THE WHOLESOME FERTILITY PODCAST
EP 293 Ozempic Babies, Miscarriages, & All Things IVF with Dr. Armando Hernandez-Rey
Dr. Armando Hernandez-Rey is Conceptions Florida’s medical director and triple-board certified in Reproductive Endocrinology and Infertility; Obstetrics and Gynecology; and Surgery. Dr. Armando Hernandez-Rey has over 24 years of experience in the medical field. He graduated from Universidad Autonoma de Ciencias Médicas de Centro America in 1998. He attended medical school at the University of Miami Miller School of Medicine for his specialization in Obstetrics and Gynecology. He specializes in treating patients with polycystic ovary syndrome (PCOS), recurrent pregnancy loss (miscarriage), and severe endometriosis. He is especially interested in fertility preservation (eggfreezing) for patients who must delay childbearing for personal or medical reasons, including cancer and systemic lupus erythematosus. Dr. Hernandez-Rey is an assistant clinical professor at the Herbert Wertheim College of Medicine at Florida International University and serves as an ad-hoc reviewer for the prestigious peer-reviewed journal, Fertility and Sterility. He has also published several articles and chapters in medical literature.
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Transcript:
Michelle (00:00)
Welcome to the podcast, Dr. Hernandez -Ray.
Armando Hernandez-Rey MD (00:04)
Thank you, Michelle. Thanks for the invitation. It's really an honor and a privilege to be on your show, on your podcast.
Michelle (00:09)
Yes, well, I've heard a lot about you over the years because I've had a lot of patients go to you. And one of the things that I've heard is that you do really well with surgeries and fibroids and you're able to in and
but in a way that still preserves fertility. So that was one of the things that I've learned.
Armando Hernandez-Rey MD (00:32)
Well, reproductive endocrinology and infertility as a subspecialty is a surgical subspecialty as is OB -GYN, which is a mandatory path to get to the infertility route. Unfortunately, a lot of the newer generation is not operating because they're not taught, not through no fault of their own, they're not taught. The reality is that it is...
Michelle (00:47)
Mm -hmm.
Armando Hernandez-Rey MD (00:55)
for a myriad of reasons this phenomenon has happened. Number one, the minimally invasive surgery tract has been developed where you have the person who's really just really perfected their obstetrical skills. And then you have the gynecologic oncology route and the pelvic urogynecology or pelvic reconstruction route and the minimally invasive surgical route. And a lot of the reproductive endocrinologists,
have said, you know what, I'm going to forego surgery and I'm going to refer it out. My personal philosophy, and this is in no way critical to absolutely anybody, it's just my own, is that I went into medicine to be a surgeon, I actually wanted to be an orthopedic surgeon. I ended up not liking it, I had a very bad fracture when I was in my teens playing competitive soccer, and I really had some PTSD from that fracture, so I just couldn't see myself doing.
orthopedic surgery, but I somehow found my way towards OBGYN, absolutely loved it. And eventually towards the reproductive endocrinology route, which encompasses a lot of surgery, should you allow it. And so yes, like you said, fibroids are an important part of fertility. you, tubal reconstruction used to be much more important than it is now. People are more, are bypassing that route and going directly to in vitro fertilization.
Endometriosis, as I said, I was running a little bit late today. I was in a very, very complex endometriosis case with a patient with bilateral endometriomas and complete frozen pelvis and scar tissue. And, you know, just a little bit longer, I had to work with the colorectal surgeons to do some resection of the colon because it was, you know, endometriosis is such an awful, awful disease. So yes, to answer your question, I...
Michelle (02:41)
Yeah.
Armando Hernandez-Rey MD (02:44)
Absolutely love surgery. I think it's an integral part of the infertility journey to get a patient from being infertile to getting them to a high level of success with any sort of treatment. And hopefully it's more conservative than having to resort to artificial insemination or in vitro and with just surgery and corrective surgery, we can help the couple achieve a pregnancy.
Michelle (03:07)
Yeah, and I think it's important because I think that a lot of people might not realize that there are certain people that specialize in this or have experience doing that, doing surgery and really getting in there because it is important to find somebody who's specialized if you have a complicated case.
Armando Hernandez-Rey MD (03:23)
I think it's important. I think people feel well taken care of. Again, my perception, people feel well taken care of when everything is done in house. Meaning, you know, there's no messages that get lost as you refer a patient out who may have the minimally invasive surgery knowledge, but not necessarily the focus on infertility, reproductive endocrinology.
Michelle (03:33)
Mm -hmm.
Armando Hernandez-Rey MD (03:50)
specialist has and I think people feel comfortable with that.
Michelle (03:52)
Yeah, absolutely. Because there's some people that will take out fibroids, but they're not doing it with fertility in mind. You know, for many women, it could just be just taking out fibroids, but you're doing these things with fertility in mind.
Armando Hernandez-Rey MD (04:07)
There are many great surgeons out there that are not infertility specialists. You know, I want to make sure that I'm clear. I just think that I was, I always love surgery. I happen to do surgery and I feel my patients feel very comfortable with me doing the surgery and not being referred out. It's what I think. You know, the journey, the infertility journey is very complex. It requires a lot of a woman in particular more than the male and to be
Michelle (04:25)
Yeah.
Armando Hernandez-Rey MD (04:36)
you know, passed around, it gets complicated. And I think it's nice to be able to offer that service to patients.
Michelle (04:44)
Yeah, for sure. And then you do specialize in miscarriages.
Armando Hernandez-Rey MD (04:49)
Sure, I mean, I think we all really have a focus on on as you know, we're all specialized in miscarriages and and PCOS and all that there's some people that tend to see More miscarriage patients or they people will refer miscarriage patients to us We have a particular kind of focus on that, you know, I think a lot of it is
genetic, a lot of it is immunologic, a lot of it is just taking a holistic approach to things and not just focusing on one or the more common causes of infertility. And even now, I think that, you know, the use of supplements, which maybe 15 years ago was maybe considered some snake oil. Now, I think there's a lot of provocative data that has shown that supplements do work, in particular in
Michelle (05:18)
Mm -hmm.
Armando Hernandez-Rey MD (05:44)
cases with recurrent miscarriage. And now we have the ability to measure those levels and we are now ability to supplement those levels and they have tremendous impact positively on these patients.
Michelle (05:57)
And what supplements have you seen help with miscarriages?
Armando Hernandez-Rey MD (06:02)
Well, I think a lot of it has to do with what the cause of the miscarriages is. Oftentimes, believe it or not, miscarriages can alluded to fibroids, it could be anatomical, sub -mucosal myoma. Well, there's not gonna be any supplement that's gonna help with that. It's just purely the surgical route or the diminished ovarian reserve,
Michelle (06:07)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (06:29)
cause for recurrent miscarriages, which is older women or ovaries that are behaving or eggs that are behaving older than what their chronological age would dictate, you have a higher chance for aneuploidy. And in those cases, there's a variable cocktail of supplements that we use, including ubiquinol, including N -acetylcysteine, including vitamin E, even melatonin has been shown to be very, very effective. And I can go on and on, even alpha lipoic acid.
Michelle (06:50)
Mm -hmm.
Armando Hernandez-Rey MD (06:57)
as well. There's some very nice studies coming out of Mayo Clinic that have shown that aflalipoic acid is very, very good for recurrent miscarriages. So again, things that we thought were, well, they can't hurt, now we know that they absolutely help.
Michelle (06:57)
Yeah.
Right. Yeah. I mean, that's great because it just helps to know that there's something that people can do that really does make a difference. And it's not just like in theory with miscarriages when it comes to immunology. I'd love to talk about that because I know that that's a big one. Actually, I did see a study that showed that women who have are more sexually active, that their immune system calms down. It behaves differently in the luteal phase.
Armando Hernandez-Rey MD (07:31)
Mm -hmm.
Michelle (07:44)
so that it's able to receive life so that it's not seeing like the sperm as an invader the, yeah.
Armando Hernandez-Rey MD (07:50)
So women that are more sexually active than others, it's probably a function of repeated antigen exposure, which is the more the woman is exposed to the antigens of the sperm, more there becomes an acquiescence by the immune system to be more receptive of that embryo. Because remember, the embryo is
Michelle (08:06)
Mm -hmm.
Armando Hernandez-Rey MD (08:19)
a haplotype, meaning it's half female, half the woman, half the mother, and half the male. And the only genes that the immune system of the mother has got to harbor the pregnancy are her own. And so oftentimes the immunologic processes are heightened because it does not recognize the male antigens that are formed part of the embryo in general. But as a whole, I mean, recurrent pregnancy loss,
Michelle (08:33)
Mm -hmm. Right.
Armando Hernandez-Rey MD (08:47)
is, is a small portion of the general population and, it's skewed towards advanced maternal age and advanced paternal age. so the immunologic component, while absolutely important, I think it's the one where we're still not a hundred percent sure how to absolutely treat it. Although supplementation and.
immune suppression definitely are known to work. It's the testing that I think we still need a lot more work in doing because you know people talk about NK cells and you know that was part of my thesis when I was a fellow. So we talk about NK cells and ANA and antiphospholipids and all of that and the reality is that these tests have very very
poor sensitivity in the realm of immunologic infertility or reproductive immunology. And so you may have COVID and then you can test positive or lightly positive for NK cells. And so I think that the overwhelming response by the treating physician is, well, they're positive, they must be immunologically incapable of handling a pregnancy. So therefore we should treat.
Michelle (09:40)
Mm -hmm.
Armando Hernandez-Rey MD (10:04)
with nowadays what we use as intralipids. Back in the day, we used to use IVIG that has kind of fallen by the wayside a little bit. I think it's better to treat empirically than to have someone treat or test for all of these different immune markers that really, really in the presence of immunology and reproductive immunology,
They have very low sensitivity. Now if you're treating or you're looking for lupus or rheumatoid arthritis or mixed collagen disorder or Sjogren's for sure, they are your go -tos every single time.
Michelle (10:44)
And what about a PRP for ovaries? What has do you do offer that?
Armando Hernandez-Rey MD (10:50)
ovaries. American study of reproductive medicine came out with a black box warning that they do not recommend PRP for ovaries. Now, PRP for recurrent implantation failure, poor lining development, there is some very robust data that there may be some room or benefit for this.
Michelle (10:57)
okay.
Mm -hmm.
Armando Hernandez-Rey MD (11:14)
And we do do offer that. We do not offer intra ovarian PRP because ASRM has a huge black box warning on this. It's a liability. The potential for infection is there. Tubo ovarian abscess have been reported, adhesions, periovarian adhesions, and with very little to no benefit whatsoever. I mean, the whole premise for it is that we are...
Michelle (11:16)
Okay.
wow, okay, I didn't know that.
Mm -hmm.
Okay, got it.
Armando Hernandez-Rey MD (11:42)
regenerating the follicle complex and therefore improving egg quality and that definitively has not been shown to be the case. Although anybody who suffers from that as I would be would be like, slide me up. But unfortunately, you know, it's very easy for us to fall prey to things that we desperately want without having the medical literature to corroborate it or back it up.
Michelle (11:49)
Got it.
Right.
Got it. So that's actually showing to not necessarily be what a lot of people originally thought, but for the uterus, it has been shown to help.
Armando Hernandez-Rey MD (12:15)
Yes, we are doing PRP installations and very select group of women with those diagnoses in particular. And.
Michelle (12:25)
So who would be a good candidate? Somebody who's had failed transfers, inflammation.
Armando Hernandez-Rey MD (12:30)
Yes, someone with very high quality embryos, high quality embryos that are not getting pregnant. Also patients, for example, patients who have adenomyosis that do not develop a nice lining, a thickened lining. Those have been shown. Our numbers are very small, you know, by no means.
Michelle (12:42)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (12:53)
they are in the realm of what a randomized controlled trial should be. We're following the data from the randomized controlled trials and from the literature that's out there. So patients with adenomyosis who have poor lining development, recurrent implantation failure, so patients with euploid embryos, that means a normal embryo that's tested that looks to be high quality. Also, after a second implantation failure, we'll...
offer that to the patient as a possibility.
Michelle (13:19)
Mm hmm. Got it. Awesome. And then also we were talking about Ozempic pre -talk. So I'd love to get your... Yes. Yeah. Ozempic babies.
Armando Hernandez-Rey MD (13:24)
the topic du jour these days, right?
It's right. So as we were discussing, I mean, this, this phenomena is not really a phenomenon that's surprising at all. It is just a, a byproduct, a side effect of, of how the medication works and the effects that positive effects that I have on women with in particular, and ambulatory disorders, specifically polycystic ovarian syndrome, which is often tied to or associated with insulin resistance, obesity, sometimes even overt.
type 2 diabetes and the elevated levels of insulin, the elevated testosterone levels, they all work together to create this sort of environment within the ovary and the system of the female which creates an ovulatory disorder or dysfunction. And as a woman loses weight by virtue of the way that these GLP1s or glucocortes
Michelle (13:58)
Mm -hmm.
Armando Hernandez-Rey MD (14:22)
Glucagon like peptides work They're very successful. They're very good at number one slowing gastric emptying which in turn slows down the release of sugar into the blood system to the Number one number two it stops the the release of glucose produced by the liver and Number three increases insulin levels so increase insulin levels helps get the the
the sugar into the muscles out of the circulation and out of stimulating the ovaries and the theca cells to produce more androgens which then get produced produce more estrogen which then stops the hypothalamic pituitary ovarian axis from functioning correctly and as these levels drop patients automatically begin to have spontaneous ovulation if the system is working and the male has normal sperm and they're sexually active.
this is how the ozempic baby phenomena occurs. And what we discussed also is that the concern is of the downstream consequences of ozempic babies given that the current recommendations are to have at least a two month washout period before anybody starts to try to conceive.
Michelle (15:32)
So two month washout means like really not trying anything. Yeah. And then also, I know like naturally, myonocytol is really helpful as well for insulin resistance. It might take a little longer. And then also metformin has been used as well.
Armando Hernandez-Rey MD (15:37)
No exposure, right? No exposure.
Yeah. Yes. So, my own hospital is, is a, is a great product. my own hospital alone, although you will find oftentimes my, my own hospital with a D chimeric, hospital and really the literature shows that my own hospital by itself is the one that truly has the most benefit might be hard to find.
Michelle (16:06)
Right, yeah.
Right because for a little while they said my own hospital and dechiro, but now they're going back to saying just my own ocital, correct?
Armando Hernandez-Rey MD (16:23)
Yeah, well the way that it's normally found in the body is at a ratio of 20 to 1. And that's what those supplements show, 20 to 1. Although we know now that in the ovary it's almost 40 to 1 ratio of myoinocytol to D -chimeric, inocytol.
Michelle (16:30)
Mm -hmm.
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (16:49)
Myo Inositol is actually not an essential vitamin, but it's considered like a vitamin, but it's in the category of B8 It's a glucose like peptide that basically helps to Help the system function by processing the circulating blood sugar in a way that's more physiologic and there by lowering insulin levels and thereby also helping tremendously with
Michelle (16:56)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (17:16)
regularity of cycles and even spontaneous ovulation as well. And metformin obviously is medication that's been around for many, many years. It is somewhat of a controversial drug. It is an anti -aging drug even these days because we know that insulin levels are so profoundly toxic for aging for the muscle and for the system in general.
Michelle (17:29)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (17:45)
And so we know it works, we know that it helps with the efficiency of insulin. And so it's certainly been used for many, many, many years in the presence of patients with polycystic ovarian syndrome. I would challenge people to be a little bit more meticulous about using it in patients who are the lean PCOS.
Michelle (18:11)
Right.
Armando Hernandez-Rey MD (18:11)
or the skinny PCOS or the ovulatory PCOS even though insulin levels have been shown to be higher, slightly higher in...
Michelle (18:19)
So you're talking about being cautious with metformin, not necessarily myonositol. Yeah, yeah.
Armando Hernandez-Rey MD (18:22)
Metformin, you also don't want very high levels of myelonostetal because they can be, you know, there is some quote unquote toxicity. I think the recommendations are up to four grams per day. I think all the recommendations are four grams per day in two divided doses, two grams in the morning and two grams at night. I've seen patients be on eight grams and 10 grams and toxicity really starts happening around the greater than 10 gram dose.
Michelle (18:29)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (18:52)
I in our office we only use it, you know, what's recommended which is the four gram total per day two grams in the morning two grams at night and I don't think it's the end -all be -all I don't think it's you know treating anything in life is multi -pronged. It's not just one single thing perhaps but I definitely believe very wholeheartedly that it does assist in in adjunct treatment, although we certainly have patients put patients on on myocytil and combined with
Michelle (19:06)
Yeah. Right.
Armando Hernandez-Rey MD (19:20)
diet and exercise and have been able to achieve pregnancies on their own, which is obviously what we want instead of having to go through treatments.
Michelle (19:27)
That's great. I mean, I will say that I was very surprised this past year. two different patients came from different, different places, not yours, it was other doctors, but I think the nutritionist there suggested metformin when they did not have insulin resistance or PCOS for egg quality.
Armando Hernandez-Rey MD (19:47)
Yeah, I'm not familiar with any studies that have shown that have improved that. In fact, when I was a fellow, we were, just as I was coming into fellowship, where I trained, Rutgers was involved with a very well known and publicized study, it's called the PP COAS study, which looked at patients on placebo versus metformin alone versus metformin with Clomid, sorry.
placebo versus clomid versus clomid with metformin and there was no difference in pregnancy rates or anything else. I'll go one step further with them going back to the myonocytol. It has even been shown to decrease the rates of gestational diabetes and so in our patients with PCOS with who are you know
Michelle (20:18)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (20:39)
Stage one, type one obesity, type two, we'll continue them on the myonostetal throughout the pregnancy and when they leave us and go to their OB -GYN, in our referral letter back, we'll say that we're recommending for her to continue on myonostetal because there have been improvements in sugar levels and glycemic control and reduction in gestational diabetes overall.
Michelle (20:54)
Yeah, that's good to know.
another big one is vitamin D. A lot of people, even though we're in Florida here, we have a lot of sun. A lot of people are very deficient in vitamin D.
Armando Hernandez-Rey MD (21:11)
Yeah, What it is is a combination of things. Number one, we're not as sun exposed as you think we are. You know, we're always in a car, we're always indoors, it's very hot. And yes, we go out to the beach and there is a lot of sun, but we become very, very sensitive to the sun and to the untoward effects of the sun.
Michelle (21:17)
Mm -hmm.
Armando Hernandez-Rey MD (21:35)
So we protect ourselves tremendously. That's number one. Number two is that I think the levels are set higher than what the average person can sustain with just diet and sun exposure. And actually the recommendations now in the infertility world that when you order a vitamin D from Quest, they'll tell you that the levels are, you want them at
Michelle (21:38)
Mm -hmm.
Armando Hernandez-Rey MD (22:04)
definitively above 20 Certainly above 30 and now recently now the recommendations are that for them to go above 40 and and and Yeah, I'm not yeah, so I heard I've read 40 I it was a Paper that came out of Either the Lancet or
Michelle (22:11)
Yes, yep, I've been hearing that or even 50. Yeah.
Armando Hernandez-Rey MD (22:27)
or fertility necessarily, anyone, one of, that they recommend now for vitamin D levels to be above 40. So that's really hard. I mean, I work really hard. I take a lot of vitamin D and I'm just barely scraping like 50. You know, I take about 5 ,000 units a day, which is what we're recommending nowadays, 5 ,000 units of vitamin D. And I take that every single day and I barely scratch,
Michelle (22:38)
Mm -hmm.
Yeah.
Armando Hernandez-Rey MD (22:56)
you know, 45, 50 every time I get an average check. So I'm not getting as much sun as I think I am, number one. I am out fairly often. I do play some golf, not enough. And yet it's not enough. So definitely supplementation's important.
Michelle (23:03)
Mm -hmm.
Yeah, magnesium is also important. That's another thing. It's to not be deficient in magnesium because magnesium plays an important role of our absorption of D, which, you know, obviously doing this, I learned, I was like, that's might be deficient magnesium and be taking a lot of D and then their body's not processing, which is why it's important sometimes even in foods, foods have everything. So like,
even beef liver, you know, from Chinese medicine perspective is so beneficial because it has iron, but it has it in a combination of nutrients that helps the body absorb it.
Armando Hernandez-Rey MD (23:46)
Yeah, B6, B12 are incredibly important for iron absorption as well. So all of these things are extremely important. Everything is all intertwined and we're just learning about this. And for us, I've really gotten grabbed hold of this whole longevity thing, hence my aura ring and all of this. And...
Michelle (23:57)
It is.
Yeah.
Armando Hernandez-Rey MD (24:09)
I'm just trying to apply a lot of the things that we know today work for longevity medicine and anti -aging principles to the infertility world because it's all intertwined. It's all intertwined.
Michelle (24:16)
Yeah.
without a doubt. It's funny because that you say that because I always say it's pretty much anti aging. Yeah.
Armando Hernandez-Rey MD (24:26)
Yeah, totally, totally. They're even coming up with a way to stop menopause.
Michelle (24:36)
wow. How?
Armando Hernandez-Rey MD (24:37)
which is extremely interesting. Believe it or not, recombinant antimullerian hormones.
Michelle (24:42)
How is that? Explain that.
Armando Hernandez-Rey MD (24:46)
So the way that antimullerine, the function of antimullerine hormone at the level of the ovary is that it stops follicular recruitment. That's why women with PCOS have higher AMHs and therefore they have higher egg counts and higher, they tend to go into menopause later on, et cetera. That's because they have high levels of antimullerine hormone. So by reproducing or creating it in the laboratory and then from an early stage,
This is in its infancy, by the way, okay? So this is, yeah, this company, I believe she's a Harvard scientist, biochemist or something, who's coming up. My point is that, listen, that it's all intertwined, aging and even in menopause, for God sakes. Now I've been doing this for so long that I now,
Michelle (25:18)
It's new.
Mm -hmm.
Armando Hernandez-Rey MD (25:39)
seeing menopausal patients who were like, you know, listen, you took care of my baby, you're a reproductive metachronologist, you understand the science, will you treat me? And, you know, like, and I realized, like, somewhere, some women got like, they got a some bad luck thrown their way because, you know, with the WHI results and the way they were interpreted, they made hormones bad. And somewhere along the way, someone said,
It's okay for women to suffer from menopause, just suck it up. Like it's not okay. That's not okay. That's not okay. And so if you start from very early on and, you know, and, and really practice what you preach, which is healthcare and not sick care, which is what we practice in the United States, you know, we're just very, we, we're not proactive. We're reactive to when a patient is sick instead of early intervention, early screening and all of that.
Michelle (26:25)
Yeah, absolutely.
Armando Hernandez-Rey MD (26:30)
And that goes for the infertility world and that goes for a woman's long reproductive life extending past menopause. I think we still have a lot of challenges to overcome, but I think that we're heading in the right direction. Sorry to digress a little bit. I went off on a tangent there for a second.
Michelle (26:43)
Yeah, for sure. no, it's okay. But you know what? I love the passion and I love that, that, you know, ultimately is great. It's important, very important, because it's true. And I agree a lot with what you just said, that we should be proactive when it comes to healthcare. I mean, really when it comes to so many things and something else that I...
that I read, it was an animal study. It was a study on, I believe it was like, I don't remember which kind of animal it was. I think it was like either sheep or cows or some form of those where they actually gave them oxytocin right before IUI. And that improved the chances of the conception rates, which I thought was very interesting because I think that that's one of the things with IUI that's missing because obviously you're taking away the connection.
that is usually there when you're just under natural circumstance. And I thought it was interesting because I was looking into it for something else to understand from a Chinese medicine perspective, because they have this heart -uterusconnection, that connection, the bonding. And so what I found was interesting too is that oxytocin increases around ovulation and after intercourse. And usually what they look at it as its role is usually for labor.
not so much conception. So I was just going to kind of like pick your brain on that. Any thoughts on that?
Armando Hernandez-Rey MD (28:13)
Well, I mean, oxytocin is secreted at the time of... I'm not sure of ovulation, I didn't know that. But definitely at the time of...
Michelle (28:21)
or it increases around that time, like right before ovulation in the cycle, a woman cycle.
Armando Hernandez-Rey MD (28:27)
What we know that it's involved is at the time of orgasm. And so this may promote uterine contractility, which is what is used for intrapartum, to promote contractility of the uterus, to promote descent and eventual delivery. And we know that it's intimately involved in orgasm, we're seeing.
Michelle (28:33)
Mm -hmm.
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (28:55)
during intercourse and orgasm and so with you know the projection of with the secretion of oxytocin and it causing uterine contractility obviously not at the same level that it does during labor but at smaller amounts then I can see how there could be a role for oxytocin in artificial insemination.
Michelle (29:18)
even in fertility in general and because it's got to be there for a reason why would the body produce it around that time?
Armando Hernandez-Rey MD (29:25)
Well, yeah, I guess, but it's either IUI or IVF and we definitely don't want oxytocin during the IVF cycle.
Michelle (29:33)
Right, because you don't want to contract, right?
Armando Hernandez-Rey MD (29:35)
Right, because we're transferring an embryo where there should not be any oxytocin. And you can have the most beautiful embryo, but if you screw up the embryo transfer, through no fault, just because it's a difficult transfer for a myriad of reasons, and you cause uterine contractility, then there's a high likelihood of pregnancy not occurring during that time.
Michelle (29:57)
Right. I think it would be an interesting thing to look into for IUI. There might be something to it, because if it works with animals, and the animals obviously have similar certain functions that we do, mammals, that seems like an interesting thing.
Armando Hernandez-Rey MD (30:10)
Yeah.
I think there's not going to be a lot of resources put into improving IUI, to be honest with you. IUI, I think it is what it is. And I mean, I think the majority of research is going to go to improving even more IVF rates, because I think ultimately patients are going to want to go more.
Michelle (30:22)
Mm -hmm. Yeah.
Armando Hernandez-Rey MD (30:40)
towards IBF, no matter how hard we try to say, hey, listen, there's this option or this option or this option. It's more become a more of an instant gratification society. Number one, number two, people are waiting longer. So therefore they're more pressed for time, if you will. And I think there will be less of a motivation to go down a treatment option that frankly,
Michelle (30:48)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (31:07)
You know, has a low pregnancy rate.
Michelle (31:09)
Right. And then my other question is, what are your, thoughts about a lower intensity cycle?
like lower amounts of hormones for older women. In some cases I've heard it might be a little better. you do? Yeah, yeah.
Armando Hernandez-Rey MD (31:24)
We use it all the time. Yeah, we use it all the time. I think it's...
a very successful option in cases with severely diminished ovarian reserve. I think that the senescent ovary does not do well with high impact medication or high doses of medication separately, but you know, jointly the medication costs are exorbitant and you end up having the same number of eggs that are mature, that get fertilized with a mini stent protocol as you do with
Michelle (31:38)
Okay.
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (31:59)
a high dose regimen.
Michelle (32:02)
Okay, so you've seen good success with that.
Armando Hernandez-Rey MD (32:06)
Well, I mean, not good success because generally these cases are, we've seen success. Let's call it that. Because the patients that you're treating with these medics, with this protocol are patients who are POI, you know, premature ovarian insufficiency, diminished ovarian reserve, poor egg quality, high rate maniploidy. So these are your poor responders essentially. And they're very...
Michelle (32:12)
Yeah, okay.
Mm -hmm. Mm -hmm.
Armando Hernandez-Rey MD (32:34)
specific factors that propel a woman to have success with this protocol compared to her twin sister with almost the same testing who doesn't do as well.
Michelle (32:47)
Got it. And then lastly, we talked about this in the pre -talk, let's talk about marijuana and sperm, data is showing. Yeah.
Armando Hernandez-Rey MD (32:55)
I don't do it myself, but I have no problem with people that do. What the data has shown that we're just becoming more and more familiar because the overwhelming number of people who are using cannabis and open about it, which is the second part, which was very difficult to conduct studies because it was so people were ostracized. They were looked at.
not the wrong way and seen as in the fringe. And now it's, you know, it's so mainstream. but so now we're, we're keenly aware, of patients were able to analyze them and what we know without a shadow of a doubt that the potency of the cannabis that's being produced these days is anywhere between eight to 12 times more potent than I think I use the joke of the guys at Woodstock back in the sixties, right?
Michelle (33:21)
Mm -hmm.
Mm -hmm.
Armando Hernandez-Rey MD (33:46)
where everybody was getting pregnant and everybody was high on life, all of those things. And then what we've also known, which I did mention, is that using the vape pens, whatever types of inhalers as opposed to the traditional joint, if you will, increase the potency of that by a factor of two to three. The cannabis that was already potent to begin with.
Michelle (34:08)
Yeah.
Right.
Armando Hernandez-Rey MD (34:14)
So what you're seeing in males in particular, and I'm not sure that the literature is so complete on the female aspects, are that we're seeing a high levels of fragmentation. And what fragmentation is, is imagine that sperm is like an Amazon box. And inside that box, there's a porcelain doll that's wrapped in these packing cubes. They're held very, very tight. And under...
Michelle (34:26)
Mm -hmm.
Armando Hernandez-Rey MD (34:40)
The best of circumstances, those packing cubes are wound so tight, packed so tight that nothing, if I kick the box off the Amazon truck, nothing is gonna happen to the porcelain doll. Well, as fragmentation occurs and it happens under natural conditions and old guys like me, you know, patients who, occupational hazards, firefighters, exposed to toxins, a lot of people who use fertilizers, et cetera, et cetera.
you see high levels of fragmentation. I'm talking about DNA fragmentation. And so what we're seeing is high levels of fragmentation at the level of the DNA of the sperm, which has significant effects on embryo quality, embryo development, and pregnancy rates, and high levels of aneuploidy, which is abnormal embryos. So,
Michelle (35:10)
So you're talking about DNA fragmentation. Yeah. Yeah.
Mm -hmm.
Armando Hernandez-Rey MD (35:33)
You know, I'm not here to like, you know, slap you on the wrist and say don't smoke weed, but really that's what you're facing. And we know that this happens in women with cigarette smoking. Like this is a well -known cause of an accelerated transition to perimenopause. You know, 65 % of women who smoked a pack a day for greater than 15 years will go into menopause before the age of 40, assuming they started before their 20s. That's a pretty...
Michelle (35:40)
Bye.
Mm -hmm.
Armando Hernandez-Rey MD (36:03)
ominous number, actually. Thankfully, not many women smoke these days, cigarettes anyway. So I guess the results of cannabis on females is yet to be elucidated, but we definitely have some pretty compelling evidence in terms of the male data that show that it can have detrimental or deleterious effects on sperm quality and not necessarily on numbers.
Michelle (36:04)
Yeah.
Mm -hmm.
right, which is what people look at usually when I mean, that's like the, the analysis is always on numbers shape and, numbers shape it. Yeah. And morphology and they won't necessarily look at the DNA fragmentation. That's actually not something that REIs usually initially look at.
Armando Hernandez-Rey MD (36:33)
Exactly.
the thesis in morphology.
is done in a well not initially unless there's comorbid situations or things that raise your red flags. For example, advanced paternal age, we always do it. Particularly in egg donor cycles, right? Because patients will be like, well, I'm using an egg donor and why don't I have bad energy? Well, because your husband could be 70 or 60 and
Michelle (37:11)
Yeah.
Armando Hernandez-Rey MD (37:14)
And then their fragmentation is completely elevated and through the roof. So yeah. So, you know, firefighters, occupational hazards.
Michelle (37:18)
Right. So, yeah, it's important. It's important for people to hear this because they can go in and say, the semen analysis was perfect. But that, like what you just said, is not really checked. So they may not, in a healthy, like, younger guy.
Armando Hernandez-Rey MD (37:35)
It's not as nuanced as we once thought it was.
Michelle (37:38)
Yeah. Yeah. Interesting. It's, it's fun. It's always fun for me to talk to our, our ease, you know, just to get, to pick your brain and get your thoughts. and you're my neighbors. So it's pretty cool.
Armando Hernandez-Rey MD (37:50)
That's right. Thank you very much for the invitation. This was really fun. We spoke about a wide array of different topics here. So this was really nice to connect this way.
Michelle (37:53)
Yeah.
Yeah.
Yeah, for sure. And I know that a lot of people are going to be like, this is interesting information. Cause I know that what you just mentioned, a lot of it is not common knowledge. people don't know automatically hear about this or really know to think about asking about it. So, so I appreciate all your information, all your good, good data. And, for people who would like to work with you or in town, how can they find more about you?
Armando Hernandez-Rey MD (38:27)
Well, we are at Conceptions Florida. We have two offices in Merritt Park, Coral Gables and one in Miramar and hopefully soon also in Boca. And I'm there Armando Hernandez -Ray, MD I'm sure. Easy to find these days on Google, but I'm happy to help in any way that we can. We've been doing this for a long time, quite successfully, thankfully. And we take a lot of pride, humbly speaking, but probably also.
in having a good footprint in South Florida and the infertility world and trying to offer the best care possible.
Michelle (39:01)
Awesome. Well, this was such a pleasure and thank you so much for coming on today.
Armando Hernandez-Rey MD (39:05)
Thank you, Michelle.
EP 285 The Power of Whole Foods for Fertility | Judy Simon & Angela Thyer
Dr. Angela Thyer and Judy Simon discuss their book 'Getting to Baby' and the importance of nutrition and lifestyle in fertility. They share their backgrounds and how they came together to help women improve their nutrition and health for better fertility outcomes. The book covers the connection between food and fertility, the importance of whole foods, debunking misconceptions about diet and fertility, and the benefits of intuitive eating and cooking. They emphasize the need for diversity in food choices and the impact of processed foods on fertility. The book also includes practical tips and recipes to support a healthy pregnancy journey. The conversation covers topics such as the importance of breakfast and meal timing, the impact of nutrition on fertility, the role of integrative medicine in fertility treatment, and the power of lifestyle choices in influencing fertility outcomes. The guests emphasize the importance of combining foods and the role of vegetables in supporting digestion and overall health. They also discuss the impact of stress, sleep, and epigenetics on fertility. The conversation highlights the need for a multidisciplinary approach to fertility treatment and the importance of finding a supportive healthcare team.
Takeaways
Nutrition and lifestyle play a crucial role in fertility and improving fertility outcomes.
Eating whole foods, including a variety of fruits, vegetables, plant-based proteins, and whole grains, is important for fertility.
There are many misconceptions about diet and fertility, such as the need to cut out carbs or follow specific diets. It's important to focus on nourishing the body with whole foods.
Intuitive eating and cooking skills are valuable in creating a healthy and sustainable approach to nutrition.
Diversity in food choices is essential for optimal fertility and overall health.
Processed foods can negatively impact fertility, and it's important to prioritize whole foods.
The book provides practical tips, recipes, and a six-week blueprint to support a healthy pregnancy journey. Breakfast is an important meal for fertility and overall health. It is best to have a substantial breakfast with protein, fiber, and vegetables.
Meal timing is crucial, and it is recommended to have more calories earlier in the day and fewer at night.
Combining foods, especially vegetables, can support digestion and nutrient absorption.
Stress, sleep, and lifestyle choices have a significant impact on fertility outcomes.
Epigenetics plays a role in fertility, and lifestyle choices can influence gene expression.
A multidisciplinary approach to fertility treatment, including integrative medicine, can provide comprehensive support.
Finding a supportive healthcare team is essential for navigating the fertility journey.
Guest Bio: Judy Simon
Judy Simon, MS, RDN, CD, CHES is an award winning registered dietitian nutritionist who specializes in reproductive health. She is the founder of Mind Body Nutrition, PLLC and a clinical instructor at the University of Washington. Judy’s expertise includes fertility, PCOS, eating disorders, weight inclusive medicine and reproductive health.
Judy has held leadership roles in the American Society of Reproductive Medicine Nutrition Special Interest Group and is a Fellow of the Academy of Nutrition and Dietetics.
Judy integrates mindfulness, intuitive eating, eating competence, while taking a non-judgmental, inclusive down approach to help people have healthier, more fertile lives.
Judy is the co-founder of Food For Fertility program and co-author of the upcoming (April, 2024) book Getting to Baby A Food-first Fertility Plan to Improve Your Odds and Shorten Your Time to Pregnancy, Ben Bella Publisher
Guest Bio: Angela Thyer
Angela Thyer, MD is board certified in Reproductive Endocrinology and Infertility, Ob/Gyn and Lifestyle Medicine. She is a founding partner of Seattle Reproductive Medicine. Dr. Thyer completed her undergraduate education at Duke University, medical school at the University of Cincinnati College of Medicine, residency at Oregon Health and Science University, and fellowship at the University of Texas Health Science Center at San Antonio. She completed The Culinary Coaching program through the Institute of Lifestyle Medicine in 2020 and became a certified plant-based chef through Rouxbe in 2022. She and Judy Simon, MS, RDN created the Food for Fertility program and have co-authored a book coming out in 2024, Getting to Baby: A Food-First Fertility Plan to Improve Your Odds and Shorten Your Time to Pregnancy which highlights the best foods to optimize fertility.
Website & Social media links (Facebook, instagram, twitter)
Instagram: @angelathyermd
Website: angelathyermd.com
For more information about Michelle, visitwww.michelleoravitz.com
The Wholesome FertilityFacebook group is where you can find free resources and support:
https://www.facebook.com/groups/2149554308396504/
Instagram: @thewholesomelotusfertility
Facebook:https://www.facebook.com/thewholesomelotus/
Transcript:
Michelle: So Angela and Judy, welcome.
Angela: Thank you so much. We're excited to be here, Michelle.
Michelle: So I'd love for you guys to give a background first. , I'm very excited to be talking about your new book, Getting to Baby. I would love for you first to share your background so people can know more about you and what got you to doing this type of work.
Angela: Okay. Sure. I'm a reproductive endocrinologist and infertility specialist. So first I trained in OBGYN and then specialized in reproductive endocrine and infertility. And then I got board certified in lifestyle medicine. So, which is a more holistic kind of way to look at all healthcare, more of a preventive lens of like, how can we look at lifestyle measures to, you know, really help people in all phases of their life.
Angela: And I've always been interested in food, nutrition, exercise. And so over the years, it just became a bigger and[00:01:00] bigger part of my practice. And I've always been interested in obviously hormones, but metabolism and Judy and I started working together at the university of Washington. And we found we had this common interest in really helping women, you know, work together to improve their nutrition and health, which subsequently leads to improvement in their fertility.
Michelle: Oh, totally.
Judy: And I'm a registered dietitian, as Angela mentioned, and my master's is in community health education. And I sort of went through traditional training, and when I came back and re entered, you know, medicine, gosh, about 20 ish years ago, all of a sudden, PCOS and all these things that I had never really learned about just came front and forward.
Judy: And so I was fortunate to connect up with Angela and really do the deep dive into, Hey, what do we know about insulin resistance? How is this affecting fertility? And these were things that traditionally I hadn't been taught. [00:02:00]So really, I think we kind of joined each other's worlds. You know, I joined American Society of Reproductive Medicine and, you know, joined all the fertility docs.
Judy: And You know, Angela would come to the nutrition conferences. So we did a lot of cross pollination and from that we went off and both started into private practices and she'd refer these amazing patients and we decided, wow, we're seeing them one at a time. Wouldn't it just be the coolest thing if we could start classes?
Judy: So about 12 ish years ago, we started the food for fertility classes where we brought women in who were trying to conceive. Many of them had PCOS, endometriosis. unexplained, lots of different diagnosis. And that's who we brought the food and the people and the lifestyle into the classroom, which is really why we wrote the book.
Judy: It's kind of, we took all our years of experience, science and knowledge and said, let's make it accessible to more people.
Michelle: That's awesome. And so [00:03:00] talk about the book. What's in the book? And obviously it's for people trying to conceive, getting to baby. What were the top things?
Angela: Yeah. Well, we, we started off by, you know, kind of, we always want people to understand the whys, you know, why this, why that what's the connection, what's the underlying biology and physiology? And then what evidence do we know? A lot of nutritional studies about fertility or observational studies, like they'll a population will be observed and they'll say, okay, people who ate these kinds of diets or these kinds of foods had higher fertility and more successful outcomes than people who ate this kind of diet.
Angela: So, you know, we, we want to, wanted to present all that information. So people kind of have background and good knowledge and can kind of say, oh, okay, well. Maybe that would be a good idea for me. You know, it's not, it's, it's a broad spectrum of what, you know, a good diet could look like. It's not just one thing.
Angela: Obviously [00:04:00] mainly plant forward. Cause I think we all need to eat more fruits and vegetables and plant based foods. But there is room, you know, for some animal foods too, especially things like fish and whole fat dairy, which have shown to increase some fertility benefits. So, you know, we kind of go through all the food groups and talk about what's, what we, where we have evidence, what's good, what's not so good and what vitamins and minerals and nutrients they're adding.
Angela: And then, you know, some of the biggest things that we're like, if you want to incorporate this, it's a really, it's a how to. Right. So we wanted to make it like accessible in this sense that anybody at home could be like, Oh, okay. I, gosh, I just want to add one little thing this week. What would I add? What can, what's my takeaway?
Angela: What's my smart goal? So people can kind of set their own goals and try to move forward with that, making a little progress at a time. And then the greatest thing I think is sharing stories from our patients who are just fabulous[00:05:00] women who've been on their own journey. And we had so many stories, we couldn't even share them all in the book.
Angela: But kind of telling these journeys that sometimes took months, sometimes took years and how they were able to incorporate changes and see changes in themselves. and feel increased energy and then kind of have improved fertility. Maybe if they had a partner, you know, their partner's health was also improving at the same time.
Angela: And so many of them were successful either With natural conception, or if they were infertility treatments, having better success in those treatments and making better quality embryos that we were like, wow, you know, that's really what's in the book. So as much as we could share and keep it accessible and reasonable in length.
Angela: That's, that's what the book's about.
Michelle: I found it very user friendly and I really enjoyed the image of the plate and how half of it was greens, which is great because I do believe that it's so important to get the greens. And there's so many nutrients that you can get[00:06:00] from that. And you talked about some misconceptions too, like on treating PCOS and like common misconceptions on what to eat for fertility.
Michelle: So I'd love to touch upon that.
Judy: Yeah, well, one of the things that we tried to bring out in the book is when we first started doing our classes, a lot of the reasons women would be referred to us as we'll just go lose weight. So nothing, you know, focusing on their health and we're like, Oh no, no, no, this is not a weight loss class.
Judy: This is totally about how to nourish yourself. And actually. Take away the shame and guilt in, you know, whatever size body you have being able to get the benefits of the nutrition and the lifestyle. Right? So, for example there's a lot of people that would come in with a whole list of foods that they thought they shouldn't eat because somebody told them that.
Judy: And we're like, well, are you allergic to them? No. Well, okay, you know, here's a safe And that's what we tried to do in the [00:07:00] book. Like showing in all these different, you know, sure, maybe you can't tolerate dairy. Here's a sub, here's something else you can, you can place out so that everybody would feel included, that anybody could be in the classes, read the book and really get the benefit out of it.
Judy: So when, when you talk about myths, probably the biggest one is, you know so many women are told cut out carbs. Cut out carbs and we're like, Oh no. Well, what's in whole grains and ancient grains. We know those inositols we hear about in PCOS. Guess where they come from? White beans, buckwheat. So we're saying where can you get these ancient grains are just so filled with minerals and also really showing that looking at the quality of carbs that you're choosing most of the time is actually going to be beneficial.
Judy: And this is kind of relief for women to hear like, I don't have to starve myself. I get to eat and try new things.
Michelle: Yeah. That's such a good point. And also, cause a [00:08:00] lot of times when people have carbs, it's simple carbs or juices where you're taking basically, even if it's fresh juices, like we're really meant to have the whole fruit, right? The fiber like, and digest it slowly so that it's not a sugar spike. I'd love for you to talk about that too, the importance of, of actually having the whole food.
Angela: Yeah, we definitely talk about kind of it being a whole food diet because that is so important and The issue with I mean, yes, you can get some of the nutrients if you juice But you're also gonna get mainly sugar without the fiber if you've removed the fiber. So the fiber is so important both to slow down your digestion and really pay attention to gut health.
Angela: And I know you focus a lot on gut health. You know, that's where so much of our health overall starts. And there's so many connections between the gut and the mind and the body and the hormones and everything else, every, every system. And so, having that [00:09:00] fiber in your diet, really from whole foods. I mean, especially plant based foods, right?
Angela: Because animal foods don't have fiber, but the plant based foods really then is is great food for the microbiomes, the microbiome, our microbiome and the bacteria, the 3 trillion bacteria that live in our gut. And it helps create, you know, it's more anti inflammatory because so many people kind of can get.
Angela: almost a chronic inflammation from not eating enough fiber, not feeding their microbiome. And then that can lead to more issues in more body systems that they may not even be aware of. But nobody is, you know, advertising whole foods, like whole foods. So much of what people see and kind of the noise that feeds in is just, you know, everything else that's marketed in a box or a bag or somebody.
Angela: And so that's what, and so sometimes those help people put health claims on other products that [00:10:00] aren't whole foods and then whole foods kind of get neglected. And so, yeah, we definitely want to say, you know, it's important. And we talk about eating the rainbow and the colors because each colors, providing different phytonutrients.
Angela: And so, you know, you want that broad range because the more diversity you have in your fruits and vegetables, the more diverse a microbiome you're going to develop, the better protection for your immune system and just make everything else work better in your whole body.
Michelle: I love that you talk about diversity because actually a lot of people end up developing sensitivities even if it's healthy food that they eat all the time and it's important to have diversity because it really allows the body to get so many different benefits and also not get too intolerant of one specific thing.
Michelle: The body likes diversity.
Judy: Absolutely. And we really wanted people to feel inclusive with the book. So that's why there's so much [00:11:00]culinary medicine, like just basic skills. Here's how you can throw something together without even a recipe, you know, just really, you know, five steps to a great salad. What should it have, you know, different things like that.
Judy: And we also wanted it to really highlight the, All the global cuisines. And so for example I see a large population of South Asian women, right? And so there's, there, there always were like their diets too high in carbs. And we talked about what are all the wonderful things that herbs that you're using, the dolls, you know, the pulses, but we tried to make sure we had things from all regions because unfortunately a lot of people here in the medical world, like, Oh, just eat the Mediterranean diet.
Judy: We're like, Oh no, no, no way. That that's so exclusive. It's not inclusive. We want to talk about, you know, foods from, you know, West Africa or Central America, a lot of the indigenous healthy foods, and then also what's seasonally available. And so one of the things that we really tried to [00:12:00]share is a lot of different types of foods.
Judy: Simple preparation, but let people start where they're comfortable. So if you're a chef that only has three or four recipes and you're still sort of using some are processed foods, maybe they'll start with adding a soup or adding some vegetable dishes or adding a salad and letting them know you're going to get benefits from those first steps.
Judy: Because some people feel like, like I just talked to someone, she goes, I'm trying to be all in, you know, trying to be perfect. Do you know what I mean?
Michelle: Yeah,
Judy: And that's stressful. It's stressful to feel like you're getting a grade on your diet. And we want people to feel like it's fun. They're having a date night with their partner and maybe they're trying a new recipe in the book.
Judy: Or they got inspired because there is a lot of pressure when people are trying to conceive. And the book is also for those people who are like, Hey, we want to get pregnant in the next year. What's the path to a healthy pregnancy? We have no idea how long it's going to take, but [00:13:00] what's going to prepare us?
Judy: And you know, Michelle, that like 50 percent of pregnancies are unplanned. So a lot of people, you know, maybe they're exposed to a lot of those fertility disruptors, and if they would have known even a few months in advance, they could have decreased some of the risks, you know that could impact their fertility and pregnancy.
Michelle: definitely. I remember seeing something, it was about a burger or like a chicken sandwich or something. It was a sandwich with a bun that the woman just kept in her closet and just saw what happened and it was not, it was not good. Breaking down and I'm like, whoa That is crazy. Like things are supposed to break down if they don't break down and they don't yeah Just break down like what happens in your body So talk about the importance of eating whole foods.
Michelle: Listen, we're going to have processed food once in a while. It's not like, you know, end all be all like, it's not one thing or another, obviously, [00:14:00] but talk about the importance of really being intentional about choosing more whole foods in your diet.
Angela: Well, you know, I do think, I think that everybody's so different in what they eat, but I think that, yeah, the ultra processed foods and processed grains, so like breads, cereals, pastas, Anything it's just so it it's everywhere, right? It's it's you can't get away from it and it's become normalized And it and so it has become acceptable and ordinary And the problem with those foods is yeah, you don't need to say i'm not never going to eat that again But it replaces it, you know, it takes the place of whole foods.
Angela: And so I think you know Where do you get whole foods? Well, it's hard to get whole foods You You know if you're eating If you're buying foods at convenience stores or fast food restaurants or even regular restaurants Sometimes i'm surprised that menus don't have Kind of like more vegetables available when we talk about the fertility plate[00:15:00] and the whole plate being half Vegetables, right?
Angela: You're not going to get that in a restaurant, like the restaurant usually. So, you know, we, we have talked to women, we didn't really talk about this that much in the book, but like, I think some of the women gave us examples of, you know, planning when you go to a restaurant, gosh, what can I eat from this menu that would be more of a whole food, what are the, sometimes the side vegetables are something they'll order from some of those things to say like, yeah, I don't need to necessarily go for the most. Indulgent luxurious meal. I want to go for the whole foods cause I know that's what my body needs. So we talk about being intuitive eater or competent eater. It, you know, I don't think this is taught well in schools. So, you know, to, to be honest, nobody, it's nobody's fault. Like where you are, it's a growth opportunity for everybody to be like, Hey, I didn't really get this education growing up.
Angela: My parents worked. I didn't, you know, I didn't cook that much growing up, but now I'm an adult. And I need to really learn about [00:16:00] nutrition and what my body needs and how to heal myself through food. And what that might mean is I need to cook more. And if I don't know how to cook more with whole foods, You know, there's opportunities to learn.
Angela: There's so much now available on YouTube, or that's both good and not so good, but you know, you can find the good, the good things and learn to cook with whole foods and buy things like our book, which are trying to teach people almost some intuitive cooking skills. Cause you don't always want to be cooking from a recipe.
Angela: You want to get some basic staples and some comfort in the kitchen and some things you really are good at, and then always build new and add new. Okay. But yeah, so that was like one of the tenants of our philosophy of how we taught was, let's talk about, you know, building a meal. Let's talk about what vegetables are going to be in the meal, what protein is going to be in the meal.
Angela: And for us, that was mainly going to be a [00:17:00] plant based protein. So either beans, lentils. tofu or tempeh or edamame, so a soy based protein, or fish, since all of those have been shown to increase fertility. And then whole grains, those ancient grains, so not processed and kind of putting that all together and nuts and seeds and other things that provide those denser nutrients.
Angela: And really starting with like cutting things up, like, okay, let's prep everything. Let's do the mise en place. Let's get everything ready. Let's plan meals. So you're going to have leftovers. because it takes work and effort. You don't want to put all that effort in and then only eat once. So you want to have some leftover meals that you can repurpose throughout the week or free some of these meals that you're going to be able to then thaw out next week or next month when you're more time pressed, and you know, you've got your own freezer meal that you've prepared that you're going to be able to thaw out and cook and have a nutritious, delicious, quick meal, right?
Angela: So it's just a, I think it's a mindset, right? [00:18:00] It's a different way to think. And, and everybody can get there and just build that knowledge and build those skills. And that's exciting.
Michelle: It is exciting. I find that whenever you're learning something new, like you, you make it more complicated in your mind. You're like, oh, I have to do this whole thing. But you don't realize, like as you learn it, you could really strategize and make it so much easier and cheaper. You could save money that way.
Judy: Absolutely. Michelle, you bring up a really good point. And what's really fun is a lot of the women who've taken classes or patients of ours, like even after like two years after they have their baby, I'll get an email. You know, I saved all those recipes from class and I still love the, you know, the quinoa mango black bean salad.
Judy: It's so delicious in the summer. I take it to parties or one patient just wrote me about the soca bread made out of chickpeas that they start to add them to their repertoire or you want to increase their self efficacy, their confidence and their competency. And then when they do eat out, you know, maybe [00:19:00] they do broaden and they, you know, they go for an Indian meal or an Asian meal and they know like, Hey, I'm going to order one whole vegetarian.
Judy: So I get more broccoli and veggies like they know how to order and feel good. When they go out or they travel, you know, how can I take that and keep it better? And, you know, just really, you know, giving them that support. And so in the book, for some people, this is really new. We kind of do like a six week blueprint, but we also say like, If you feel pretty good on some of the skills and you've checked the box, awesome.
Judy: Work on some of those things that you, you want to build up stronger in your repertoire. And if you feel like you need more time, I remember when our class switched to virtual and we started to go to every other week, the women were like, this is kind of good because I have more time to work on my goals.
Judy: I kind of like that other, remember the every other week model? You could do that with a six week plan. Maybe I'm going to try to do this over twelve weeks, you know, three months, give myself some time to To try new things.[00:20:00] And the thing is you're getting the benefit with every step you take. There's a benefit, you know?
Judy: And so the cool thing for us is sometimes at the end of the class, women who didn't eat in the morning, they like. You know, we started eating in the morning because of class and the food was really good. They started regulating their cycles, Michelle. It was amazing. And one of our last live classes before COVID, I remember one table of four, they were all kind of waiting to get their cycles and things and getting ready for IVF.
Judy: And they all went on to conceive. They all got their cycles and went on to conceive. And that was just, the cost of food and, you know, putting a little bit of time in so that lifestyle does make a difference whether someone's going for art treatment or they're, you know, they're, you know, they're just maximizing their fertility options.
Michelle: Yeah, there was actually a study on girls in college that skipped breakfast and how it impacted their cycles I thought that was interesting[00:21:00]
Judy: I would guess negatively. I'm thinking if
Michelle: Negatively, yes negatively. Yeah. Yeah,
Judy: You know, I just want to check.
Michelle: They most of them started regular and it they became irregular.
Judy: You know, and people are getting into a lot of fads where they're really time boxing their food. I just talked to someone in a smaller body and she says, I'm trying to eat clean. So I only eat between this time and this time. I go,
Michelle: Mm hmm
Judy: you should eat when you're hungry. Your body needs nourishment all day, not just eight hours.
Judy: So sometimes we see people that are going to overboard. And they're restricting, and then their reproductive axis is not getting the nutrients it needs. And I'm like, that's not what you want to do for ag health. That's not what you want to do for reproductive health. If you feel cold at night and you're, and, and you know, and as we know with, you know, acupuncture and Chinese medicine, energy is such an important concept.
Judy: So if you're freezing all of a sudden, and you're starving [00:22:00] yourself, you're not nourishing your body.
Michelle: Absolutely. And actually in Ayurvedic medicine, they say that when the sun is out, that is when, because we, you know, we, we respond to the elements. And when the sun is out, especially like around 12 PM, you should have your largest meal because it increases your own digestive fire because we get influenced by nature.
Michelle: And actually the morning you should have breakfast, you should have food during the day when the digestive fire is. Increase the most and when you shouldn't is as it gets darker like a couple hours before you go to sleep That's when you can give your body a break. So it kind of According to Ayurveda, it's a little bit more flipped than what's typically done where people skip breakfast.
Angela: Right. And, and, you know, that, that exactly parallels some of the metabolic studies, right? So what Ayurvedic medicine is known for so long, right? And then Western medicine has to come and prove it that like our digestion is[00:23:00] better in the morning and the way glucose and, and. nutrients are processed in the morning is better when we have more energy and we're more active throughout the day.
Angela: And then at night, things are winding down and slowing down and you want your body to relax for sleep and not be digesting a big meal. And, and we do talk about that, but it is really hard for people to flip to try and get more calories and earlier in the day when fewer at night when the typical pattern is, is the opposite.
Michelle: and it's going to give them a lot more productivity and energy to have a good breakfast because you know, protein, you got those good fiber and vegetables and berries and, really start your day right.
Judy: We encourage people if they're really set in a way, we're like, we'll do it as an experiment. Be curious. Try it on the weekend. Maybe try it on the weekend because you don't want to change your flow. See how your energy feels, especially when people are telling us they're fatigued.
Judy: They're like, I'm so tired. And it's [00:24:00] like, and most of their energy intake is at night. They wake up not hungry. You know, we do try, you know, try to flip that around and that's part of that intuitive eating and eating competence and see where your body, because really people know a lot about their body and so we want them to be in tune to that too and trust that.
Angela: And I was just going to add that, you know, sometimes people have these ideas of what a typical breakfast, lunch, and dinner is and what food should be part of those meals. And we say, Hey, that does not have to be the case either. I love a breakfast salad. I love eating my leftover dinner from the night before for breakfast.
Angela: If I've made something delicious, I made this great stir fry and I've had a little bit because it's late, but I'm like, I want to have that for breakfast. I'm going to have a big bowl, you know, so I love having those other things early in the day because I do feel like it gives me great energy. And then the other thing that we talk about is, you know, the[00:25:00] walking after meals and especially getting outside early in the morning and getting that sunlight to really Start your day and, and get your clock going and how important those rhythms can be to recognize that you have, your body has a rhythm, sleep consistency is important, exercise and movement throughout the day is important, all these other things that we want to build in, you know, to our base for overall wellness to support fertility.
Michelle: Yeah. I love it. I love it that you're a doctor and you're interested in this because unfortunately it's not as common. Like people don't know about all of these things about really connecting with nature and the nutrition aspect of it. So it's amazing. It's so well rounded because you have like so many different backgrounds and perspectives on
Judy: We, we, we, yeah, we try to bring it all together and that's why this book would have been much longer if our publisher didn't say stop, you know, it was like twice as long. You'll see when you're writing your book, you want to share everything. And so we did include [00:26:00] two chapters on like boosters and disruptors, you know, talking about stress and sleep.
Judy: And then also some of the disruptors like, you know, alcohol, cannabis, endocrine disruptors, because we didn't want to scare people, but we felt they needed to know. And you know, science based, evidence based, but we did put it at the end. You know, we really focus on the food and feeding yourself because really that's what our program is all about.
Judy: But we find that when they put it all together and they get to those boosters and they add the movement and the stress and so many of our patients, patients who do acupuncture will say, well, that's one of the ways I always say, what do you get out of it? Cause I always want to know. And they go, Oh man, I'm such a good place to do.
Judy: I leave in my stress level is so much better. I go, then that's something you want to include in, in, in what you're doing for your health. If you have the privilege and you have the accessibility to it. So we, we try to make everything accessible. Because there's so [00:27:00] many women and men who don't have access to medical care when it comes to fertility.
Judy: It's really the underprivileged do not have access or such limited access that we thought if we could at least cover the main things and it could be, you know, available in libraries or, you know, things like that and audio books that that would be a way that more people could really have that information.
Michelle: Well, it's great information. And also, I love that it talks about. combining foods, in Chinese medicine, we have a lot of formulas of herbs. So each herbal formula has different herbs and they work together as a symphony. And a lot of times they'll include ginger or digestive herbs to help assimilate.
Michelle: So working together, And a certain symphony is what makes it that much more beneficial for the body. And I like how you talk about the importance of combining foods. You were talking about putting [00:28:00] vegetables because if you just eat meat without vegetables, it's not going to be able to simulate as well and digest as well without those vegetables helping in that fiber.
Angela: Right. The vegetables are actually pretty protective, right? So I mean, there, you know, there have been studies that look at people who eat just more of an all meat diet and then people who eat more of a vegetable based diet, but with meat and the gut is healthier, right? If you incorporate those vegetables the, the, because the fiber from the vegetables is so protective.
Angela: That then you are able to digest the, the meat and make use of the nutrients in the meat as well. So I think that's, that's great advice. And I think that, you know, out here we're in Seattle. And so we have a lot of, you know, we have a number of people who are trained in acupuncture. They are, you know, trained in traditional Chinese medicine.
Angela: And we have always basically said, you know, gosh, I don't know that area, [00:29:00] but I trust. The practitioners in my area who knows so much this has been around for so long that let's, you know, combine and talk about the best of all worlds and support everybody's health. And then the same with fertility clinics, like some people really are going to need that extra step of a traditional IVF clinic.
Angela: They might need insemination. They might need IVF. And then all these other things are going to be supportive and enhance their success because it's so expensive. And the last thing you want to have to do is multiple cycles. And so the more efficient you can make each cycle by bringing your best self forward into the process and taking the time, like a lot of people, you know, want to kind of take a lot of time to get to a fertility clinic.
Angela: And then once they get there, they want IVF yesterday. Like they want to be pregnant yesterday. So And it's still really about the time and the investment in, [00:30:00] you know, producing optimum health for you and your partner. And so that, you know, it might take a good three months, right? Of preparation to say, let's make sure when you do IVF, if you need IVF and you're going to do it, that everything's perfect.
Angela: As great as you can make it going into the cycle instead of just like, Oh, there's an opening next week. Let's get started. You know
Michelle: I wish all reproductive endocrinologists spoke like you
Angela: Oh, yeah. Thank
Judy: she, and she, and she walks the walk, you know, for all the patients we've had together. A lot of times after that initial consult, she'd be like, okay, I want you to do, you know, food for fertility and work on nutrition and lifestyle for three months. You know, let's see, you know, what we can do with some of these biomarkers that are, that are elevated in a very positive way.
Judy: And then quite often during that three months, a woman starts cycling. I always, I remember saying to Angela once years ago, I go, What if you put the [00:31:00] fertility clinics out of business? I mean, we were kidding, you know, when I said that they have the role. So please don't think I'm saying that, but you know, we did.
Judy: And she's like, great. She was like, wonderful. Let's help people on the easiest journey. Let's not, you know, when someone gets sent to me and they've already had three failed IVFs. for whatever reason. And they're like, okay, I want to work on my nutrition. I'm so happy to work with them, but I feel really bad because they're pretty wounded because they've been pretty disappointed and let down.
Judy: And sometimes it was something obvious that nobody ever brought up, you know, their eating disorder, their PCOS, that things could have been optimized first. So I think that's where we all work together. So I feel like that's why when you work in integrative planning, You know, practices. We, we work with, you know, fertility yoga instructors that we really trust and, and, and, and D's and dietitians and, and, you know, we know which clinics are going to be weight shaming, you know, we want to know [00:32:00] where can our patients put the best team together, where can they get support groups from resolve or other organizations so that they feel as fully supported as they go on this journey, because a lot of people, Never expected this.
Judy: They just, I went through unexplained infertility for years. Never thought that was in the bags for me, but it was like. You know, you feel helpless. So having a community, and I think when we all work together interdisciplinary, you know, and we know the best people to send our patients to, or best organizations, or how to check, we really help them.
Judy: We really, we really can help. So we're excited about you, you know, your future book. Yes. I mean, you know, I was just coming first, but yeah, looking for resources is so important, Michelle.
Angela: And I, right. And I think, you know, those resources are great. And then also if somebody is seeing somebody and it's not clicking. You know, it could be it could be their doctor. It could be their [00:33:00] dietitian. It could be whatever They you don't have to stay with the same person. You can actually go get another opinion you might You know, click better and work better with someone else who Has different information even it's not all the same.
Angela: So each of us don't necessarily provide the same information or You know, it's an art and a science and I think we all feel that that we connect with people It's so important, but we all connect differently And and as an individual each person should really You Make the most of that and, and really make that work for them.
Angela: They're the ones they're invested in it.
Michelle: That is so true. Absolutely true. I've seen people who have been going for years to one reproductive endocrinologist and then when they changed different approach, different energy, just like, and it was a different outcome,
Angela: Yep.
Michelle: you know, it happens.
Judy: And if you make a change, [00:34:00] no one's mad at you. We all want the same end result. I always tell them all the clinics in this town, they're all friends. They all know each other, you know, professionally, they all know each other. They're going to send your charts.
Judy: They're not going to hold them back. You know, everybody does want a positive outcome, you know, to take place.
Michelle: Yeah. Yeah. That's great. I mean you know, not always the case, , but when it is, it's amazing, and it's true you really do have to find that alignment and I always say, you know, it takes a village and creating a team of different people that can support you in different ways.
Michelle: When going through this, but of course nutrition is so important in Chinese
Judy: We all eat.
Michelle: Yeah, we all eat and we eat for a reason a good reason, right?
Angela: Mm hmm.
Michelle: And the spleen and stomach are actually the center and they're like the mother in a sense, you know the nurturer Aspect of our bodies and that is really where everything else gets built they [00:35:00] talk about pre heaven chi pre heaven energy in the kidneys And of course the kidneys are really important But sustenance, the energy with which we can sustain and increase after our genetics is food,
Angela: Right. And I think, you know, that's just kind of being understood. I mean, I think in science, Yeah. We now are recognizing, you know, there's genetics, and then there's epigenetics, which is how the genes are expressed and the epigenetics is how we influence which genes are expressed. And that has to do with our nutrition, our stress.
Angela: Our sleep, our movement, our community, our mental disposition, our mental health, our optimism. All these things have a huge impact in our health by the epigenetics. And I think people sometimes think it's just genetics and things are. A predetermined and it's going to be one way and it's totally [00:36:00] not. You have so much influence as a, as an individual about what path your life can take and how your health is affected by these decisions you make every day.
Michelle: which is so empowering, I think, to know that you actually can have a hand in your
Angela: Mm hmm.
Judy: , I was just thinking we almost wanted to add a whole another chapter on epigenetics, but we had to pull it back. So we just kind of sprinkled it in, you know, the lifestyle things. But even when we work with people who are using donor eggs, their health will have an impact on these epigenetics. So that really empowering that mom, you are the full mom, you know, even with a donor egg, what you eat, your life, your health.
Judy: Is going to have an impact on your baby. And I think that really helps people to know that
Michelle: That is such a good point. It's really true because it's, it's all important. It's all parts of the [00:37:00] whole.
That's where you do have control right over your lifestyle. And these some of these decisions because you don't always have control over your fertility. I mean, certain aspects are just out of your control, and you do feel that helplessness.
Angela: And so I think where you can feel good and feel empowered is, you know, these are the actions I can take. These are the steps I can take. I am making progress. I am growing as a person. I'm helping myself. I'm helping my community. Whatever the case may be, I try to recommend not kind of losing yourself in just trying to get pregnant.
Angela: Really recognize your, yourself as a whole person and all the things you are providing to, to your community through purpose and service and love and, and everything you're doing is just, it's key to who you are and it brings you strength and peace. And that's just really [00:38:00] Great to know and you, those are decisions you can make.
Angela: That's not something out of your control.
Michelle: That's so important. And thank you for bringing that up and you guys, I could talk to you guys for hours cause you know what, you know what I love? Well, first of all, your knowledge, you guys are very knowledgeable about what you're talking about, but the passion , and the compassion. With which you are operating
Michelle: I think we both have one major thing in common is that we love this community and it's a beautiful community to serve. And so for people who want to find you or read your book, how can they find you?
Judy: Well, the book is available at all major books, booksellers and many of the independent ones request it getting to baby book.com. It will be released April 9th. So I'm not sure when this is released, but April 9th will be released. It can be pre-ordered. You can follow me at Fertile Nutrition or on my website, mindbody nutrition.com [00:39:00] and Angela.
Angela: And you can also request the book from your library. So libraries don't automatically stock books, but if individuals make a request to a library, the library can order the book. So that's something to know as well. And then I'm at AngelaThiremd. com or at AngelaThiremd on Instagram.
Michelle: Awesome. It was such a pleasure meeting the two of you. You guys are so nice and so knowledgeable and just really lovely to talk to. So thank you so much for coming on the podcast today.
Angela: Thank you, Michelle.
Judy: Michelle. Thanks, Michelle.
Angela: to you as well.