Latest / Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss / Trying to Conceive: Weight, Hormones & Fertility | How Metabolism Affects Ovulation and Getting Pregnant

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Trying to Conceive: Weight, Hormones & Fertility | How Metabolism Affects Ovulation and Getting Pregnant · Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss

• 0:10
  Crying Out Loud, a podcast by Chasing the Rainbows with your
• 0:18
  host Bernice Quisenberry. Today's conversation is one that
• 0:28
  we approach with a lot of care and compassion.
• 0:30
  When weight infertility come up in reproductive medicine, the
• 0:33
  conversation often gets reduced to 1 oversimplified message.
• 0:37
  Just lose weight. And for many people navigating
• 0:40
  infertility, that advice can feel dismissive, stigmatizing,
• 0:43
  and incomplete. Because the reality is far more
• 0:46
  complex than just that. Weight is not simply a number on
• 0:49
  a scale. It reflects a web of metabolic
• 0:51
  health. Hormones, inflammation, stress
• 0:54
  Physiology, along with other factors can ask us to care for
• 0:58
  this. And for many individuals trying
• 1:00
  to conceive, especially those navigating PCOS, insulin
• 1:04
  resistance, or infertility, the question isn't just about
• 1:06
  weight. It's about how the body is
• 1:08
  metabolizing energy, regulating hormones and responding to the
• 1:11
  environment that we live in. Our listeners know this well.
• 1:14
  Many of you listening in today have already gone down the
• 1:17
  rabbit hole of research, reading studies, exploring nutrition,
• 1:21
  learning about insulin singling, you know, inflammation, gut
• 1:24
  health, all of it, and how we feel our bodies, you know, which
• 1:28
  then can affect ovulation, egg quality, implantation and
• 1:32
  pregnancy outcomes. So today, we're not staying on
• 1:35
  the surface. We're diving into the whole
• 1:36
  picture of weight, metabolism and reproductive health, not
• 1:40
  through shame or simplistic advice, but through science,
• 1:44
  compassion, understanding. We are joined today by Doctor
• 1:48
  Nicole Marchetto, a board certified reproductive and
• 1:51
  chronologist and infertility specialist.
• 1:53
  Doctor Marchetto earned her medical degree from Drexel
• 1:57
  University College of Medicine, where she also completed a
• 2:00
  Master of Public Health. She then completed her OBGYN
• 2:03
  residency at Mount Sinai Saint Luke's, Mount Sinai West in New
• 2:07
  York, followed by her fellowship and reproductive endocrinology
• 2:10
  and infertility at Rutgers New Jersey Medical School.
• 2:14
  She is also an accomplished researcher whose work has
• 2:17
  explored pre implantation genetic testing, racial and
• 2:21
  ethnic disparities in fertility care, and polycystic ovary
• 2:25
  syndrome. As we all know, PCOS areas that
• 2:28
  intersect deeply how wheat metabolism and systematic
• 2:31
  factors influence reproductive health.
• 2:35
  Doctor Marchetto, thank you for joining us today for what we
• 2:38
  hope we will get, deeper and more thoughtful conversation
• 2:41
  around health and nutrition and fertility.
• 2:44
  Thank you so much, Bernice. I really, really appreciate the
• 2:46
  opportunity to come speak with you and to your listeners.
• 2:50
  I remember when we met several years ago at the Bereavement
• 2:53
  conference, and I'll never forget that.
• 2:55
  This is just such a great organization and so needed for
• 2:59
  all of us who have gone through infertility and loss.
• 3:02
  So thank you so much for having me.
• 3:04
  Thank you, of course. And we're just so excited to
• 3:07
  have you and to really talk through a lot of this.
• 3:09
  You know, when I heard you speak at that conference, you spoke so
• 3:12
  beautifully and the way that you really broke things down just
• 3:16
  gave us a huge understanding of, you know, different things.
• 3:19
  So I'm really excited for you to be on here for our listeners to
• 3:21
  hear you share more. Thank you.
• 3:24
  Yeah. So beyond the typical weight
• 3:26
  conversation, we'll just dive right into these deeper
• 3:30
  conversations. You know, many patients such as
• 3:32
  myself, you know, feel the fertility conversation around
• 3:35
  weight, it becomes very overly simplified, like just go lose
• 3:38
  weight, Right. And from a reproductive
• 3:40
  endocrinology standpoint, how do you think we should reframe the
• 3:44
  discussion, you know, away from BMI alone and toward metabolic
• 3:49
  health? Yeah.
• 3:51
  So I think that the first step is really speaking to a provider
• 3:56
  really, you know, a physician or somebody who is trained in
• 3:58
  reproductive endocrinology and infertility to really figure out
• 4:01
  what the person's diagnosis is. So many of our patients are
• 4:05
  coming to us with recurrent pregnancy laws or infertility or
• 4:08
  unexplained infertility. And really it's important to
• 4:11
  kind of do a full work up and figure out if there is something
• 4:14
  specific that we can identify as a cause for what they're coming
• 4:17
  in for. Sometimes weight is playing a
• 4:19
  role, but it's likely not the only role.
• 4:22
  And it's important to understand exactly how it's playing a role
• 4:26
  in their journey. We know that BMI is important
• 4:30
  and we know that extremes of BMI do play a role in miscarriage
• 4:34
  and infertility. You know, at the very low end of
• 4:37
  the spectrum, patients who are really underweight, the body
• 4:40
  definitely needs more nutrients to be able to apply resources
• 4:43
  directly to conceiving. But it's, it's many times more
• 4:48
  than just ABMI factor that needs to be addressed.
• 4:51
  So we do a full work up and we want to see exactly what is
• 4:54
  happening with their hormonal communication from the level of
• 4:58
  the brain down to the ovaries and how they're really
• 5:01
  communicating directly with the ovaries and the uterus to be
• 5:04
  able to address what the best next steps would be, what the
• 5:07
  treatments are. And it's not simply going to be
• 5:11
  gaining weight or losing weight depending on you know what what
• 5:13
  their background is. Yeah.
• 5:15
  Oh, that's great. Thank you for sharing it like
• 5:17
  that. And you know, BMI is often used
• 5:20
  as a screening tool in fertility care, but it doesn't always
• 5:24
  reflect the insulin resistance or inflammation or metabolic
• 5:27
  dysfunction. How do you evaluate metabolic
• 5:31
  health more holistically when someone is trying to get.
• 5:35
  Right. So I think, I think you know,
• 5:37
  taking a full history and understanding the patient's
• 5:40
  journey so far. So any medications that they're
• 5:42
  on, if they've had any drastic changes in weight, weight loss
• 5:45
  or weight gain that coincided with their, their history, if
• 5:50
  they, if they, you know, recently have had a change in
• 5:53
  their menstrual cycles that were also reflective of what that
• 5:57
  change in weight has been. We want to know, you know, did
• 6:00
  they recently are, are they struggling with depression and
• 6:04
  that their weight gain has been associated with depression and
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  trying to figure out if there's anything else that might be
• 6:09
  going along side of the weight gain or weight loss.
• 6:13
  We know that really BMI is, is like you said, it's a number,
• 6:18
  right? So it's BMI is a a calculation
• 6:20
  of the height and the weight and how it it's sort of supposed to
• 6:26
  reflect the person's overall risk for other diseases.
• 6:29
  But it's not perfect. So we really can't rely on that
• 6:32
  alone. And so we want to do other tests
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  to see, you know, do they have any evidence, lab based evidence
• 6:38
  of insulin resistance or pre diabetes or diabetes?
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  We know that that weight that has hormonal impacts, so excess
• 6:46
  body fat can have estrogen effects.
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  We know that adipose tissue can directly turn into estrogens in
• 6:53
  the body with different hormone pathways that we have.
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  We know that that weight can also directly impact the level
• 6:59
  of inflammation in the body and that inflammation crosstalks
• 7:02
  with insulin resistance. Now it's not super
• 7:05
  straightforward in terms of how to be able to test somebody for
• 7:09
  insulin resistance. There are a couple of gold
• 7:11
  standard measurements that we can use, but are often, you
• 7:14
  know, not not as straightforward to actually measure.
• 7:17
  So often we'll get a summary hormone, which is the hemoglobin
• 7:20
  A1C, which is kind of like your, your glucose summary of the
• 7:23
  control over the last three months.
• 7:25
  That's a good place to start. I also like to get fasting lab
• 7:29
  values on a comprehensive metabolic panel as well as a
• 7:32
  fasting insulin level and a fasting glucose level.
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  There are some other labs, like I said that that may be
• 7:38
  described more eloquently in the literature that may not be as
• 7:41
  practical for our patients to be going and doing all the time.
• 7:45
  But we want to get a sense of what is happening sort of in
• 7:48
  their day-to-day life, their nutrition, their habits and
• 7:52
  other medical conditions and other medications that may also
• 7:55
  be playing a role in that risk. Are they on Prednisone for an
• 7:58
  autoimmune condition? Because that can impact your
• 8:00
  your resistance to insulin and glucose intolerance.
• 8:04
  So and any other risk factors, you know, if they have
• 8:07
  polycystic ovarian syndrome. So this is going to come out
• 8:10
  when we do their full history and physical exam.
• 8:13
  We're going to evaluate how regular their cycles are, what
• 8:17
  their ovaries look like. Some of the other hormone values
• 8:20
  that we're going to be checking. Patients with polycystic ovarian
• 8:23
  syndrome also have an increased risk for metabolic syndrome.
• 8:26
  These are two conditions that that really go hand in hand.
• 8:29
  And so we have to assess for the patient's overall risk for
• 8:32
  cardiovascular disease later in their life and really both
• 8:36
  within a pregnancy, you know what their risks are as well as
• 8:39
  post pregnancy and and how to make sure that we can keep them
• 8:41
  healthy and safe long, long term.
• 8:44
  I think taking that overall approach too, I mean, with
• 8:46
  looking at medications, because I know sometimes the one
• 8:49
  medication I was put on caused waking and things like that too,
• 8:52
  which also was then affecting because it was very rapid
• 8:55
  increase things like that. So I think mentioning Dr.
• 8:59
  Marchetto that, you know, looking at everything, OK, let's
• 9:02
  like look at this and see what's causing it, you know, root cause
• 9:05
  and really evidence based than just, you know, trying to to
• 9:10
  guess at it. Right, I think too, I mean, I, I
• 9:13
  see patients all the time and we, we do talk about weight and,
• 9:17
  and how hard it is to lose weight.
• 9:19
  And I think that it's, you have to also be practical.
• 9:22
  And I think leaving a patient with the instructions to just go
• 9:26
  lose weight is, is like the least helpful thing that we
• 9:29
  could do. So I think, you know, having
• 9:30
  some tools, we often will work with a nutritionist.
• 9:34
  We also have been starting to use more of the new medications
• 9:38
  that focus on the GLP one receptor agonists and what role
• 9:42
  they may play in helping patients who are at particularly
• 9:46
  high risk of weight gain because of the Physiology of their their
• 9:51
  their ovaries. And so there's a lot of other,
• 9:53
  you know, multi pronged approach that is is needed in these kind
• 9:56
  of conversations. Absolutely.
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  And I think too, you know, taking in all the stressors,
• 10:01
  everything that you're dealing with when you're on an
• 10:03
  infertility journey and sometimes food is comfort,
• 10:06
  right? And then to, you know, try to
• 10:08
  create another new routine on top of, or, you know, trying to
• 10:14
  readjust your, you know, food and, and intake and, and all of
• 10:17
  that is so difficult in those moments when you're already
• 10:21
  trying to navigate so many other things.
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  So I, you know, love that you say from this compassionate
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  approach, you know, we work with a nutritionist, we help you,
• 10:29
  we're here for you, We're alongside of you.
• 10:31
  It's not like we're just going to leave you high and dry and
• 10:33
  figure it out on your own. Right, exactly.
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  I think that's that's really valuable.
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  And I think we've learned a lot as a field to to really
• 10:41
  understand that it's not a blame situation.
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  And this is really you, you have to understand that.
• 10:46
  And I think we're starting to now that there's a lot more data
• 10:48
  and more discussion on it. But but yeah, I mean, the the
• 10:51
  worst thing that we can do is just kind of abandoned a patient
• 10:53
  and, and expect them to kind of be able to handle all of this
• 10:57
  without any kind of other help when it's really their their,
• 11:01
  you know, hormones and Physiology that are affecting
• 11:03
  it. Yeah.
• 11:05
  Well, and the other factors, you know, let's talk through
• 11:07
  inflammation, for example, and how that, you know, can affect
• 11:10
  egg quality and, you know, implantation, so many different
• 11:13
  things as well. And it's really hard to
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  sometimes get that under control or regulated too.
• 11:19
  Yeah. So the the tough thing and I
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  talk about this a lot with my patients, especially in the
• 11:25
  first visit is there is a whole lot that we don't understand
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  about the body and about reproduction.
• 11:30
  And I think that understanding that that sort of lack of
• 11:34
  knowledge is crucial in our approach because we have to be
• 11:37
  open to the idea that there may be something happening on a
• 11:40
  molecular level that we have not yet diagnosed or figured out.
• 11:43
  And so many times when we are working with patients who either
• 11:46
  have recurrent pregnancy laws or infertility who are going
• 11:49
  through maybe the IVF journey and, and maybe, you know, we're,
• 11:53
  we're struggling with miscarriages with IVF, we have
• 11:56
  to think that there is more happening than what we can just
• 11:59
  detect and measure. And being open to understanding
• 12:02
  those other pathways and, and sort of trying different things
• 12:05
  is important. We do know that that high weight
• 12:09
  and obesity does create a chronic inflammatory state.
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  And there's a host of cytokines, inflammatory cytokines that are
• 12:17
  up regulated that function to dysregulate hormone secretion
• 12:23
  and metabolism. And we know that this can affect
• 12:26
  egg quality, it can affect embryo implantation, it can
• 12:30
  affect the the environment and the uterus.
• 12:33
  And again, we don't fully understand all of it.
• 12:35
  And so there's sort of a different approach for every
• 12:38
  patient and trying to figure out what they've tried before and
• 12:41
  really what some of these other conditions that are might be
• 12:43
  playing a role could be and what we can do to help address each
• 12:46
  of those conditions along the way.
• 12:49
  Oh my goodness. Yeah.
• 12:50
  And right. So when you were saying about
• 12:52
  like the macro nutrients, the micronutrients, the, you know,
• 12:56
  what do we know from research with that and the influence it
• 13:00
  has on egg quality and you know, the ovarian function?
• 13:04
  Yeah. So I think, I think that the
• 13:07
  important thing is making sure that we understand what, what
• 13:12
  nutrients our bodies need to develop a healthy pregnancy,
• 13:16
  right? So we, we, we need all of them,
• 13:20
  but in different amounts, right? So I think, I think protein we
• 13:23
  know is really important. Sugars are important too.
• 13:26
  Just, you know, understanding the the the sugars that are
• 13:29
  gonna up regulate your glucose system quicker and less
• 13:33
  efficiently are probably not as helpful.
• 13:35
  And and again, some patients are more sensitive to certain
• 13:38
  nutrients than others. And certain patients may have
• 13:43
  conditions that we have to think about.
• 13:44
  They may not be absorbing certain nutrients or macro
• 13:47
  nutrients as well as others. So if a patient has come to us
• 13:50
  with a history of the gastric sleeve or bypass surgery, we
• 13:54
  have to think about how are they're going to get, get all of
• 13:56
  the, the important vital nutrients they need to, to
• 14:00
  become pregnant. It's again multidisciplinary,
• 14:03
  you know, working with their, their, their bariatric doctors
• 14:07
  and, and nutritionists and, and kind of giving them the tools to
• 14:12
  be able to, to feel their best as well.
• 14:15
  Absolutely, yeah. And that's, you know, that's
• 14:18
  right. Like when you're on this
• 14:19
  journey, it's self-care, taking care of yourself and having the
• 14:22
  right people in your corner and the right team really is is so
• 14:25
  vital. During all of this, right.
• 14:28
  I mean, I think I think all of us have been been in some part
• 14:31
  of a journey in our life where we feel like we're kind of lost.
• 14:35
  And it's so important to have, you know, someone in your court
• 14:39
  to help figure out some of these these questions that come up.
• 14:43
  Yeah. I think mental health providers,
• 14:45
  nutritionists, also friends, networks, support groups because
• 14:50
  nobody is alone. And I know myself sitting in
• 14:53
  this seat as a physician sees see patients all the time that
• 14:57
  are going through difficult scenarios.
• 14:58
  And I've also been on the other side of the table where I'm in
• 15:00
  the patient. And yeah, I mean, it's it's hard
• 15:03
  to to kind of navigate when you think you're doing this by
• 15:06
  yourself. But that's why support groups
• 15:07
  are so vital. Yeah, yeah.
• 15:10
  Thanks, Doctor Marcheto for that.
• 15:12
  Yeah. And emphasizing Exodus, it
• 15:14
  really is, especially, you know, when you're feeling like you're
• 15:16
  getting hit at all angles, you know, and, and trying to
• 15:18
  navigate and figure it out. So, you know, and then this
• 15:23
  really brings up and what's interesting is gut health and
• 15:27
  microbiome, you know, and the evidence of around that with
• 15:30
  reproductive hormones and fertility outcomes.
• 15:33
  You know what a lot of people have questions around that gut
• 15:36
  health is it's almost like a a word now that's like going
• 15:39
  buzzword that's just going around.
• 15:42
  Yeah, that's so true. And I think that's an area of
• 15:44
  research that that is blooming and is getting a lot more
• 15:48
  attention now. And, and I think that we're
• 15:51
  understanding that the gut Biome plays a really important role
• 15:55
  in, in our hormone access. So as women, you know, our
• 15:59
  hypothalamic pituitary ovarian access in terms of modulating
• 16:05
  different pathways, men too, you know, in terms of, of their
• 16:09
  reproductive pathway, how, how certain microbes and how, yeah,
• 16:14
  really what is going on again at the molecular level is playing a
• 16:18
  role in, in your hormone level. I don't know that we have really
• 16:22
  reached the surface. I think we're almost at, you
• 16:24
  know, the tip of an iceberg when we get down to what is happening
• 16:27
  and, and the disk biosis. You know, we know that patients
• 16:31
  with PCOS have really a different microbiome than
• 16:36
  patients without PCOS and that's probably true for a lot of other
• 16:39
  conditions as well. But yeah, I think when we look
• 16:42
  at the link between the the gut Biome and infertility and
• 16:46
  inflammation, it's all probably along the same sort of
• 16:49
  continuum. So I think, you know, we are
• 16:52
  constantly looking for new areas of research and this is really
• 16:55
  just just hitting the, the top of the, the beginning of the
• 16:59
  understood mechanisms related again to inflammation and and
• 17:03
  really oxidative stress and injury.
• 17:06
  Yeah, absolutely. And you know, I just kind of
• 17:09
  want to circle back and, and for this, you know, when we talk
• 17:11
  about like GLP ones, you know, and utilizing different things,
• 17:17
  you know, cycling through dieting, weight, metabolic
• 17:21
  stress, all of that. How might like that, you know,
• 17:24
  repeated weight fluctuations like really affect this as well,
• 17:29
  'cause I think trying to keep with a routine or stabilizing
• 17:34
  because, you know, I, I'm one that's guilty of a crushed diet,
• 17:37
  right? Like I'll change it for a little
• 17:38
  bit. And I feel like because I'm so
• 17:40
  regiment with it, then I real quick go back to how I was
• 17:43
  eating 'cause it's frustrating if I break it for a couple of
• 17:45
  days or something like that. So love your opinions about that
• 17:49
  as well. Yeah, I think, I think that the
• 17:52
  the GLP ones are one of those like sort of huge once in a
• 17:57
  lifetime discoveries that I mean of course they came out a
• 18:01
  couple, you know, at least a decade ago.
• 18:03
  But I think that the, the impact that these medications are
• 18:06
  having on so many different body systems is, is huge.
• 18:11
  And I think that we we really know that obesity and weight
• 18:17
  health is probably a lifelong chronic disease that is likely
• 18:22
  not something that can just be treated and left alone without
• 18:25
  chronic medications. I mean, we kind of see it like a
• 18:27
  blood pressure. I mean, yes, your blood pressure
• 18:29
  is probably under control. If you have hypertension, you're
• 18:31
  on antihypertensives. But when you go off the
• 18:33
  medication, the disease likely is going to resurface.
• 18:36
  So that's kind of likely how this is going to be sort of
• 18:40
  addressed long term. And so the question is, OK, well
• 18:42
  then how do we, how do we manage this in the the preconception
• 18:47
  and prenatal time frame? And I don't know that we have an
• 18:51
  answer for that yet, but, you know, we do know that a lot of
• 18:53
  patients with PCOS who are going on the GLP ones and are
• 18:57
  achieving pregnancy because their cycles have become a
• 19:00
  little bit more regular and they're ovulating more
• 19:02
  regularly. We're starting to gather more
• 19:04
  data on what the role of those medications will be in the
• 19:07
  pregnancy. You know, obviously right now
• 19:09
  our recommendation is for patients to come off really when
• 19:11
  they're trying to conceive or at the very least as soon as they
• 19:14
  find out they're pregnant. But I think long term the
• 19:16
  question is, you know, will will there be a world where patients
• 19:20
  can stay on AGLP 1 during pregnancy to help maintain that
• 19:24
  symbiosis and homeostasis in the insulin resistance during
• 19:29
  pregnancy. But right now, I don't know that
• 19:31
  we have any any good data, Not good.
• 19:33
  I'm not an expert on the GLP ones, but this is just something
• 19:35
  that we're seeing, you know, patients coming in with with
• 19:37
  lots of questions. Absolutely, 'cause it is, it's,
• 19:40
  it's now that it's easily accessible for people through
• 19:44
  insurance, things like that, it's getting covered.
• 19:46
  More people are seeing the need for it and to really help it.
• 19:50
  It's interesting, especially with, you know, looking that as
• 19:53
  an option to really help control your weight or, you know, lose
• 19:57
  weight. Exactly.
• 19:59
  Yeah, Yeah. So, so much research in my, you
• 20:03
  know, fertility world of what these medications can do for our
• 20:07
  patients. It's really just we're just at
• 20:10
  the beginning. So yeah.
• 20:11
  Yeah, it's fantastic. I know science.
• 20:13
  It's always, you know, evolving and I feel like more rapidly
• 20:17
  over these last couple of years in the fertility space and just
• 20:20
  hoping that continues. Yeah, I know we, we really, you
• 20:23
  know, as as women, we're, we're always looking for more research
• 20:27
  to be dedicated to what's happening in, in our patients
• 20:30
  and in our lives. And I think a lot of fear of
• 20:34
  math research and, you know, pregnancy and rightfully so.
• 20:36
  But I think, you know, the more creative ways of addressing some
• 20:39
  of these questions in the lab are.
• 20:41
  Are vital. Agreed.
• 20:44
  Agreed. And so you know, when, when they
• 20:47
  are using assisted programs or things like that, also a lot of
• 20:50
  times, you know, patients are told you also need to look at
• 20:53
  how you're fueling your system, like what you're consuming and
• 20:56
  all of that. Like what would your, what would
• 20:59
  it mean to actually like fuel the body for fertility, if that
• 21:02
  makes sense. I know you touched on a little
• 21:03
  bit with protein and things, but if we could even go into a
• 21:06
  little bit deeper with that. Yeah.
• 21:09
  I mean, I definitely don't think that there is a single diet that
• 21:12
  is right for somebody who's trying to conceive, but I think
• 21:15
  making sure that you're getting the specific nutrients such as
• 21:19
  folic acid. So we know that that's a
• 21:21
  nutrient that's required for the beginning of the baby's
• 21:24
  development of the neural tube. And and many times we're not
• 21:27
  getting that enough in our diet alone.
• 21:29
  And so the general recommendation across the board
• 21:32
  is if you're of reproductive age, even if you're on birth
• 21:35
  control, to be on some form of a prenatal vitamin that has folic
• 21:38
  acid in it. So that in the event of a, a
• 21:41
  spontaneous, you know, unintended pregnancy, that that
• 21:44
  early time frame is protected. So folic acid is a nutrient that
• 21:48
  is in it should be in every prenatal vitamin.
• 21:51
  You should be on at least 400 micrograms a day.
• 21:54
  And there are certain populations that may need to be
• 21:56
  in a slightly elevated dose, for example, for twin gestations or
• 22:00
  a history of a neural tube defect.
• 22:02
  So that's like the most vital thing that we can recommend
• 22:04
  across the board that everybody should be on.
• 22:07
  And then outside of that, you know, in in our patients, we're
• 22:10
  worried about egg quality and we're always looking for any
• 22:13
  kind of nutrients, vitamins or supplements that might be
• 22:16
  helpful for egg quality. The only real one that we have,
• 22:20
  you know, right now that I can say, you know, with certainty is
• 22:23
  Co enzyme Q10, which is an antioxidant that is really
• 22:27
  great. It's it's marketed for like
• 22:29
  heart health, but it's something that can help improve egg
• 22:33
  quality. And, you know, it's not a magic
• 22:35
  pill, but this is one of those things that people are always
• 22:37
  looking for something extra that they can take.
• 22:39
  And there's some other other supplements out there that, you
• 22:43
  know, are still being studied, but that one we're pretty
• 22:45
  clearly recommending across the board, along with the folic
• 22:48
  acid. Otherwise, you know, I think I
• 22:50
  tell my patients that, you know, we see, we see a lot of these
• 22:54
  things as inflammatory disorders where you know, if you're kind
• 22:58
  of looking at ways of life, anti-inflammatory type of
• 23:02
  approaches is always gonna be great.
• 23:03
  So, you know, avoid any kind of toxins like tobacco, chew
• 23:08
  tobacco, smoking cigarettes, vaping, nicotine, you know,
• 23:12
  anything that is gonna increase risk for oxidative damage is
• 23:19
  probably not going to be great for egg health and sperm health
• 23:22
  and for, you know, pregnancy. We have a lot of data, you know,
• 23:25
  that that is all true. So I think just trying to lead a
• 23:28
  cleaner lifestyle in terms of avoiding some of those those
• 23:31
  modifiable risk factors, it's helpful.
• 23:35
  And again, there's no magic bullet.
• 23:36
  Sometimes there are things that we really cannot avoid.
• 23:38
  Sometimes there are genetic predispositions to conditions
• 23:43
  that we we can't really address. But but it to the much of the
• 23:47
  ability of being able to kind of avoid some of those things, you
• 23:49
  know, binge drinking and and you know, some of the things that we
• 23:54
  know probably aren't great for your overall health.
• 23:57
  Absolutely. Doctor Marchow Yeah.
• 23:59
  And well, that leads into, you know, what out things outside of
• 24:03
  significant weight change do you see to like sleep patterns, you
• 24:07
  know, rhythms, things like that that can maybe be changed in
• 24:11
  someone's lifestyle or, you know, life to help with
• 24:15
  fertility. Yeah, I mean, again, I think, I
• 24:18
  think some of this is what we have control over and some of it
• 24:21
  is not. So if you're, you know, an RN
• 24:24
  working night shift, you know, that's your, that's your job in
• 24:27
  your life. And so you know, that's not,
• 24:29
  that's not one of those things that you can necessarily change.
• 24:31
  And we don't really know the overall impact and it it
• 24:34
  probably does not have the same impact on one patient over
• 24:36
  another. But sleep is important and
• 24:38
  having some sort of a routine with sleep is, is good.
• 24:42
  What I can say is that some patients, you know, if you're
• 24:46
  worried that you're not getting restful sleep or you feel like
• 24:48
  you're somebody that snores or you're waking up in the middle
• 24:51
  of the night gasping for air, you know, I would definitely
• 24:53
  recommend a sleep study or seeing or asking your doctor
• 24:57
  about, you know, whether or not you are a candidate for work up
• 24:59
  for obstructive sleep apnea. We know that sleep apnea is a
• 25:03
  condition that can limit your oxygenation overnight.
• 25:06
  It can definitely affect, you know, your blood vessels can put
• 25:09
  you at risk for blood hypertension and pulmonary
• 25:13
  hypertension, both which are big, big precursors for
• 25:17
  cardiovascular disease, probably has an impact on egg quality and
• 25:20
  sperm quality as well. So, you know, we we will often
• 25:24
  as part of our assessment when when we're kind of evaluating a
• 25:26
  patient, talk to patients about, you know, their overall patterns
• 25:30
  of, of their day-to-day life. And if they're really not
• 25:32
  getting a lot of sleep because of something like this, that
• 25:35
  might be something that you could be addressing with an
• 25:38
  intervention like a CPAP machine.
• 25:40
  This again, you know, something that you would talk to with your
• 25:42
  primary care doctor. But but yeah, sleep is sleep is
• 25:45
  crucial. We can't all sleep all the time
• 25:48
  as much as I'm sure many of us would like to.
• 25:50
  But but yeah, to the best of your ability, you know, knowing
• 25:52
  that everybody has busy, hectic lives, be sure that when you are
• 25:56
  sleeping, you're getting some some rest.
• 25:57
  Quality, yeah. Quality sleep.
• 25:59
  Absolutely. Wow, thank you so much.
• 26:02
  And I would love for us to close with if someone listening feels
• 26:06
  like they've tried everything, changing diet, exercising, doing
• 26:09
  all the research and still feel stuck in their fertility.
• 26:13
  You know, what would you want to, you know, leave with them
• 26:15
  with and any advice that you have also Doctor Marchetto.
• 26:20
  I think knowing that you're not alone is always a really
• 26:23
  important message. So, you know, I have the benefit
• 26:26
  of of, like I said, seeing patients every day that that I
• 26:30
  know that, you know, as a patient myself that I am not
• 26:33
  walking alone through any of this because I see how many
• 26:35
  people are affected by all these different things every day.
• 26:38
  But I know that patients are not so aware because this is
• 26:41
  something that not everybody talks about.
• 26:43
  So just just know that you're not alone.
• 26:46
  There are support groups out there such as chasing the
• 26:49
  rainbows and, and you know, really seeking out help and
• 26:52
  seeing a reproductive endocrinology and infertility
• 26:55
  specialist. You know, we are our physicians
• 26:57
  who are, are trained in OBGYN that then sub sub specialized in
• 27:02
  reproduction and fertility. And really it's it's important
• 27:07
  to kind of have somebody who has that background be able to
• 27:10
  assess what what's going on and how we can help you.
• 27:13
  Great. Thank you so much, Doctor
• 27:15
  Marchetto, for being on here, for sharing your expertise, your
• 27:18
  perspective and a deeper understanding all around this.
• 27:21
  Thank you very much. Thank you.
• 27:23
  Thank you so much. It was so good to see you again,
• 27:25
  but hopefully we'll talk again soon.
• 27:27
  Absolutely so great to have you on.
• 27:29
  To everyone listening to maybe navigating infertility or still
• 27:33
  birth, infant loss, any type of pregnancy loss, please know your
• 27:36
  story matters, your baby matters, and your grief matters.
• 27:39
  Healing doesn't follow a timeline.
• 27:40
  Trauma and loss don't have a schedule, and you deserve
• 27:43
  compassionate care through every step of this journey.
• 27:46
  If this conversation resonates with you, please share this
• 27:49
  episode with someone who may need to hear it as well.
• 27:51
  And if you are looking for support, want to volunteer,
• 27:54
  donate, host an event in honor of your baby, you can learn more
• 27:56
  at Chase and the rainbows.org. Thank you for being here, for
• 27:59
  listening, and for continuing to break the silence around
• 28:02
  infertility and baby loss. Until next time this is cried
• 28:05
  out loud.