Advantages of Being An Older Mama and Self Prescribing Do’s and Don’ts with Dr. Iva Keene – #22

0:27 Charlene Lincoln: Welcome back to another episode of The Fertility Hour. I’m going to say this in the very beginning and I’ll probably say it again: If you like the content, if you like the guest then please subscribe. It just shows great love and support and we will continue to do this great work. We work very hard to get you the best guest we can, we search all around the world. So, please support us by doing that. Thank you so much.

And welcome back. I have Dr. Iva Keene with us today. And I’m always excited to have you here. So welcome, Dr. Iva.

Iva Keene: Thanks, Charlene. Thanks for having me.

1:08 CL: You’re welcome. Okay, so if you want to find out more about Dr. Iva, her website is natural-fertility-prescription.com. She is a naturopath. She is based in Verbier, Switzerland. You can find out more about her in the podcast notes because I’m going to go right to the questions. But she has been helping couples all around the world for over 10 years now. She’s amazing. You might have heard it from another podcast she helped me get pregnant and I had my daughter at 42. So I’m a big fan and I always love the opportunity to ask her questions. She’s so knowledgeable. So let’s get right to it. And Dr. Iva had her daughter Ella at 41 and so we’re both really fortunate to be older moms because that’s a whole different, interesting phase of life. I’m thankful for it. I think I’m a more patient person now. What about you, Iva? Has it been a very good experience being an “older” mom?

IK: Look, it’s been great because, I mean, we all have different histories and there are lots of reasons why women delay having children and that can be so individual. But I love having Ella in my life. She completely changed my life. I’m incredibly grateful for her and every day she grows a little, she changes a little and she’s just becoming this amazing person. Not that she wasn’t amazing when she was born but it’s just this continuous growth and just how they develop and the love they show and express. That’s so amazing. Yeah, I love being mom and honestly, I don’t know what I would have been like as a mom if I had kids in my 20s. I’m a very different person now than I was then and, yeah, I think these things happen when everyone’s ready.

3:30 CL: Yeah, absolutely. I honestly don’t know if I would have been a great parent in my 20s. I’m just a little bit self-absorbed, so like all of us and I think that’s the time to do it, I’m always impressed that people can be great parents and they’re younger. I think, wow, that’s a very unique individual because it is huge. They give so much to you and you sacrifice. It would have felt more of a sacrifice back then than it does now. Now I feel like, “Oh, it’s not a sacrifice at all. I’ve done all that, I don’t care.”

Anyways, so I wanted to ask you a question about AMH because I think there’s a lot of emphasis put on that and I know you probably get asked this all the time, how do I increase low AMH? How does one naturally increase low AMH? Just give us some background information about when it’s important and when it’s not as important.

IK: Sure. Look, AMH is a bit of a misunderstood hormone because it’s not like FSH which can vary; it can go up and down depending on where you are in your cycle. AMH (anti-mullerian hormone) is a hormone that’s produced by the primordial cells which women are born with. So these are the cells that have the potential to become egg cells. They’re not egg cells yet. And from puberty until menopause, every four months, 5 or 6 of those primordial cells are selected for maturation and they undergo this maturation process that lasts approximately four months. Only 1 or 2 make it for ovulation. So these cells are producing the anti-mullerian hormone and this is used by IVF clinics to determine the level of stimulation drugs to use in an IVF cycle. The lower that number, the poorer the ovarian response.

There is actually a gynecologist in the UK, Dr. Nikolaou, who said that antral follicle count, AMH, these tests should really be called ovarian response tests and not ovarian reserve tests because they tell us nothing about a woman’s ability to get pregnant naturally with her own eggs even if antral follicle count is low, even if AMH numbers are low. So these numbers, these figures are only important for IVF so that they know how well a cycle will go and they know how many eggs they can retrieve. Obviously the smaller the number of eggs that can be retrieve, the poorer the outcome of IVF. So IVF works then better for women with better AMH numbers and higher antral follicle counts. So women in their 30s rather than women in their 40s who naturally have a lower AMH number because they’ve already ovulated quite a few eggs over their fertile years.

Now, what we also know is that at the time of menopause a woman still has anywhere between 500 and 1000 eggs which never developed, and menopause starts because of the breakdown of the communication between the pituitary and the brain and the ovaries, and not because the ovaries ran out of eggs. So that also tells us that, again, these numbers are important for IVF but not for natural conception. It simply means that you need to work on improving the quality of the eggs that you do have left. Now, we have seen some women have a slight increase in AMH after they do a full preconception program, take all the supplements, clean up their diet, clean up their lifestyle, remove all the toxins or most of the toxins, you can have a slight increase and it doesn’t mean that suddenly you have more of these primordial follicles. It simply means that those follicles that you do have left, more of those have become active. They’re now available for selection and this maturation process.

So really, don’t panic about your AMH numbers. I mean, of course, it always depends if you have to use IVF or not, if you have blocked tubes. Some women and some couples simply have to do IVF. So for them, I will just say try and optimize your eggs as best as you can. We had one patient who was 44 when she came to us and she had to use IVF and she also had low AMH. They could never retrieve more than 2 or 3 eggs and then after she did a program they retrieved 12 and called her a “medical miracle” at 45.

So again, it is possible if you make changes. If you don’t make any changes, if you don’t adjust anything, then the chances of improving are not there. You have to change something if you want to see different results.

9:12 CL: I was reading one comment from a woman. It was sort of confusing to me. She said, “I have low AMH so my doctor is telling me I need to rush into IVF.” But if you have low AMH then you wouldn’t be a good candidate for IVF? I don’t know, that was a little bit confusing.

IK: Yeah. You get lots of confusing and mixed messages out there and a lot of it just boils down to statistics which are based on extremely old data. And yes, for women in their 40s if they don’t have to use IVF because of tubal issues or because of some other anatomical abnormalities or problems with the man, then they should really just try and optimize their natural fertility as much as possible and just keep trying each month with the right timing because if you get the timing right, you’re also increasing your chances of getting pregnant than if you don’t. So that’s sort of where the focus should be and even if you do have to fall back on IVF, you can do as much as you can to improve the quality of those eggs that you have left.

10:26 CL: Thank you for clarifying that. I came across some fertility statistics and they were based on I guess some data from rural France between 1670 and 1830. I think you showed me that information. These statistical numbers, yeah, what were they saying and does it represent I guess today, our modern age?

IK: Well, look, this interesting statistic was reported in an article that was published in 2013 or 2014, I believe, by a psychologist who wrote The Impatient Woman’s Guide to Pregnancy. She actually came across these stats and she observed that women always thought if they’re in their 30s they have about 20 percent chance of getting pregnant per cycle and women who are 40 only have 5 percent chance of getting pregnant per cycle. So if she started questioning “where is this coming from?” “which stats are all these people quoting?” And so her research led her to an article that was published in the Journal of Human Reproduction which was quoting these stats from church birth records from, yeah, exactly was it 1670 until 1830 and it showed a rapid decline in birth rates when women hit 40 or 41. That was kind of the cutoff point, no more kids were born after that. But you’ve got to remember that women back then started having kids when they were 15 which meant by the time probably when they were 25 they already had all the kids they wanted. And yes, mortality rates were much higher because they were no antibiotics, no running water, no electricity. Who knows what kind of hygiene people had access to? And so on. So of course, all these factors play a role but also the life expectancy was much shorter then and people were regarded as really old people when they were approaching 40.

So I think we can really rely on this information and this data that’s 200 to 300 years old but yet the same sort of numbers keep showing up in many fertility clinics. They’re still all saying the same statistics which is not true. Some other research and statistics from 2013 show that – I made some notes here – out of 3000 couples in Europe, 78 percent of women aged 35 to 40 got pregnant within a year if they were having intercourse during their fertile time. So that’s 35 to 40 in a group with 3000 couples. That’s a lot. And 78 percent got pregnant within that first year. So that obviously shows a completely different picture to what a lot of clinics are quoting. And also, another study showed that women aged 40 to 43 who already had at least one child had 60 percent chance of getting pregnant within six months. Again, that’s not statistics you hear when you look at some of the numbers that are being shared.

So you have to do your own research. This information is out there; this is not secret. You got to question because statistics are so easily manipulated. You can also turn every statistics around to make it sound scary and to make headlines which is what media reporting sometimes is all about. They want their articles to be read so they have to catchy titles and get people to read them. They will use fear as a way to get their reading rates up, I guess, and so you just have to be careful about how you’re interpreting these stats and don’t really just panic and take it as a gospel.

15:16 CL: But then there’s people listening and even if they did look at the statistics, I guess if you’re struggling then you feel like it is an age thing. Like, “Oh, if I tried 10 years prior or whatever, I probably wouldn’t have these same difficulties.” So it’s a little contradicting in a way.

IK: I hear what you’re saying and the thing is that most people who, unfortunately, today most of the statistics are derived from IVF clinics and, obviously, people who end up going to IVF clinics are those people who have issues trying to get pregnant. It’s kind of all just lumped together. So if someone is 42 and has blocked tubes and hasn’t been able to get pregnant for the last 5 years, is it really age related? Or is it due to the fact that her tubes were blocked the whole time so she couldn’t get pregnant all this time. Or the man had poor quality sperm for whatever reasons all this time as well. So, is it really then the age factor? That’s kind of what you got to ask, and yes, of course we see from statistics that while you can get pregnant when you’re in your 40s, it just may take you much longer to achieve that pregnancy and you may need to try like literally every month for a year to be successful, even longer. Whereas if you’re younger, it may take you three months or six months. But again, it depends on what other factors you have. But if you address all the underlying issues, then you’re increasing your chances of getting pregnant in spite of your age.

So age doesn’t really become the main factor. It’s just that the way statistics are presented at the moment sounds like the age is the main factor and then everything else comes underneath. It’s not really like that. It’s everything else that comes on top and then your age is an add-on factor that tells you okay, because of your age, you have a natural decline in fertility which is normal but it’s still possible. But if you address all these underlying issues, your chances are increasing. So you’re kind of erasing some of that age factor too if you can prep your body and help those cells mature because they’re really not older than four months. They’ve been there since before your birth because they formed when you were an embryo in your mother’s womb but they’re in their dormant state until your body says, “Hey you, you’re up for maturation” and that’s when that cell wakes up and starts maturing. So that’s kind of also the message we’re trying to share with women because it’s just so sad how many women and couples are devastated or come out of fertility clinics crying because they’ve been shown these numbers which basically tell them you’ve got zero chance of getting pregnant because you’re 43 now and those statistics end at 41. So it’s not going to happen.

18:26 CL: Yeah, it could be devastating but it also can be motivating like it was for me. When I heard the statistics, it made me go, “Well, I need to increase those statistics.” Don’t think of yourself as the average of the population, hopefully you’re not and you’ve lived a good lifestyle because I was thinking “oh”, I’m not an average statistic and I need to just increase that. And that’s where I think a lot of people searching you out, they go, “Okay, well yes, the age is a little part of it but I can do so much to increase my success.”

IK: Absolutely. When you are in your 40s, you’ve got lots of advantages. You’ve worked on your career, you’re financially more stable and you can look after yourself better. You have kind of your life more or less under control or at least some routines in your life which a lot of 20-year-olds don’t have. So I think Tina Fey made a funny comment about how they’re basically advising women to get pregnant in their 20s, and she said, “When I was my in 20s, I was living above a biker’s bar and I was earning $12,000 a year. I wouldn’t have been a great mum.”

19:55 CL: Right.

IK: Then she did I think get pregnant in her 40s. So there you go. You just have to do your best, work with what you have and give it a go.

20:12 CL: I agree. What about timing? You were talking about timing in intercourse and how important that is and kind of brings up a couple of questions I want to ask you about. Charting – which I’m a big fan of and I always try to educate people on charting because some people go, “Well, why do I need to do all that? I just use the ovulation predictor kits,” which I think they’re some shortcomings with that even though it seems very convenient, etc. So, intercourse timing is crucial and of course it can reduce the time to conception. So talk a little bit about that. Because I think a lot of women are taught like day 14 is your day of ovulation and that’s a big myth, I think.

IK: You can learn how to chart not just to help you pinpoint ovulation but also to learn about your cycle. It shows you how long your luteal phase is, how long your follicular phase is, it shows your temperatures. If they’re consistently low, they can be a sign of poor thyroid function so that can be a sign that you may need to have your thyroid checked. If your luteal phase is shorter than 10 days, then that doesn’t give your body enough time to prepare the endometrial lining for the fertilized egg to implant, so that can be an issue. It can be progesterone issues. So you can learn so much from a chart.

The main issue people have with charting is measuring their temperature and making sure they had enough sleep. This becomes quite problematic for women trying to get pregnant with their second baby if they have a young toddler in the house and they wake up in the middle of the night, they come to their bed or you have to go to see them and so your sleep is disrupted. Then you have to go to the bathroom.

22:08 CL: Right. It’s true.

IK: So mothers say, “Gosh. I have no idea if these temperature readings are correct because I’m getting up and I’m not sleeping properly.” So you have different options today. You have the Ava bracelet which measures all your data while you’re sleeping and so it’s measuring averages, so it doesn’t matter if you got up. For some women it makes no difference if they actually get up out of bed or not or it’s a tiny little difference. But I don’t think it makes a big difference. So I always advise women, “Look, just measure anyway and compare then you will know what your body does and where you’re at.” But in any case, I think if you chart for three months it will give you a pretty good idea of how long your cycle is.

So going back to your question about 28-day cycle and ovulating around day 14, that’s not always the case for every woman. If your cycle is 26 days, you’re probably ovulating earlier than 14 days. But it doesn’t have to be. It could be just that your luteal phase is shorter which is why it’s good to measure that. So there are a few apps a lot of women like using. Fertility Friend, I think, then there’s Natural Cycles – these are apps which help you plot your cycle so you still need to do the measurements yourself. Or you can also use computers like Baby-Comp or the bracelet Ava as I mentioned. So there are a few gadgets out there that can help you with this.

The problem with the ovulation sticks is, one, they cost money. Two, different brands can give you different results and sometimes if you’re not using the expensive digital ones, you could just rely on the ones that show you a couple of lines then you kind of go, “Well, is this a really faint line or is it a darker line? Let me do another one.” So it can cost a lot of money, plus on top of that, they’re looking for LH surge. LH surge precedes ovulation, so they can give you a positive result for LH surge but you actually don’t know if you ovulated.

So I’m a big fan of cervical mucus and observing your fertile mucus because that’s a true predictor of what’s going on because when your body is producing lots of estrogen leading up to ovulation, you’re going to be producing lots of fertile mucus or the super stretchy egg white mucus. That is a sign that ovulation is coming and it’s this sort of mucus where sperm can survive and so you really want to have your intercourse when you see that fertile mucus because you want a medium for sperm to travel to the uterus and then continue their travels to the fallopian tubes and that fertile mucus is also protecting them from bacteria in the vagina and it’s feeding them. So it’s a fantastic medium for the sperm to reach your fallopian tubes and it’s kind of your body’s way of telling you now is the time. So try to really learn how to measure your mucus and it’s not something that you have to obsess about as well and make extra trips to the bathroom to check it. You just check it in the morning when you wake up when you’re going to the bathroom anyway, once in the afternoon and once in the evening, and you just leave it at that. You can also pay attention to how it feels when you’re walking – does it feel wet and slippery, or dry? Some women just go by that as well. They don’t necessarily check. But some would like to check especially in the initial months where they’re not familiar with it until they get a bit of a feel for the cycle.

So I recommend at least for three months, chart with temperatures and observing mucus and then you’re going to have a pretty good idea of what’s normal for you and you’ll be able to pick up any abnormalities. When your normal cycle is not recurring or like I said, if your temperature is too low in the first half of your cycle could be a sign of thyroid issues.

26:38 CL: It kind of brings up another couple of things too because I think that it’s not totally uncommon for some women to not really have, like “I don’t know if I have cervical mucus, I don’t feel it.” So then that could be a sign of estrogen deficiency, right? That’s another indicator.

IK: It can. Some women just don’t produce enough, so it doesn’t necessarily just have to be estrogen related. It could be that they’re not drinking enough water or they don’t have enough manganese which you need for production of fertile mucus or production of mucus and secretions. Same with men when it comes to sperm. So it could also be due to trauma to the cervix and the cervical crypts. Some women, if they have to have laser treatments of the cervix because of HPV or something like that, that can damage the crypts so they’re just not able to produce. For some other women, the cervix could be damaged from the birth of the first child. So you got to just look at all these different factors and not just jump to a conclusion that you’re low in estrogen. This is what we see a lot. When clients come to us, they just take so many herbs and so many supplements because they read this is good for progesterone, this is good for estrogen, this is good for that. And it can make a real mess. Because you’re basically instructing this incredibly intelligent endocrine system what to do, so you’re telling it what to do and your body just knows exactly what to do and how to do it. But if it’s not doing something properly, it’s because it has an issue with something so you just need to find out what it is rather than just quickly try everything under the sun hoping something will work.

28:39 CL: A very good point. I guess I was thinking like don’t make the assumption, like that’s when you maybe get a hormone panel done. But I agree like the dehydration and those things can definitely be an underlying factor. What’s your thoughts on, what is called, Pre-Seed lubricant or something? Is that for when women feel like they have insufficient cervical mucus they’re recommended that? What’s your thoughts on that?

IK: That’s one lubricant that’s been shown to not damage sperm. The problem with a lot of the other lubricants is that they can damage the sperm because they have too much water or too little water and that change in the fluid around can actually kill the sperm, so you need to aim for that perfect pH. So that’s one option that can be used. Then I think in different countries you may have different brands. I think here in Switzerland there’s something called Prefert. It’s also a type of lubricant that is especially designed for conception. And also, you need to sometimes just check if there is any fertile mucus around your cervix. So you may not have enough or not enough comes out so that you feel it in your vagina or see it in your underwear. But it’s actually around your cervix. So you can just check a few times because if it’s around your cervix, it’s enough for conception. When you have intercourse, the sperm are going to be deposited there and it’s waiting for them there. So that’s something to also consider.

30:22 CL: Okay. You were talking about not self-prescribing herbs. We’re all sort of guilty of doing that. I mean there’s so much information, a lot of good information out there but of course, sometimes we feel like more is better. I know it’s kind of not. But anyways, talk about some of the key nutrients that all of us should be taking who are trying to conceive and kind of some of the pitfalls of self-prescribing herbs you have seen when women and couples do that.

IK: Look, I think we need to differentiate between nutrients that are body needs to make cells just basic building blocks. Then we have nutrients which can impact our hormonal balance, so herbs would come into that picture. So things that everyone should be taking in my opinion are good quality omega-3’s, some fish oils especially from krill or from fish, not from linseeds. A lot of vegans and vegetarians use linseed oil and, unfortunately, we don’t convert enough of linseed oil to a form that our body can use. We can only convert about 20 percent if we take it together with a source of sulfur, so some yogurt or an egg or broccoli or something like that. But even so, you’re only converting 20 percent. So that’s a really important nutrient because you need it for egg cell and sperm cell development, for hormone balance to keep your inflammatory markers in check and also for your mental health. Brain is made of DHA fatty acids so when you’re dealing with infertility, you need a lot of that support so you don’t become depressed and anxious, so it’s super important.

The other one is CoQ10 or ubiquinone, a form of it which is really important for mitochondrial function. Mitochondria are cellular engines. So these are the nutrients you would need on a regular basis. This is just to keep your engines running, the engines inside our cell running as well as they can especially for egg cells and sperm cells because if these engines don’t run very well, then there is a greater room for error and also problems with DNA replication can occur. So this is where we’re seeing chromosomal issues and this has been linked back to older age moms and women trying to get pregnant and the fact that they have all their eggs because the mitochondria are not functioning as well.

So vitamin D is another crucial nutrient because it’s a prohormone which means it’s a precursor to steroid hormones, so estrogen, progesterone and testosterone. It’s also super important for your immune system. Vitamin D deficiency is very common in people with autoimmune conditions. So having adequate amounts of vitamin D is crucial and then of course also your folinic acid and activated B12 depending on your genetic polymorphisms. So you need to find which type is the right type of folate and B12 for you and then you need to be taking that just for your methylation to support the methylation which again is taking place in every single cell. It’s basically I like to refer to it as a recycling factory where you turn the most potent free radical our body makes, homocysteine into methionine which is an amino acid. So it’s a very clever recycling mechanism but if you have certain genetic polymorphisms, it won’t work unless you know which nutrients you need to use to bypass the areas which are not working.

34:39 CL: I guess there’s so many herbs out there and there’s like this adaptogenics like maca or Panax ginseng. They seem so benign. Is there any problem to taking those?

IK: Look, one very commonly used herb is vitex because it’s got such an amazing reputation online and it’s part of lots of premade fertility formulas that you can buy online as well. And it is great for some women but not for all women. It can actually disrupt your cycles, it can make your cycles shorter or longer because it’s communicating directly to your pituitary gland. It doesn’t contain hormones so it’s not really blocking some receptors or activating others, but it’s kind of just communicating with the pituitary and telling it “do this, do that”. So it’s basically increasing your LH and that can have all sorts of impact on your cycles. So I would just be careful because it’s not ideal for everyone. Other herbs like maca, if you’ve got endometriosis, the maca tends to kind of just help your body with estrogen. Again, it doesn’t contain the hormone itself but it behaves similar to what estrogen would do. So then you wouldn’t take it necessarily for that reason if you already have what’s considered an estrogen-dominant condition.

And so you just need to be really careful then with, what is it, not the bee pollen –

36:34 CL: Royal jelly?

IK: Royal jelly. That’s another common one. And that can have similar effect. But if you’re also allergic to bees or honey, you shouldn’t be having any bee products, so there you have to be careful then. I think it’s good to take the basic building blocks in the form of key nutrients. You’re optimizing your body nutritionally and then if you have antibodies, you have high FSH, if you have some other issues then really speak to a practitioner who’s trained in herbal medicine to really be able to prescribe the right herbs for you for your case and then to be able to monitor you. Because for a practitioner too they can’t really see automatically how well the herb is going to match your condition and how good you’re going to be on it. So if they see that your cycle is actually not going where it should be, they can quickly change it and change the prescription. Whereas if you’re doing it yourself you wouldn’t be able to see that and make those changes on time.

37:49 CL: I know that you educate people about like fertility cleanses and things like that and I think they’re pretty gentle, the type of cleansing that you do. But what about things like chelation therapy before conception? What if you had like a hair analysis and you found out you had some heavy metal? Is that a good idea while you’re trying to conceive?

IK: That’s a great question. It all depends and it’s a tricky area. It really depends on how old you are and how many fertile years you’ve got left because with some of the chelating protocols, it can take between six months to a year or even longer to get the results you’re after. And you shouldn’t be trying to get pregnant during the chelation protocol because when you are pushing these metals out of their hiding places, they’re entering your circulation and they have high affinity for cells which contain a lot of fat, and egg cells and sperm cells do. They have in their membranes all the hormones and these toxins are attracted to these cells so they can accumulate in those cells and then you’re trying to get pregnant with those cells and there could be complications or it could end in a miscarriage or there could be some permanent damage in the offspring as a result of that which is why we always say do not try to get pregnant.

Now, you can’t tell a 43-year-old woman “don’t try to get pregnant in the next 2 years”. By that time she is 45 and as we know it’s still possible but her chances are becoming smaller of getting pregnant naturally. So you just got to weigh it up. You got to see where you’re at and sometimes it’s better to then leave those metals alone until after pregnancy and then focus on it. It’s really an individual decision and I guess it also depends on their other symptoms and conditions that they may have and where they’re at. If they’re severe, if those toxic metals are extremely elevated and they’re only in their 30s, I will say yeah, maybe it’s better to remove them or if they have recurrent miscarriages. So you got to really take it on a case by case basis. It’s not something that you can have just a standard protocol for everyone regardless of their age when you’re dealing with fertility. And when you want to get pregnant as soon as possible, then you really have to weigh it up.

40:43 CL: Okay, thank you. Now, when couples are trying to conceive, can you kind of give us a guideline of first steps to start taking when you’re starting off in the process. What tests do you need to start considering? Everything kind of along that line.

IK: That’s a great question. I think you should always start with tests. The sooner you can test the better because then you know already you may need to use IVF. You’re not trying to get pregnant naturally when it’s not possible for you. Or you do know that you do need extra assistance. So, check your hormones, check your thyroid. Check your thyroid antibodies because you can have normal TSH and your thyroid antibodies can already be present. So what we learned now is that thyroid antibodies can precede changes in TSH, T3 and T4. Whereas before, it was believed that if your TSH, T3 and T4 look normal, there’s no point checking for thyroid antibodies. But it takes sometimes up to 10 years for this new scientific evidence to show up in medical textbooks before it’s accepted as a new clinical practice and that’s a long time. For a woman trying to get pregnant 10 years is huge. So check your thyroid, check your FSH, LH, estrogen, progesterone, sex hormone-binding globulins. The men can check all these as well on top of that free testosterone. For women, we also recommend checking testosterone because even though it’s not a major hormone for women, it does play a role in fertility and especially libido. It’s important that you check that as well.

And then for men also checking sperm and asking for sperm morphology which is important and oftentimes it’s not included as part of just a regular sperm analysis, checking for DNA fragmentation. That’s where the DNA and the sperm can start uncoiling so there’s a high risk of chromosomal damage. And also checking for sperm antibodies. So antibodies could be interfering with sperm development and it’s important to look at as well. And then women should also check her tubes because like I said, if they’re blocked then you should know that from the start. So you’re not just trying to get pregnant naturally for months on end without any result. And then just look at what’s the best next step. It’s always a good idea to optimize your natural fertility, optimize your hormones, egg quality and sperm quality even if you need to use IVF because we know that IVF success rates go up when these things are addressed.

44:07 CL: Thank you. Hold on one second. If you hear a cat in the background, you are not imagining it. Let me stop just one second. There’s a cat meowing in a few of these recordings, so I hope people like cats.

Anyways, so thanks for breaking that down. A couple of questions. The more I learn about testing, I feel like the type of tests that you use is so important but clarify this for me because I feel like if most people, if go to their general practitioner and get the hormone test done, it is going to be a serum test, right? I mean that’s kind of the most common. I feel like that is not the most accurate picture of what’s going on with the hormones in the body and then a lot of times of course a thyroid test, they will do TSH. If you ask them to do antibodies then I’m sure that they’ll do that as well, but then if they don’t do like T3, reverse T3, T4 that you won’t get an accurate picture of that as well. Or sometimes even with the hormone tests, you’re just looking at a short little window of the hormonal cycle and now they have what’s called cycle mapping where they go through the whole cycle because a lot can be missed. So kind of clarify that for me. What’s sufficient enough as far as hormone testing goes?

IK: Look, in the last five years we’ve seen some amazing new tests come on the market and this is obviously fantastic because you can now measure hormone metabolites urine. It was long believed that salivary hormone tests are better than serum, but now dried urine test is actually showing to be more precise in some of the areas and can also tie into your methylation especially when it comes to how you’re processing estrogen through the COMT gene. These are fantastic advances and I think we need to use them. And as far as the thyroid goes and trying to get some of these tests done in the US, you have a service called RequestATest.com where you can bypass a doctor and you can order a test yourself. Of course it’s not going to be claimable in your insurance because you are the one ordering the test so you pay out of pocket but at least you can get some answers if you can’t get it from your doctor. And if you look for functional medicine practitioner, then they will definitely more than happy to check your toxic metals and food intolerances and reverse T3 and thyroid antibodies and dried urine tests. So things which are not common practice yet in conventional medicine clinics, but they will be. These things, like I said, take time. They can take up to 10 years before they make it up there. So you have lots of options. I think we live in a fantastic time because we are so fortunate to have all these tests and options and alternatives and that you have IVF and you have donor eggs and donor sperm. There’s so much available to us that was never available before. So as such, you have a huge sea of opportunities, but yeah, you just need to speak to a practitioner who knows a bit about it and understand that if you have TSH over 2, that’s not really ideal for fertility even though your GP may say your thyroid is fine. And looking at those reference ranges, yeah, it looks like it’s in the middle so it’s fine but for fertility we’re looking at a slightly different range so your thyroid needs to be working a little bit better than that.

So again, you just need to become proactive. I think this is really important. People need to start taking responsibility for their health and they do. Our job is to educate and teach, and most functional medicine doctors do the same. That’s really when you get the best results. When you know how you feel and you know what your test results mean and you know how to look after yourself, what to eat and which supplements to take, that’s really when you get the best outcomes.

48:52 CL: Just a time to kind of plug your coaching, people can work with you because not only are you a functional medicine practitioner, you specialize in fertility. Because I think we need to kind of differentiate that too. I mean there’s functional medicine people that are wonderful but they don’t treat a lot of fertility and so things get overlooked. Maybe they don’t know about cycle mapping or just all of the different kinds of different tests that are available out there and kind of how to look at herbs. For example, we talked about Vitex. Maybe they don’t know that it can change a woman’s cycle and they feel like it’s an herb that most women can take safely. So I think it’s really important you and your team and the fertility service that you’ve created, I think it’s phenomenal and I just want to put it out there that people are able to work with you. You are in Switzerland but you work with people all around the world and you have for over a decade. What’s the best way for people to find out more about you and your services again?

IK: The best way is just to go to Natural-fertility-prescription.com website or you can go straight through Fertility-coach.com and you can sign up for more information about our 16-week online coaching program. We also have a blog with lots of articles and various fertility-related topics and you can find lots of good information there. You can also ask questions and or just email us, email me. You can email me at Iva@fertility-coach.com and we can see how we can help you with your case and if the coaching program is a good next step for you.

50:51 CL: Thank you. Hearing more and more about gender selection, what is that? Things you can do to increase the chances of having a boy or a girl. Is there any legitimacy to those?

IK: I think a lot of people say and it’s true. People just say “I just want a healthy baby.” And of course, we all want a healthy baby but I think subconsciously or maybe in the back of your mind, you’re like, “I’d really like to have a boy first and then a girl,” or just like two girls because sisters are so cool, or two boys. And the man could be thinking the same thing. So while people always say “I don’t care as long as they’re healthy,” and that’s true, I think in the back of their minds they still may have a preference. Or if they already have two boys, they desperately want a girl because they want to balance their family; and if they have one girl, they may want a boy. So with IVF we know we can pre-select the embryos but for natural conception, for a long time it was believed that Dr. Shettles’ Method was the right method. According to the method, the Y sperm are faster and they live for a shorter time. The X carrying sperm are slower but they live for a longer time. So he said to conceive a boy, you should have intercourse closest to ovulation because the Y carrying sperm are going to reach the egg first and fertilize it. If you want a girl, you should have intercourse a few day before ovulation because by that time, all the Y carrying sperm will die and only the X carrying sperm will still be around and so your chances of conceiving a girl are higher.

But over the years, people who have used his method have shown that they had opposite results. So when they waited until they ovulated, they would conceive a girl; and if they had intercourse a few days before ovulation, they would conceive a boy. So now, actually based on lots of new statistics and research and studies they’re actually showing that is the case. So if you would like a boy, you should be aiming to have intercourse few days, 2 to 3 days before ovulation; and if you’d like to have a girl, you should have intercourse on the day of ovulation even like a few hours after you ovulated. But for most people it’s difficult to exactly say “Oh, I ovulated at noon so I’m going to wait until 4 to have intercourse.” But that’s just very interesting and that’s what I love about science.

Science is an ever-changing field and things that are constantly disproven and new approaches come out. That’s why you just can’t rely on a lot of this information that’s been published, I don’t know, 5 plus years ago. A lot of these things don’t change but a lot do and that’s why it’s so difficult to not get confused and it’s so easy to get confused because you can be reading information that’s really outdated or the practitioner you’re talking to has an updated information yet and just looked at the recent research. So it’s no wonder people get really confused and they come to us and they’re like, “I don’t know who to believe anymore. I read this, I read that. That practitioner says A, you say B. The other person says C. What’s the right way?” And everyone is really confused. So you just got to accept that in health and in science and in medicine there is this element of science that it’s ever-changing. It’s constantly changing, it’s constantly evolving so you got to embrace that and yeah, just work with people who do like to do their research and stay on top of research.

55:10 CL: Right. There’s all these little soundbites you see maybe on a Facebook reel or something. Because it’s tedious to actually go into PubMed and actually read the whole article, it’s sort of boring if you’re not into that so people get little blips or something. I have a mother-in-law who kind of does that. She’ll watch the local news. “Oh, I heard all vitamins and organic is just a big waste of time.” She doesn’t want to go and actually look at the research. They did a little soundbite to catch her attention on the local news and then she makes up her mind based on that or something that Dr. Oz said or whatever is just facts. So it does, it gets extremely confusing and just like you said, I’m basically repeating the same thing. You know, go with someone who’s actually reading these extremely long and somewhat tedious publications, research articles and find out the real facts because it’s really misleading. And especially like nutrition and diet, oh my God, people get so frustrated because that literally changes all the time of what is considered “healthy”. It’s kind of maddening.

Before I forget, I had one question about progesterone. I read that online a lot like in the forums and things like that. People will start taking progesterone cream. There’s a really popular doctor, Dr. John Lee who was big into progesterone therapy. So you can like in the United States, I was interviewing someone else who said you can’t get over-the-counter progesterone cream in some countries but here you can just go into your local health food store and get it a tube. Is there anything that we should kind of know about self-prescribing progesterone cream? Is there any downfall to that?

IK: Again, I think you just really need to, first of all, get your progesterone checked either using the dried urine test or if you want to do serum test, it needs to be 7 days post-ovulation and that’s not always cycle day 21 for everyone. It’s important that you know how long your cycle is and when you ovulate and then count 7 days from then. And based on that, if you do need progesterone support, the next step would be to speak to a functional medicine practitioner who also specializes in women’s health or in fertility who can then look at, “okay, do you have a progesterone issue? Let’s look at your diet. Let’s see if you are actually giving your body all the building blocks that it needs to produce progesterone.” Using hormones really should be your last option when all else fails. Because when you’re buying hormones be it through suppositories, be it through creams or pills, you are basically forcing a hormone onto your body and your body now needs to metabolize that and it’s going to adjust everything else based on this new input because that’s just new information that’s coming to your system. And that may not have a good impact on all the other hormones. It’s a very delicate cascade of hormones that is relying on all this input from various hormones and glands. And if you now just put lots of progesterone on your skin and it just enters your body, it’s going to disrupt that.

So, you can create a lot of disruption in your cycle doing that and what you also see a lot is that a lot of women who are afraid of miscarrying, they believe that if they just support their progesterone, they won’t miscarry. What happens then is the embryo stops developing maybe around week 6 or 7 but they don’t miscarry until week 12 or 13 because they had all this progesterone coming into the system that maintains the pregnancy even though the embryo wasn’t alive anymore. And what it takes to miscarry rather than just going, okay look, if your progesterone really is low, your obstetrician is going to be able to act there and then and support that while still having your scans to make sure the baby is developing properly. But sometimes your body is going to drop the progesterone on purpose to cause you to miscarry because your body knows that this embryo is not viable for life.

59:57 CL: Right. That’s a really good point. I think just because we’re on the topic of progesterone, another hormone is DHEA because a lot of people read about DHEA on paper, sounds phenomenal and it sounds like something you should take and so people do it. They don’t get tested to see what their levels are. What’s the issue there of just starting to take DHEA supplements?

IK: Look, I think you got to separate supplements into two groups: supplement for natural conception and supplements for IVF. So with DHEA they’ve seen increase in number of eggs that can be collected through IVF. So I think if you’re going to go for that option, DHEA may be a good thing to help you especially if you’re in your 40s and your AMH is low. So maybe that’s a good option to get your egg number up so they can collect more eggs for IVF procedure, but I think same with melatonin, it can do the same thing. But too much melatonin is going to mess with your cycle. So the dosage is sometimes what you read what’s being used for IVF really works for IVF but it does not work for natural conception. It can cause more disruption to your natural cycle. Because if you think about it, if you’re trying to get pregnant naturally, all you need to know is when you’re ovulating so that you can time your intercourse on top of making sure you’re getting all the nutrients to optimize the egg and sperm quality. If you’re then taking all these hormones in the forms of creams or pills and you’re disrupting that balance, suddenly you don’t know when you ovulate. You don’t know where you are on your cycle. So it’s totally lowering your chances of getting pregnant.

But having said that, a lot of women have taken DHEA before conception. We don’t recommend that you take it for longer than six weeks before conception because our bodies are very economical. If the body is getting a hormone from an external source it’s going to stop producing it internally because it doesn’t need to or it’s going to decrease what it produces internally because there’s no need for it since there is a convenient external source of it. So if you’re just playing with dosages, without really knowing what you’re doing or what you should be taking, you could be again doing more harm than good especially if you’re doing it long-term.

62:25 CL: Thanks for clarifying that. Last question. There’s a lot of talk back and forth when you’re trying to conceive if you should have intercourse every day during that fertile period to the day of ovulation or every other. I’m assuming it has to do with sperm but people say kind of across the board, “Oh, you should have intercourse every other day”, and that seems to be kind of the opinion out there.

IK: Yeah. I mean if the sperm count is low then if you have intercourse every single day, you’re kind of diminishing that reserve of sperm that’s available but if you give it a 24-hour break, you kind of give the testes a time to reload the sperm, so to speak. If the sperm numbers are good and normal, then you could have intercourse every single day. But sperm still live in your system between 3 to 5 days. So if you’re having intercourse every other day, that’s okay as well because there are some sperm which are deposited there. Again, this just also means that you need to make sure that you have fertile mucus around because if you don’t have fertile mucus around then that sperm is not going to be able to get to the uterus and to the eggs. So yeah, I think that just pinpointing your ovulation and then timing your intercourse 2 to 3 days before day of the ovulation then you kind of cover that fertile window. And then if you’re hoping for a specific gender then you can apply some of those recommendations on when to have intercourse.

64:13 CL: Okay. Well, thank you so much for your time. That was wonderful. And please support us, subscribe to the Fertility Hour and we’ll bring you more wonderful guests. So thank you, Iva, for your time. It was great.

IK: Thanks, Charlene. Thanks for having me.

64:30 CL: You’re welcome. Bye-bye!