Latest / Gladden Longevity Podcast / The Fertility Crisis: Understanding the Causes - Episode 289

Transcript

The Fertility Crisis: Understanding the Causes - Episode 289 · Gladden Longevity Podcast

• 0:01
  Welcome everybody to this edition of the Gladden Ongevity podcast.
• 0:04
  I'm your host, Dr.
• 0:05
  Jeffrey Gladden.
• 0:06
  And today I'm sitting here with Gabriella Rossa.
• 0:08
  m Gabriella, welcome to the show.
• 0:13
  Thank you for having me.
• 0:15
  Lovely to be here.
• 0:17
  So you're really involved with fertility, both male and female uh infertility.
• 0:24
  um How did you get into this field?
• 0:30
  good question.
• 0:31
  It was not by default or, you know, kind of deliberate decision.
• 0:37
  It was, it wasn't necessary.
• 0:39
  Well, was kind of by design, but you know, look, I've been doing this work now since 2001.
• 0:45
  So it's kind of the memory gets hazy in terms of like, you know, why did I really decide to do this?
• 0:51
  I remember very well.
• 0:53
  As I was studying, used to work for an obstetrician gynaecologist and we had this conversation one day, I trained as a naturopathic doctor and I was having this
• 1:02
  conversation with him and I said, you know, I'm thinking of specializing in pediatrics.
• 1:06
  And the funniest thing, this man used to be such a wonderful, kind, supportive mentor.
• 1:12
  In fact, he's still one of my dearest mentors to this day.
• 1:15
  And he turns around to me and he says, Gabriella, that is the worst idea you've ever had.
• 1:19
  I'm like, okay, Jim, tell me what you really think.
• 1:22
  Okay.
• 1:23
  And he goes, well, yeah, because, you know, like your patient's not your patient, your patient is the parent of your patient and your patient can't speak.
• 1:31
  And I'm like, okay, that's actually really some very good points.
• 1:35
  I do take them on board.
• 1:36
  And as a result of that, I remember the very next week, going into clinic hours and you know, kind of considering, okay, so if I'm not going to specialize in pediatrics, what am
• 1:46
  I going to specialize in?
• 1:48
  And as I'm walking up these spiral stairs, I see this little poster that says natural fertility.
• 1:53
  thought, yep, fertility, that's it.
• 1:55
  And so it was very much one of those moments that I didn't really think about it in all of that massive deep, you know, kind of pondering that normally one takes for the biggest
• 2:10
  decisions in life.
• 2:11
  But it turned out to be exactly where I needed to be.
• 2:15
  The first 10 years of my career, I think that is fair to say that I was treating the front end of the infertile population.
• 2:25
  know, the people who essentially have been trying for about 12 months, they are kind of desperate to get pregnant.
• 2:32
  They feel it's taking too long and they're ready to do the next thing.
• 2:36
  know, whether the next thing is IVF, whether the next thing is just engaging in some more formal treatment and therapy or
• 2:45
  whatever it is that for them and their values and beliefs that kind of, you know, means to them is essentially where they will find me next.
• 2:53
  I did that for, you know, quite a while.
• 2:56
  And then one day a lady came into my office who had been trying for 10 years.
• 3:01
  And I was like, and by that stage I had treated the maximum kind of length of infertility that I had treated was about two years.
• 3:08
  And, you know, I was like, I'm not really sure.
• 3:11
  She hadn't had done multiple failed IVF cycles.
• 3:14
  And I said to her, said, look, I can, you know, tell you that I have never treated somebody with 10 years of infertility.
• 3:22
  And I don't know if this is going to be enough, you know, if the process that I have been using for this, for the patients that I have had success with is going to be enough in a
• 3:31
  situation like that.
• 3:33
  And she turned around and she said the thing that actually changed my entire career, which is I'm going to give up anyway.
• 3:40
  So I just want to be healthier.
• 3:41
  And I was like, okay, I can do that.
• 3:44
  I can do that.
• 3:48
  And so that's where we began.
• 3:51
  that was where that began.
• 3:52
  And after 10 years of her not ever getting pregnant, she had never had a positive pregnancy test.
• 3:58
  She had never had, obviously, a miscarriage or a baby.
• 4:01
  And five, about four months later, she was pregnant for the first time.
• 4:06
  And I was a little bit dubious, I'll be honest.
• 4:09
  I was like, yeah, I don't know that this was really the thing.
• 4:13
  It's 10 years is a long time to say that this was it, you know, that this was the thing that did it.
• 4:19
  But then soon after I treated this woman, another woman came into my office who had been trying for 19 years and she was really not willing.
• 4:28
  She was not a willing patient at all.
• 4:30
  Her husband was the willing patient and bless you.
• 4:35
  Her husband was really the very willing patient.
• 4:38
  In fact, he was quite adamant that he wanted to do this last thing before they gave up entirely.
• 4:44
  And similar story, they as a couple had tried for many years and nothing had worked.
• 4:49
  And they basically were pregnant within several months after beginning treatment.
• 4:55
  And at that point I became really curious.
• 4:57
  I was like, okay, either this is immense synchronicity,
• 5:03
  or there is something to this.
• 5:05
  And so I started then at that point advertising my services to people who had been trying to get pregnant for two years or more.
• 5:15
  So that was my level of comfort.
• 5:17
  I had gone up to two years and then we went from two years or more.
• 5:21
  And that was the next 15 years that brings us to now.
• 5:26
  since there have been lots of developments in terms of like doing my Harvard.
• 5:30
  Masters in Public Health, which led me to study our results and what it is that we did and completing my doctorate now.
• 5:37
  And, you know, it's been really an interesting journey to go from not sure to yeah, actually, this really does have quite a potent impact.
• 5:46
  So let's let's that's a fascinating story.
• 5:49
  I appreciate you sharing that.
• 5:51
  Let's kind of deconstruct the whole thing a little bit.
• 5:54
  So when you think about young people trying to get pregnant, you know, there is kind of a crisis in fertility.
• 6:01
  feels like at this point in time, like there's so many people that struggle to get pregnant.
• 6:07
  You know, there's also a decline in birth rates.
• 6:09
  I think there's a decline in people getting married.
• 6:12
  There's a decline in people even wanting to have children.
• 6:15
  which is an interesting thing in and of itself.
• 6:17
  um And I know there are a number of countries that are kind of really facing population, I won't say decimation, but certainly population decline, right?
• 6:27
  Japan, Italy, lots of South Korea.
• 6:30
  um So it's a really pertinent topic, this idea of fertility.
• 6:38
  And we know that sperm counts have been dropping for...
• 6:41
  for decades, right?
• 6:42
  And we know that uh women have struggled with more infertility.
• 6:46
  Do you wanna kind of, with the 25 year, know, span that you've been doing this, let's say, um do you wanna give us some of the insights as to on the female side and the male side,
• 6:58
  what are some of the biggest contributors you see to people struggling with fertility?
• 7:03
  Look, actually on the female side and the male side, I would say it's the same thing.
• 7:07
  It's lack of proper diagnosis.
• 7:09
  You know, despite all of the things that you've said, which are all true and very much correct.
• 7:15
  And, know, there is obviously an impact on environmental endocrine disrupting impact.
• 7:20
  And, you know, there's a whole lot of different things that.
• 7:25
  Categorically are making a difference to fertility, hormonal health, and just overall long-term quality of life.
• 7:32
  But when it comes to fertility on that subset population that I see of patients, and I can only speak for the subset of patients that I have been seeing in the last 15 years,
• 7:43
  because the patients that I see typically, are the ones that haven't been to, know, they haven't conceived in 12 months.
• 7:54
  They've been and they've done their treatments and nothing has worked.
• 7:58
  So by the time they come to me, in fact, we know this from the study that I did, my Harvard thesis was understanding our results.
• 8:06
  The average number of years of infertility when people came to us was four years, plus or minus two and a half.
• 8:13
  So that is already, and almost 50 % had done failed IVF treatments previously.
• 8:19
  51.5 % miscarriage rate, decline to 13.5 % after treatment.
• 8:25
  But the point here is this, is that by the time people have gone through the standard medical treatment, right, where they go to their GP, they announced that I haven't
• 8:37
  actually been able to get pregnant, I've been trying for 12 months.
• 8:40
  And it's interesting because even infertility is a self-reported diagnosis.
• 8:45
  Literally all you have to do is go to your GP and say, I've been trying for 12 months, you are diagnosed with infertility.
• 8:51
  The cause of infertility, which is the much more important
• 8:54
  important thing to understand is usually not the thing that doctors care about whatsoever until um probably somebody is ready to stop treatment and they'll say, look, I don't think
• 9:07
  that this is working and I'm going to stop.
• 9:09
  And then they go, well, let's do some more tests and let's see what else we can do.
• 9:13
  And then, of course, because diagnosis at that point and the person is just so at the end of their tether by then, it's so still superficial and high level.
• 9:23
  Patient typically decides that, I don't want to continue IVF.
• 9:27
  I need to go and do something else.
• 9:29
  So by the time they find a clinic like mine, that really we specialize in helping couples overcome infertility, recurrent miscarriage and fail treatments.
• 9:40
  They really are wanting something very different.
• 9:43
  They want, they want answers.
• 9:45
  They want the clarity of why is this not happening?
• 9:48
  And so
• 9:50
  what I'm hearing is basically that when people struggle with infertility, the infertility physicians are essentially performing treatments uh like IVF, vitro fertilization, to uh
• 10:06
  kind of boost the chance.
• 10:08
  But what you're saying is that there are underlying situations that are being ignored that are really the drivers here.
• 10:13
  yeah.
• 10:14
  in the vast majority of cases.
• 10:17
  And that's also why in the vast majority of cases, these patients will come to us and they will conceive naturally.
• 10:24
  you know,
• 10:25
  of the things that you're finding?
• 10:26
  What are some of those underlying things that you're uncovering?
• 10:29
  So see, this is where then it becomes interesting.
• 10:32
  It's like, it's figuring out, okay, out of all of the possible things that obviously we take medical history into account and we take that person's family history and what else
• 10:42
  is going on for them into consideration because we need to understand where do we even start testing?
• 10:48
  As you know, there's thousands of tests you could do.
• 10:50
  You're not gonna do all of them, right?
• 10:52
  And so you're gonna have to narrow down on, there's some.
• 10:55
  basic things that obviously we're going to be looking at, but then obviously narrowing down on some more functional testing, narrowing down on interpretation of results.
• 11:03
  Even to that level, like let me put it to you in this way.
• 11:06
  Like if you go and have a thyroid function test done, your TSAGE might be within normal range and you might come back with a 3.5 TSAGE.
• 11:16
  We know very clearly that.
• 11:18
  When it comes to fertility, you need a TSH below 2.3 to reduce the risk of miscarriage.
• 11:23
  So even though you might go and have a TSH within range and be told by your doctor that everything is normal, if you have had recurrent miscarriage, you can't take that as the
• 11:34
  truth.
• 11:34
  You have to then investigate further.
• 11:37
  So really what we're saying is that um you're really kind of stepping into more of a functional medicine space actually to kind of look at this through different lenses,
• 11:47
  right?
• 11:47
  So, I mean, in our case, we don't, yeah, very holistic.
• 11:52
  just, yeah, you can't just look at it and go, it's all about the testing.
• 11:56
  Cause then you're also going to miss on, what are the exposures doing?
• 11:59
  Right?
• 12:00
  What are all of the things that are actually in that person's life that we do need to take into account.
• 12:05
  Yeah, the environment's incredibly important and the environment includes, you know, sort of the psycho spiritual relational elements as much as the toxins in the air or the water
• 12:16
  or whatever else.
• 12:17
  Right.
• 12:18
  um yeah, so that's an interesting.
• 12:21
  So you have developed some sort of uh a system based on the history to kind of deconstruct this.
• 12:27
  You know, then there are things like PCOS, right?
• 12:29
  Polycystic Ovarian Syndrome, you know.
• 12:32
  uh
• 12:33
  decreased fertility, uh insulin resistance, things like that.
• 12:37
  Testosterones are elevated.
• 12:38
  So I can imagine that what I'm hearing you say, and we don't work in infertility here, although we have helped several people get pregnant through some fairly simple things that
• 12:50
  seem simple to us with PCOS and things like that.
• 12:54
  But, um you know, it's kind of a deeper dive.
• 12:58
  So it'd be interesting to understand.
• 13:01
  You know, what are some of the common things that you actually find and uncover?
• 13:04
  So thyroid, that's an interesting point.
• 13:06
  What else?
• 13:07
  I think that, you know, when it comes to infertility, the difficulty here is not so much about what you find, because for example, you can do a semen analysis and find that there
• 13:21
  is low morphology.
• 13:22
  The shape of the sperm is not what it should be.
• 13:24
  You can line up 10 men and there will be 10 different reasons as to why the morphology is low.
• 13:31
  One might be in contact with occupational hazards.
• 13:34
  The other one might be, you know, a cyclist.
• 13:36
  The other one might be a smoker.
• 13:38
  The other one.
• 13:39
  So, you know, you have it's so it goes beyond what you find, right?
• 13:45
  It's actually because when it comes to fertility, what you find is only the initial piece of the puzzle.
• 13:52
  You need to understand what is going on so that you can actually understand how to even direct treatment because otherwise
• 14:01
  you're finding it, is what you're saying.
• 14:02
  understand why you're finding it.
• 14:04
  You then need to understand what is going to be the most direct path to addressing it because you see, if you can line up 10 men and have 10 different reasons, you might find
• 14:13
  that all of them smoke, but then you might remove that and that doesn't fix the problem for every single one of them.
• 14:21
  So then you have to figure out, okay, what else is there?
• 14:23
  And of course, smoking, if we were to just, you know, kind of open a little parenthesis here, if you're trying to get pregnant, male or female,
• 14:32
  affect the pregnancy for male and get pregnant for a female.
• 14:36
  And if your wife, partner, whatever is trying to get pregnant, none of you should be smoking full stop, right?
• 14:43
  I still see to this day, people who come into my clinic, who have recurrent miscarriage, who have been trying to conceive for the longest time and both partners smoke.
• 14:54
  And I'm like, is this a typo in your question there?
• 14:58
  Am I seeing this correctly?
• 15:00
  And I get it, there are difficulties that people have in terms of making implementations of a lifestyle nature of that level.
• 15:06
  But at the end of the day, when it comes to fertility, these are some of the things that you just cannot ignore.
• 15:12
  Because if you are ignoring the basics, the way that I like to look at fertility, particularly the way that I like to look at it from a perspective of a couple who perhaps
• 15:22
  they've been trying for six to 12 months and a lot of the...
• 15:26
  uh perspective grandparents usually worry.
• 15:30
  They're kind of the ones waiting for, okay, when am gonna get the, she's pregnant or they're having a baby kind of announcement.
• 15:38
  And so they're usually listening out for us and they're listening out for, okay, what is it that I need to, is there anything that I need to do?
• 15:44
  Do I need to ask the question?
• 15:45
  The point is that sometimes people are going through that process without actually wanting to also
• 15:54
  tell people that they're struggling and that creates another layer of difficulty because then you can't understand more about what could be going on in that situation that could
• 16:04
  be helpful to address.
• 16:06
  But you know, when I look at a couple in that very early stage, from that perspective of like six to 12 months, we're looking at let's just clean up the lifestyle.
• 16:16
  Let's clean up lifestyle environmental factors.
• 16:19
  Let's look at what are the basic things.
• 16:22
  that if we were to remove the obstacles to optimum health, right, let's do that and see what kind of impact that has.
• 16:33
  After a couple has done that, if we're still talking six months later and it still hasn't quite, you know, being where they need to be.
• 16:41
  And this, you, depends on their age because it also depends on their FSA levels for the female.
• 16:47
  FSA John day three, their image on day three, you know, are we looking at a situation of diminished ovarian reserve, you know, do we have a low egg count that's happening here?
• 16:59
  Do we need to action things faster?
• 17:01
  Because that's also another fallacy in the standard care system where you have a situation where people are being told across the range of trying to get pregnant.
• 17:12
  If you've been trying for 12 months, go see your doctor.
• 17:14
  The reality is that if you've got a woman who's 40, you do not want her trying for 12 months before you intervene, before you really understand what are the potential areas for
• 17:24
  her and her partner that could be getting in the way.
• 17:27
  And what is it that can be done about it as quickly as possible?
• 17:30
  Because usually, as we know, couples are delaying pregnancy.
• 17:35
  They're deciding to get pregnant later, focusing on careers.
• 17:39
  some deciding not to get pregnant at all and kind of then getting to that 40 age and going, oh, but now I think that I really want to and am I out of time?
• 17:49
  So, you know, there are those different situations as well.
• 17:52
  And one of the other kind of big components that I'm seeing more and more are very young women who come in with premature ovarian failure, right?
• 18:02
  Who literally have just discovered that their FSA age is
• 18:08
  20 or 30 on day two and their AMA is at point something, you know?
• 18:14
  And in those kinds of instances, you don't have time and even IVF is not going to be the best approach there.
• 18:21
  So then having a look at what is going on first is going to be the first step that people who may be wanting to try to get pregnant need to get clear about what's happening to
• 18:32
  them.
• 18:32
  So explain the FSH for the audience, the follicular stimulating hormone and the.
• 18:38
  So follicle stimulating hormone essentially is a hormone that gets the ovary to release the egg.
• 18:45
  it starts to kind of, you know, it goes down after when you get a period and it starts towards the second half of the cycle to go up so that it recruits the eggs for the next
• 18:57
  cycle that are going to be ovulated.
• 18:59
  So typically when those eggs are recruited towards the end of the cycle menstruation has occurred, FSH will drop.
• 19:06
  So the best time to test baseline FSH LH AMH, anti-malarion hormone, is day three, day two, day three.
• 19:15
  So that you have a baseline understanding of what is happening with that woman's fertility.
• 19:20
  If your FSH is above 10 at day two, you need to possibly ask some questions.
• 19:27
  If it's about 15, above 15, you definitely know that, okay, there is an elevated FSH.
• 19:33
  that could decrease the chances of IVF working.
• 19:37
  there is a potential for needing to kind of fast track fertility treatment and understanding of what else is going on because that is a sign of the initial or at least
• 19:47
  the beginning or kind of somewhat perimenopause being in process.
• 19:54
  Perimenopause happens five to 10 years before a woman actually hits menopause.
• 19:59
  So different women are going to have that perimenopause stage happening.
• 20:03
  at different ages and stages.
• 20:05
  For women who smoke, typically perimenopause arrives five years earlier than for their non-smoking counterparts.
• 20:13
  So that's also another thing that we do need to take into account is that lifestyle history.
• 20:18
  Do we need to action things sooner as a result, Shabesh, or later?
• 20:22
  So when FSH is high for the audience, when FSH goes up, it's the body's, it's kind of like trying harder to get the hormones and the eggs to come forward, right?
• 20:33
  So if it's low, if it's low, then that means the body's responding uh at a low level when the body's not responding as a feedback loop and the FSH goes up to kind of push the body
• 20:44
  harder to release the egg, right?
• 20:46
  So yeah, and the same is true for TSH, right?
• 20:49
  With regards to the thyroid.
• 20:51
  TSH goes up when it's trying to push the thyroid harder to make thyroid hormone.
• 20:56
  Yeah.
• 20:56
  oh
• 20:57
  opposite of that.
• 20:58
  So AMH is produced by the teka cells in the ovaries, which basically means that if the FSH is low, it tells us that the ovarian reserve, the amount of eggs that are in the ovaries
• 21:10
  is actually declining.
• 21:12
  I mean, it declines as we age anyway, but you know, it's certainly there are rates for age groups that we want to look at a normal
• 21:21
  AMH is between one and four angioperuml.
• 21:26
  And so anything that, and I'm by normal within a massive scope of like, you know, ages between, let's say 30 and 40.
• 21:34
  Right.
• 21:34
  And it doesn't mean that AMH alone is the thing that you're to be looking at, because here's what can happen.
• 21:41
  You can have a within range AMH level that is normal and an elevated FSH.
• 21:47
  That still tells us that we have
• 21:51
  a potential issue when it comes to the over is not responding to recruitment of the eggs.
• 21:57
  And so.
• 21:58
  about the opposite of that?
• 21:59
  What about if the FSH is low and the AMH is also low?
• 22:05
  can happen, but that just tells us that yes, we have a lower ovarian reserve, but the ovaries are still responding to recruitment of the eggs at an appropriate level.
• 22:17
  What can happen is the kind of a similar situation to this is where you can have normal FSA and elevated AMH.
• 22:24
  That's usually a sign of policies of ovarian syndrome.
• 22:28
  So women with PCOS will typically have a higher than normal.
• 22:32
  i.e.
• 22:33
  above 4 or above their age broad range um than women otherwise.
• 22:40
  Now, women with PCOS will also have a typical elevation of their LH to FSH ratio.
• 22:47
  Anything of a 2 to 1 nature, so 2 LH to 1 FSH is going to be what that range looks like.
• 22:56
  And then that in combination with an elevated AMH tells us that, oh
• 23:01
  there's possibly a PCOS picture here.
• 23:03
  And then of course, we would look at all of the other parameters and look at, you know, at the ovaries, polycystic in nature.
• 23:09
  And it's not always the case that you can have that you're going to have polycystic ovaries to be diagnosed with polycystic ovary syndrome.
• 23:16
  But you know, some of those, because as we know, you have the diagnosis of PCOS being based on guidelines and different symptoms can actually make up that guideline.
• 23:28
  you do end up with having to do a little bit of detective work.
• 23:31
  It's not always as straightforward.
• 23:33
  You can have a situation where you don't have those elevations of hormones and still have PCOS.
• 23:38
  I was diagnosed with PCOS when I was 20, when I was 18, actually.
• 23:43
  And so, and the doctor was most interesting.
• 23:45
  He literally on the phone told me, you have policies that are going to disease.
• 23:49
  And I'm like, am I going to die?
• 23:51
  You know, and, and he goes, no, no, you're probably just never going to have children.
• 23:56
  I'm like, okay.
• 23:58
  So.
• 23:59
  bedside manners did not come today to the office, clearly.
• 24:03
  oh But what was interesting is that, you know, knowing that in advance and knowing that early on, it made me focus on my own health and my own lifestyle and how I was living my
• 24:14
  life.
• 24:14
  And obviously looking at all of the possible complications of PCOS, you know, whether it's insulin resistance or pre-diabetes or, you name it.
• 24:22
  And so it turned out that when I actually decided to have a baby, you know,
• 24:27
  kind of started preparing about two years before.
• 24:29
  So when I decided that I was ready and that I wanted to have a baby, I was able to conceive first try with my first son and second try with my second son.
• 24:37
  So it's very possible to manage those kinds of features.
• 24:40
  It's just that you need to know what you're dealing with first to be able to do it.
• 24:44
  how did you do that for yourself?
• 24:46
  How did you manage that for yourself?
• 24:47
  So I did what I do for my patients.
• 24:49
  you know, I did the whole lifestyle gamut of things that I was talking about from exercise to healthy nutrition.
• 24:56
  I used herbal medicines for myself because I knew that that was going to be an easy way to regulate my cycles.
• 25:02
  And I basically just made...
• 25:04
  did oh you use?
• 25:06
  Look, we use, I'm trained in Western herbal medicine.
• 25:09
  So we use pharmaceutical grade tinctures.
• 25:12
  And so basically I use things like licorice, prioni, chase tree, you you name it.
• 25:20
  women with PCOS will have different needs, you know, like in my case, certain times within my, my reproductive life, I've had elevated testosterone other times I haven't.
• 25:30
  So obviously my treatment would be adjusted.
• 25:33
  Mm-hmm.
• 25:34
  to what was actually presenting at the time.
• 25:37
  You know, I've never been one to have insulin resistance or pre-diabetes.
• 25:42
  So even now I keep myself very much, you know, kind of tight checked and my insulin is perfect.
• 25:49
  My, you know, like I've done my two, two RGTT recently and everything was just most, you know, unremarkable, which is good because obviously I am intentional about it.
• 26:00
  But I think that that's one of the things that a lot of times people don't realize is that the more intentional you are about your health, the less likely you are to have to deal
• 26:11
  with these long-term complications.
• 26:13
  Obviously, when it comes to a situation that you don't know, and for lot of the people that I treat, they are healthy, and they think that their level of healthy, because
• 26:24
  healthy, I'm sure you agree, comes in a very big spectrum.
• 26:29
  And so you have these types of situations that let's say optimum health is somewhere above my head as I stand here and point to above my head.
• 26:38
  And let's say that healthy is around somewhere around my neck.
• 26:42
  You can have a huge spectrum of what that means for people who are trying to get pregnant, especially if they've been having difficulty.
• 26:50
  So it's not necessarily that you need to get them to that optimal level every single time, sometimes just improving.
• 26:58
  you know, an amount from where they are to where they need to be is enough to get a result.
• 27:04
  Sometimes it isn't.
• 27:05
  And the more I find the more deliberate you are about diagnosis to begin with, and the more you actually are able to really understand what are all of the factors, because for
• 27:16
  example, even with PCOS, if you are dealing with a person with PCOS and they are slim and they don't have insulin resistance,
• 27:24
  you're going to be treating them differently to somebody who is the opposite of that, even though they have diagnosed with the same condition.
• 27:32
  And so that's the type of thing that often standard therapy does not take into account is the fact that patients aren't just some protocol on a piece of paper and that unless you
• 27:45
  are going to really look at what is impacting this human being, you're going to end up with results that work sometimes.
• 27:55
  you know and with fertility you unfortunately don't have the luxury of just keep trying you know
• 28:03
  right.
• 28:04
  Yeah, there is a time.
• 28:04
  There's a timeline on it.
• 28:06
  So yeah, it's interesting.
• 28:08
  think I think, uh you know, in our world, what we do is we try to be as thorough in the deconstruction of the situation before we make the recommendation so that we actually can
• 28:17
  make them as elegantly and as effectively as possible.
• 28:20
  It's the same concept that you have.
• 28:22
  It's like, let's deconstruct the situation, see where we need to go.
• 28:25
  um So the other thing is that it seems like fertility is kind of a um
• 28:32
  I don't know if this is the right term, but kind of a canary in the coal mine around general health, right?
• 28:37
  So somebody's, right?
• 28:39
  With fertility, it's like, well, this is not just about fertility.
• 28:42
  This is a wake up call to health in general, right?
• 28:45
  So.
• 28:45
  it's so awesome that you say that because most people, most doctors do not get it.
• 28:50
  They do not understand that if you are dealing with infertility, you are dealing with decreased quality of life in the future.
• 28:58
  And so what happens, and there's been a couple of studies actually on this very topic, looking at the diagnosis of infertility and the rate of um all-cause mortality.
• 29:11
  Mm-hmm.
• 29:12
  on all-cause mortality for men and women.
• 29:15
  So there were two different studies that have been published.
• 29:18
  And what it showed was that if somebody had a diagnosis of infertility and it was not addressed, they just go and do treatment and get a baby, but leave the causes of why that
• 29:30
  natural conception wasn't actually happening.
• 29:33
  They have a much increased chance or risk of all-cause mortality from diseases like cancer, disease, and diabetes.
• 29:41
  than people who did not fall into that category.
• 29:45
  So what that tells me, and I've been saying this for years and years, which is exactly what you just said, is that fertility is a red flag for many other health conditions that
• 29:56
  usually are underlying.
• 29:58
  Look at all of your, you know, your phallusemias and, you know, APSs like antiphospholipids syndrome and clotting factors and clotting diseases.
• 30:10
  All of those are typically reasons as to why people experience recurrent miscarriages.
• 30:15
  Recurrent miscarriages are usually not actually diagnosed um or investigated as they should be until after somebody has had three miscarriages.
• 30:27
  The problem is that even in some places, because we treat patients all over the world, so we see this happen in every healthcare system.
• 30:34
  And even in some places, when people have had five different miscarriages, they're still not investigated.
• 30:40
  Now, usually we will investigate it.
• 30:43
  If somebody has been infertile for more than a year, what I already know is that in that year, the possibility that they got pregnant, but just haven't seen a positive pregnancy
• 30:53
  to term is very, very high.
• 30:57
  And so infertility is usually a fertilization failure or an implantation failure situation.
• 31:03
  And when you have a chemical pregnancy or, you know, which you see the positive pregnancy test and in a couple of days later it disappears, or you had a miscarriage at any stage of
• 31:13
  gestation.
• 31:14
  Sure, later stage miscarriages may be other reasons that we also need to look into.
• 31:19
  But in that first or second, early second trimester, typically you're looking at things that you can't just...
• 31:28
  see how you go.
• 31:29
  It is not just a luck of the draw.
• 31:31
  It is not just a situation where, better luck next time, you know, keep trying.
• 31:37
  Especially when people are younger, because that should not be happening.
• 31:41
  Most of the reason that chromosomal abnormalities and the miscarriages happen is because of chromosomal abnormalities after 40.
• 31:46
  But for somebody who's 30 or under and they've had three miscarriages, please pay attention to the fact that that is unlikely to be, especially with normal carrier type.
• 31:57
  that's unlikely to be because of some genetic factor.
• 32:00
  And so we really do need to take into account what are all of the things that could be impacting here.
• 32:05
  And what that is again, takes me to is what this discussion that we're talking about in terms of long-term health, because we know antiphospholipid syndrome increases the risk of
• 32:15
  stroke.
• 32:16
  In the beginning, when you first were either diagnosed or when it came up out of nowhere and nothing was done about it, it caused miscarriages.
• 32:25
  But later when you're 50, 60, 70, do you want it to be a cause for your stroke?
• 32:31
  No.
• 32:32
  So, you know, this is one of the reasons why.
• 32:35
  It's a really good point.
• 32:36
  So I think if anybody's listening to this and you've had a miscarriage, the question is, why did I have it?
• 32:41
  What underlying thing?
• 32:42
  Even if you had one miscarriage and you decided just not to try after that, it's still a bit of a red flag for you in terms of your overall health that should be understood
• 32:52
  because you don't want it to catch up to you later on.
• 32:54
  That's really kind of what we're saying here.
• 32:56
  Yeah, absolutely.
• 32:58
  And the thing is the body keeps the score, right?
• 33:00
  And we know that at some point it is going to catch up to you if you are unaware and if you don't address it.
• 33:06
  So it's about understanding and being proactive about the things that come up and not just expecting that, you know, your reference ranges are going to be enough for your quality of
• 33:16
  life later down the track.
• 33:17
  We know that for us to be excellent at 90, we have to be exceptional at 50.
• 33:24
  That's right.
• 33:24
  And so in order for that to be the case, you're not going to leave all of this kind of like cleanup situation that has arisen out of reproductive misfortune to chance.
• 33:36
  You know, you want to understand what's going on.
• 33:38
  And if you are there, you definitely want to understand what's going on so that you can prevent multiple failed treatment and have a healthier baby.
• 33:47
  Because that's also another thing that a lot of times people don't understand is that
• 33:51
  The time to optimize a child's health isn't when you're pregnant.
• 33:54
  The time to optimize a child's health is way before a pregnancy was even in place.
• 34:02
  I mean, we know that, you know, fertility is a transgenerational situation, you know, like you and I were both in our grandmother's womb when our mother was gestating us, you know.
• 34:12
  And so there is that level of impact that we also need to take into consideration and the health of a child.
• 34:19
  when the child is at eight weeks gestation in utero is already defined for the rest of their life.
• 34:26
  All their predispositions, all their health um impacts are going to be developing at that point.
• 34:34
  It's not a situation where, oh, let me wait until I'm pregnant and then I'll be healthy.
• 34:39
  It's like, that's way too late.
• 34:41
  The time to optimize a pregnancy if obviously is...
• 34:46
  when your great grandmother was you know, about to get ready, that's too late.
• 34:50
  That's going to be difficult.
• 34:53
  But we can there was there's a lot of things we can do now, but it's not leaving it to like, okay, next month, I want to be pregnant.
• 35:01
  And now I'm going to start because the egg maturation cycle is 12 months long.
• 35:06
  You know, that's
• 35:08
  longevity itself, right?
• 35:09
  Where it says, you're going to be, you know, in our world where we're making 100s of new 30, you know, right?
• 35:17
  If you're going to...
• 35:18
  Okay, good.
• 35:19
  Come on over.
• 35:20
  So if you're going to be 30 at 100, then you need to be 30 today, right?
• 35:25
  Or younger than that today, right?
• 35:27
  So it gives somebody an active metric.
• 35:29
  So what you're saying is if you're going to have a healthy pregnancy and have...
• 35:35
  your optimal fertility, then you need to actually understand your health now and be in your best shape now to prepare for that.
• 35:44
  I did see some interesting data on pregnancies in women, which was that women that have a single pregnancy actually have an increase in longevity compared to women who never uh had
• 35:55
  a child.
• 35:56
  And then if they had two children, they had a further increase in longevity.
• 36:00
  And with three children, they even had a further increase in longevity, which is interesting.
• 36:04
  But at four children, they had a significant decline in longevity, which is.
• 36:08
  imagine why.
• 36:09
  Having to run around after poor children, I feel the same way.
• 36:14
  Right.
• 36:14
  Exactly.
• 36:15
  But um yeah, so this this whole reproductive thing is really a nice look into health in general.
• 36:22
  Do you treat and end up treating the men?
• 36:25
  It sounds like you do end up treating men.
• 36:28
  Right.
• 36:29
  What do you find is the biggest issues for the men?
• 36:31
  Is it low testosterone or?
• 36:35
  actually, it's usually environmental.
• 36:37
  It's endocrine disrupter environmental factors that will play a role.
• 36:42
  You know, it's interesting because when it comes to fertility, the things we don't typically take into account is the fact that for example, diet is your greatest daily
• 36:55
  exposure.
• 36:57
  It happens several times a day.
• 36:59
  So depending on what it is that you're doing in terms of your nutrition, in terms of how you're nourishing your body, you're either going to be having a positive effect on your
• 37:08
  health and fertility, or you're going to be having a negative effect.
• 37:11
  Let me put it to you this way.
• 37:13
  When you're not trying to get pregnant, nutritionally speaking, the body can be a little bit more forgiving, right?
• 37:21
  And you don't have such hard black and white lines as,
• 37:26
  either something is going to have a positive effect or it's going to have a negative effect.
• 37:30
  There is a gray area, there is a neutral effect, you know, and you can neutralize some of those impacts.
• 37:35
  But when it comes to fertility, which is very multifactorial, there are many different things that could be playing a role.
• 37:42
  And there are many different things that the body has to do to optimize reproductive health.
• 37:47
  So what happens in that situation is not going to be the same as, you're kind of just wanting to be as healthy as you can possibly be because all of a sudden you have any
• 37:59
  potential neutral effect taking away energy from creation of optimization when it comes to fertility.
• 38:07
  Yeah, so it's really, it's a high performance sport, quite honestly, right?
• 38:13
  very short lived.
• 38:15
  If you think about it, it's very short lived male fertility declines with time just as women's, but it declines at a slower rate with time.
• 38:25
  Whereas women is a much sharper decline.
• 38:28
  But I think that that's a really great analogy that, you know, it's, it's a performance endurance focused activity.
• 38:36
  You're not going to be that top athlete.
• 38:39
  your entire life in the same way in which you are not going to be that top reproductive athlete for your whole life.
• 38:49
  There will be a point in time where it begins and where it ends.
• 38:53
  And so that's how people need to really understand fertility.
• 38:56
  Cause a lot of times when you say to people, look, you need to really look at this in a very holistic way.
• 39:01
  And there are many different aspects that you need to take into account.
• 39:05
  People sometimes feel like
• 39:07
  They feel a little bit like it's overkill or they feel a little bit like it's it's a, oh it's a burden.
• 39:13
  It's something that's just like, you know, it's an overwhelming kind of proposition.
• 39:17
  And then I remind them, say, listen, in a year or two years from now, this is not even going to be an option for you.
• 39:25
  You know, if you don't act quickly and effectively and deliberately now.
• 39:30
  So this is the focus point and that needs to be the maximum effort needs to go into that moment.
• 39:37
  it's interesting if you frame it up in this uh athletic kind of analogy, because, you know, if you were training for the Olympics or you're training to climb Mount Everest or
• 39:45
  you're training to do something like that, right.
• 39:47
  Then you start years ahead of time and you're right.
• 39:53
  And you're really on point about your diet, your sleep, you know, your stress, you know, you get the toxins out of your life, the alcohol, the cigarettes, um things like that.
• 40:02
  You know, you.
• 40:03
  And it's a progressive overload process, right?
• 40:06
  So you're starting where you are, you're improving and getting better and harder and stronger as you go along, which is really what's required for you to be able to see the
• 40:15
  transformation from infertile to holding your baby.
• 40:20
  But I think that that analogy is actually a brilliant analogy because you are going to be an elite Olympic athlete for a short period of your life in most situations.
• 40:32
  Yeah.
• 40:33
  so that's the time to prepare and focus and go for the gold medals.
• 40:38
  it helps people kind of get get their mindset around it, because I think people tend to think that pregnancy just sort of happens.
• 40:44
  Right.
• 40:44
  Because clearly it does for some people.
• 40:46
  It's like, oops, well, there we go.
• 40:48
  So it can just sort of happen.
• 40:51
  Right.
• 40:51
  But to actually do it well.
• 40:54
  Yeah.
• 40:55
  population, it's literally have sex, get pregnant, have a baby done, we're no longer having this conversation.
• 40:59
  And that's happening for 90 % of couples.
• 41:02
  So it does, it does.
• 41:03
  But here we're not talking about the general population, we're talking about a subset of a subset of patients.
• 41:09
  even in the 90%, it feels like the babies would be healthier.
• 41:13
  uh You know, they would have a better, you know, a better in utero experience, less stress, you know, the higher IQ.
• 41:21
  I saw something really interesting about just actually having adequate iodine in your diet can raise a baby's IQ by 10 points.
• 41:28
  Right.
• 41:29
  And so
• 41:30
  And that's nutritionally in general, nutritional deficiencies will have that kind of negative impact overall.
• 41:36
  So yeah.
• 41:37
  it's really, it's actually a team sport.
• 41:40
  um It's you and the baby.
• 41:43
  It's you and the baby.
• 41:45
  It's not only you and the baby.
• 41:46
  It's you and the partner, but the baby's on the team too.
• 41:51
  The baby is definitely on the team.
• 41:52
  we see that more so than any other time than when we have an IVF cycle fail.
• 41:59
  Because when you have an IVF cycle fail, you have had an embryo transferred.
• 42:05
  And at that point of transfer, you were pregnant.
• 42:09
  Mm-hmm.
• 42:09
  The fact that you did not stay pregnant to see a positive pregnancy test or the fact that you had a chemical pregnancy or a miscarriage tells us that there is something very wrong
• 42:18
  beyond not getting the egg and the sperm to meet.
• 42:21
  Because if that was the only problem, IVF would have solved that problem, you see?
• 42:27
  And so what happens is that we can't take it, fertility is absolutely a team sport.
• 42:32
  I've been saying it for decades, but the point here is that as soon as you have that baby,
• 42:38
  Yes, the baby has to be added to the team.
• 42:41
  And if it's not happening, i.e.
• 42:44
  seeing a positive pregnancy test after fertility treatment, there is no time more important than digging deeper before going into and buying into the idea that it's a
• 42:54
  numbers game.
• 42:55
  Just keep trying.
• 42:55
  It is never a numbers game.
• 42:57
  You've had your egg, you've had your sperm, you've had your embryo, you should have a baby.
• 43:01
  If that's not happening, and 70 % of IVF cycles fail, unfortunately, so there's a lot of times in which
• 43:08
  patients just go to that appointment and are told, oh, you know, it just was a bad cycle.
• 43:13
  Let's just go again.
• 43:14
  And the doctor doesn't do another thing to understand what is it that could have been going on, you know, wrong.
• 43:21
  doctor should actually be like a high performance coach, right?
• 43:25
  If you're not, if, right, if you're not, if you're not improving your, your performance, so to speak, then, it's breaking down the entire thing.
• 43:34
  So you can be coached in the right way to get the results that you're looking for.
• 43:38
  So, yeah, I think the sports analogy kind of factors across the physician as well.
• 43:43
  Right?
• 43:44
  So the team could actually include the, the physician.
• 43:47
  So, yeah.
• 43:49
  Very interesting.
• 43:50
  You know, we did have a guy who and his wife were trying to get pregnant and they weren't getting pregnant and they came to see me.
• 43:58
  uh She was a client and I had a phone call with him and just in talking through with him, it turned out he was, you know, he'd been on a longevity kick.
• 44:07
  He was in his thirties and so he started doing saunas every like five days a week, right?
• 44:11
  And so I'm like, well, that could be a problem because he'd actually kill sperm.
• 44:16
  So it's like, I think you need to get out of the sauna.
• 44:19
  Um, and you know, they got pregnant about two months later, right?
• 44:22
  So I mean, sometimes there's just some really simple things like that.
• 44:25
  there are and, here's the part that, sometimes people get, um, also can tend to waste a lot of time, which is, know, in a situation like that, that's great.
• 44:36
  was the thing that worked, but what can sometimes happen as well.
• 44:39
  And I see this so much, unfortunately, is people basically going online and trying to figure it out by themselves.
• 44:45
  And then they will buy the list long of herbal teas and supplements and this and that.
• 44:51
  When they haven't done any testing, they don't know even where to start in terms of understanding their own physiology and their own biology and what's going on.
• 44:59
  And they're just taking these random things that, you know, are all not talking to each other.
• 45:05
  some of them they don't even need.
• 45:07
  And so what ends up happening is that they end up losing precious time.
• 45:13
  that they could really be understanding more about what's going on as opposed to just trying to put some band-aid solution on the problem.
• 45:21
  So I find that often this is something that also gets people stuck.
• 45:26
  It almost represents one of the obstacles because people want to do better.
• 45:30
  They want to know what they can do.
• 45:32
  And when their doctors are just saying, no, no, there's nothing you can do.
• 45:35
  Just keep trying.
• 45:37
  People don't accept that.
• 45:39
  They never accept that.
• 45:40
  that's right.
• 45:41
  The problem with that though is that they then go and do things that are not evidence-based, not scientifically sound, and not even clinically sound, and continue not
• 45:51
  to have the result and waste a lot of time.
• 45:54
  even more than that, they're not specific to their situation, right?
• 45:58
  So that's kind of the worst travesty.
• 46:00
  We see this in longevity all the time too.
• 46:02
  It's like, somebody says everybody needs this or everybody needs that or whatever.
• 46:06
  Well, maybe, but in actual fact, if you don't test, you don't really know what you need.
• 46:12
  And so we're big advocates of testing so that you can actually tell what levers you need to pull on in order to get where you want to go.
• 46:19
  Exactly.
• 46:20
  you're just throwing darts at the wall and hoping they stick.
• 46:22
  And that's not a way, not a way to win the Olympics.
• 46:27
  when it comes to fertility, you have very limited time to even get to competing, know, alone winning.
• 46:34
  So the last thing you want to do is wasting time doing that.
• 46:38
  So that's one of the reasons why, you know, for me, it has been such a passion for so many years.
• 46:43
  I've run a free program that actually educates people on exactly these things, because I just find that
• 46:49
  It's horrific to me how many people come to me asking, are these the right supplements I should take?
• 46:56
  I'm like, how am going to know?
• 46:57
  I know nothing about you.
• 47:00
  you know, like I have no idea, but people don't even understand the basics.
• 47:05
  And so in those kinds of situations where there's lack of education, lack of understanding, or even they've been told certain things, but they don't know what the
• 47:15
  right answers are.
• 47:16
  I've developed this 30 day program that I've been running now for gosh, it's like 13 years.
• 47:21
  This is the 13th year that we're going into it.
• 47:23
  We've taken over 140,000 people in more than 110 countries through it.
• 47:28
  And it literally this, function of it is literally just to get people to understand the situation, you know, just to understand what's going on.
• 47:37
  Because I find that the more they understand, the less likely they are to waste time on things that will never get.
• 47:45
  that needle to move any closer to the outcome that they're looking for.
• 47:49
  You know, so it's called the fertility challenge.
• 47:51
  So people can just look for it online, find out, happy to send the link.
• 47:55
  But you know, it's just one of those things that I think the more people understand themselves, understand their situation, understand their exposures, understand that when
• 48:05
  it comes to having a baby, I think that one of the biggest things that people can do, because I often get asked this question of like, okay, well, what can I do to improve my
• 48:12
  fertility?
• 48:13
  oh
• 48:13
  As a couple, the way that you need to do this is act pregnant now to get pregnant later.
• 48:19
  So you need to think about it like this.
• 48:21
  If you were pregnant right now, just stating the little baby that you want to create, whether a man or a woman, men have to indulge me in this moment and think like, what would
• 48:29
  it be like if I was pregnant?
• 48:31
  oh But think about that for a moment and understand that already within you, whether you're a woman or a guy, you are carrying 50 % of that little baby you want to create.
• 48:43
  That's right.
• 48:43
  all of the things that you would absolutely start doing or you would absolutely stop doing if you were pregnant right now are the things that you need to start and stop doing
• 48:54
  immediately, way before a pregnancy has even been placed.
• 48:57
  Because as I mentioned before, an egg maturation cycle is about 12 months long.
• 49:03
  Sure, the sperm matures much quicker.
• 49:05
  It's like three to four months.
• 49:06
  You've got a whole fresh batch of sperm and uh typically better quality ones.
• 49:10
  And that kind of process is happening all the time.
• 49:13
  So hence why two months of not being in the sauna, you have somewhat better quality sperm.
• 49:18
  Four months later, you're definitely gonna have better sperm.
• 49:20
  Sometimes it can take up to 12 months depending on where you're starting from.
• 49:24
  But it's very possible to address, like I've had situations where I had a guy on literally about the, he was on a kidney transplant list and he was on daily dialysis.
• 49:35
  He came to us, his sperm was 0.2 million.
• 49:38
  And by the time he was actually,
• 49:41
  six months later, he had 52 million spam still on a kidney transplant list.
• 49:46
  So it's very possible to optimize sperm cells, sperm quality, depending on the cause.
• 49:53
  Like if that was a client filter situation, no, it's not gonna happen, right?
• 49:58
  But there are certain situations where it's, again, that goes to understanding what's happening so that you can address it effectively.
• 50:06
  depending on the situation, well, he had kidney failure.
• 50:10
  Yeah, I realize, but how did you boost it up?
• 50:13
  Cause he's still on dialysis.
• 50:14
  we basically, we, we still, worked with him, we gave him nutrients.
• 50:18
  Obviously we were monitoring very closely.
• 50:19
  We're working with his, with his specialist, but, his, his wife was a doctor.
• 50:24
  So she basically brought him and her to us because they had had two failed IVF cycles.
• 50:30
  And so they basically were like, you know, this is not working.
• 50:34
  I don't want to continue doing, you know, failed cycle.
• 50:36
  They had two XC cycles that had failed.
• 50:39
  And they didn't want to continue.
• 50:40
  they basically, she came to be treated.
• 50:42
  Obviously, we treated them together.
• 50:44
  We started very gently with him, you know, with giving nutrients and optimizing different aspects.
• 50:49
  And, you know, then we obviously got to the point, we were able to get him to take herbs, we were able to get him to take nutrients.
• 50:55
  And, you know, he basically had a completely different situation.
• 50:58
  Two years later, he had had and this is such a cute story.
• 51:03
  So he basically found out she was pregnant the day he was in the hospital to go and have his kidney transplant.
• 51:09
  So yeah, so basically she gave him the news and he had his kidney transplant came out.
• 51:14
  Everything was great.
• 51:15
  Two years later, they're like, we're now running out of time more than before.
• 51:20
  ah She was kind of getting a bit impatient with not wanting to wait.
• 51:26
  Went down the path of doing ICSI again, had two ICSI cycles that failed again.
• 51:32
  And then contacted me again and went, Gabriela, we just had two failed cycles.
• 51:36
  Can we come back?
• 51:37
  I'm like.
• 51:38
  let's do this.
• 51:38
  And then she conceived and had her second child.
• 51:41
  Now their family is complete.
• 51:42
  And you know, he's feeling much better because that was the other thing too that happened between having his kidney transplant and stopping treatment.
• 51:49
  He was also not feeling great.
• 51:51
  And that was another reason why they actually decided to go into XC because he wasn't really feeling that sexual, he was feeling more tired.
• 51:58
  And so in treatment, again, he felt much better.
• 52:01
  And then they realized that, okay, this is a life thing for them, you know, in terms of
• 52:06
  being quality of life and being optimal in their health is going to be important for various reasons in this instance.
• 52:13
  I mean, in every instance, you know, as we talk about, but certainly.
• 52:16
  It's fascinating the range of people that you're able to help.
• 52:19
  think, um you know, if you're listening to this, it's like, um and if you're struggling with infertility or know somebody that's struggling with infertility, I think the message
• 52:29
  is it really can be helped if you're willing to deconstruct the situation, understand what the root cause issues are, and then kind of build a plan based on that.
• 52:39
  So yeah, really interesting.
• 52:42
  Gabrielle, it's been a pleasure chatting with you.
• 52:44
  um Yeah, good stuff, really good stuff.
• 52:49
  Thanks so much.
• 52:51
  Thank