fragmentation, at like 52%.
• 34:28
  Speaker 2: She had all sorts of autoimmune markers, positive a&a and two bodies and she had a little defect.
• 34:38
  Speaker 2: So we knew that there was something going on with progester.
• 34:42
  Speaker 2: And she had very, very elevated prolactin Because of a polycystic history and also stress.
• 34:48
  Speaker 2: You know, prolactin is is one of the red flags for me and something I always Investigate because we living in times where people are under a lot of stress and fertility is stressful.
• 35:01
  Speaker 2: But But equally, this couple were also just so great because they were like we are not going near each other until you give us The green light and I was really like I don't know when we're gonna be ready for this.
• 35:15
  Speaker 2: Because Their mental health was a primary concern.
• 35:20
  Speaker 2: We recruited in my psychologist.
• 35:22
  Speaker 2: They were doing acupuncture and they were very much that.
• 35:26
  Speaker 2: Our clinic was very much their place of care.
• 35:29
  Speaker 2: But yeah, they were, and she was like everything was going in decline.
• 35:33
  Speaker 2: Her AMH was in decline and Her progesterone was very like, like luster.
• 35:38
  Speaker 2: But the great thing about working with couples like this, they're so motivated and they've been everywhere, done everything and that it was very their last Protocol.
• 35:48
  Speaker 2: But you know so you know I put them on these kind of compounded formulas that we use in the clinic.
• 35:54
  Speaker 2: We were being very heavy-handed with their methylating nutrients.
• 35:59
  Speaker 2: You know I had him on Sammy because his DNA frag and a few of his methylation markers were absolutely less than ideal and his sperm DNA was Really terrible.
• 36:11
  Speaker 2: But and then all the antioxidants you know there was a big one, oh, he had high doses of.
• 36:17
  Speaker 2: I had him on 600 milligrams of a Bitcoin, all.
• 36:20
  Speaker 2: But you know also.
• 36:21
  Speaker 2: You know the zinc and the Poic acid.
• 36:24
  Speaker 2: That is also one.
• 36:26
  Speaker 2: You know the Poic acid is often really forgotten but especially with these couples where You know the cost can be a real kind of barrier to their treatment plan.
• 36:37
  Speaker 2: We've got to remember humble old Lapoic acid is such a fantastic antioxidant Recycler, andrew.
• 36:44
  Speaker 2: You know both fat and You know water, so soluble antioxidants.
• 36:49
  Speaker 2: So if we're really having to pair back their treatment plan, i'll often kind of use Lapoic acid with them.
• 36:55
  Speaker 2: And also they've had some history of some toxic exposure due to Mold and paint in their house and they would did a huge renovation etc.
• 37:04
  Speaker 2: Etc.
• 37:04
  Speaker 2: So we had them on kind of Lapoic acid too.
• 37:09
  Speaker 2: And there's great evidence for Lapoic acid and Polycystic ovarian syndrome, which she definitely was on that spectrum even though she was ovulating.
• 37:18
  Speaker 2: But you know, as I said, you know I just got the photos of their beautiful daughter, you know, just last week, you know.
• 37:27
  Speaker 2: So it was just a very, very Happy.
• 37:32
  Speaker 1: Yeah, yeah, you live for those stories, don't you, you know?
• 37:38
  Speaker 2: yeah, but those kind of stories that they're the longest pregnancies in the world for me, they're like you know, every time I see them I'm like you're only six weeks pregnant, we're only eight weeks pregnant.
• 37:51
  Speaker 2: They feel like They have elephant pregnancies for me because we're hanging on the edge kind of constantly, especially when they're oh yeah.
• 37:59
  Speaker 2: Yeah.
• 38:01
  Speaker 1: Yeah, and and constant like chronic hyper vigilance, you know, hyper stress.
• 38:06
  Speaker 1: Because of this concern, amanda, like I wish we had another hour and even then we'd be just scratching the tip of the iceberg.
• 38:16
  Speaker 1: But Would you join us back on another podcast if we wanted to delve down another couple of rabbit holes on another couple of topics, would you mind?
• 38:27
  Speaker 2: Absolutely Love to I've loved chatting with you.
• 38:30
  Speaker 1: It's been great and I've learned so much in a very short period of time.
• 38:34
  Speaker 1: Thank you.
• 38:37
  Speaker 2: Thank you, andrew, thank you for listening.
• 38:39
  Speaker 2: You know, i know I can.
• 38:39
  Speaker 2: You know it's a very, very I mean like it's what I do.
• 38:43
  Speaker 2: It's what I do day and night And I and I'm very, you know, i feel forever blessed that I still I'm able to do love.
• 38:52
  Speaker 2: You know, able to do what I love absolutely.
• 38:56
  Speaker 1: Um, can I just ask you one last quick question Where can we find out more?
• 39:00
  Speaker 1: Do you?
• 39:00
  Speaker 1: do you offer practitioners mentorships?
• 39:03
  Speaker 1: do you Do ebooks, anything like that?
• 39:09
  Speaker 1: like.
• 39:13
  Speaker 2: Yes.
• 39:14
  Speaker 2: So I Definitely do a lot of mentoring with practitioners or, you know, definitely if they've got kind of difficult cases, they seek me out and Bookend you know bookend to see me.
• 39:26
  Speaker 2: So I do that absolutely, very Happily.
• 39:29
  Speaker 2: I'm like everybody else got a ebook, you know, about 90% kind of complete, but what actually happens, andrew?
• 39:37
  Speaker 2: then there's further evidence that comes through and you feel like you have to start again, like I'm really fascinated by this.
• 39:46
  Speaker 2: You know new diagnosis of Mo Mo see with.
• 39:49
  Speaker 2: You know male fertility.
• 39:51
  Speaker 2: I think it's going to be a really kind of exciting area and a very kind of inclusive area for That kind of work that we Do, absolutely so yes, i do have an ebook particularly with males.
• 40:04
  Speaker 1: Particularly with males, i think if you're finding it hard to rope them in, you want a quick test.
• 40:10
  Speaker 2: Yeah, yeah, absolutely.
• 40:12
  Speaker 2: And then they've got the evidence of you know they're total Antioxidant capacity and what nutrients can make a difference, and you've got really that evidence and it also helps recruit them In just to tell them you know, hey, dude, you are actually Part of this picture and we're going, you know we're gonna get to The outcome and you know that you want and it's, you know, as we always say to our patients, it's not just about pregnancy, it's about a healthy child, andrew.
• 40:39
  Speaker 2: So if we've got all that starting material the sperm at its most optimal health and the egg at its most optimal health We're gonna have the you know, obviously the best possible outcomes for that child, you know, and the generations beyond.
• 40:55
  Speaker 1: Wise words from a wise and expert woman.
• 40:58
  Speaker 1: Thank you so much for joining us today.
• 40:59
  Speaker 1: Amanda Harbright on Wellness by Designs, and thank you everyone for joining us today.
• 41:04
  Speaker 1: Remember you can catch up on the show notes for this and they There will be many For this show, for these show notes and the show notes and the podcast, the other podcast on the designs for health website.
• 41:17
  Speaker 1: I'm Andrew Whitfield cook.
• 41:19
  Speaker 1: This is Wellness by Designs.