Ep 370 The Truth About Fertility Decline and Reproductive Longevity with Gabriella Rosa
On today’s episode of The Wholesome Fertility Podcast, I’m joined by Gabriella Rosa @dr.gabrielarosa, a globally recognised fertility specialist and researcher, to unpack the truth about fertility after 40.
We explore why age alone is not the real issue, what actually impacts egg and sperm quality, and how metabolic health, lifestyle factors, and emotional wellbeing play a much bigger role in conception than most people are told. Gabriella also shares insights from her clinical research and discusses the importance of addressing fertility-related trauma and stress.
This episode offers clarity, hope, and evidence-based guidance for anyone navigating fertility in their late 30s and 40s.
Key Takeaways:
Fertility myths around age 35 and 40
Egg quality, sperm quality, and mitochondrial health
Why fertility is a team effort
Metabolic health and lifestyle factors that influence conception
The emotional impact of infertility and why support matters
Gabriella’s clinical trial supporting emotional wellbeing in fertility
Connect with Gabriela Rosa:
Website: https://fertilitybreakthrough.com/
Facebook: https://www.facebook.com/FertilitySpecialistGabrielaRosa
Instagram: https://www.instagram.com/dr.gabrielarosa/
Fertility Breakthrough Instagram: https://www.instagram.com/fertilitybreakthrough/
Fertility Breakthrough Facebook: https://www.facebook.com/rosainstitutefertilitybreakthrough
Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care.
Ready to discover what your body needs most on your fertility journey?
Take the personalized quiz inside The Wholesome Fertility Journey and get tailored resources to meet you exactly where you are:
https://www.michelleoravitz.com/the-wholesome-fertility-journey
For more about my work and offerings, visit: www.michelleoravitz.com
Curious about ancient wisdom for fertility? Grab my book The Way of Fertility:
https://www.michelleoravitz.com/thewayoffertility
Join the Wholesome Fertility Facebook Group for free resources & community support:
https://www.facebook.com/groups/2149554308396504/
Connect with me on social:
Instagram: @thewholesomelotusfertility
Facebook: The Wholesome Lotus
Disclaimer: Some of the links shared are affiliates but this is at no cost to you and can even get you discounted prices!
-
Grabriella: Welcome back to the podcast, Gabrielle, I'm so happy to have you.
Thank you so much. You know, it's so lovely when I get to invited back so that I know that, okay, the first conversation went really well and people have gotten benefit and it's always wonderful. So thank you for having me.
Of course. And we covered so many different things, but I'd like to get a little bit more deep dive with you, um, on a topic that. I hear often and it's, um, it's a topic I feel pretty passionate about too because I think that there's a lot of misconception about it. And it's fertility over 40. You know, people, people even say, you know, after 35, it just goes nose dive, and I've seen so many, so many conceptions happen after 40.
And then you also, I always love sharing the Guinness Book of World Records, Don Brooks. Who got pregnant and had a healthy baby at 59[00:01:00]
Wow. Yeah, that's, wow.
you know, those stories
I hope that doesn't happen to me, Michelle. All I have to say.
that is so great. No, no, me too, me too. I'm like, um, I'm good there. But it just shows the possibilities
Yeah. Yeah.
we believe in a certain, um, like limit on what our bodies are capable of. And I know that you have a lot of amazing. You've had a lot of results in that and worked with a lot of people over 40, so I'd love to really explore that topic
Yeah, absolutely.
in that.
Yeah, for sure.
I think that it's, you've started it exactly where I think a lot of people. Land when they first hear of the conversation of fertility or infertility is that after 35, your fertility takes a nose dive and it's like, oh my God, can we please stop perpetuating that? Um, it's not to say that biologically.
[00:02:00] Women do have at this point. And it's interesting 'cause you know, every time I start this conversation, I think about how obsolete this conversation is going to be in 50 years from now. You know? Because right now we do have a biological limit in terms of women are born with all the aids that we will ever have.
But I am pretty certain that. You know, in a not so distant future with all of the research that's going on regarding stem cells and, you know, different aspects, and I don't wanna say specific things because we're still very early on, I often get asked about. Procedures right now that people, you know, see as possibly available to them.
And the evidence really isn't there for a lot of these things that are being sold, you know, quote unquote in the marketplace to women who are desperate and who want to, you know, give themselves the best possible chance of having a baby. [00:03:00] And so I'm always hesitant to say. You know, women need to do things to improve their egg quality.
From a perspective of interve high level interventions, uh, you know, there are absolutely things that are going to make a huge difference in terms of improving egg quality for women at any age. That come from taking charge of the things you do and optimizing results. So from that perspective, and we'll dive deeper into that, um, I highly recommend that people pay attention to the things that they're exposed to in their day-to-day, the choices that we make.
You know, all of those things will be important when it comes to egg quality. But, you know, going back to the conversation that we were just having. When we talk about in the next 50 years where it's going to and how it's going to be possible for ovarian reserve to replenish itself or for us to be able to develop more eggs.[00:04:00]
And have babies with our own eggs and extend the longevity of reproduction for women. You know, the, this, the, the sky's the limit. You know, I think as we start to dive deep into these new and unchartered washes, but we're still kind of very early on in that process. You know? Yes, there are some animal model studies.
There are some interesting, you know, things that are being done in terms of science. But from a, from a viability perspective of it actually being done right now, it, it's, we're not there yet. You know, so we have to then have the concept that we don't want to be delaying fertility for the sake of delaying or for the sake of the fact that.
You know, it is true that life extent, uh, um, average, the, the, the, um, sorry, the life expectancy rates of [00:05:00] populations have increased drastically, you know, just 50 years ago. If you think about it, you know, we were dying at 50 or 60, you know, whereas the life expectancy. Today in Western countries. I mean, I know that in Australia it's 84.5 years for females, you know?
So you think about that and you go, wow, okay, so if I'm going to be alive with good quality of life into my eighties, and fertility wise, let's say menopause is the. Natural end of, and again, you know, in these types of cases where women are conceiving afterwards, it's not that it's impossible, it's just that it becomes highly unlikely.
Um, but, you know, post menopause. But um, before menopause, certainly we need to start thinking about the fact that, okay, if we're hitting menopause, say on average. At [00:06:00] 45 to 50, and we know that five years, five to 10 years before menopause and the diagnostic criteria, there is one year of no periods. After, you know, you basically have ceased periods for one year and your FSH levels rise, your estrogen levels decrease.
Then, you know, okay, I am in menopause. Five to 10 years before that, we women find themselves into this stage called perimenopause, which is where. There are more imbalances in terms of hormonal levels. There are more challenges in terms of regularity of cycles. Egg quality also decreases and ovarian reserve decreases as well.
And so, you know, from that perspective, we do have to take into account that we. Right now, we'll hit that place somewhere. If we talk about five to 10 years before, if somebody hits menopause at [00:07:00] 45, then you know, from 35 to 40, they already are potentially in that perimenopause stage. If they hit menopause at 50.
At 45 to 40, they are already in that perimenopausal state in perimenopause. It is not impossible. In fact, there are still many things you can do to optimize the chances of taking home a healthy baby. And so a lot of the patients that we would be seeing would be in that kind of, you know, 30 to say 45, you know, range where.
They could potentially, and certainly when we talk about premature ovarian failure or premature ovarian sufficiency, where a woman is much younger and has a very elevated FSH and ovarian reserve, that's much declined. It obviously also comes into the conversation of like, okay, is it still possible to optimize the egg quality that is remaining so that we can improve the chances of taking [00:08:00] home a healthy baby?
And the answer is absolutely yes. And in those situations, what is really important to highlight, and I think that it's even more important to take into consideration, is the fact that if we do have lower ovarian reserve, and if we do have impacted egg quality, sperm quality becomes of paramount importance because it is.
The egg that has to, you know, do all of the work to ensure that we don't have the, the errors in the DNA of the sperm being passed on to a, a potential embryo or potential child. And so what happens is the egg has to utilize its own energy production that, you know, it's mitochondria that is already kind of struggling a little bit.
For improving its own, um, division and, and maturation process. And then of course we'll have to go on [00:09:00] to produce an embryo development, you know, process. Um, it's going to have a much harder time if the sperm is not good quality, right? If we, if it's having to utilize its energy to. Eradicate or prevent those DNA fragmentation errors to be passed onto the baby, it's going to have less energy for embryo development and you know, kind of that whole process.
So that's where we need to start really looking at this conversation. And we've talked about before, and I always say that fertility is a team sport and this is very much why? Because from a mechanistic perspective. Effective. If we don't have the best quality sperm, we are going to be putting an additional burden on the egg.
That is, you know, that is not warranted. And certainly that didn't need to be there. So, you know, even though, and I think that this is the important takeaway from this whole conversation, is that. [00:10:00] As much as at this stage, we want to think that female fertility can be extended beyond, you know, uh, it's kind of quote unquote natural stages.
It cannot. And so we do have to ensure that we're being smart about what it is that we do. We are not delaying. And it's important also for men to realize that because males male fertility is seen as more. Infinite, so to speak. It's not infinite by any means. Right. But we, we do hear in the media, you know, oh, Hugh Hefner made a Playboy, uh, Playboy Bunny pregnant, you know, um, at 90, and you kind of go, well, yeah, but she was 20, you know, and so.
It's a very, very different situation with mitochondrial health being different and egg quality parameters being in a different, at a much earlier age, it can afford [00:11:00] to utilize its energy to fix the errors in a 90-year-old sperm, um, as opposed to, and the sperm is not 90-year-old because obviously sperm is being produced throughout a male's lifetime.
But, um, the quality of its, uh, DNA certainly does decrease with. Time. And so, you know, it's a different conversation. So I think that a lot of, a lot of men think that, oh, I don't really need to worry about my fertility so much because obviously, you know, it's a woman's issue, which again, hopefully by now people understand that it's not and why it's not.
But, um, it, with us seeing that, you know, sperm parameters are declining. With age and as the passing of time. Just even, you know, like I was reading a study, I was reading a a, an analysis the other day that was talking about the fact that since the 1970s sperm count, male sperm counts have decreased by 60%.[00:12:00]
60%.
I've heard of that. It's nuts.
It's absolutely insane.
so the, the normal, today's is not by any means what the normal used to be. So
I.
been like almost dumbed down to be considered normal.
And, and this is the thing that a lot of times people don't understand is that reference ranges for lab results actually are derived from the population. So what happens is that if health is declining in the entire population over time, and diabetes and diabetes diagnosis and blood sugar level. You know, parameters and insulin parameters are a great example of this, and they also drastically impact fertility.
But sperm is another one where, you know what a normal sperm count used to be in the seventies is literally 60 times higher, 60% higher than it is now. And now it's like, you know, you get 20 million, which is the minimum that you [00:13:00] know we need to have now. And most men struggle. You know, who, uh, who are having fertility problems, especially, you know, a huge percentage of the population who struggle to conceive.
You know, if we talk about the fact that it's a 40% male factor, 40% female factor, and 20% embryonic factor. The reasons as to why people don't conceive or take a healthy pregnancy to term. So again, increased risk of miscarriage. Increased risk of infertility becomes a major issue here. Um, it's, it's, you know, it's not a woman's thing at all.
It's actually a couple's thing to begin with. That then gets impacted by the embryo that ensues from those originating cells. So if we want to make those embryos into healthier embryos, we do have to pay attention to what's happening in terms of egg quality and sperm quality. For sure.
And what do you think it is that causes it? I mean, we know environmental toxins, like what are your thoughts on why [00:14:00] it's
Look. Absolutely environmental toxins will play a role. But if you also think about how men used to work back in. You know, the fifties, sixties, uh, the fifties, we started to have more office work, right. Being part of the, the, the day to day. But, you know, there used to be a lot more movement in general in terms of people actually not sitting down.
At their desks the whole day. There used to be a lot more activity. And if you think about, just from a, purely from a heat perspective that we know impacts sperm, you know, we know that sedentary behavior increases the, the risk of many chronic illnesses, but it's also having a huge impact on, in terms of sperm because.
There is a reason why the testicles hang outside of the body. It's because typically the testicles, in order to produce quality sperm, need to be about one degree centigrade lower than the rest of the body. And so what that [00:15:00] means is that if we are heating the testicles because we're sitting, men are sitting on it the whole day on their desks and doing computer work, or they have occupational hazards that are part of, you know, that conversation and then they go out.
Side and they engage in cycling that, you know, retypes and do all sorts or have their phones in their pockets, or go in the baths or spas or saunas, you know, anything that increases heat to the testicles is going to negatively impact. Firm and you know, sitting down on the couch all day for four hours watching Netflix after work they've already been sitting all day is certainly not going to be beneficial.
But then, you know, outside of that obvious kind of very physical mechanistic process, there is also the fact that, you know, we do have more endocrine disruptors than ever in our environment. And so what that ends up meaning or translating into is the fact that, okay, now what we have is a [00:16:00] situation. Where there are exposures from our food, from where our food is packaged to what we put on our bodies and the air we breathe that really are impacting that lock and key, that is how the endocrine system operates.
You know, the cell. Is the lock and the hormone is the key. A hormone is a substance that you know is, is built in one part of the body and affect another part of the body. And what happens with these endocrine disruptors is that they mimic the key. And so you end up with something that is, you know, estrogen.
And a lot of these endocrine disruptors are estrogenic. Now men need to have a higher dose of testosterone in, they're circulating in their body in order to be able to produce sperm. And because a lot of these endocrine disruptors are estrogenic, what ends up happening is that they're being loaded with additional estrogens that were never naturally found, you know, in most men's uh, [00:17:00] bloodstreams, and certainly not in the cell receptors that these mimicking chemicals find themselves in.
And so instead of, you know, the cell receptor for testosterone, having. A molecule of testosterone in that cell receptor that's going to do the right job that is encoded for it to do. It has a mimicking molecule that basically, essentially changes the function or the instruction that is delivered to that cell.
And so we end up with issues that, you know, obviously we didn't anticipate in terms of many health conditions. I mean, we are seeing. Lots of different estrogen related cancers in men these days because of this very reason. So, you know, I think that there is an environmental component that is really a big part of what we need to take into account as well.
And now I'm learning about LEDs and [00:18:00] how, I mean, we're still programmed by light and, and are. really respond to the circadian rhythm of nature.
Hmm.
then you have LEDs, which don't have a complete spectrum. I can confuse the body as well, and I'm learning about that. There's so many, um, aspects of how we're living.
It's crazy.
Yeah. I mean, look, you know, this is the thing. I think we are, the human body is highly unprepared for modern life. You know, there's the, and especially the speed in which technology is developing and unveiling new and improved, quote unquote, you know, ways of living. Certainly convenience is at an all time high.
Uh, bodies, they weren't built for convenience. Really, if you think about it, what actually kept us healthy was the struggle, right? And so we are now in a situation where. We don't have those same struggles in the day to day and we have to add back some [00:19:00] friction to be able to, you know, really help the body to kind of rebalance.
And, you know, this is one of those other really interesting points too, that, you know, the adaptation response that is required for the body to be in homeostasis is also being confused, right? So there is a lot that the body can take, but. For the most part, one of the things that I think we need to, to understand, and it's almost kind of like going back to um, an earlier time so to speak, is the fact that.
The body really does know what to do. Its internal wisdom is in impressive on so many levels, right? And so sometimes it's not what we need to do. It's not doing more. That is the answer. It's like, what are the things that we need to stop doing, right? What are the things that we need to remove from. Our day to day, that actually helps to enhance [00:20:00] the way that our body operates simply from and not being there.
And I think identifying those things for ourselves that each person kind of knows. You know, like if I was to go back to a more natural way of living. What does that look like? Um, I think that that's a question that more and more we're going to need to ask ourselves. And it's not to say that, you know, we ignore technology or these conveniences.
There are many, many things that, you know, are wonderful. I mean, just the development of antibiotics for one is, you know, like I would never, if somebody needs antibiotics, I'd be the first one to be saying, go take it. You know, like there's no need to apply. Some herbal medicine to, you know, something that will be resolved for, you know, with an antibiotic.
Like, you know, sometimes I get patients in my clinic that have literal infections that are silent, but are causing infertility. Chlamydia is, you know, a, a common one. Like I'm not gonna be telling them, oh, here, [00:21:00] take a bottle of herbal medicines. It's not that I don't use herbal medicines, we certainly do, where it's indicated and where it's necessary, and there are some incredible benefits to utilizing it.
But it's about knowing what tool to use when, rather than we only do one thing, or we only do things in a certain way because then we lose the benefit of technology and development and we start to add friction where it, we shouldn't, you know?
Yeah, a hundred percent. I, I think that everything, if you really take all of the different technologies and look at the ancient wisdom and then also the modern technology and combine it, and I think that that's what makes a really good practitioner is somebody who can decipher
Yeah. Absolutely a hundred percent. And also I think that, you know, it's, it's about patients learning where things are most effective. Let me give you an example. You know, sometimes we, I often have people asking me [00:22:00] about, you know, like, should I take metformin right? For improving my insulin resistance? And I say, well.
equality, they say, uh,
That's right. And, and it's actually for implantation. You know, there's a lot of studies now coming out and they, and some of these studies, by the way, they're not actually human studies. They're, they're animal models. And so I think that one of the really important things to highlight here is that there's a lot that gets talked about, or especially on social media, like.
Uh, yesterday I did a video. I do a lot of patient education on my Instagram account. Gabriela Rosa fertility is the handle. But you know, like yesterday I did a video on seed cycling because seed cycling is something that gets perpetuated a lot. There is no human evidence on the impact of seeds on hormonal regulation in the body.
Okay, now if you like seeds. And you wanna eat them. They're crunchy. They're delicious in salads. You know, they're going to provide fiber, they're going to provide some omegas. You know, it's not that I'm saying don't eat [00:23:00] seeds. It's that the way in which people then want to extrapolate. Evidence from an animal model or an animal animal study into human, you know, processing is, is inaccurate at best and dangerous at worst.
Because what ends up happening is that then people think that, okay, I'm going to not take. The appropriate treatment to go and do something that is being denoted on social media, as you know, the way, their natural way to improve my hormones. And it, it, it's bollocks. It doesn't work. It's not actually, you know, the, the intention of benefit is there, but.
You know, good intentions aren't everything. Sure Placebo still results in 30% of the benefits in drug trials. 30% of the result is actually derived from placebo. So if you think it works, it probably, you know, will give you some benefit, [00:24:00] but the reality is.
harm. And that's, that's the
You see, but this is the problem. The problem is that there is harm because if you think about it, if somebody is taking quote unquote, some, you know, trendy, whatever from social media and applying that instead of applying effectiveness and effective treatment.
They've lost the opportunity to actually make a difference to their situation. And so there is harm in that. And I think that there is a lot that we need to take into account when we are making recommendations to general public that it's not, it's, there is no neutral effect in a recommendation that a practitioner makes because the practitioner.
At the end of the day is being seen as the person that is guiding that, that individual, towards hopefully a better outcome. And so if we're giving, you know, evidence-based rubbish as recommendations, people get confused and in that there is harm, whether it's [00:25:00] misinformation that's not derived from a malice of wanting to misinform to make money, which then becomes this information.
It doesn't matter because by the time somebody has lost the opportunity to have a baby altogether, because they were doing a thousand things that would actually not move the needle in their particular situation because they heard from a book or they heard from a forum, or they heard from somebody's social media account that it's the thing to do well, we've done harm.
Right. And I think that that's the, the problem.
is harmful, like things
Oof.
like is really harmful because knowing what's really happening in your body, and people do, I mean, because you're able to get the supplements, those kind of things. But if you're having, um, you know, certain diets, of course if you're doing it exce, uh, like instead of something else, then yes, it's harmful, but. If you're doing it in addition, and it's just like, it's really just adding more things to your diet. Different story.
Oh, for sure. I think that, you know, again, it's, it's really. [00:26:00] How people understand the communication of accurate information. Right. But going back to the example in terms of like Metformin the best way still, you know, and I've done extensive reviews on this topic. Insulin resistance is one of the biggest issues when it comes to ovulation.
You know, failure, irregularity of cycles, sperm parameter issues, you know, and it's silent and usually people don't even understand that they have it, or their doctors don't even get to diagnose it because they, they do it too late. Uh, and, and so what happens is that. The best way still, if you go to the evidence and you, you can do a clinical, uh, uh, a full literature review on this, and you will find that still, the best way to improve insulin resistance and blood sugar parameters is diet and exercise.
If in some instances it's necessary because people either are not compliant [00:27:00] enough or they have some other issues in terms of the compliance aspect, then sure we can add Medica medications to that, and of course where there are metabolic disease already in situ, then obviously there might be a need for medications to help to correct those issues.
If somebody already has diabetes, then yes, take your insulin right. The reality of it is that when we are looking at hormonal imbalances derived from a metabolic place in terms of like blood sugar dysregulation, insulin resistance, in the very early stages, diet and exercise is going to be better than drugs and medication.
But that's not the message that most people receive or understand because, well, there are misaligned in interests in the healthcare system, right? And we also as patients, uh, you know, most people want convenience. So most people are going to like, you know, if I can get. Take a [00:28:00] pill and not have to bother about all of these other things that take time, effort, energy, and and so on.
Then I might just take the pill. But that goes back to the conversation that we were having before where the convenience is actually not in our best interest. Right, because it's, this is precisely where like if you really want to improve insulin resistance, hey, 45 minutes of zone rate in zone, zone range two, uh, heart rate range, um, training 45 minutes.
Three to four times a week and go build muscle at the gym and you're going to do a much better job at your overall health. The way that I like to think about this, uh, in terms of building muscle and that whole mitochondrial impact throughout all of your cells that are going to help to improve every aspect of health and fertility, it's almost like.
Muscle is the air filter of the system, you know, uh, air purifier, so to speak. [00:29:00] So it's going to be removing and utilizing items and things within the bloodstream that actually is going to help the environment for the egg maturation period and for the sperm maturation or development period. To to happen in a better way.
So by us ensuring that we are implementing healthy strategies in our day to day, from building muscle to a healthy diet, we're going to be not only impacting. Our cells and how our body operates in general, but we are going to be having a very direct impact on fertility from adding those strategies. So it really is, it's a comprehensive approach that's going to ultimately optimize the chances of taking home a healthy baby.
But. Knowing when to utilize convenience and knowing when to actually go for the hard stuff at the gym is a really important part of this conversation for optimizing fertility over [00:30:00] 40 or at any age. Right? One of the things that I do say to my patients all the time is that. If you want to improve and optimize your mitochondrial health for your eggs, and this is not going to have a direct impact on eggs necessarily, but what happens is that if your body is in better health overall and your mitochondrial health is better in your body overall, what ends up happening is that it gives those those cells that are in development better opportunity to be healthier and that can only improve your fertility outcomes.
Yeah, 100%. It, it really is truly like a holistic approach and to understand that your body is not made in little, um, you're not focusing on the puzzle pieces. You're, you're looking at the whole picture.
Wow.
everything impacts everything. And then, you know, even worse than metformin, you know, this whole ozempic baby trend that's happening.
And, uh, people don't realize that in some cases it can really impact digestive [00:31:00] system and in a way that's irreversible. there are, it's not coming for free. And there's always like, you know, the shortcuts that people, you know, they, they've had stories when we were little, like on shortcuts
Yeah.
is for free.
There's no such thing as a shortcut.
You see, this is the thing, and I think that that's a really important thing for people to realize. Like GLP ones are a miracle. Like honestly, they are a miracle of modern technology and of pharmaceutical prowess. Like I will take my hat off any day of the week and say that, you know. For certain people with developed disease, it's going to be, and particularly where they struggle with implementation, they struggle with, you know, a whole bunch of things.
It's not that it's something, it, it, I don't see it personally. I, and I, and I have the same view about every aspect of medicalization, right? There is a, a time and a [00:32:00] place for certain things and you know, with GLP ones there is definitely a, a. A time and a place where that might be useful, but it does not replace, and I think that this is the important takeaway message.
It does not replace people having to take ownership and responsibility for their day-to-day actions, their behaviors, their habits, you know, and it's an aid for sure. It's an aide. For some people, it actually is going to make the entire difference between them dropping enough weight in a sustainable way that it enables them to be able to have a healthy pregnancy.
Make the mistake about it, you know, being overweight, insulin resistance and diabetes, all of those metabolic health, uh, conditions. Drastically negatively impact egg and sperm quality and, um, uterine and [00:33:00] receptivity, and therefore the ability to actually carry a healthy pregnancy to term. Now, there's also no evidence suggesting that it's entirely safe, and you're absolutely right that there are going, there is no free lunch here, right?
So it's not something that is going to be a situation where. You can take it with no repercussions. There's always gonna be repercussions. There are, there are, there are kind of, you know, cost effectiveness and effectiveness analysis and, and pros and cons that you have to put into consideration when we, you are making a decision to use or not use certain treatments.
So, you know, the thing about it is that. If somebody is in a situation where they would have to choose between bariatric surgery or GLP ones, I'd be going GLP ones any day of the week. Right? Like
Yeah,
Exactly. Because you know, with bariatric surgery like that. Stuff is permanent. You're [00:34:00] gonna have permanent nutritional deficiency issues.
You're going to have multiple other health condition issues to deal with later down the track from something that you know is very, very permanent. Now, mind you, some people with, you know. Morbid obesity. Maybe that's some that might be the only way for them to be able to actually get their health back on track.
And so it's not to say that there is a right or wrong approach. There is an approach that is going to actually support. The values and preferences of the patient. And I think that that's one of the really important things that we need to take into account. For some people, certain decisions, particularly in terms of their health, is going to be determined by their values and preferences.
And taking those into consideration is the job of any clinician, right? So we, we are not going to be saying to people, oh no, this is the only way, and I mean certain clinicians do, and that's just. You [00:35:00] know, it's them. Um, I don't think that we're, we're going into an era in terms of, of healthcare where patients are highly educated, they have access to all of the same tools that clinicians have access to, and they use it, you know, they will literally, you know, sometimes I, I have seen patients in my clinic come in with.
Detailed files of their situation, and they're not, they're lay people, right, but they have highly educated themselves on their situation and what's going on and what it is that they need, and they can ask and answer questions that some medical doctors cannot even. Understand yet, you know, so we have to be also very mindful of the fact that the more that somebody educates themselves, the better they're going to be able to advocate for themselves.
And I think that in this [00:36:00] conversation of trying to get pregnant over 40, it's so, so important because time is finite. It is essential that you don't just keep applying the same strategy, hoping for a different resolve, but that. Understand what are the options available to me in my situation and how best to stage those things in such a way that's actually going to benefit me the patient in the best possible way.
And if medications are a part of that, and if surgeries a part of that, and if something else needs to be brought in as a part of that strategy, then it's much better that their clinician is able to guide that process. Then the patient tries to make these decisions and, and put these things together on their own and end up in the complete wrong place that they didn't intend as a result of not having that kind of support.
So I think that there's a lot there to, to disentangle, but there's, these [00:37:00] are all very important considerations, particularly when all the most patients over 40 are going to hear is, you're running outta time. You need to hurry up and do IVF. And it's like, well actually. I think that there's a whole lot more to it that, you know, than just continuing to apply more treatment when we don't understand why treatment is failing.
'cause it's age is a proxy. It's a proxy for the underlying metabolic factors that are getting in the way. To the healthiest possible outcome, which is, you know, the normal outcome that we are wanting to see when it comes to fertility is you have sex, you get pregnant, you have a baby, we're done. We're no longer having this conversation.
Anything other than that means that you may have investigated some, but there are still missing information. You need to arrive at to be able to transform results. So that's an important consideration for patients in this kind of situation that I, I have to say, [00:38:00] it's one of the most important things in my clinic is understanding why that's, you know, my fertile method that we've been using for the last 24 years.
The f infertile is, is not what you think it's actually fact finding. You know, it's, that's the first step. So it's really important.
Yeah, for sure. And it, it's true. I agree with you. You, you first start with what you can do. Rather than going from zero to a hundred and then going straight for like the hardest medication, which I find happens a lot. And so this is
Oh gosh.
very, it's very important. And from a Chinese medicine perspective, we look at the spleen and stomach and we want the digestive system to be optimal.
You don't wanna rush to do something too strong. You need to take the steps, the proper steps. You can't jump from like, um, no foundation to like the third floor or whatever, you know?
Yeah, absolutely. And you know, and this is the other thing too, is that the escalation of what's required, there is a timing for all of [00:39:00] that, right? And so understanding where someone is to where they need to be, but understanding what are the steps that they need to get there is critically important.
Otherwise, we end up with more of the same. And you know, more of the same usually means no baby. And that obviously is not the outcome that patients are looking for.
So now I, I definitely wanna get to this, um, topic because it's exciting, new and exciting news that you've had, which is that you're currently undergoing or, or working on a clinical trial. And I'd love for you to, you're gonna explain it much better than me, so.
Yeah, no, for sure. I mean, look, you know, I have been going on this kind of scientific joy ride for the last seven years. Um, finally I've graduated from my master's in public health at Harvard, and that was where we did our first study of my patient results. You know, like we had a, a study of. 544 patients going through our treatment and figured out that the live birth rate is [00:40:00] 78.8% and lots of other really interesting things out of that.
And that weed my appetite for understanding more about, you know, how to really answer scientific questions that are gonna benefit my patients. And so I went into the Doctor of Public Health program at Harvard and I'm gradu about to graduate. Yay
Yay. That's
Cannot. Yeah, so May next year is, is my deadline. Um, but as a result, you know, part of what I wanted to really, um, skill up on was running clinical trials.
And so I'm running a clinical trial on testing and intervention, uh, specifically. Focused on how it impacts infertility related trauma, grief and distress. So it's, it's basically a writing intervention where people have a prompt that is the guided prompts. Um, we have two groups. Everybody gets the intervention at the end of the [00:41:00] study, but, um, ultimately looking at, you know, there's a lot of evidence that supports.
In the way that we obviously are, are testing. And the impact in chronic diseases on the emotional component of how people experience their situation. Certainly we know that infertility is a trauma inducing event, right? And so figuring out ways, and unfortunately, even though that is the case, you know, a lot of times people don't.
Get given any kind of emotional support through very difficult, challenging fertility journeys. And so I wanted to really look at something that I have been using with my patients for many years and test it in a way that, you know, I already knew that there was some benefit because otherwise I wouldn't have gone into, you know, doing this particular trial.
But, um, we really are looking at, you know, what is the effect for people who really do self-report [00:42:00] with, you know, a high level of distress on their fertility journey. How can we, you know, is there a way to actually help them to, to reduce that, um, that level of the stress and that level of, of trauma reaction and the, the feelings of grief through the journey.
And, uh, and if so. Is that a sustainable effect? So that's really, these are the questions that this study, uh, aiming to answer. It's called the Inspire Study. Uh, and people can go to Inspire Study online. So, um, that, I'm sure you will put that in the show notes, but. Via study online, we're still recruiting.
We need 220 females for this study. And the reason that we actually chose females only for this particular study is because we wanted to not have to disentangle the effect that could be differential between men and women. But you know, I have a hunch that [00:43:00] the same effect that we would experience in, in terms of improvements in women would be.
Derived in men as well. And I think that it's even a, a, a more important study to be honest, because often if women don't get the support, the emotional support men get it even less. Right? And so, you know, that might be a future study that we'll be recruiting for at sometime down the track, but for now, females over 18 who might be interested in addressing some of their emotional, you know, challenges through the fertility journey.
Can go to Inspire study.online and get more information.
That's so exciting and I'm very curious to see your findings. Um, which I know it takes time. Everything takes time. It's like really something that you have to follow and, um, but I will be sharing this in the. Of show notes and I'll be also sharing it with my own patients.
Amazing.
exciting thing.
And anything that you can do really to give tools to people going through the fertility journey, it could be [00:44:00] so confusing for so many people. And, uh, it, it really is. We we're talking about this before in the, like before the show, is that. A lot of this, and you had mentioned that, uh, people don't even realize that they need it. They don't even think about it because anything that really comes down to mindset or emotions can feel very abstract. And when you're already in that state of mind, it's really hard to see how to get out of that. So having the tools or something that makes it a little bit more digestible or manageable in any way can help so many people.
Tremendously.
Yeah, a hundred percent. You know, it's, it's interesting 'cause my patient this morning was saying this to me. She literally was like, you know, and she had gone through 12, imagine 12 failed IVF cycles and four miscarriages.
terrible.
And, uh, and she said, she said, I didn't realize until I got into your program, I didn't realize how much I was [00:45:00] holding in terms of trauma and in terms of, you know, how much I needed emotional support.
And it's a, it's an experience that, you know, my doctoral chair, the, the chair of my doctoral, uh, committee is um, is an obstetrician gynecologist. She's actually the primary investigator of the Apple Women's Health Study and. An obstetrician gynecologist, and it's really interesting because we were talking about, you know, this particular study and I, and obviously being part of her lab, I was presenting it to the team and one of the big pieces of conversation about it was the fact that so much of the journey that people go through in terms of infertility is emotionally unsupported, you know?
She's extremely excited. 'cause you know, she works at the MG MDH, um, the, the Massachusetts General Hospital here in Boston and she is really excited to be able to, depending on the results, to be able to give [00:46:00] this as a tool for her patients and, and the patients in the, in the hospital, you know, going through IVF to be able to utilize 'cause it's so easy, so easy to apply tool.
It's very effective and so, yeah, it'll be interesting to see results. I'm very excited as well.
Yeah. Well I'm very excited and I definitely wanna be following up on you and I'll be checking it out, um, as it goes. So if you ever have any updates,
Absolutely we could actually do a podcast, um, a show on taking people through the intervention. So
Oh, that would be awesome. Amazing. Yeah, that would be really cool.
let's do it.
yeah, so great. So if anybody wants to check it out, I will have that in the episode notes. um, of course, as always, I really enjoy talking to you. I feel like I learned so much. You have such a great perspective that really has like a foot in both worlds, which I find to be [00:47:00] tremendously impactful. not just having one perspective, you know, really understanding the science and kind of like looking through and working through the data and then also having a holistic perspective on the different modalities can
Thank. Thank you. Thank you. And thank you for helping share the word. I think it's such an important thing that we do this, so thank you.
Yeah. Thank you so much Gabriela.