Geriatric pregnancy is another really horrible term for it, where, you know, women hear this number and they're like, Oh my gosh. It's almost like this, this fear that at 35 all of a sudden, things are going to fall off a cliff, and you're going to have, you know, no ability to get pregnant. You're going to have a horrible pregnancy. And that really isn't the case. Age is a factor, but it is only really one factor.
Hello and welcome back today. We are talking about something that is near and dear to my heart, and that is fertility. When you're getting a little bit older in your fertile years. This is something that a lot of women are thinking about as our culture has shifted to be having babies later in life. This can apply to women, whether they're actively trying to get pregnant or just planning ahead, and this specifically is looking at getting pregnant in your late 30s, early 40s. I record this as I am currently pregnant with my fourth in my 40s. So this, like I said, is very personal to me. There is so much noise out there on Tiktok and Instagram, things that are making you really scared to get pregnant, but also maybe some things that aren't clear enough. And today, we're talking with a very special guest, Dr Miranda Naylor. She is a functional medicine physician who specializes in women's health, hormones and fertility, and she brings a really thoughtful, whole person approach to care, which blends her conventional training, along with an understanding of how functional medicine and lifestyle, functional testing root cause work can support fertility at any stage of life. We're specifically going to cover why ovarian aging and diminished ovarian reserve are a little more nuanced than just your running out of eggs, and this is what you're stuck with. We're also going to explain specifically what's going on physiologically as we age, and how to possibly slow it down and how to support fertility before you're ready to conceive. We also talk about what you can do in your late 30s, early 40s, if you're trying right now. So please tune in if this is relevant to you, or if you know someone who's this is relevant to we're also going to be talking about male factor fertility, so send this to the man who may be also trying to help that woman get pregnant. We're talking about non-negotiables for optimizing fertility. If you enjoy this episode, we would love to hear from you. Please leave us a message and subscribe. Send us a DM, whatever it takes to help us make this podcast as helpful for you as possible. We'd love to hear from you now. Let's get started.
It's never a bad time to start working on your fertility, even if it's like, yeah, I think I want to have kids one day, but it's really not on my radar at all right. Now still doing things to support your overall health now is going to support the longevity of your fertility.
Well, Dr Naylor, thank you for coming on. I am super excited about this topic today, because this is something that I feel like there's not a ton of information about out there. So thanks for sharing your fertility expertise today.
Yeah, my pleasure, happy to be here.
Well, so specifically, we're talking about advanced maternal age, but also what we call diminished ovarian reserve, or sort of what to do when you're trying to get pregnant and those ovaries are not acting as youthful as they should, or as they once did before we get to that, tell us a little bit about your journey, because you treat fertility from a functional medicine lens, what conspired to or what transpired rather, to lead you to this place?
Yeah, well, in family medicine residency, you know, I'm a conventionally trained doc, and in my residency in family medicine, I decided that was a great time to start a family. In retrospect, I was like, Why was I thinking that at the time during this very stressful time in my life? But it seems like a good time. I stopped taking birth control, and I didn't have a period, and I was there stuck in the patient side of things, going, Wait, what's going on? What? What's wrong with my fertility? Why am I not getting a period back? And the conventional approach was very lacking in providing answers, and I suddenly saw it from both sides. Wow. As a doctor, I'm really limited in what I could do in this situation, and as a patient, I'm really dissatisfied with not having answers, not knowing how I can best support my body. I really wanted to be proactive and do something rather than just sit around and wait. So that was my really big aha moment. It was also at the time of just treating people in a hospital, where the conventional approach, I just saw them coming through as this mill and they weren't getting better. And so I was already feeling really inspired to look for a better way. That's when I learned about functional medicine. And was really like, wow, this makes a lot of sense. And so I put those two things together to say, how can we better support women's health, especially fertility with functional medicine? And they just tie together so beautifully that that's where my professional journey began.
I love it, and now you're really committed. You're all in with women's health and specifically fertility with your clinic.
Yeah, obviously, one of these issues, like we talked about, one of the issues that comes up with women having babies, is the idea of, in our culture and across the world, people getting pregnant, women getting pregnant a little bit older in their lives. And I am, you know, you can call me an older mom. Our first baby was born when I was 35 and I'm my mom's youngest, and she had me at 35 so there's definitely a cultural shift of us having babies later. And I always chuckle because I get patients who come to me and are like, I want to make sure I get my kids here before I'm too old. And it used to be that patients would say, like, I can't have babies. I'm 35 and I'm sitting there, you know, very pregnant at 35 and then 38 and then 41 and another question that I hear from patients a lot is, when is the safest time for me to have babies, or is it safe to have babies after the age of 35 or the age of 40? And again, I'm pregnant now with my fourth and I'm 44 and so it's funny for me when patients ask that, and I'm like, you might be talking to the wrong person, because I am that older mom. So this is a topic that's near and dear to my heart. Tell us about your experience with this, about why this is an issue, even just start from the very basic about why are people even concerned about fertility? As we will start with aging, and then we'll kind of expand that to diminished ovarian reserve, because that not necessarily the same thing. But tell us why this, why this is even a topic, and should patients be concerned about it? Yeah, well, you're absolutely right. There is this big cultural shift where a lot of women and a lot of couples want to maybe focus on their career first. They have other things in mind before they want to have a family. And you know, with that, there can be a little bit harder time with couples getting pregnant. Also, there are other things going on in our world that have changed fertility in general. So I think there's a lot more concern for people, you know, they have friends or family who have had struggles with fertility, and so a lot more people are aware of it, which is great in a lot of ways. But there is this worry too, and especially with there's sort of like this magic line in the sand at 35 where all of a sudden you are of advanced maternal age, or, you know, geriatric pregnancy is another really horrible term for it, where, you know, women hear this number and they're like, Oh my gosh. It's almost like this, this fear that at 35 all of a sudden, things are going to fall off a cliff, and you're going to have no ability to get pregnant. You're going to have a horrible pregnancy. And that really isn't the case. Age is a factor, but it is only really one factor, and there's so many other things that go behind even why aging is the factor, absolutely and I think it is good to talk about because in certain communities, on social media and such. I think people dismiss the idea of age being a factor, right? Like, you can get pregnant any time or there's no problem. And the fact is that complications with pregnancy do start to go up a little bit as we age. And those we won't get into that a lot, but some of those things, some of those complications, like miscarriage, for example, they do go up as we age. Can you explain just a little bit about what the idea is with the ovaries aging? Because I think that helps us understand some of the issues with fertility and and potentially with that increased risk of miscarriage as our ovaries get get a little tired out. I love the way you put that. Yeah, absolutely. I mean, one of the things that is most commonly talked about is the idea of running out of eggs. It is true. You know, we're even before we're born, we have something like six to 7 million egg cells. That even goes down to one to 2 million at birth. From there, it just goes down and down and down, and especially once we start ovulating at puberty, that's about like 300 to 500,000
goes down to about 100 to 150,000
at age 30. And you know, from there is dropping significantly. Again, through ovulation, we're losing egg cells. They also die off naturally. It's part of the normal process, and that becomes, you know, again, more accelerated depending on some other factors that go along with with egg aging. So so that's where part of it comes up, again, like age, as you know, a factor with that natural process of losing eggs over time, and that can be a little bit faster for certain people compared to others. There's also just the wear and tear on our cells in general that also affects our egg cells, and that can be another factor with how quickly, again, our eggs are aging, and maybe how many issues they can have, like, basically, the health of the egg cells becomes a factor, especially in those older years. Again, hey, using these older years, but, like, I know five on, you know, it absolutely is possible to get pregnant and have a healthy pregnancy, but there is a higher risk of pregnancy loss, and of, you know, not being able to get pregnant, because those egg cells, while they're they might still be plentiful enough, they might have more damage to them where they're not able to come together and create a health.
Embryo or healthy baby as well as I could have before. Yeah, a lot of this is just sort of normal wear and tear on the body, or excessive wear and tear on the body. And the more that we are doing that ages our bodies that has more wear and tear on our body, then those ovaries are going to be more sensitive. Those egg cells are going to be more sensitive than a lot of our other cell types. Skin cells are another one that are pretty they're pretty good at showing us how well our body is aging. Right? If our body is aging quite rapidly, the skin is one of the first places to show you'll get more wrinkles and the skin will be a little more crepey and a little more thin, whereas, when we're taking really good care of our bodies, the skin can be really robust and bouncy, and all of these things, and the skin and egg cells and a couple of their cell types. Are those really, really sensitive ones that kind of shout out to us when they're like, Ah, we're not okay right now. Yeah, tell us about diminished ovarian reserve as it relates to younger women. Is there anything else we need to say about that, that that may be different than just natural aging? Yeah, so diminished ovarian reserve is basically where we're having a low reserve of eggs, which are basically those, you know, premature eggs that are going to then be able to be recruited and developed and maybe ovulate. So basically, having a diminished number of those, those reserve eggs, and they're, again, you know, some different factors that can go into this. Typically, this is, you know, for people who aren't familiar with this before 40 typically is, is when this would show up. And it's also called things like premature aging or premature ovarian insufficiency, which is maybe a better term to really describe what's happening. And there are some factors that we don't fully understand. There are some genetic factors that go into that, and again, that aging process where, like we said, it's not just aging as a number, it's that biological age of those things that our body's exposed to, and you know, the oxidative stress we're exposed to, the damage that our mitochondria are under for exposed to a lot of toxins, smoking, alcohol, any things like radiation and chemotherapy, chronic stress, which is one that I like to highlight, because a lot of us are living under chronic stress, and many of us may manage it well, but that can be a huge factor. It isn't everything people don't have to you know, think all is lost if they have some stress going on, but that can be a big factor as well as just a poor diet, insulin resistance, inflammation, autoimmunity can be another big factor here that can again create that extra wear and tear on the ovaries. So how do we know the state of the ovaries? How can we evaluate how our ovaries are doing? Are they aging? Well, are they aging more rapidly than they should? Yeah, that's a great question. Unfortunately, we don't have a direct view, right? We can't just, like, put them under a microscope and see how they're doing. So we have to sort of infer from other, you know, data. One I love that you described that like looking at our skin, looking at our health overall, how energetic are we feeling? You know, what is our typical diet and lifestyle look like. That can give us some idea. We can also do some testing, even just basic markers, like looking at insulin levels, looking at a hemoglobin, a 1c and blood sugar, inflammation levels, I like to do a high sensitivity CRP. Those can give us a great idea about you know, is our body under maybe some extra wear and tear. You can also do more advanced functional testing, like organic acid testing, which can give us an idea about oxidative stress, and can actually look at if our DNA is being damaged more quickly than it should be. And that can be really helpful to then compare that to our antioxidant levels and really see where is our balance. If we're completely out of balance, then we have a higher concern for there being more damage. And toxin levels can be great to look at here too, because, again, if we're seeing a high toxic burden, for seeing something like heavy metals being really high or being really deficient in certain nutrients, that helps us combat those things, then we know that, you know, there is very likely a higher, higher level of that aging process. Yeah, Okay, wonderful. I think we should mention, too, a couple just routine blood tests, like an FSH and an estradiol and anti mullerian hormone. Will you touch on those as well? How those come into play? Because oftentimes that's already been done, and people already kind of come knowing that, but tell us what that adds to the picture. Yeah, yeah. So looking at some of those hormones can be really helpful, too. So FSH, and follicle stimulating hormone, is that hormone that's recruiting those eggs to then become, you know, to then ovulate. And that does start to creep up when we're getting into typically for the normal person into perimenopause and more so like mid to late perimenopause, and that's the one that I do like to do for everyone, sort of screening for and if we're seeing that, you know, even being above 10 to 15, I'm getting suspicious if that's in a younger person, because that shouldn't be that high.
At least around like day three to five of their cycle. So that should be a very baseline time where it's below that LH as well, should not be elevated unless someone is about to ovulate. Otherwise, it should really be low for most women. And so if that's starting to creep up, then that can be really big warning sign. And AMH is anti mullerian hormone. This is a hormone that is also producing the ovaries, that is part of the ovulation process, and this can be an indicator of ovarian reserve. It's kind of like the most common one, and there are factors that affect it outside of just the number of eggs that we have, but that's another one where it gradually declines with age, and if that number is way lower than we're expecting it to be, and especially if there are other factors, you know, other factors that can affect that, like vitamin D, for example, if that's in line but the AMH is still really low, then we know that we have a heightened concern about that. Now, in the conventional medical community, it's generally considered to be irreversible that, like, once your ovaries start to age, then you're out of luck. What is the general feel in the functional medicine community? How accurate is that? Because again, I think you can find some, definitely, social media accounts and other coaches and such, who will say, like, Oh, no way. But the answer is probably a little more nuanced. It is, yeah, it's, it's sort of in the middle of that, as most things end up being. It is a warning sign. It is a decline that is faster than than normal. It's not to say that it's all over and you can't get pregnant at all after that, but it is the one thing that's saying, Okay, your clock is going a little bit faster than other people's. And what we don't have a, you know, a crystal ball to say, Oh, it's just one year or two years. We know that if certain numbers are at a certain place, then, you know, we have much less time than they might have otherwise. But there are things that can definitely help that. And some of those things I think we're going to talk about today where, you know, anyone can help, sort of preserve their fertility in a sense, and even those people with diminished ovarian reserve or premature ovarian insufficiency, they can do things to prolong, things a little bit, to help their chances in getting pregnant, whether they're trying naturally or using something like IVF. I'll go back to what you said earlier, which is, we really don't have a perfect way to evaluate ovarian reserve. I totally agree with everything you've said. I remember, this is kind of a tangent, but I remember an episode of that show new girl, which is old now, but and one of the characters on there went and they were gonna test their ovarian quality, right? And number one, I'm glad that this is getting out and that it's coming to the forefront, but it's just the perfect social example of like, real life for a lot of us is like, well, I'm thinking about having a baby, but like, Oh, am I? Am I okay with that? And they had on the show, one of the characters was great, no problem. And the other one suddenly found out that her ovarian reserve was really, really poor. And
I'll say it kind of goes both ways, like I'm I think people should be conscious of it, but we really don't have a transparent enough single look at the ovary to be able for for you to come in and be like, how's my ovarian reserve? And for us to know 100% here's what your ovarian reserve is. So I like the idea of testing, and I like the idea of getting an idea of how our ovaries are doing, and it's imperfect, so I certainly wouldn't, wouldn't have someone panic if they're getting testing done, unless they're also, you know, skipping periods and having hot flashes and night sweats and all of that like that definitely brings it a little more to the forefront that your ovaries are full on, like shutting down, but if someone's cycling regularly, then the rest of Those tests are to help us kind of risk stratify to say, let's, let's maybe see if we can shape things up a bit. Let's see if we can slow your body's stress and strain a little bit better. Anything you want to add to that, yeah, well, I was going to say again with AMH, you're absolutely right. It's like, we think it's, oh, you know, this is our insight into our egg numbers that we have left, and it's absolutely not perfect testing. Something that I always remind people is for one you know, one number doesn't mean enough, especially if there are factors that we're seeing that maybe this is affecting it. Maybe we retest it. It also depends on the timing your cycle when you're doing it, that can change, you know, so, so not maybe jumping to conclusions with one number, and really looking at the whole picture and making sure that you're working with a someone who is really well educated and familiar with this, so that you're being treated appropriately for one they're not, you know, putting you into treatments that you don't need Maybe, and maybe, like, jumping on the fear even more, but then also really giving you the support you need so that You don't maybe miss the window that you have. Well, let's talk about let's start with one patient scenario, and that's a patient who is, you know, married or unmarried or whatever, but deciding to she wants to start having babies. She's 3435
not quite ready today, thinking about it, in the next few years.
Yeah, and comes to you saying, you know, I really want to make sure I'm doing everything I can to support my fertility, because I know I'm going to be having babies sort of on the later, later end of my my childbearing years, so to speak. Let's see how many different ways we can talk around getting old and having babies. But it's really, it's it's words matter. So So she comes to you and she says, I want to do everything I can. How are you evaluating her and and how are you walking through that with her? Yeah, well, I love this type of patient. I have a lot of these types of patients. And, yeah, I think it's a great time actually, to be thinking about things and just saying, hey, like, you know, maybe checking in, seeing what the status of your health is at this point, and then doing things to support your health. First and foremost, the foundations of our health are always going to be the most important start. So if you are totally stressed out, you're not sleeping well, you're not nourishing your body appropriately, you're not moving appropriately, those are going to be factors that we want to talk about and make sure that those are dialed in, because those, while we like to take them for granted, are really the most important factors when it comes to our overall health and preserving our fertility and really helping with that longevity of our fertility. So those are always going to be first and foremost, as boring as they are. Again, maybe doing some testing to see where someone is with their health, and then maybe dialing in certain things again, you know, are you really low in vitamin D or iron, some of these very basic, easy to replenish things, and making sure that, you know, those are, you know, there aren't some warning signs if you are insulin resistant or, you know, really throw it off in some way in your Health, maybe making sure that's dialed in. And then, when it comes to nutrition, really making sure that antioxidants are the forefront. So typical recommend a Mediterranean type diet where it's really focusing on whole fresh foods getting a lot of color. You know, all of those different colors from plants are eight different types of antioxidants. So really trying to make sure that you're getting all those good things in to, again, combat the things that are happening to our body, the wear and tear that's happening, getting those good antioxidants in. And then again, like filling in the gaps in nutrients, there are certain ones that we can test for and really see they're also ones that we just know are really common, like magnesium, for example. So making sure that those are being well supported in the diet. But then maybe, you know, having a good prenatal on board, or something simple that can, you know, give them some good nutrients in addition, where it can be really hard to get through our diet.
When it comes to prenatals, I'm really picky, and kneaded is the one that I personally use and love. It's the brand we recommend most often at uplift for her, because it is so intelligently formulated. It's formulated with the right forms and optimal doses of nutrients your body actually needs before, during and after pregnancy, from their complete prenatal vitamin to omega threes, collagen and other essentials needed cover so much more than the standard prenatal and it's all clean, well sourced and easy to absorb, so I don't have to worry too much about what they're putting in it. I can just stress that they're making a great quality product. When I first started taking the comprehensive prenatal vitamin, it was a lot of capsules, but I felt so much better after a short period of time, and really think that it was a huge game changer. With the amount of energy and feeling like I've been able to stay going during pregnancy and feeling well needed. Also makes a really smart product, which is their powdered prenatal vitamin. So for people who have terrible morning sickness in the early stages of pregnancy that just cannot do capsules, they have a powder alternative that tastes good and can be thrown into water or a smoothie. I just think it's so smart. Why did we not have this before? And then they also have a smaller dose prenatal vitamin, so you don't have to have all the capsules that just covers the essentials, and that's another really good help for the beginning of pregnancy. So if you're interested, you can get 20% off your first order with our affiliate link, which is in the show notes, or you can find it on our favorite products page at uplift for her.com now back to the show yeah, I love that you bring up antioxidants, because the
I think a lot of times we think about what you shouldn't be doing, like make sure not to use those, you know, non stick wear. And I'm not knocking that, but oftentimes we kind of miss the boat on the very basics, and I think underestimate the body's ability just to repair itself and to be sturdy and resilient. I think oftentimes the body starts to break down because we have lack of repair mechanisms in addition to extra insults. And we think about removing the insults, but we don't add the extra repair mechanisms, and those antioxidants are what help our bodies repair. So when we talk about food and diet, there's so many different recommendations and so many different dietary approaches, and it can get really confusing. Of like, Wait, I thought that was good for me, or I thought that was bad for me. And it's important to know what we're trying to target.
Get. So for you, what you're saying is to really support the body's healthy aging, and that includes the ovaries and healthy repair mechanisms, to make sure that as we go through natural wear and tear, the body is replacing those tissues with the healthiest tissues possible. Antioxidants are king, and we get those primarily through those really bright and colorful food. So I'm glad, I'm glad you brought that up in addition to everything else. So you've, you've walked them through the foundations. What are, where are you going next with this person? Yeah. So again, you know, in when someone's coming to me, you know, I do functional medicine. So of course, we're going to talk about the functional medicine things. We're gonna start with the foundations. We're gonna do some testing again to get a really good idea of of what their health looks like. And that can start with very simple tests. Also, usually we're going beyond what is done during a basic physical, but including those maybe being a little bit more comprehensive, and then again, treating those things that we are seeing as sort of a red flag or a warning sign, something that could impact their fertility in the future, even if that's not what they're doing right then, yeah, being proactive. I love that you brought up, you know, all the toxin exposures, and really trying to limit that, that is a huge piece of it, because we are exposed to so many more things. So when you have control over certain things, like, you know, the products that you're choosing, the cleaners that you're using in your household. It is important to try to limit what you can but again, going beyond that too to really working on your repair. And it can be helpful here too to go back to testing, to test both male and female. This is really important when we're trying to conceive, but even beforehand, in the preconception phase, this can be great for a couple to do together, and again, go to get a good baseline. A sperm test is pretty easy to do. Most men still, you know, complain about it a little bit. It'll love. It's kind of awkward, but they can be done from home nowadays, and that can be really great, because it is for for men, it's a lot easier to see exactly what those cells look like. And it can be a great time to see, oh, wow, I do have something that's affecting, you know, my cellular health. What can I do about it now? And even if you're not ready to conceive at the moment, it can be great. And it's even actually more advantageous to do it ahead of time. So those are great things to look at. Start affecting. Okay, awesome. And all of the things that you're talking about for women to do with the antioxidants in the Mediterranean diet and eating for healthy blood sugar, decreasing toxins, those are all the same things that men do to support their sperm. Is there anything else men can do to support their sperm as they age? Yeah, yeah. So for men, another factor comes in, and it's their testes. Basically, the testicles hang for a reason, and heat exposure and other types of damage can also really impact sperm health. So this is more so important when they're actively trying to conceive, and in the three month window before they're trying to conceive, they should really be avoiding saunas. They should be avoiding biking and direct, you know, trauma to the testicles, basically, cold exposure can be on the, you know, opposite of that, and can actually help with this. But that shouldn't have a long term impact beforehand, if they're just, you know, trying to, you know, start working on their health before conceiving the the big things like, you know, to go along with toxins, also using drugs and alcohol and smoking, those are things that that could potentially have a longer term impact, and so starting to wind those down earlier can be really helpful. Well, let's shift gears a little bit then to the patient who is maybe 35 and beyond and struggling to get pregnant. Maybe her FSH is a little bit elevated, or she's starting to show some signs that maybe her body is not easily getting pregnant. What is your work up with them? What is your approach? How does it different from what you've just mentioned? So a lot of is very similar, but we're really dialing things up to get a little bit more aggressive, because again, that, you know, the time frame has changed, and usually when they are coming in that, in that time, they're feeling like, either they wanted to get pregnant two years ago, and so already, every day that they spend not pregnant is like, too long, or they are concerned, okay, but, you know, I'm 40 now. I am healthy, but 41 feels like, so, you know, like it's gonna get harder every year. And so there really is more of a time crunch. And so it's, it's definitely bumping things up. It's making sure that those foundations are really, really solid, and then building up their their antioxidant support, even beyond that, really using supplements, because it can, and you know, for for anyone, again, it can be really hard to get everything we need through diet. And so really bumping up those antioxidants using things like CO Q, 10 Alpha Lipoic Acid, P, Q, Q. There's some other ones that are out there now, like urolithin A which is really exciting. So really getting those, those good antioxidants in to to purposely, almost like use them like a treatment, to really try to counteract that wear and tear that their body is already been under. Where do you go next? Are there any other.
Or functional testing, or any other functional medicine approaches that you're taking beyond the antioxidants you mentioned, yeah, yeah. So again, you know, a lot of the basic testing we kind of mentioned a lot of those. You know, the hormone testing and things like that are always going to be first and foremost. Doing functional testing, like organic acid testing, is another one that I rely on frequently, because it gives us really targeted information to see, like, what is the oxidative stress numbers? You know, their antioxidant levels? Are they getting enough protein or not? Like, there's a lot of really great information that we can get from that. I also like doing stool testing and looking at the quality of someone's gut, because our microbiome can have a big impact. It's really like an entry point into our body, and so that can have a huge impact on our health and our fertility. So when someone is already, you know, they're really concerned about their fertility, they really want to have the best approach, then we're looking there as well. I also like doing genetic testing, which, you know, I think there's a lot of misconception about genetic testing where it's like, oh, it's just DNA. It's just set in stone. We can't do anything about it anyway. But there are genetic factors that we can change. It's called epigenetics, where we can turn on and off genes and the way that we treat our body, the way that we eat and move, those can actually change the way our genes are being expressed. So that's another one that can be really helpful to see. Okay, what factors do you have on board? There are some great panels out there too, that that are purposely for preconception to see. Oh, do you have, you know, risk factors for pregnancy loss or something like that, you know? And then we can be even more targeted again, with the nutrients they need to best support their unique body. So go back a little bit, because you mentioned some important words. There the idea of you mentioned mitochondria earlier, and then you mentioned oxidative stress. What you're talking about there is cellular health, the individual cell. How are cells? And this is especially important for fertility, because the whole act of fertility is reliant on one egg cell and one sperm cell, and they are very susceptible to cellular damage. So maybe first go into a little bit of detail of what, what are cells particularly susceptible You've mentioned a couple of these things, but when we're really getting down to the cell, what things are particularly harmful to to a cell? Yeah, great question. So you know, again, yeah, we mentioned those toxins and things like that, high high blood sugar, inflammation, there are a lot of those things, you know, even our immune system, you know, again, autoimmunity and how inflamed it is, how responsive it is, those things can create inflammatory cytokines that, then, you know, impact our cells. Nutrients are also really important here, where, you know, even just again, you know, we talk about that, the exposure to the bad things, so to speak. But it's also like you were talking about our repair mechanisms, our ability to even have our cells function normally, that can be a big factor. And there are very simple things there too, with with how we can really support those mitochondria, the mitochondria too, to take that back. You know, we think of it as, like the powerhouse of ourselves. They are the energy producers, but they're also these, like sensitive cells that, or I should say, organelles in ourselves, that that can really sense our environment. So, you know, if we're having a very stressful environment, if we're having a lot of toxins on board, they're sensitive to that, and even their ability to turn over and be really healthy can be impaired. And they are so important when it comes to getting pregnant. Mitochondria are in all of our cells, but they are especially concentrated in egg and sperm cells by exponential amounts, because they are so important. There mitochondria in the sperm cells. They're they're imperative to even get the sperm to be able to swim appropriately and get where it needs to be, to be able to get into the egg cell. So we literally can't conceive without really healthy mitochondria. They're also, like I kind of mentioned nutrients. Zinc is, is one mineral that is super important for this. I love talking about the zinc spark. A lot of people haven't ever heard of that. Tell us more about it. Yeah, yeah. So it's, it's when the sperm is entering the egg cell. There is this flash of light that you can actually see on high powered microscope, that is zinc having this reaction to allow the sperm to enter the cell and like, have the DNA be shared and create this embryo. So it's literally the spark of life. And and zinc can be really hard to get in our diet, what with our Western diet, zinc is not very prevalent. And so little things like that can have a really, really big impact, again, on just how are those cells in particular, are able to function, how they're able to, you know, unravel those DNA and bring them together appropriately. Those little steps in the process can be a big factor. And these are things that are important for us at any age. But the longer we can do them, then the less damage there is to begin with, right? If we're eating a diet high in antioxidants and zinc and magnesium.
And B vitamins. If we're doing that for decades, then there's going to be less damage. You know, there just is. If we're eating a blood sugar balanced diet, there's going to be less damage. That idea of oxidative stress, you mentioned, blood sugar, and blood sugar is one of the biggest oxidative stressors there is for the cell, and the longer we can stay in that good zone, then the less repair we need to do last minute when we're trying to conceive. But if we haven't, then today's a great place to start, you know, to say like, Okay, let me stop stressing the cell with blood sugar and toxins, but then let's also add those repair mechanisms for the cell in antioxidants and nutrients and vitamins. I think one of the things that comes up a lot is the idea of taking mitochondrial supports. And you mentioned those, and they they are great, but they're not going to outrun consistent, continued damage to the mitochondria. There's just they're not that powerful. The mitochondria are very susceptible and very sensitive. And so if you're doing things that are damaging the mitochondria, then no supplements are really going to outstrip that. Now, if you've cut down on things that are damaging the mitochondria, and you're stabilizing blood sugar and getting more light exposure, sleeping, well, all of these things that are really good for our cells, then adding the mitochondrial support, I think then there is some definite improvement. There anything you want to add about that? Yeah, I mean, I completely agree you can't out supplement a bad diet or poor sleep, or any of those things. And we want that. We want that magic pill that makes it so easy for us we don't have to make any changes, but it just isn't going to be enough, but, but if there are factors where we're doing our best and we just can't be perfect, big, obvious air quotes there, because there is no perfection when it comes to our health. We have a stressful job and we love it, but we can't quit tomorrow and never work again. We can then do things to bump things up and really be able to work within the lifestyle that we have, the risk constraints that we have. Now, you mentioned toxins a couple times. Will you go into that? What are the things that you really recommend someone who's trying to protect those little, fragile egg cells from or sperm cells from being damaged? What are the big things that we really know can be helpful and you really recommend patients making that investment of time or money to change in their lifestyle, so that their cells can be protected, yeah. So to start with the big, obvious ones, smoking cigarettes, obvious air pollution, you know, trying to really avoid the chemicals that are obviously not good for you. When it has a horrible smell, you know, you get walk into a room, it's like a bad paint smell, or those like cleaning fumes. Obviously, those are going to be the most obvious ones to remove to get less obvious. And you know, the things that we're exposed to very frequently are going to be our beauty products, our cleaning products, our detergents and those types of things, those often times contain things like parabens and phthalates, which we know can be damaging. They can mess with our hormones and cause reproductive harm. Phthalates, typically, we're talking about fragrance. So if someone's just starting off, removing fragrance, or at least any synthetic fragrances, from their products, is a really important starting point. If it says perfume, if it has, you know, any sort of fragrance on there, that's a chemical that you don't understand what it is most of the time, it just says some fragrance. And that's like the hidden chemical names behind that. Those are going to be things that you want to avoid for your general health plastics as much as possible. Avoiding those, especially for food and water. If it's going to be at any sort of you know, it's good. It's going to be heated at all really. Removing those you mentioned, non stick coating on pans and cookware, the plastic utensils. Really trying to get all of that out of your kitchen can be really helpful. Going more for like stainless steel or cast iron can be a great one, ceramic some of those things, or glass for storage. Doing the switch for those can be really helpful. And then again, if there's something obvious, like you're exposed to, you know, pesticides in your neighborhood, because they're spraying regularly for that, or something like that, really trying to to modify how you can maybe getting an air filter, getting a water filter can also be a big one. At least in our area here, we have terrible water quality, and so that's one that we're typically talking about, like, where are you getting your water? Water is essential for detoxification and flushing things out. And if you have terrible things like arsenic coming in in your water, like we have here, you're basically like poisoning yourself as you're trying to detox. So, so that can be a really helpful one that is, is a, you know, worth the investment that comes with that you can look up the quality of your water in your area. Yeah, yeah. So you can look up, and now I'm forgetting off the top of my head, I think it's like tap water database, but you can basically Google this and look up the quality of water in your area, and just be able to see, you'll get a rundown of the things that are present and where it compares to the allowable limits of things.
So that can be really enlightening to see, because it can be surprising. I'm in Southern California, you know, we have mountains not far away. You'd think, oh, yeah, our water should be good, and it's just really not so. So yeah, that can be a great thing to do before you start worrying about it. And then again, maybe considering some, some level of water filter. They're sort, you know, very different levels, from Brita or simple water filter to a very robust whole house filter or reverse osmosis filter. So, you know, sometimes landing in the middle can be really appropriate for a lot of people. Well, I'm glad you say all that I it. I always have two minds about this, because I just am really sympathetic to the difficulty of this journey. You know, having been on it myself and helped so many people through it, the idea of cutting everything out is super annoying, right? And I think there are people who are like, I just, I'm not going to do that. I'm not going down that road. I don't want to think about it, I don't want to talk about it, and I totally empathize with that side of things. On the flip side, we know fertility rates are going down. We know that it's getting harder to get pregnant, and we know that, especially if the trend also is to try to get pregnant older, that that wear and tear is going to start adding up. You know, you're going to feel it earlier in your life. And so when I'm treating fertility, and I'm sure this is the same thing for you, it is a little bit of a time sensitive issue, partially because of aging, but also just because it's emotionally difficult. You know, it's really quite wearing on a couple to be trying constantly for every month, for years, to get pregnant and then to see those negative pregnancy tests over and over, and your periods two days late, so you're sure this time it's real. And you take five pregnancy tests and it's they're all negative, and then your period starts, and it's exhausting and and expensive on the soul, you know, like, it's very draining on a couple and on on the individual. And so
when I'm working with couples for fertility, I've had to shift my approach a little bit, because I tend to be somewhat of a conservative person in nature. When it's like, well, let's try this thing, and then let's try this thing. And if that doesn't work, then we'll get a little more aggressive with fertility. You kind of do have to go all in, especially if we're dealing with fertility in the later years of our fertile years, you don't have time. You don't have time to take a layered approach, to say, let's do this for, you know, three cycles, and then let's add this on, and then wait three more cycles, and then let's add this on and wait three more cycles. You really do have to go all in. And so I just want to draw attention to that, because it is frustrating, and I wish there was a different way, and I wish there were different answers. But the fact is, we know a lot about what could be causing infertility and difficulty with fertility and diminished ovarian reserve. We know a lot that that could be trickling down and causing those effects, but we don't have time to try them one at a time, so you do kind of have to have a little bit of a sweeping approach. Now, if you're 21 and you're like, gosh, I'm listening to this, and I want to preserve my fertility as long as I want, then do one thing at a time. You know, take your time and maybe focus on cosmetics first, and then cookware and then all of these things. But I don't know, I just bring attention to that, because I find it really annoying that it's so hard to do things the right way. You know that it's it can be really difficult to live in our culture and our climate and and still take good care of ourselves, and yet here we are. This is the reality of it. The reality of it is, if we want to return to optimal fertility, we have to be quite aggressive about it, because those ovaries are real picky. They're little they're real finicky little ones, so we just have to be kind of aggressive with it. Yeah. Will you share your thoughts on that? Because I know you can't avoid this when you're taking care of couples who are trying. Yeah, yeah, you're so right. And I take a similar approach to you. You know, I try to be conservative and really realistic. You know, what do you need to change? I'm not the doctor who's putting every single person on a super restrictive diet. I think that's way overdone and unnecessary for a lot of people. But yeah, when it comes to fertility, it is really wearing. I love how you say it's expensive on our soul, just like it's very tiring. It's very exhausting and very heartbreaking. And so we definitely do want to bump things up. And really, you know, get more aggressive, really do more things. And it's, it's hard, even as a practitioner, it's finding that balance of, you know, how can we still be strategic and work with the body in the best way that it's going to respond to things and not overwhelm the person? Because still, it can be overwhelming if you're just throwing a bunch of really difficult to take supplements or, you know, things that, like, the timing is complicated, it can be very overwhelming. Yeah. And so it's, it's marrying that like, okay, let's, let's really get on top of things, but let's also be strategic, too. And I always talk with people, you know, what can you take on right now? Are you at a place that.
That you can really shift things or not. You know, doesn't mean that if they're like, I really want to be pregnant, but I just can't take on that much. Doesn't mean you have to just not do anything. Then we can still meet you where you are. But most people are very motivated to do a lot and make some major changes at this time, which is also very inspiring to me, to see just how dedicated people can really be with their health, but, yeah, you know, we want to make sure that we're not, you know, wasting time, so to speak, or, really, you know, spending that, that time where they're just guessing. And one of my big goals is, really, because it's hard, we can't guarantee pregnancy outcomes. We can't, you know, guarantee that each person is going to, you know, have exactly what they imagined. But I what I really prioritize giving people is confidence and feeling really supported and held during the process, because that can just make it so much better and feel better on your soul when you're going through it, and give you better outcomes. Well, thank you for sharing that. Yeah,
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Yeah. So especially, for example, if you have mold toxins on board, sweating is amazing to get those types out. Awesome. I think one of the things that I see with patients is they'll say, like, oh, yeah, I do all of that. And so really being picky about again, I tend to be more of a conservative, like, Okay, if you think you're doing enough. But when we're really trying to get better, and we're really trying to repair the body, we have to be a little bit picky about how aggressively we're doing that. And I think for I don't know what you tell people for cruciferous vegetables, but cruciferous vegetables and the dark bitter greens, I mean, like, two servings a day. And so when people say, Oh, I eat a lot of broccoli, how often do you eat broccoli? Like, once a week, we're talking about a lot more broccoli. You know, it's a lot more. It's cauliflower with lunch, and then broccoli with dinner, or Brussels sprouts next to your eggs and and spinach with your lunch. Like, it's really a big amount. Do you have a different amount that you're recommending? I mean, usually tell people at least one serving a day, but you're right. Like two, even better. And I like to talk about the different ways you can get it in so they can kind of wrap their head around it. We think, like, oh, broccoli. Like, it's just steamed broccoli. It's like, that is the only way, but that can get kind of boring. And so it is talking about the different types, how you can integrate them in. Actually, just recently, I haven't tried it yet, but saw on Instagram a broccoli bread recipe, and I'm like, Cool. Like, that's amazing to get it in a different form. I love talking about sprouts too. Here, like broccoli sprouts, it's a great way to get those nutrients from it. And they're even more potent in the sprout form. And they can be they can feel a lot easier, especially for certain people. They maybe if they have got stuff going on, they get bloated with eating a lot of veggies, especially cruciferous veggies. So doing sprouts can be great, where they can digest it a little bit better also, but then get these really potent forms. Well, that that goes back to one thing that you mentioned earlier. I wanted to come back to one of the functional tests you mentioned. Was doing stool testing and looking at the gut and looking at gut health. Are there specific things that you're looking at with the gut when it comes to fertility, per se. Like, obviously everything about the gut should be optimized always, like, that's always what we're looking for. But is there a specific approach that's different when you're dealing with fertility? Yeah, yeah. So, like you said, I mean, all of the things are important, there are a few things that we're especially looking at. One, you know, with a microbiome, there are good bacteria, there are bad bacteria, there are yeast and all these different critters in there. And really making sure that balance is in a healthier pattern can be important. We also now have other microbiome testing, like vaginal microbiome, but our microbiome sort of speak to each other, and so if we're seeing a big imbalance in the gut microbiome, we can be pretty sure that they're more prone to imbalance in other microbiomes in their body, so maybe more prone to skin infections, for example, vaginal yeast infections, and that can impact fertility. There are certain types of vaginal bacteria strains that can actually kill sperm. And you know, if there's inflammation there, that can be another factor too. And even now, there's more going into more research going into looking at the uterine microbiome. We used to think it was a sterile environment, but now we know that there are actually beneficial microbes there too. And so again, kind of starting it can be a great place to start assessing the microbiome in stool, testing another thing is inflammation, just seeing if there's a high amount of inflammation there, if so, you know, we're much more concerned about inflammation, systemically throughout the body, which, like we talked about, can just really increase that wear and tear on the body. We can also look at detox factors in the gut. So one is called beta glucuronidase. It's an enzyme that's produced by some gut bacteria, and can actually mess with detoxification in our gut, particularly of estrogen metabolites. And so looking at that can also be really helpful too, especially if someone is maybe, you know, like, a higher estrogen state, or they're having symptoms of higher estrogen seeing that we're like, Okay, now we're seeing, you know, a factor in maybe they're having a harder time clearing out estrogens. So that can be really important as well. That's great. I'm glad you brought up the vaginal microbiome, because it it just reminds me, oftentimes, when we see women say she's 38 and she's trying to get pregnant for the first time, and it's taking a while, oftentimes the first thing we're thinking is like, Well, it's because you're getting old, right? Those old ovaries, they're just not what they used to be. And that's not necessarily the case. I think you've mentioned several things now, you know what we're specifically talking about is diminished ovarian reserve. But not all 38 year olds have diminished ovarian reserve, right? I think there are some times when just because you are not 25 years old and you are struggling to get pregnant, it doesn't mean that it's because your ovaries are unhealthy. It could be that the vaginal microbiome is off. It could be that your tubes are blocked. We haven't even gone down that road, but, yeah, but it could be your partner, like, oftentimes there's just this assumption, like you are a woman over the age of 35 therefore your fertility issues are because of your age, and that's that's just not the case.
We can still approach it from the perspective of a holistic approach to healing and supporting hormonal health and fertility, instead of just assuming that it's diminished ovarian reserve. Now, if the AMH is low and the FSH is high and the estrogen is low, and you're having any symptoms of perimenopause and stuff like that, then it makes more sense to really target the lower ovarian reserve, but it's just you can't really take anything for granted when we're dealing with fertility. And I'm going to come back around to it yet one more time, that male fertility is at play here. So I don't care how old the woman is, it could still be the male it could still be the male factor playing into it, and it's a waste of time to just be focusing on the woman over and over and over. If I have a fertility couple that's on the younger end, and she's not ovulatory, then I may not test the male right away, although more and more I do anyway. But if she is ovulatory, and things are at all looking okay with her. I want to know about him day one. I want to know about his metabolic health and his stress and his inflammatory symptoms and what his sperm look like. Instead of waiting until you've optimized everything you can with the woman and you're still not getting pregnant and then finding out that male factors and issues so I'm glad you bring up the vaginal microbiome and the gut microbiome to just show us that I think especially the gut microbiome, can contribute to what appears to be diminished ovarian reserve with inflammation, but it also can just be an issue in and of itself. Yeah, yeah. I'm so glad you bring that up, because absolutely the same fertility issues that can be for someone at a younger year could also be impacting here, especially when you've never tried before. You've never gotten pregnant before. You know, there's nothing to say that it's not just endometriosis or something else like you mentioned block two that's actually the culprit. And unfortunately, the conventional approach, luckily, you know, rather than making you wait for a year of trying to conceive, they only make you wait for six months at this age. But it's still very focused on age, and the conventional approach, like, you know, doctors will be very quick to refer to IVF in the later years, and it might still not be successful, because they could have one of those other issues going on. It is 5050, when it comes to male and female fertility factors. It's actually a third female, a third male and a third both. So it really, you know, both partners are really important in the process. And unfortunately, even to this day, there's so much more focus on the female. It's like, because she's the one who's getting pregnant, she's the one who's carrying the baby. And when it comes down to it, even pregnancy loss is 5050, with male and female factors, regardless of their age. So absolutely, it's very important to talk to both partners and be, you know, ideally, doing testing for both, you know, at the least, changing their lifestyles. So many, you know, men are resistant to, unfortunately, there's sort of this, like, air of, you know, the masculinity comes in. And I think it's like, still thought that it's like not masculine to have something wrong with your sperm, but it is so common. And so if both partners can be a team in this and really make these changes together, do the testing together, their outcomes are going to be much better across the board, and most likely, they'll save a lot of time and heartbreak. Yeah, for sure. Are there any success stories that you can share with us? Anything that comes to mind of couples that you have seen this process work for where you can address their foundations and address their inflammation and address their lifestyle and really see pregnancy happen? Yeah? Yeah, absolutely. I mean, I've had a number,
I can think of just one good example, yeah. I mean, when there was one couple in particular who kind of, like fits his age group, where, you know, late 30s had been trying to conceive for a couple of years, and it wasn't working and and it really, you know, there were some factors as far as inflammation and things like that, that needed to be addressed. But it was sort of like a perfect situation where we address the foundations. We did the testing again. We don't wait around to do the testing, you know, we do it up front, address some things like some gut health things. And really quickly, even after a few years of trying with no success, it was like, I think it was, you know, four months later, or something like that successful pregnancy. I think at this point they now have another child. I think they've already had the second child also. And so it was just a great example of just how, how things can move smoothly. And it's not to say, you know, to point out that on the other side, there are other couples who are doing everything right, and they're, they're trying so hard and pouring everything into it, yeah, and it's not coming around easily. And I think it's important to say that also, even though, you know, I think a lot of practitioners don't want to, like talk about those, they want to talk about their success stories. But there are also people who we just, we really don't know, unfortunately, still, you know, we're looking at everything. We're treating the talk.
Since we're going deeper with testing, and it's still just really we don't know why they're not getting pregnant naturally. And luckily, we do have other resources, you know, like all the IVF process and IUI and things like that, when, when we are stuck in that situation. But luckily for most people, they respond really well and are successful after doing these things? Well, that was my next question. So I'm glad you brought it back to that it it does make it feel like if you do everything perfectly, then it will work. And as we know, anyone involved in any sort of aspect of pregnancy, people's bodies do whatever they want to do, you know, they don't always play by the textbook. So it's, it's important to not feel guilt or shame if it's not working. It's one of the things I tell especially with my PCOS patients. You know, I get PCOS patients, they've lost weight, they've managed insulin resistance, they've they've fixed the inflammation, and sometimes it still is just not coming online. And we do a little bit of fertility medication, and they do great. And that's what I tell them. Like you, you don't get a gold star if you if you manage to do this without fertility medication, but if we can get your body as healthy as we can get it and then tip you with, you know, a little fertility support, then that's okay too. That means that we're still improving pregnancy outcomes and hopefully postpartum outcomes as well. So guys don't always, they don't always play by the rules, right? And it's not all or nothing. I think when we pigeonhole ourselves into thinking, Oh, we're just going to do it naturally, we're just going to be completely holistic, then we're missing out on opportunities that we have. So I agree, you know, I don't recommend people just jump to IVF, because it's not a guarantee. And you know, if the health of their body isn't in line, then then all of the outcomes are likely to be poor. But yeah, if they've done all the due diligence and they're like, I'm just, I really can't take another, you know, year of waiting and guessing, it's like, then do what's right for you, you know. So, yeah, I'm glad you bring that up. Well, we are out of time. Is there anything else that we've missed? Anything else you want to say as we finish up here? I mean, I think we really covered everything. The thing I'll just go back to is, you know, it's never a bad time to start working your fertility, even if it's like, yeah, I think I want to have kids one day, but it's really not on my radar at all. Right. Now, still doing things to support your overall health now is going to support your the longevity of your fertility. So it's, it's great when I have people come in earlier, I love to see that. And really, you know, getting that going right off the bat is awesome. Well, thank you so much, Miranda for being here. Will you tell our listeners where they can find you? Yeah. So I'm on Instagram at Dr Miranda Naylor, and go to my website, Dr Miranda naylor.com
I have some great resources there. I have my own podcast as well called Modern women's wellness. It's on all the podcast platforms, wonderful. Yeah. And on my website too, I have a free resource for a fertility nutrition guide. So that can be a great thing. You know, we talked about a lot of the big things there, but that can be a great resource to really know how to build out your plate and to best support your fertility. So, so that's on my website as well. And where do you see patients, um, swim in Encino visa, California. And I see patients in Solana Beach, California as well. And virtually, yeah, so only to California residents or, um, yes, in terms of full medical care, but we do have some ability to some health coaching outside of that awesome well, thank you again for being here. I think it's been hopefully a really helpful conversation for people. Yeah, definitely. My pleasure. Thank you so much for tuning in to today's episode. A huge thank you to our guests for sharing their insights and time with us. We are grateful for the incredible support from our sponsors and to all of you listening. We couldn't do this without you. If you enjoyed this episode, please consider subscribing on your favorite platform. You can find us on our website, uplift for her.com, YouTube, Apple podcast, Spotify, or wherever you love to listen. And if you found value here today, please share this episode with someone who would benefit from it. Leave us a comment or give us a review. It really helps us reach more listeners like you. Thank you for being part of our community. Stay tuned for our next episode. Lastly, this information is for educational purposes only and not intended to be medical advice. You.
