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Hello and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama. com and this episode goes deep on fertility and in particular understanding some acronyms like AMH, POI, DOR and others and this is I will admit something I didn’t know a lot about going into this podcast and was fascinated to learn more about.
I’m here with Sarah Clark, who when she was 28 years old was told she had premature ovarian insufficiency and accepted this diagnosis and had both of her children through in vitro fertilization. And years later she realized that the root cause of this was actually a food sensitivity, a gut infection, and chronic chronic stress for her.
And so she is now the CEO of Fab Fertile, which is a functional medicine and nutrition support that helps couples with low AMH and or high FSH to make lifestyle and diet changes that improve their outcomes and chances of a healthy pregnancy and baby. And we go in a lot of directions in this episode.
So without any further wait, let’s jump in and learn from Sarah. Sarah, welcome. Thank you so much for being here.
Sarah: Yeah, thanks for having me, Katie.
Katie: Well, I’m really excited for this conversation because I will admit it’s not a topic I know a ton about, and it’s one I see a decent number of questions about. So I think this is going to probably be really helpful to a subset of our listeners. And also for me in a place of personal curiosity, I’m really excited to learn from you today.
And we’re going to be talking on a kind of a broad level about fertility as a general topic. But within that a lot of kind of subsets that I personally don’t have any knowledge on, including things like premature ovarian insufficiency and ovarian reserve and AMH. And I feel like there’s a lot of acronyms in this world.
So to start off broad, I would actually love if you could define some of the acronyms we may hear a lot in this episode, starting with AMH, if you don’t mind.
Sarah: Yeah, so this is one where when someone’s on the fertility journey, and so I was diagnosed with premature ovarian insufficiency about 25 years ago, and they weren’t testing the AMH back then. So now the fertility clinics, when you go to see your OBGYN and you get some tests run and they’ll run your AMH, so your anti malarian hormone, and you’re told it’s below one and that maybe you’re going to be struggling. And so people, this AMH number will really kind of embed into people’s subconscious and they think that they’re doomed because it’s essentially they’re being told it’s their ovarian reserve, the number of eggs they have left. The thing is AMH does not predict your ability to get pregnant naturally. It doesn’t look at your uterine receptivity. So it’s not looking if you’ve got endometriosis or fibroids or cysts or polyps. And it can’t test your egg quality cause there’s no test to look at that. And so it’s looking at your reserve, but it really is used to see how well you’ll do with IVF. And if the majority of us can get pregnant naturally, then why are we running to IVF and then looking at this AMH number and they’re using it to really tell us like, Uh Oh, like you had better boogie. And it just perpetuates this panic for couples. And it’s.. we want to know the number, we don’t want to be blind to it, but we don’t want to hang our hat on the whole thing and think, that’s it.
The only thing they can do is either rush to IVF or go to donor eggs.
Katie: Okay, gotcha. So that makes sense. So it does give data, but it’s not the only data that you want, nor is it seemingly like any sort of sentence in any one direction or the other. Just good general information to have, it sounds like. And you mentioned your own personal journey with this. Before we get into defining more terms, can you also, if you’re willing, just share a little bit about your experience and how you ended up learning all of this?
Sarah: Yeah, sure. So, yes, I was diagnosed with premature ovarian insufficiency, which is a loss of function of the ovaries before the age of 40 at 28. And so I remember going to my OBGYN’s office and she sent me the brochure and said, Sarah, the only thing you can do is donor eggs. And I like, weirdly enough, I did not even get a second opinion. I’m like, okay. And I got off, I went to the fertility clinic, got on a list for donor eggs. And my daughter’s 23 and my son is 20 and they’re both from two separate donor eggs. So I didn’t know there was anything I can do about my health. This is back when you were in these little forums. You know, 25 years ago thing, P.O. I. Is you’re basically you’re bound for heart disease. Your bones are gonna be brittle. The only thing you can do is maybe go on birth control and then, you know, transition off to H. R. T. There’s lots of things we can do. And actually, 25 years later, it’s still the same recommendations. Like they’ll tell you, okay, you know, there’s nothing you can really do.
But when I know for sure, you know, we’ve helped many people with AMH as low as 0. 02, which would be, 0. 01 would be considered undetectable, 0. 02 is extremely low. And they’re going to tell you that donor eggs is your only option, but we’ve helped them get pregnant naturally. So I believe with functional medicine and functional nutrition, there’s a lot of things we can do to improve the chances of pregnancy success. And again, people get stuck with their POI diagnosis, the premature ovarian insufficiency diagnosis, diminished ovarian reserve, similar, but not as low. They get stuck with that diagnosis and we think, Oh, it’s only conventional treatment, IVF, IUI, PRP we’re doing platelet rich plasma, ovarian rejuvenation. So there’s many things that we think that’s the only option, but no one took a step back and said, wait a minute, let’s look at our health.
Katie: That’s interesting. So to clarify, can an AMH level improve? Like, is that a marker that someone might see improvement? But they’re probably conventionally not often told that. That’s kind of like, oh, this is your sentence, your number is this, like, this is what it is. But from what you’re saying, it can change. Like, there’s factors that women can work on to improve it.
Sarah: Exactly. We see AMH go up all the time. And if you taught your REI, so your reproductive endocrinologist infertility specialists, they’re going to say, that’s not the case. And even if you go and ask the REI, Hey, are there any diet and lifestyle changes that we can do to improve this? They’ll be saying, you know, you can maybe make sure you don’t do drugs, make sure you’re not consuming alcohol and maybe they might tell you a few supplements, but it’s very…and to maybe reduce your caffeine, some very basic recommendations, but we’ve just asked the wrong person. So the REI is trained for surgery, like most doctors in conventional medicine trained for surgeries, trained to prescribe and medical schools, the majority of them can be funded by big pharma. So we just asked the wrong person. So it’s not about excluding the REI when you’re on your fertility journey, it’s getting a team. And the biggest thing is that you know your body best and you go in and you’re saying, you know what, my hair is falling out.
My skin feels dry. I’ve got horrible insomnia. My blood sugar, I feel like hangry, like all these different symptoms are like, Oh, that’s okay, fine. But we’re looking at your AMH, it’s super low and your FSH is high and we’re over here and no one took a step back to look at your health.
Katie: Oh, I feel like you’re saying so many good things and I’m, I love to go deeper on this topic because as someone who was told in a different realm, when for me it was thyroid related with Hashimoto’s, I was told you have this, it’s lifelong, there’s nothing you can do about it. It will not improve and you’re going to take medication for the rest of your life.
And I currently have normal thyroid numbers, don’t take medication and no longer use that word of Hashimoto’s in association with my identity anymore. But that wasn’t what conventional medicine told me. I also have a very firm belief, in fact, one of the only things I would say I believe for sure is that everything does in fact work out perfectly.
So I don’t want to ask the question of what would you do differently necessarily, but I would love to know what would you give advice to someone in your same shoes now, perhaps, or like from learning what you learned, like what would you tell your younger self in a, you know, a holographic world where you were going through it again?
Sarah: And I see so many people talk to so many people at my age that have the diagnosis that I do and I never thought thought I would end up helping people doing this. I was almost like scared to help them because POI is like, so it can be like it feels hopeless, right? There’s nothing you can do. And so the piece on that is actually people believe it’s hopeless and therefore they don’t do the work. The doctor says there’s nothing you can do that is so low. So what I would tell my younger self is like, focus on your health. You know your body best don’t give up, don’t take no for an answer. Medical gaslighting is a real thing. You know, really understand your body, read, educate yourself, be your own advocate, know your blood work. Like you can look at your blood work, making sure it’s in the optimal range, being told, you know, that your blood work is normal. Hey, everything’s normal. And people will come to me and they’ll say, I’ll be like, how’s your health? Well, I’ve got this POI diagnosis or a diminished ovarian reserve diagnosis. So with diminished ovarian reserve, it’s you could still have your period, it could be irregular, whereas POI, sometimes the period is not there. Typically the FSH is not as low as it is with a premature ovarian insufficiency, but it’s still considered low. Potentially with a deal with the diminished ovarian reserve, you may be able to be a candidate for IVF. Typically with premature ovarian insufficiency, you’re not even a candidate. I get people being told, you know, I’m walking through Target or I’m on the phone and the clinic calls me and says, sorry, the only thing that you can do is donor eggs. And so it’s like, it’s devastating. So especially when people are young and you didn’t even think this was coming. So for both of those pieces, being able to look at your health and just really dig deeper and know that your body, that the majority of us can get pregnant naturally, there’s only a small fraction that can’t, right?
If you’ve got both your tubes blocked, then we need to, that’s why IVF was developed, but now they’re doing it for every diagnosis. And people don’t even know there’s things we can do. Like our whole thesis on this, is it actually early menopause? Because that’s what people think they have. It’s early menopause and you’ve got those night sweats, insomnia, you’ve got low libido, maybe painful sex , you’ve got the hot sweats, things like that. And then you’re thinking, you know, that you’re going into menopause or is it your adrenals? Your adrenals will impact the thyroid, which then impacts the AMH, the FSH, and the follicle count, the body’s ability to implant. And so I really see this stress component being a huge piece of this equation, and really, it’s also a lot of very type A, ambitious, get it done kind of women that we work with that have essentially burnt themselves out. And I see them where they’re working full time, maybe more than 50 hours a week. They are probably with the fertility clinic. I’ve got people doing 20 IVFs just over and over and over again. And then also interestingly enough many people at that point of time say, you know what? Now’s a good time to do a graduate program. I’m going to do my master’s, my PhD. I’m going to put it all together and wonder why, you know, because they’re trying to… maybe they’re in a job that’s no longer serving them.
They’re in it too long. Let’s distract myself with school. And then wonder why none of this is working because we’re so stressed out.
Katie: And I feel like this is a perfect springboard into a topic that I feel like I want to approach delicately, but it seems like could be really helpful for a lot of people listening, even if fertility is not the thing they’re focused on, which is I say often on here that we are each our own primary healthcare provider.
And then at the end of the day, the responsibility lies within each of us. And I feel like when we’re talking about fertility, there’s actually even more of an impact here because, I also talk about symptoms being messengers and I’ve always kind of had the understanding that fertility is a good kind of general benchmark that a lot of things are going right in our body. Like, especially for women, if our body thinks like I can carry a pregnancy right now, then that’s a good indication it doesn’t have too much else going on. Whereas if we have something imminent that our body is trying to tell us about that it wants us to help it with and fix, it may not be in the optimal place to carry a baby at that moment. And that is our symptoms actually trying to give us a clear message.
And I know this is a delicate topic and I can understand how painful that might be for someone who really desperately wants to get pregnant and carry a baby and for whatever reason can’t, but I would love to delve into that idea. You said, most of us can get pregnant naturally, which I think is very inspiring and full of hope and with fertility kind of being a benchmark of on a deeper level what’s going on in the body. I would love to just delve into that because it seems like this might be a springboard into a lot of insight for a lot of us, even if we’re not trying to carry a pregnancy right now, but knowing our fertility status is a way of kind of knowing what’s going on within our body.
And if one of these things is out of alignment, being able to help our body get back into a more balanced state. So like I said, I know it’s a controversial topic and I want to approach it with a lot of love and gently, but what is your take on that? And or like, what is the body communicating when someone is having a fertility struggle? And or if most of us can get pregnant naturally, how do we move from having trouble with fertility to that state, which I would guess is a lot of nuance as well.
Sarah: Yeah. A lot of people, so it doesn’t matter how old you are when you started trying to have your baby. If you’re in your twenties and your forties, wherever you are, whenever you started, that’s when you want to expand your family and you don’t want to wait. And so there can be this impatience and this worry, and then we get these numbers and the AMH is low. And then we think, okay, and then we better do the fast track, which we believe in our mind, we’ve been programmed to, you know, by whatever it is that it’s the pill. It’s, I see people taking so many supplements, then they’ve done IVF after all these different treatments. And no one really took a step back. And it’s not a step back, it’s a giant leap forward to really focus in on your health and to know that with the fertility industry, it can perpetuate this panic because they tell you, you better go in and do an aggressive IVF. Your egg reserve is dwindling as we speak.
You better go freeze your eggs. You know, there’s nothing you can do. There’s just a lot of worry and people come to me and I’ll say to them, you know, there’s going to be a period of time because our protocols are about three to four months if we’re looking at a parasite or we’ve addressed something that’s going on with your gut microbiome, making sure your thyroid, your blood sugar, all that piece is optimal. We want to reduce the risk of pregnancy loss. And so I literally other day, I was having a conversation with someone saying, you know, everything we’re doing is reducing that. And sometimes the body in the beginning will come back online, and then you have a loss because we keep trying. So there’s going to be a period of time that we don’t want you to try because we don’t want you to have that loss. And even that conversation, like, I have a 6 page document in our program explaining why this is so important because people they want to keep trying. They want to try every single month. Then I see people having losses and the trauma of that, it’s like this is very, very delicate side. I think people have still… and also, we’re not talking about the health of your pregnancy, the health of your postpartum. I’ve got people telling me that they weren’t even able to bond with their child because of the anxiety and depression that they had afterwards and and then also the health of their child. So, all this piece to me, you’re in an extremely powerful position right now to really work on your health that impacts, you know, this might sound crazy, but like impacts generations your family. And really to take that giant leap forward and really put your health first is key. And this racing, like you don’t have a medication deficiency. This is not about you taking more letrozole, more medications to force this to work.
I’ve got people telling me in their circle of friends, how many of the different friends are all doing IVF. And just because now insurance companies are covering it with, you know, it’s being covered by insurance companies are in this huge push to get that covered by your workplace.
Well, that’s great. But who’s covering all the, why don’t we eat healthy, get good sleep and not burn ourselves out and work 80 hours a week? They talk about this wellness piece in business, but is that really just like a talking point or now we’re just big pharma is funding all that insurance piece. That does well for them when put all that medication in our body.
Do we know the longterm side effects ofall of that? We don’t really know and anyone would think putting all those hormones in our body it can’t be good. So it is to really like focus on your health and there’s things you can do, from some simple strategies to really start.
Katie: Yeah. And it seems to me as you’re explaining that, that this almost is seemingly universally like a both and type situation. That even if a person was going to go down one of these paths of IVF or one of these alternative treatments, still, all the things you’re talking about would help that process go a lot more smoothly.
And I’m also curious, you mentioned, I know we see some crazy stats around fertility and what’s expected over the next several decades, especially in the United States. And I personally know so many people who have turned to IVF for a variety of reasons, including some of the ones you’ve mentioned. I’m curious if there are downsides to IVF that are not talked about, especially if it’s not actually needed and or are there cases for either IVF or for freezing eggs or embryos that you actually think are warranted and it would encourage. Or like where does the both and versus that these are a good approach kind of crossover happen?
Yeah, it’s always health, a fast track is your is your health, so health first, and either you get pregnant naturally, or if you do need to do an IOI and IVF a medicated cycle, PRP, health is always first. And so with the IVF side of things, what we see with the diminished ovarian reserve and the premature ovarian insufficiency is that they’ll go to IVF and it’s a canceled cycle. They’re labeled a poor responder, that the embryo is abnormally tested. It doesn’t implant or they have pregnancy loss, multiple pregnancy losses, and they keep doing the same thing. So we see that that piece has not worked out. Like I said, I have someone with 20 IVFs and they’ve got digestive issues and there’s things that could be done. I see people then saying, you know what, I’m going to select donor eggs, slam dunk donor eggs. I’ve got my anonymous donor. We’ve got the embryo, the embryos all tested great. That still doesn’t implant because the host potentially is inflamed and there’s health issues that have been missed. And so that’s what we’re seeing with IVF. Obviously, you know, I had both my kids with donor eggs, so I was very fortunate. It worked on the first transfer for them, so we’re not putting it down and we’re not, I’m not anti IVF.
I’m pro health and it’s there for you, but you’ve got to work on your health 1st. And so it is a personal decision though. Sometimes people feel like they’ve done a bunch of, made a bunch of changes. They’ve taken the supplements. They’ve changed their diet. They’ve tried for over a year and they’re like, I just want to go. And so we support people where they are, what feels right for them. But my thing is, if you go to the REI right now and you have low AMH and you have, maybe your cycle is a little bit irregular. If they think they can help you, they’re going to get you in for the cycle next month. We just need to be mindful that we want to look at our biomarkers, looking at all of our blood work to make sure that’s in the optimal range. We want to look at the health of your gut microbiome, which is highly tied to the health of your ovaries and the health of the sperm.
We want to see if you got a food sensitivity. You want to look at your thyroid, making sure that’s not out of balance where we see thyroid dysfunction across the board. We want to look at your blood sugar. That might be a reason why you’re not ovulating or your cycle is irregular. So we want you to make an informed decision and then, you know, armed with the data about your health, make a decision when IVF is right for you.
Cause right now you’re just guessing. The REI says, I say to people, when is the next IVF? Oh, I’m told to do it next month. Well, is that written in stone? And I’m like, well, they think about it. No, it’s not written in stone. Of course it’s not written in stone. They’ve just suggested it to you, you need to decide when to do it. So this is really having someone being very empowered with information. And then with the piece about, when is it warranted? It’s, sometimes if you do want to freeze your eggs, maybe you don’t have a partner. I see many people that are single by choice and they want to freeze their eggs.
Obviously freezing earlier in their early thirties is better. So you could do that before you freeze the eggs. You still want to work on your health to make sure that you freeze good quality eggs. Maybe you’ve gone and frozen your eggs, but you were in a high stress job, your blood sugar was out of balance, your thyroid was out of balance. You were exposed to all these environmental toxins. You had mental, emotional stress and maybe you didn’t freeze the best quality eggs. You go and thaw those in your 40s thinking you got this, you’re golden and then none of them work. So you have this false sense of security, thinking you have your backup plan, but with our health. So it’s always important to work on your health before that. Same with the platelet rich plasma, the ovarian rejuvenation. A lot of times for diminished ovarian reserve, premature ovarian insufficiency, they’re going to recommend a PRP to wake up the ovaries. And then I see that still doesn’t work because people are putting inflamed cells into their ovaries because you’ve got all this inflammation in your body. And so our thing is, you know, PRP can be good, but let’s reduce the inflammation in your body from a food sensitivity. Maybe you’ve got a parasite or a gut infection, the other biomarkers are out of balance. And so when you work on all that piece, you have a better chance of the other assisted reproductive technologies actually working.
Katie: I love this. And to your point, I have several friends in real life who were told at various points in their lives by doctors, even one, when she was in her late teenage years, I think like you will never get pregnant naturally, essentially like your body is broken. She now has four kids naturally.
She never needed any, but just, I think that’s an important thing with that, like you said, that stepping into the driver’s seat and stepping into that place of empowerment is realizing very often things that seem set in stone. When you’re given a word that’s a diagnosis are not actually set in stone.
And even if you’re going to end up taking an alternative route to your point rather than asking the question, How do I override what’s going on and force my body to get pregnant right this second? Looking at like what can I learn from what my body’s telling me right now? So that however, I get pregnant in the future, I can have the healthiest pregnancy journey possible and the healthiest child possible.
And so I love that this seems to be so much both and in this approach and that also like universally, like the more we understand this probably improves mother’s health, baby’s health in the future and so much more. A couple areas I want to go from there. You mentioned the stress piece and it seems like this is an important one worth diving into.
Can you go deeper on the stress topic and how it relates and or I know it’s the elusive billion dollar question but things we can do to help address the stress piece?
Sarah: Yeah, like we see all the time. So what is that the thesis? Is it actually early menopause or is it your adrenals that impact the thyroid impact the AMH, the FSH and the follicle count? And so sometimes even if you’re like, you know what? I feel great. I’m coping fine. Because we’re working with that type A. I have people triple type A.
They classify themselves as keep going 80 hours a week. And it’s interesting actually when I’ll talk to them about what, you know, before you got the diagnosis, what was going on in your life? Oh, you know, I had a period of one year, where I had one woman, she said, I slept for one hour a day. Didn’t sleep at all. I’ve got, you know, what happened before the diagnosis? Maybe there was a death in the family. There was.. a lot of it I see is either relationship issues going on, alot of stress in relationship. Overworking is the piece, like a lot of work demands and then school we’ve added school in that piece. And so that can be just too much on the body. And so some things to really help with that, obviously we can do some testing. We look at the Dutch test and look at your adrenals. They should go up in the morning, your cortisol and then come down at night. Maybe yours is flat lined. So we can just really see in black and white.
And sometimes people just need the data. Okay. What can I do to pull back? And then a lot of this stuff is… so as part of our program, we have a fertility mindset coaching, which is equally as important with us looking at a food sensitivity, looking at your gut microbiome. We use genetic testing so we can improve pregnancy outcomes, prevent gestational diabetes, prevent preeclampsia. We look at the vaginal microbiome. We look at heavy metal testing, nutrient deficiencies. We love the testing like that’s… and looking at all your blood work. It is equally as important for us to work on the mindset piece, because if you don’t believe this is going to work, because that number of the AMH is implanted in your subconscious and you feel hopeless, you feel broken.
Everyone around you is moving on while you feel that you’re stuck. That is equally as important with us dealing with the physical side of things. So having someone to… and maybe the body’s just in fight or flight. Years of this, you just keep going. You’ve done multiple IVFs, working more than 50 hours, supporting everyone else, being maybe at a job that no longer serves you because you’re still there waiting to go on mat leave and don’t want to change and therefore you’re in a job that’s just, and you feel stuck that way too. And so you sort of put joy on hold. And the baby comes when you’re happy and joyful now. And even your relationships: I had one couple I talk to and he said, I don’t, I’m the caboose to her train. I don’t know when she’ll ever stop. It is tearing us apart and she is just driven to do IVF after IVF and she doesn’t know.. and a lot of it there is a biology piece in women where we will just keep going.
We don’t know, can’t really explain it. The biology takes over and the relationship can really struggle and then that can put so much pressure and sometimes people don’t make it. But if you start to communicate and talk to each other, then many people will strengthen their relationship and things can improve.
And then you start going on date nights. You guys have vacations. You don’t work, you know, every minute of the day, you’re not opening up your laptop at 10 at night and working, you are prioritizing your self care. You can actually leave the office or even at home close down the laptop at five. You don’t need to because everyone else is going to take care of their kids and you don’t have kids. You can put yourself first. You don’t need to feel guilty about that piece. And so obviously there is a timeline here. We can’t be blind to biology and time. But, you know, there’s chronological age and biological age.
And so we need to be able to work on chronological age and biological age, but we don’t want to be blind to the age part, but to understand if we’re feeling impatient. Because this impatience piece will come up over and over again. And we think, okay, we’re in our early forties. There’s, you know, it’s now or never. We’ve got to rush to the IVF clinic. We have got to, you know, I’ve only got one good egg, all this piece. So that is not good. Then the body’s like, Oh my goodness, we need to be in receiving.
Like we need to feel that. And that’s where we have people lean in on their faith, or their intuition and or that peace spirit baby, that’s kind of intuition where we just know that our child is waiting. And when we’re feeling in a good place, and we don’t want to control, because there’s a lot of control in this piece, we want to control the path. So when we start to get into that, then we can really be able to visualize a positive path forward. Because without peaceful and calm and feeling good about it and feeling joyful instead of just this panicked, overwhelmed impatience.
Katie: Such a good point. And as someone who also, I would say I was in probably sympathetic nervous system dominance, fight or flight for a solid 10 years. And I was also that very type A woman. I was ignoring really severe trauma that happened to me in high school. And also in that like fight or flight, I thought I was totally fine as long as I kept all those plates moving and everything. And then when I finally addressed that so much changed for me, but I know it can also be a very hard journey to like actually begin to address that, especially for these women, I’m sure who wants something so badly.
And it seems like a fear of taking the foot off the gas, even for a minute might make the chances go down. But as you’re explaining, like actually that can improve things so much. And I love that you brought up the mindset piece. I once got interviewed at a conference and they were doing a whole series.
And they were like, what’s the worst thing you can put in your body? And I think they were expecting me to say, you know, glyphosate or some food dye or gluten. And I said, fear, guilt, and shame, because those things actually serve no purpose for us. And they’re very detrimental to the body. And there’s a positive side to all of like, you can flip them.
There’s a lesson in each of them. Instead of fear, you can move into gratitude or you can take that same experience and you can shift it and have even just a better mindset, certainly, but even a physical experience in that moment. So I love that you brought that up. I also believe anything we say repetitively is a mantra, whether it’s positive or negative.
So if we’re going around saying, I can’t get pregnant, this is so hard. That’s what our body’s hearing over and over and reinforcing. I would also also love, you mentioned labs a couple of times. Can you explain some of the top labs that you recommend to people or as women in general, like what are the kind of labs and functional tests we can keep an eye on to get a good benchmark of our health and our fertility?
Sarah: Yeah, so we definitely want to get our glucose down and we want to do a full thyroid panel, including antibodies, looking at your iron markers, looking at lipid. We definitely look at your lipids, looking at your vitamin D. We do see vitamin D levels correlated in studies too with low AMH. We see people in conventional medicine, they like it above above 30. We like it around 60 to 80. So we see people with a very low B12 and then really getting the full CBC, CMP panel as well, making sure all those are in the optimal range. And a lot of times people will tell me everything’s, it’s normal. We want it optimal. So otherwise you’d already be pregnant, so something, you know, is missed there.
So it’s really important to know your blood work and looking and make sure they’re in the optimal range. I guess I’d say the glucose and thyroid are two of the biggest ones that we regularly see off. We have people do continuous glucose monitors to really manage their blood sugar. And then thyroid, sometimes we do need to have a thyroid medication to support it. Many times that the REI will recommend thyroid medication to get your TSH below two. But we want to look at the full thyroid panel, including antibodies. I got people running in for transfers and doing IVF and their antibodies are like 800, 900.
I’m like, how are you going to be able to sustain the pregnancy? And why did someone not tell you not to do that? It’s just, some of the stuff that’s happening here where we’re forcing our body. We don’t like the mental, emotional… just because you have insurance and it’s covered, doesn’t mean that the whole heartbreak piece of this is… we can’t ignore that side of things of you pumping your body full of medication every month and then having outcomes that aren’t working out.
It can be devastating. So definitely knowing your biomarkers from the blood standpoint. And then we do the food sensitivity testing. We have people doing an elimination diet, taking out the top allergens. And we have you tweak the food sensitivity testing. We do gut microbiome testing. Like we’re saying, we see a lot of people that have parasites, bacterial infections, fungal infections, H. pylori. I was just on a Q and A just before this, someone’s like, Oh, you know, I’ve had H. pylori, I’ve had symptoms of H. pylori. Does this impact… what are you seeing this with fertility? We see H. pylori overgrowth all the time and passing back and forth between partners via saliva. And you circle around and you know it’s difficult to get rid of. Obviously a lot of us have this, but if it’s overgrown and you’ve got GERD or acid reflux, maybe you’re not absorbing all that beautiful organic foods you’re eating. So you’re nutrient deficient. So we see that a lot. Parasites, Bacterial infections, fungal infections. People do a candida diet, you chase that around a circle. Fungal issues are opportunistic so we need to really do a hierarchy of how we address this. And so looking at the health of the gut is key. And then we do genetic testing different than the karyotyping testing you do at the fertility clinics, which only impacts about 10 percent of couples.
This is looking at your gene variants and maybe you need more methyl folate to support your methylation pathways. Maybe you have a genetic predisposition with for thyroid or glucose or the vitamin D piece and then that vaginal microbiome side of things. Maybe it’s just a hostile environment. Maybe you’ve got infections in there. People that have bacterial vaginosis, UTIs, thrush. Anyone on the fertility journey or anyone that has experienced pregnancy loss needs to do a vaginal microbiome test. But you start with the gut and then you do the vaginal microbiome test. And also there’s a, there’s a seminal microbiome test where the man can do the semen test as well.
So it is, there’s a lot of testing you can do there, but knowing that that piece is key and this is you taking charge of your health.
Katie: Well, and I was just thinking as you were explaining all that too, as someone who’s been pregnant six times, most of those issues, if you have them, you can’t really effectively deal with once you are pregnant. Like I know like they’re not going to want you to do a parasite cleanse while you’re pregnant, or you’re not going to be able to take anything, especially anything really strong, to deal with a fungal thing or a candida thing or any of those things while you’re pregnant.
So even for mom’s sake alone, dealing with these things ahead of time can probably help women have a much more comfortable pregnancy. And you mentioned a test for the man as well. And I would love to just briefly touch on, obviously, we now understand that it’s not just a woman who comes into play with the health of a pregnancy, that actually the health of the man actually makes a bigger difference than seemingly we used to think it did.
But what do the guys need to know when it comes to this? And if the couple’s having trouble getting pregnant, what can a man do to help their chances?
Sarah: You know, so many women say to me, because we’re focusing on female factor fertility, he’s totally fine. He doesn’t need to be part of this. It’s just me. I’m the problem. No, it is 50 50 unless you’re single by choice and getting donor donor sperm. And even then it’s interesting. They don’t necessarily… like they’ll screen it, but they’re like, how do we know the true health?
I was talking to her, cause we helped many same sex couples. She’s like, how do I really know that that’s… what do you, like his health? We’re just going by him self identifying. But it’s really important to look at the health of the semen. Many guys will be like, I haven’t even been tested yet. The majority, if you’ve gone through IVF, you’ve been tested. You want to look at the DNA fragmentation. Maybe that’s why you’re having pregnancy loss. Sometimes they haven’t even looked at this piece when there’s pregnancy loss. I’m like, has anyone dug into the health of the man? So we look at his semen analysis, as well as looking at all his biomarkers and making sure he’s in the best shape. And sometimes we do need to do that gut microbiome test because you’re passing infections back and forth, like the H. pylori we see. And then also, yeah, so it’s important to work on him. So the life cycle of the egg is 90 days. The egg renews every 90 days and the life cycle of sperm is 70 to 80 days. So in a short period of time, you can make a massive change. And so the health of the male is equally as important as to maybe that’s why the embryos aren’t making it. That’s why you’re having pregnancy loss.
That’s why it’s not working, right? We need to look at him too.
Katie: And it seems like, I love that the answer, of course, is there’s going to be nuance and individual personalization that comes into play. And for each of us, I believe the experimentation and the beauty of it is getting to do that work on ourselves and figure out what our own factors are. Snd at the same time, you have explained so well how fertility is connected to so many areas of health and how that is kind of like a two way street that we can improve.
So even maybe for someone who isn’t trying to actively get pregnant, but certainly for someone who is, since fertility does seem so connected to our overall health, I would love to hear what you consider as like the highest ROI things we can do, especially for the women listening, maybe in this answer. Like if we wanted you to do everything, if we wanted to maximize our fertility, kind of give our bodies the best foundation for this. What would be the highest ROI things that you would recommend as starting places for women?
Sarah: So start the diet piece, do the elimination diet, take out the top allergens, dairy, gluten, soy, corn, peanuts, eggs, processed sugar, 10 days systematically reintroduced. Keep out dairy and gluten for 60 to 90 days. If you want to fast track a test, but really dig into that diet, do it together. Not just you, do it together with your partner. Work on the sleep, optimize sleep, seven to nine hours, nine being best, most restorative sleep between 10 to 12 PM. So go to bed early. If you’re going to bed at one, you don’t want to all of a sudden go to bed at 10, start ratcheting it back 15 minutes at a time, working on your sleep. Then working on the mindset piece and really seeing where you can pull back either at work, seeing where you can set boundaries. Actually get a team or a support system.
Cause many times, people are very triggered by your friends that maybe are just asking, are you pregnant yet? Or family members. And people that haven’t been through the fertility journey, they just don’t know what it’s like. And it’s just sort of that question, Hey, are you have kids yet?
People just this innocuous sort of conversation starter. That can like cut people to the bone. And so not that you got to educate the person at the grocery store, but figure out how you want it like a small people to start educating people around you about how you want them to handle things. Sometimes maybe with the baby shower. Or gender reveals and things like that, they might know you’re trying so they don’t want to tell you and then they didn’t tell you and then you feel upset they didn’t tell. So how do you want this handled? And sometimes we haven’t really even thought about what do we want them to do?
Maybe they’ll just leave a little message. And we’ll get back to them, you know, as we feel fit. So think about how you want this to be handled. When you go to see family at family events, you know, tell a few close people what you’re going through that feels comfortable for you. And then you start to understand to really think about what you want instead of just being triggered by people that they just don’t have any clue what you’re going through. And many times in a time of struggle, connection is really key. And so maybe we’ve withdrawn from friends that have children. So not to say you’ve got to hang out with a whole friend group, a pack of kids all day long, but maybe to see are there certain ones that you want to, and it actually gives you joy. Maybe your church, you’ve kind of withdrawn from church because there’s so many children there and there could be other people at church that are that are struggling too. So that connection is key and to really think about what you want and you don’t need to have your feed filled with children all the time.
You can curate it and have it filled with what gives you joy and what you and your partner feel happy with and creating your own your own traditions.
Katie: I love that. Are there any other kind of big topics related to this that I haven’t asked you about or do you think we really need to cover before we get to the end of our time today or have we gotten to all the big ones?
Sarah: Yeah, I think it is to understand the testing, there’s things you can do. The bottom line is we’ve got to take our health in our own hand. There’s not gonna be anyone tapping on the shoulder and if you’re waiting around for this piece, you’ve got to take charge, And get your blood work, look at the testing, understand, get someone to call you out on your own stuff.
Sometimes we don’t know. Like I literally, when I was going through this fertility journey, I actually would have said I wasn’t stressed. I’m totally fine, I feel great. No, similar to you. I was like, not until years later did I understand I had chronic stress. I wonder why I had TMJ. I could barely open my mouth. I didn’t know I had anxiety, I had anxiety. And you can put all these labels on these things. I feel that I had nonceliac gluten sensitivity as a young kid. I didn’t really know I had all these stomach issues. And then thyroid issues. I wasn’t able to breastfeed my child. Like when it came, breastfeeding was extremely difficult pumping for hours.
I’m like, how could everyone do this so easily? I’m pumping and pumping. And you can see if there’s thyroid dysfunction sometimes the milk doesn’t come in. So it is to really just understand your health, know that there’s things that you can do. The fertility clinic is there when you need it, but right now do this in a targeted manner and then have someone call you out on your own stuff.
Sometimes we self sabotage, like you said, the things that we’re saying to ourself, are we negatively saying, I can’t get pregnant. This is going to be a struggle. Or some people say to me, I always knew it was going to be a problem. I always knew I was going to struggle with pregnancy because my mom told me this when I was younger. And we see many people that have… I don’t have this, I have a great relationship with my mother, but we see many people on the fertility journey that actually have mother wounds or just very difficult relationships with their mother. And so there can…and also maybe we have people that are on the journey that are dealing with secondary fertility issues.
People come to me and say, I had the first one. It was easy peasy. I got pregnant on the first month. No problem. All of a sudden now out of the blue, I’ve got this diminished ovarian reserve premature ovarian insufficiency. The AMH is so low. They’re telling me there’s nothing we can do. Well you just sustained life. You went through breastfeeding, all this stuff. Maybe the body is just tilted the wrong way. We need to bring it back into balance. And so it is going back into really looking at your… because a lot of people will tell me, oh, my health is totally fine. My health is great. And I’ll say, well, how’s your stress?
Oh, it’s off the charts. Well, there’s the clue. And did that stress then, tilt the biomarkers and the rest of the body out of balance.
Katie: That was such a great synopsis. And I just like echo and highlight what you just said. I feel like the stress piece for me and the thyroid realm was a big piece as well. And like you, I would have said, I’m not stressed at all. Everything is perfectly balanced. As I would have said that, you know, eight times faster and while like running in 12 different directions and also learning, like no one’s coming to save me, no magic doctor, genie is going to appear out of nowhere to test the perfect things and tell me exactly what’s going on.
We do actually have to be our own directors of health and figure that out, which is also awesome news to me because that’s very empowering. That means we have the ability to affect change so much in that area. So I love that you bring that piece in as well. And I also love to always end by saying too, the body’s always on our side.
That’s one of the other core beliefs I have. So if something isn’t working exactly the way we want it to, or we have a symptom we’d prefer not to have, that’s awesome because the body’s telling us something that’s going on. So how do we learn how to listen to it? Or as I said, when I was learning it, how do we learn to befriend our body to go on that journey with our body?
I remember reading the quote and I felt like it hit me in my core. That was, I said to my body, I want to be your friend. And it took a deep breath and said, I’ve been waiting our whole life for this. And I feel like that journey for me has been absolutely life changing. And it sounds like you get to help women walk that in the fertility world. And I love that. So for anybody listening, who’s on any part of that journey, where can they find you and keep learning from you?
Yeah, so they can find me at fabfertile. com. I have a free guide. They can go to GPN this year. There’s a ultimate guide they can get there where it’ll talk about all the steps we talked about today to help with low AMH, high FSH, diminished ovarian reserve, premature ovarian sufficiency.
We have the biomarkers there for optimal ranges and some of the themes that we’re seeing. So they should go to gpnthisyear. com and get that.
Katie: Amazing. Well, like I said going into this, this is a topic I did not really have much knowledge about. Even though I’ve had six babies, I never navigated any of these topics. And seemingly it’s a very important one in today’s world. So I love the work that you’re doing here. I love everything that you’ve shared today and that message of hope that you started with of almost everyone can get pregnant naturally. And thankfully there’s resources no matter where a woman is for helping with that. So thank you so much for everything that you’ve shared for the work that you do. I’ll make sure everything you mentioned is linked in the show notes as well. But Sarah, thank you so much for your time.
Sarah: Oh, thanks for having me, Katie. Appreciate it.
Katie: And thank you as always for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of the wellness mama podcast.
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