Latest / Resiliency Radio with Dr. Jill Carnahan, MD / 342: RR with Dr. Jill: Beyond IVF: Real Causes of Fertility Struggles with Dr. Gabriela Rosa

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342: RR with Dr. Jill: Beyond IVF: Real Causes of Fertility Struggles with Dr. Gabriela Rosa · Resiliency Radio with Dr. Jill Carnahan, MD

• 0:01
  Dr. Jill Carnahan: Welcome to Resiliency Radio, your go to podcast for the most cutting edge insights integrative and functional medicine.
• 0:08
  Dr. Jill Carnahan: I'm your host, Dr. Jill and with each episode we dive into the heart of healing and personal transformation.
• 0:15
  Dr. Jill Carnahan: Join me as I interview medical experts, innovators of all types and world leaders in thought helping you on your performance to optimal performance and longevity.
• 0:24
  Dr. Jill Carnahan: I'm excited Today to interview Dr. Gabriela Rosa, an expert infertility.
• 0:29
  Dr. Jill Carnahan: So many of you have asked about these kinds of questions and I know many women and men and partners struggling to get pregnant.
• 0:37
  Dr. Jill Carnahan: So you're going to love this show with lots of details and I'll introduce Dr. Gabriela Rosa in just a moment.
• 0:43
  Dr. Jill Carnahan: Before I do, I want to remind you that we've got loads of products and services special curated for your optimal health and performance.
• 0:50
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• 1:00
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• 2:00
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• 2:01
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• 2:10
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• 2:14
  Dr. Jill Carnahan: Okay, let me introduce our guest.
• 2:16
  Dr. Jill Carnahan: Our guest is Dr. Gabriela Rosa, Doctor of Ph.
• 2:20
  Dr. Jill Carnahan: She is a Harvard Awarded fertility specialist, founder of the Rosa Institute, host of the Fertility Challenge online program, and author of the Fertility Breakthrough.
• 2:29
  Dr. Jill Carnahan: She's a creator of the proprietary fertile method, which has supported more than 204,000 across 111 countries.
• 2:37
  Dr. Jill Carnahan: Her work is backed by published research reporting a 78% live birth rate among participants in her signature program.
• 2:44
  Dr. Jill Carnahan: You're going to really enjoy this interview today, so let's interview and welcome Dr. Gabriela.
• 2:50
  Dr. Jill Carnahan: Hello, Dr. Gabriela.
• 2:52
  Dr. Jill Carnahan: It is so nice to meet you here and have you as a guest on Resiliency Radio today.
• 2:57
  Dr. Jill Carnahan: Our topic is fertility.
• 2:58
  Dr. Jill Carnahan: We got a few guests on about this, but I feel like it is becoming a bigger issue than ever before for both men and women, although women are the ones that are usually instigating the big workups because our reproductive system is a little bit more complex than men.
• 3:13
  Dr. Jill Carnahan: And a lot of women who are in their 30s and 40s are starting to realize they maybe want children, and then they're dealing with the issues of our body and this toxic society.
• 3:22
  Dr. Jill Carnahan: So we're going to dive deep with you as an expert.
• 3:25
  Dr. Jill Carnahan: Before we do, I want to know a little bit about who you are, what's driven you to this field and what your journey is to become an expert in fertility.
• 3:33
  Dr. Gabriela Rosa: Yes.
• 3:34
  Dr. Gabriela Rosa: Well, thank you for having me, first and foremost.
• 3:37
  Dr. Gabriela Rosa: And it has been a minute.
• 3:38
  Dr. Gabriela Rosa: I've been doing this work now since 2001.
• 3:41
  Dr. Gabriela Rosa: And so helping couples overcome infertility, recurrent miscarriage, and failed treatments was the natural evolution from initially training as a naturopathic clinician and really focusing on overall health to then going and doing a master's in reproductive medicine and human genetics and then doing a master's of public health at Harvard and finally finalizing my doctoral studies as well in public health.
• 4:07
  Dr. Gabriela Rosa: And I guess, you know, the journey was such that it was the patient's needs and requests that were coming into my clinic when I was already working under the idea of helping people with balancing their health overall.
• 4:21
  Dr. Gabriela Rosa: And we know that's a fraught way of looking at health because balance can only be measured in degrees away from balance.
• 4:28
  Dr. Gabriela Rosa: And so, you know, it really is such a difficult thing for us to quantify.
• 4:33
  Dr. Gabriela Rosa: But what used to happen a lot was people used to come to, they were trying to conceive for one or two years, and we would be essentially looking at, okay, where are the places of opportunity for improving health?
• 4:46
  Dr. Gabriela Rosa: Right.
• 4:46
  Dr. Gabriela Rosa: And focusing on that until one day, 10 years in, I get somebody who had gone through and done multiple failed IVF cycles and was literally At a point where she was going to go and do one more cycle, and then she was going to.
• 4:59
  Dr. Gabriela Rosa: She basically told me, this is it.
• 5:01
  Dr. Gabriela Rosa: It's the last cycle.
• 5:03
  Dr. Gabriela Rosa: If this doesn't work, I will stop trying altogether and just end this chapter of my.
• 5:09
  Dr. Gabriela Rosa: So I want you to help prepare me for the next IVF cycle.
• 5:13
  Dr. Gabriela Rosa: Long story short, treating both partners, they ended up conceiving naturally with her own eggs after 10 years of nothing else working.
• 5:20
  Dr. Gabriela Rosa: So that was the first kind of insight for me of like, oh, okay, that was an interesting coincidence.
• 5:25
  Dr. Gabriela Rosa: And then, of course, there was another person who came in and was trying for even longer.
• 5:31
  Dr. Gabriela Rosa: It was 19 years.
• 5:32
  Dr. Gabriela Rosa: But at this point, I was kind of a little bit emboldened, you know, by that initial result.
• 5:37
  Dr. Gabriela Rosa: And so I said, look, we don't know what's going to happen, but might be that we can make a difference even if IVF is the next thing that you do as a final trial.
• 5:46
  Dr. Gabriela Rosa: And again, she also conceived naturally with her own eggs.
• 5:48
  Dr. Gabriela Rosa: And so that piqued my curiosity.
• 5:50
  Dr. Gabriela Rosa: And that was actually what got me started into the path of doing my master's in public health at Harvard and then obviously my doctorate, because I really wanted to understand the patients that were treating, the results were getting, and whether it was a coincidence or not.
• 6:03
  Dr. Gabriela Rosa: And it turned out that it wasn't a coincidence.
• 6:06
  Dr. Gabriela Rosa: It turned out that in the cohort we analyzed the 544 patients, we had a 78.8 birth rate and obviously, you know, observational data of our own cohort.
• 6:18
  Dr. Gabriela Rosa: But it was enough for me to go, okay, there is definitely improvement here given the fact that the average number of years that people were trying before they came to see me was four years.
• 6:29
  Dr. Gabriela Rosa: So this wasn't, you know, early stage infertility.
• 6:32
  Dr. Gabriela Rosa: These were people who were, you know, had.
• 6:35
  Dr. Gabriela Rosa: Had multiple failed IVF cycles, multiple miscarriages, and obviously were trying for a very long time.
• 6:42
  Dr. Jill Carnahan: Wow, I love that story.
• 6:43
  Dr. Jill Carnahan: Now, I trained in family medicine, and now I do functional integrative root cause medicine.
• 6:48
  Dr. Jill Carnahan: And of course, as you would have it, that's not my primary audience, which is women wanting to get pregnant.
• 6:53
  Dr. Jill Carnahan: But of course, I see women who are in the process of treating the stuff that I treat, and then they also want pregnancy.
• 6:59
  Dr. Jill Carnahan: So I have seen a number of patients who were told they couldn't have children or tried ivf.
• 7:04
  Dr. Jill Carnahan: And same thing as you, because we're.
• 7:06
  Dr. Jill Carnahan: As we're treating that body.
• 7:07
  Dr. Jill Carnahan: I want to hear from you as the expert, but interestingly enough, it is so fascinating to me that when we go to the root cause and go to the body.
• 7:15
  Dr. Jill Carnahan: I mean, our women's bodies are made to procreate, right?
• 7:18
  Dr. Jill Carnahan: So if we just get things in balance.
• 7:21
  Dr. Jill Carnahan: So I would love to hear from you, like, where do you start with this woman who's come in, maybe tried for two years or four years or sometimes 10 or 20 years.
• 7:28
  Dr. Jill Carnahan: That's astounding.
• 7:30
  Dr. Jill Carnahan: Where do you start?
• 7:31
  Dr. Jill Carnahan: What questions do you ask?
• 7:32
  Dr. Jill Carnahan: And how do you get to the root of the things that are going to actually make the difference?
• 7:36
  Dr. Gabriela Rosa: Yeah, that's a great question.
• 7:38
  Dr. Gabriela Rosa: The first place I start is actually where every doctor should start investigations, right?
• 7:44
  Dr. Gabriela Rosa: I think that infertility medicine, the biggest issue, reproductive medicine in general, the biggest issue we have is the fact that it's very protocol driven, it's very healthcare systems guideline driven, which does not prioritize investigations and understanding the problem.
• 8:04
  Dr. Gabriela Rosa: It essentially prioritizes cost effectiveness, which is, if you're going to treat anyway, why test?
• 8:11
  Dr. Gabriela Rosa: And that is the wrong approach for the type of patient that has been trying for more than two years.
• 8:17
  Dr. Gabriela Rosa: Because in the general population the statistics are that about 93% of people will conceive within two years.
• 8:24
  Dr. Gabriela Rosa: So that 7% of people who don't, they are treated in the same way as the people who have the drunken one night stand and get pregnant without trying.
• 8:33
  Dr. Gabriela Rosa: You see, but it's the wrong approach for the people that, people who.
• 8:38
  Dr. Gabriela Rosa: It's not easy to conceive.
• 8:41
  Dr. Gabriela Rosa: And so really understanding the problem and scoping the problem properly is the first step to actually addressing what's getting in the way.
• 8:49
  Dr. Gabriela Rosa: I'll give an example.
• 8:50
  Dr. Gabriela Rosa: I had a couple once who came to me after 15 years of infertility.
• 8:54
  Dr. Gabriela Rosa: They had done multiple IVF cycles that didn't work, multiple IUI cycles that didn't work.
• 8:59
  Dr. Gabriela Rosa: By the time they came to me, she was 40 and being told, oh, it's an egg quality issue.
• 9:04
  Dr. Gabriela Rosa: You're like, well, you didn't start old, you've been trying for 15 years.
• 9:09
  Dr. Gabriela Rosa: What the hell is going on here, right?
• 9:11
  Dr. Gabriela Rosa: And so basically when I start the conversation with them and I ask, is this the first semen analysis that you've had a low count in?
• 9:19
  Dr. Gabriela Rosa: He goes, what?
• 9:20
  Dr. Gabriela Rosa: What do you mean?
• 9:21
  Dr. Gabriela Rosa: I'm like, what do you mean, what do I mean?
• 9:23
  Dr. Gabriela Rosa: Like, this was 2 million sperm, not 20 million, which is the minimum that you need to have a baby.
• 9:29
  Dr. Gabriela Rosa: So I'm like, what do you mean?
• 9:30
  Dr. Gabriela Rosa: Like, has your doctor never told you?
• 9:31
  Dr. Gabriela Rosa: No, the doctor said it's all fine.
• 9:33
  Dr. Gabriela Rosa: Now what does fine mean to an IVF doctor?
• 9:36
  Dr. Gabriela Rosa: Well, I have enough sperm that I can do icsi if I need to, I can take that sperm and put it in the egg and fertilization will occur.
• 9:43
  Dr. Gabriela Rosa: But that does not mean that you're going to end up with the ability to conceive naturally.
• 9:47
  Dr. Gabriela Rosa: And so the communication of their situation to them to begin with was already fraught from the beginning, because here they were expecting that everything is fine, just keep trying.
• 9:58
  Dr. Gabriela Rosa: Well, when we looked into it, everything was not only not fine, but they both had chlamydia and nobody had picked it up.
• 10:06
  Dr. Gabriela Rosa: Fifteen years in, and here we are talking about the most basic of basics.
• 10:10
  Dr. Gabriela Rosa: And this couple were in California, United States.
• 10:14
  Dr. Gabriela Rosa: So I'm like, what?
• 10:15
  Dr. Gabriela Rosa: This is not.
• 10:16
  Dr. Gabriela Rosa: This is not a third world country type situation.
• 10:19
  Dr. Gabriela Rosa: Right.
• 10:20
  Dr. Gabriela Rosa: And so I'm thinking, okay, this is just not ideal.
• 10:23
  Dr. Gabriela Rosa: And there's obviously things that are getting in the way.
• 10:26
  Dr. Gabriela Rosa: And so we addressed all of those things.
• 10:28
  Dr. Gabriela Rosa: Antibiotics clearly were part of the strategy and they conceived naturally for the first time.
• 10:34
  Dr. Gabriela Rosa: And she delivered at 41 after 15 years of infertility.
• 10:39
  Dr. Gabriela Rosa: So, you know, that's essentially where I start, is understanding the problem, scoping it out properly, treating it effectively according to what actually you're finding.
• 10:48
  Dr. Gabriela Rosa: Not imagining that you're just going to, you know, oh, you've had the current miscarriage, let's just give you heparin for your entire pregnancy.
• 10:56
  Dr. Gabriela Rosa: Well, that does not address the variety of possible issues that could be happening.
• 11:01
  Dr. Gabriela Rosa: It addresses one of them.
• 11:02
  Dr. Gabriela Rosa: But if you've had seven miscarriages and you don't have indication for heparin, what is that going to do?
• 11:10
  Dr. Jill Carnahan: Yeah.
• 11:10
  Dr. Jill Carnahan: Oh, I love this because we're speaking the same language.
• 11:14
  Dr. Jill Carnahan: So walk us through the biology of fertility.
• 11:16
  Dr. Jill Carnahan: I'm thinking of things like metabolic health, insulin resistance, thyroid issues, inflammation, immune dysfunction, nutrient status, oxidative stress, mitochondria, and then obviously egg quality, sperm quality.
• 11:30
  Dr. Jill Carnahan: And obviously, we could talk for hours on this, but maybe give us just a little outline on, like, the categories and the kinds of testing doing to check into these things in.
• 11:40
  Dr. Jill Carnahan: And I'm assuming they come as partners.
• 11:41
  Dr. Jill Carnahan: So you're checking both the man and the woman, if possible.
• 11:44
  Dr. Jill Carnahan: Unless it's a woman who you.
• 11:46
  Dr. Gabriela Rosa: Not if possible.
• 11:47
  Dr. Jill Carnahan: Right.
• 11:48
  Dr. Gabriela Rosa: And that's exactly.
• 11:49
  Dr. Gabriela Rosa: Yeah, that's exactly what you've just touched on.
• 11:51
  Dr. Gabriela Rosa: It's like, unless it's a solo reproduction case, we're treating both partners.
• 11:55
  Dr. Gabriela Rosa: You know, it really is not going to be any other way.
• 11:58
  Dr. Gabriela Rosa: And again, you know, the reason for that is that obviously fertility is a team sport and we're not going to Leave half of the equation that we can actually modify to chance, because that doesn't help us with the outcome that we're wanting to create.
• 12:12
  Dr. Jill Carnahan: Well, and quick question, I want to talk about what the first question I asked, but real quick question.
• 12:16
  Dr. Jill Carnahan: How often do you have a woman coming to you solo that thinks that her partner does not need to be involved?
• 12:21
  Dr. Jill Carnahan: Like, how often are you actually telling them, no, we need you both here, and then having them missed that in the original workup?
• 12:29
  Dr. Gabriela Rosa: You see, it's a very biased question for my audience because I've been doing this work for 25 years, and all I do is.
• 12:37
  Dr. Gabriela Rosa: Is all day long talk about the fact that fertility is a team sport.
• 12:41
  Dr. Gabriela Rosa: So by the time people come to have a consultation with me, usually their partner is sitting right there.
• 12:48
  Dr. Gabriela Rosa: Right.
• 12:49
  Dr. Gabriela Rosa: And if they're not, then it's a conversation about, you know, let's bring them into the next appointment as soon as possible, because this is going to be an important thing.
• 13:00
  Dr. Gabriela Rosa: So it's very seldom that I will, unless somebody like, for example, yesterday this happened where I had somebody who was trying to conceive for four months and came to me as a.
• 13:11
  Dr. Gabriela Rosa: As a single kind of, well, in a partnership, in a couple partnership.
• 13:15
  Dr. Gabriela Rosa: But she came to me as herself only in an appointment.
• 13:19
  Dr. Gabriela Rosa: But also she doesn't have a fertility problem at this point.
• 13:23
  Dr. Gabriela Rosa: So, you know, it was an initial conversation, really, just to kind of make sure that she was hitting all the right places.
• 13:31
  Dr. Gabriela Rosa: So in that kind of.
• 13:32
  Dr. Gabriela Rosa: Which is not usually what I see, like, I would say that 99.9% of the people I see are the cases of people who have been trying for many years and multiple, you know, so that's an unusual thing to happen to begin with, that somebody at that very early stage would come to me.
• 13:48
  Dr. Gabriela Rosa: So, you know, it's usually it's understood as part of the conversation for the people who come to me that you're coming in as a couple.
• 13:57
  Dr. Gabriela Rosa: So that's the first thing in terms of your question about, you know, what are the places and things that we're looking at and looking for.
• 14:04
  Dr. Gabriela Rosa: The way that I like to conceptualize this for people in a way that everybody really can see it immediately, is that we already understand that fertility is a team sport.
• 14:15
  Dr. Gabriela Rosa: We also understand that a healthy body is a fertile body.
• 14:18
  Dr. Gabriela Rosa: And you've mentioned many different things that point to that.
• 14:22
  Dr. Gabriela Rosa: You know, like, there are many areas that you can look at in terms of health, but how do you operationalize that?
• 14:29
  Dr. Gabriela Rosa: You know, how do you actually make that be real in somebody's life.
• 14:33
  Dr. Gabriela Rosa: And the way that I like to put this is act pregnant now to get pregnant later.
• 14:39
  Dr. Gabriela Rosa: So literally, yeah, absolutely.
• 14:41
  Dr. Gabriela Rosa: So think about all of the things that you would absolutely start doing or stop doing if you were pregnant at this very moment.
• 14:51
  Dr. Gabriela Rosa: That is what you need to do to improve your odds of getting pregnant to begin with.
• 14:56
  Dr. Gabriela Rosa: And that's also what you need to do if we're looking at optimizing your chances and preparing you.
• 15:04
  Dr. Gabriela Rosa: Whether you are trying to conceive naturally, whether you're trying to conceived through IVF or even if you're using done oreg at the end of the day, we need to make sure that we have the best possible environment in which the egg and the sperm are forming and maturing and that the embryo is going to be maturing and developing as well.
• 15:23
  Dr. Gabriela Rosa: So taking that approach as a person that really is wanting to do the very best that they can to improve their chances and get there sooner, that is the most direct path to baby is going to be acting pregnant now to get pregnant later.
• 15:39
  Dr. Gabriela Rosa: I actually ask always, you know, the partners, when I'm talking to the men about this, I ask them to indulge me in this moment because I know that it's like, why getting pregnant?
• 15:48
  Dr. Gabriela Rosa: What do you mean?
• 15:49
  Dr. Gabriela Rosa: But really, if you think about it, you know, 50% of that little baby you want to create is within you right now.
• 15:56
  Dr. Gabriela Rosa: Whether you're female or a male, you are carrying 50% of that baby.
• 16:01
  Dr. Gabriela Rosa: And so hence why it is a team sport.
• 16:05
  Dr. Gabriela Rosa: And you do need to act pregnant now to get pregnant later.
• 16:07
  Dr. Gabriela Rosa: Up.
• 16:09
  Dr. Jill Carnahan: Hey guys.
• 16:10
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• 16:17
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• 16:22
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• 16:37
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• 16:57
  Dr. Jill Carnahan: I love these because these are the pearls that people are going to listen and hear and remember and for someone out there, you know, they can actually Start doing these things on their own.
• 17:04
  Dr. Jill Carnahan: And of course they can see you when they get into trouble.
• 17:07
  Dr. Jill Carnahan: So what I've heard a lot of women, I have actually a dear friend who's wanting to get pregnant and she's considered advanced maternal age and she was told, it's your age, it's your egg quality.
• 17:15
  Dr. Jill Carnahan: Now you started the show with a couple stories of that and a 40 year old getting pregnant.
• 17:19
  Dr. Jill Carnahan: And I'm sure you've seen 42, 45.
• 17:21
  Dr. Jill Carnahan: I mean, other.
• 17:22
  Dr. Jill Carnahan: What do you say to that woman who's been told that her, you know, hormone egg quality is low or there's issues?
• 17:30
  Dr. Jill Carnahan: How do you start with her?
• 17:32
  Dr. Gabriela Rosa: Look, it will depend on where they're at in terms of all of their hormones.
• 17:36
  Dr. Gabriela Rosa: Right.
• 17:37
  Dr. Gabriela Rosa: So.
• 17:37
  Dr. Gabriela Rosa: And also their age at the day.
• 17:39
  Dr. Gabriela Rosa: We know that female fertility in 2026 is finite.
• 17:43
  Dr. Gabriela Rosa: We know that in 2026 we are born with all the eggs we'll ever have.
• 17:47
  Dr. Gabriela Rosa: And the reason that I punctuate this is because if you are on social media, like me, seeing all of the stem cells eggs, and you know, the fact that this is now the thing.
• 17:59
  Dr. Gabriela Rosa: No, it isn't.
• 18:00
  Dr. Gabriela Rosa: And it won't be for another 60 years.
• 18:02
  Dr. Gabriela Rosa: And so like, don't put your eggs in that basket because we're not there yet.
• 18:07
  Dr. Gabriela Rosa: And we're very far away from being there.
• 18:09
  Dr. Gabriela Rosa: And so ultimately we need to figure out if we're trying to have a baby now in the next five to 10 years, what do we do now that actually can change outcomes, that changes what it is that we're going to experience.
• 18:22
  Dr. Gabriela Rosa: And so Jeremiah published a study that looked at AMH levels and low AMH on the one and the ability for women to conceive.
• 18:33
  Dr. Gabriela Rosa: And what it showed was that for women who are younger, that is in their 30s, the lower MH diagnosis did not change the live birth outcomes.
• 18:45
  Dr. Gabriela Rosa: And so, and so that, and that's for women who are in their 30s now.
• 18:50
  Dr. Gabriela Rosa: For women in their 40s, it's a different conversation because then it also depends on how much are your ovaries having to work in order for you to release that egg to begin with.
• 19:00
  Dr. Gabriela Rosa: Right?
• 19:01
  Dr. Gabriela Rosa: So by the time your FSH elevates past, I like to say, 12, 15, on day two of the cycle, we start to see a signal that, okay, the ovaries might be struggling a little bit to start to, you know, kind of recruit those eggs and to mature them and to obviously release them.
• 19:21
  Dr. Gabriela Rosa: And so we have to answer that question under the nuance and the understanding of what is it Are they still having regular cycles?
• 19:30
  Dr. Gabriela Rosa: Are there FSH levels at baseline where they should be?
• 19:34
  Dr. Gabriela Rosa: AMH in itself?
• 19:36
  Dr. Gabriela Rosa: I don't actually.
• 19:37
  Dr. Gabriela Rosa: Even in my own cohort, when we did so, I studied our own patients, was 544 patient analysis of patients who basically had gone through the fertility breakthrough program.
• 19:48
  Dr. Gabriela Rosa: And we saw that a vast majority of people had an AMH of less than 1, and the live birth rate was 78.8%.
• 19:56
  Dr. Gabriela Rosa: So we see that correlation very clearly in my clinic.
• 20:00
  Dr. Gabriela Rosa: When we are optimizing health in every other possible way, we obviously increase the chances.
• 20:05
  Dr. Gabriela Rosa: And this is another nuance as well that I think is important for people to understand is that although in the general population you have a situation that within two years, 93% of people are going to actually be pregnant and never have to have the conversation of IVF and further treatment and all of that, what happens is that when things have not been easy, we have to approach things differently and we have to have a more nuanced understanding of every stage of where things could go wrong if we are to change that outcome.
• 20:40
  Dr. Gabriela Rosa: Because it's very easy to say every woman at this age is going to experience X.
• 20:46
  Dr. Gabriela Rosa: It's not actually true because in the general population you might have every woman or many women at this age drinking, smoking, doing drugs.
• 20:54
  Dr. Gabriela Rosa: And the people who are coming to me, they certainly are not doing that.
• 20:58
  Dr. Gabriela Rosa: And so it's not to say that they're necessarily going to be healthier, although many cases they are.
• 21:06
  Dr. Gabriela Rosa: And so that too is going to change the outcomes that they experience.
• 21:10
  Dr. Gabriela Rosa: So, you know, it's a nuanced conversation that has to be nuanced.
• 21:16
  Dr. Gabriela Rosa: When we are at a situation that we're struggling to get pregnant or take a healthy pregnancy to term or experiencing multiple failed IVF cycles, you know, that essentially are not working, even though that is common anyway, we know that, you know, close to 80% of cycles that get started do not yield a live birth across all ages.
• 21:38
  Dr. Gabriela Rosa: But, you know, the reality is that there is, there are so many considerations when we're talking about a particular person.
• 21:44
  Dr. Jill Carnahan: I really love that because like I said, I've had friends and patients.
• 21:48
  Dr. Jill Carnahan: And now with availability of lab testing, you know, most people can order themselves an AMH and they get so discouraged.
• 21:54
  Dr. Jill Carnahan: And the truth is, I love that you said it's more than that.
• 21:57
  Dr. Jill Carnahan: And granted, someone in their 40s, you want to take some note, but you don't have to pin your hat on the absolute that you'll never get pregnant with a certain number.
• 22:06
  Dr. Jill Carnahan: And I really Appreciate you clarifying that because so many women are afraid right after they see their numbers.
• 22:10
  Dr. Gabriela Rosa: Yeah, absolutely.
• 22:11
  Dr. Gabriela Rosa: And also this is another very important thing that, you know, we do have to point out, which is AMH is a proxy marker of ovarian reserve.
• 22:22
  Dr. Gabriela Rosa: It fluctuates, it fluctuates between labs, it fluctuates during different times in the cycle.
• 22:27
  Dr. Gabriela Rosa: It fluctuates.
• 22:28
  Dr. Gabriela Rosa: If you've been on Letrozole, it's going to be suppressed.
• 22:30
  Dr. Gabriela Rosa: So there are many reasons as to why FSH on its own is not a good marker.
• 22:36
  Dr. Gabriela Rosa: But also what I think is important for to realize is that when FSH levels are raised and we have a low amh, IVF automatically becomes the worst option for conception, given the cost.
• 22:50
  Dr. Jill Carnahan: Right.
• 22:51
  Dr. Gabriela Rosa: Because what happens is if you're going to go and do an entire IVF process to recruit one or two eggs, you're going to have the same chance of natural conception anyway, minus the $20,000 that you would be paying for going down that journey.
• 23:06
  Dr. Gabriela Rosa: So the thing about it becomes like, who is giving the advice and why are they giving it?
• 23:11
  Dr. Gabriela Rosa: And most of the time, women who receive the news of having a lowered amh, they're receiving that news either from an IVF doctor or they're being given a referral to go and see an IVF doctor.
• 23:24
  Dr. Gabriela Rosa: Unfortunately, in the United States, UK and Australia, 60% of IVF clinics now are owned by private equity or are stock exchange listed companies.
• 23:35
  Dr. Gabriela Rosa: Meaning that they have a fiduciary duty to produce profits to shareholders.
• 23:41
  Dr. Gabriela Rosa: Meaning that are you really getting the best advice for you?
• 23:45
  Dr. Jill Carnahan: Yes, yes.
• 23:46
  Dr. Jill Carnahan: That's a very important question because that's what I'm seeing in the.
• 23:49
  Dr. Jill Carnahan: I love that because again, I have had multiple fertility experts on the show.
• 23:53
  Dr. Jill Carnahan: So far this has been my absolute favorite interview because we're really going to the root cause versus just saying IVF is a solution and the cost is inevitable and all those things.
• 24:04
  Dr. Jill Carnahan: One thing that's really difficult for many women is recurrent miscarriage.
• 24:08
  Dr. Jill Carnahan: And you mentioned another case of that in the beginning of our show here.
• 24:12
  Dr. Jill Carnahan: What would you think about with that woman differently than you would with someone who just hasn't ever been able to conceive Is there any different roadmap that you would take her on?
• 24:21
  Dr. Gabriela Rosa: Look, it's actually, it's really interesting that you asked that question because it's a question that I have thought about for a very long time.
• 24:27
  Dr. Gabriela Rosa: In fact, Fertility Breakthrough, the book, I've made this available free on Spotify and YouTube for people to actually be able to have that further understanding, you know, that I think is required.
• 24:39
  Dr. Gabriela Rosa: And the subtitle of this book is Overcoming Infertility and Recurrent Miscarriage When Other Treatments have Failed.
• 24:45
  Dr. Gabriela Rosa: So you can imagine that it is a conversation that I've thought about for a very long time.
• 24:51
  Dr. Gabriela Rosa: I don't treat people differently when it comes to infertility or miscarriage, and here's why.
• 24:56
  Dr. Gabriela Rosa: A lot of times the reason that people think they're infertile is not because the egg and sperm aren't meeting, is not because fertilization isn't happening.
• 25:05
  Dr. Gabriela Rosa: It's because implantation is failed, failing.
• 25:07
  Dr. Gabriela Rosa: And sometimes it's failing at a time prior to them being able to see a positive pregnancy test, or they see a positive that then becomes negative in a couple of days or they have an early miscarriage.
• 25:18
  Dr. Gabriela Rosa: All of those factors fall under the same umbrella in the cases that I treat and how I approach fertility.
• 25:25
  Dr. Gabriela Rosa: So we're very proactive.
• 25:26
  Dr. Gabriela Rosa: Even though, you know, the guideline says that you have to wait for two miscarriages in some guidelines still it says three.
• 25:32
  Dr. Gabriela Rosa: Three World Health Organization differs from asri.
• 25:38
  Dr. Gabriela Rosa: But the main thing about it is this is that if you are in a situation where you are experiencing long time to pregnancy, it's most likely that you are actually experiencing either fertilization failure or implantation failure, but mostly implantation failure.
• 25:57
  Dr. Gabriela Rosa: And ultimately, if it is implantation failure, this is where we see the situation of we produce embryos in the lab through ivf, icsi and then we go and transfer the embryo and we get a negative pregnancy test at the end of that two weeks.
• 26:12
  Dr. Gabriela Rosa: Is it because you were never pregnant to begin with?
• 26:14
  Dr. Gabriela Rosa: No.
• 26:14
  Dr. Gabriela Rosa: At the time of transfer, you were absolutely categorically 100% pregnant.
• 26:20
  Dr. Gabriela Rosa: And so that essentially means that if you can conceive through ivf, the most likely cause of you not being.
• 26:28
  Dr. Gabriela Rosa: Or if you can have fertilization through Ivy ivf, the most likely cause of not seeing a positive pregnancy test is implantation failure, not fertilization failure.
• 26:38
  Dr. Gabriela Rosa: And so, you know, hence why from my perspective, when I'm treating the types of cases that I treat, which are all difficult, complex cases, I'm really not looking at people differently.
• 26:49
  Dr. Gabriela Rosa: I'm looking at how do we take every aspect and every category of systems in the body that needs to be addressed.
• 26:59
  Dr. Gabriela Rosa: Because again, fertility is not isolated to the reproductive system.
• 27:04
  Dr. Gabriela Rosa: It is a very integrated process throughout the entire body.
• 27:10
  Dr. Gabriela Rosa: So when we compartmentalize fertility and just take it to the reproductive system, that's where our leverage for creating change becomes Much diminished because all of a sudden we're in a situation that we're trying to affect conception, right from where, you know, you actually have the egg and the sperm together, as opposed to taking a much longer and.
• 27:36
  Dr. Gabriela Rosa: And overview of what are all of the things that precede what's going on, and how do you change that to improve and optimize the egg quality, sperm quality, and embryonic development and quality to create the outcome that you're looking for.
• 27:52
  Dr. Gabriela Rosa: So, you know, it's.
• 27:53
  Dr. Gabriela Rosa: I, I don't separate them.
• 27:55
  Dr. Gabriela Rosa: In fact, in our cohort, what we saw was that prior to treatment, people had 51.5% of people had experienced miscarriages, and that dropped to 13.5% after treatment.
• 28:06
  Dr. Gabriela Rosa: So that tells me that not only it increases the chances of people taking home healthy babies after recurrent miscarriage, but it's possibly also addressing the underlying issues that are creating a negative pregnancy test to begin with.
• 28:24
  Dr. Jill Carnahan: So the thing that I really love is that your approach is not necessarily natural medicine versus ivf.
• 28:31
  Dr. Jill Carnahan: It is this both and when they've tried all the root cause things, they can still have a much better outcome with ivf.
• 28:37
  Dr. Jill Carnahan: I really also loved your explanation of the implantation because of course, with ivf, that's the most important thing outside of the lab.
• 28:45
  Dr. Jill Carnahan: The last thing I want to kind of end on is fertility struggles for women and men can be an enormous source of grief and shame and hyper vigilance and all of this.
• 28:55
  Dr. Jill Carnahan: And you gave us a couple stories in the beginning that as you started to work with people, they optimize biology.
• 29:00
  Dr. Jill Carnahan: But I also wonder if you took off some of that layer of the emotional, because then they got pregnant.
• 29:05
  Dr. Jill Carnahan: Where does this fit into it?
• 29:07
  Dr. Jill Carnahan: Because I've seen many couples that sometimes even adopt, and then of course, they get pregnant.
• 29:11
  Dr. Jill Carnahan: How do you address those issues around the emotions and the shame and the guilt of infertility?
• 29:18
  Dr. Gabriela Rosa: You know, they're real.
• 29:19
  Dr. Gabriela Rosa: They're absolutely real.
• 29:20
  Dr. Gabriela Rosa: And yet, what's interesting, the evidence does not suggest that stress causes infertility or that it impacts overall live birth rates.
• 29:30
  Dr. Gabriela Rosa: What it does do is it delays time to pregnancy.
• 29:33
  Dr. Gabriela Rosa: So it's almost like you know how you're going to experience a journey if you knew categorically that no matter what you have to go through, eventually you end up with a baby.
• 29:44
  Dr. Gabriela Rosa: You would automatically feel more relaxed than if you were tense throughout the whole thing of like, is this gonna happen?
• 29:50
  Dr. Gabriela Rosa: The truth is, in 2026, if you want to put in enough time, energy, effort, and Money, you will end up with a baby.
• 29:57
  Dr. Gabriela Rosa: That was not the case 25 years ago when I started doing this work.
• 30:01
  Dr. Gabriela Rosa: You could put enough time, energy, effort and money and still end up with no baby.
• 30:05
  Dr. Gabriela Rosa: 20, 26.
• 30:06
  Dr. Gabriela Rosa: It's a different conversation.
• 30:07
  Dr. Gabriela Rosa: So I say that for most people who truly want a baby, they will have one.
• 30:11
  Dr. Gabriela Rosa: Sure, you might have to choose different avenues and choose different things that you didn't initially envision as a way to do it.
• 30:18
  Dr. Gabriela Rosa: Maybe donor aid, you know, maybe whatever.
• 30:21
  Dr. Gabriela Rosa: But at the end of the day, it's possible.
• 30:23
  Dr. Gabriela Rosa: And so I think that the more people focus on micro joys as opposed to stressing about stressing in their day to day, I find micro joys are the antidote to the stress about stressing and really focusing on what am I grateful for?
• 30:38
  Dr. Gabriela Rosa: What is, what is exciting about my day?
• 30:40
  Dr. Gabriela Rosa: What is, what is wonderful about this?
• 30:42
  Dr. Gabriela Rosa: What is in front of me right this second?
• 30:44
  Dr. Gabriela Rosa: The more that we can bring ourselves to the present moment and really focus on what's in front of us right now, not a minute from now, not a minute before now, the more that, the more ease we experience.
• 30:57
  Dr. Gabriela Rosa: And I see this for my patients a lot.
• 30:59
  Dr. Gabriela Rosa: It's something that I'm counseling them all the time on.
• 31:02
  Dr. Gabriela Rosa: And the fact that, you know, listen, you really need to focus on the things that you can actually do something about and opposed to the things that you can't control.
• 31:09
  Dr. Gabriela Rosa: And that's it.
• 31:10
  Dr. Gabriela Rosa: Right?
• 31:10
  Dr. Gabriela Rosa: And not to be overwhelmed by the sheer number of things.
• 31:14
  Dr. Gabriela Rosa: This is why I try to just make it so simple to conceptualize because then you can apply that, right?
• 31:20
  Dr. Gabriela Rosa: You can do something about it also, because knowing and not doing is the same as not knowing.
• 31:25
  Dr. Gabriela Rosa: And so if you're going to learn and not implement well, you might as well not have learned it at all because it makes no difference to your life.
• 31:32
  Dr. Gabriela Rosa: So it's about doing the things that we actually can and forgetting about the things that we can't do anything about and knowing that it's a matter of time.
• 31:41
  Dr. Gabriela Rosa: Time.
• 31:42
  Dr. Gabriela Rosa: If you really want to have a baby, there are ways.
• 31:44
  Dr. Gabriela Rosa: And I think that's a wonderful thing to know and to be left with.
• 31:49
  Dr. Jill Carnahan: Exactly.
• 31:50
  Dr. Jill Carnahan: And.
• 31:50
  Dr. Jill Carnahan: And what a great, both practical and super compassionate approach.
• 31:53
  Dr. Jill Carnahan: I hear that in your words, just as we kind of close.
• 31:58
  Dr. Jill Carnahan: If you could tell the woman listening right now who desperately wants a baby and is beginning to lose hope, just one thing, what would you want her to know?
• 32:08
  Dr. Gabriela Rosa: You are enough now.
• 32:09
  Dr. Gabriela Rosa: You don't need a baby to be complete.
• 32:11
  Dr. Gabriela Rosa: You don't need a baby to be happy.
• 32:13
  Dr. Gabriela Rosa: Like really just know that it's a choice and it's a beautiful choice to make, but it's not going to make you who you are.
• 32:22
  Dr. Jill Carnahan: Oh, that's beautiful.
• 32:24
  Dr. Jill Carnahan: Now people want to know more about your book, how beautiful that you've allowed it to be for free on Spotify.
• 32:28
  Dr. Jill Carnahan: Tell people where they can find out more about you and get a copy of your book.
• 32:32
  Dr. Jill Carnahan: Let us know the details so they.
• 32:35
  Dr. Gabriela Rosa: Can follow me on Instagram.
• 32:36
  Dr. Gabriela Rosa: I do a lot of patient education on Instagram.
• 32:38
  Dr. Gabriela Rosa: It's Gabriela Rosa Fertility and it's Gabriela with one L. So G A B R I E L A R O S A and so Gabriela Rosa fertility on Instagram fertilitybreakthrough.com is my website and they will be able to go there and find all of additional information and things that they want.
• 32:55
  Dr. Gabriela Rosa: And of course, searching the book by title, Fertility Breakthrough Overcoming Infertility and Recurrent Miscarriage When Other Treatments have Failed is.
• 33:03
  Dr. Jill Carnahan: Another way to find fabulous Dr. Gabriela, thank you for your work in the world.
• 33:09
  Dr. Jill Carnahan: Thank you for your practical advice and also deep compassion, as I said.
• 33:13
  Dr. Jill Carnahan: And thank you for coming on Resiliency Radio today.
• 33:17
  Dr. Gabriela Rosa: Thank you for having me.
• 33:18
  Dr. Gabriela Rosa: Really appreciate being here.
• 33:20
  Dr. Jill Carnahan: Hey guys, hope you enjoyed that episode with Dr. Gabriela Rosa.
• 33:24
  Dr. Jill Carnahan: You could find links to her book and resources below in the show notes.
• 33:28
  Dr. Jill Carnahan: As you know, we have new episodes coming out every single week on Resiliency Radio.
• 33:32
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• 33:35
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• 33:46
  Dr. Jill Carnahan: I also want to remind you if you're looking for functional medicine practitioners, you can find those resources at our clinic.
• 33:52
  Dr. Jill Carnahan: You can visit jillcarnahan.com, see our providers and schedule an appointment or even a free call.
• 33:58
  Dr. Jill Carnahan: If you want to know more.
• 33:59
  Dr. Jill Carnahan: Our number is 303-993-37910 and you can email info flatironfunctionalmedicine.com Always nice to see you and I will see you again next week for a new episode of Resiliency Radio.
• 34:13
  Dr. Jill Carnahan: Until then, take care and be well.