62. Real Talk on Fertility

In this episode, Dr. Monica Minjeur explores how Restorative Reproductive Medicine (RRM) can address underlying health issues impacting fertility, offering a more natural and holistic approach to conception. Through a real-life case study, we highlight how RRM identifies root causes and provides personalized care that not only promotes natural fertility but also improves overall health. Discover why this approach can be more effective—and more affordable—than artificial reproductive technologies like IVF.

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health, and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. On today's episode, I'm going to be talking all about fertility. Now, I'm going to share with you some of the many benefits of treating fertility concerns with restorative reproductive medicine. Now, RRM is a field that seeks to get to the root cause of underlying health concerns that impact menstrual cycles and fertility. By correcting these issues, we are able to help restore natural menstrual cycles, improve long term health, and promote fertility in a way that works with your body rather than by artificial means. So let's get started with a story about a past client of mine who we'll call Kay. Now Kay had been off of birth control for about four years. She and her husband were ready to start having kids and they had been trying for at least a year or so before she went and got additional help from her OB. Now her OB doctor had checked some basic labs and ended up not finding a whole lot of anything that was wrong. So they sent her home with a prescription to take for the next six months of Clomid to try and help stimulate ovulation. Now, unfortunately, Kay did not tolerate this medication very well, but she did try to keep taking it because she thought this was her only option. The OB doctor continued to increase the dosage and Kay felt even more miserable. Overall, over the course of six months of trying this treatment, she ended up spending about 700 between the medications and the office visits and still did not have a successful pregnancy. So at this time, the OB doctor decided to dig a little bit deeper. They did another semen analysis on her husband's sperm counts and found they were a bit lower than when they had started evaluation. So they were recommended to trial intrauterine insemination or IUI. Now, they ended up doing four rounds of IUI, but still no pregnancy. The additional cost for the IUI was about 1, 800, and it took them about six months to go through these courses, and again, with no pregnancy. So at this time, the OB doctor referred Kay and her husband on to IVF, or in vitro fertilization, at a fertility center. Now, over the course of the next months, they went through many, many different expensive medications, missed days of work, hyperstimulation, embryo placements on three separate occasions, and two of those were failed attempts without any pregnancy. One time she did end up having a positive pregnancy test, but ended up miscarrying a week later. Now over the course of that five months, the cost of all of that additional testing, evaluation, procedures, and medications came to about 45, 000, which is pretty typical for three rounds of IVF. So, about two years after starting to work with her OB doctor, a friend of hers referred her to come and see me. And Kay was very, very frustrated at this point in time. She thought they had tried everything, and honestly she was a little bit skeptical that there was going to be anything different that we could do. So we started off by obtaining all of the past labs and testing that she already had done. And after I reviewed Kay's outside records, I explained to her and her husband that they had not actually yet had a full workup done from her labs or evaluation of crucial hormones at different times in her cycle. So while we were working on this evaluation, we started them with some charting instruction and got some additional lab work timed to her cycle. When I was able to evaluate them after I got their first set of labs back, I identified and diagnosed ovulation dysfunction as well as progesterone deficiency, thyroid dysfunction and abnormal uterine bleeding. Now, since we knew that there may be a bit of a male factor as well, we also did some lab evaluation for her husband and worked on some underlying medical conditions on his side of things to help correct the lower sperm counts that he had. Over the course of the next four months, we worked with Kay and her spouse on lifestyle changes. We also eliminated a bunch of different expensive and unnecessary supplements that they had been trying to take over the years. You know, there were many well meaning friends and family members that said, Oh, try this. This is what worked for me. Or, I swear by this one, this is the only thing that was able to get me pregnant. And by this point in time, Kay had gotten quite an extensive list of supplements. So we got rid of almost everything that she had been taking. And once we had her actual lab results, we were able to prescribe targeted medications that worked best for Kay to get her back on track. Each cycle, I reviewed her charting as well as the objective data from her lab results to make those adjustments in order to optimize her hormones, not just into normal range, but in optimal range for pregnancy. After she had been diagnosed charting balanced cycles with normal hormones for about four cycles, she was able to achieve a natural pregnancy. All in all, this was about eight months after she came to see me and started working with us. Now, when she had that positive pregnancy test, we knew that was only part of the picture. And because of her workup that we had done prior to pregnancy, I knew that she would likely need some additional hormone support during that pregnancy and provided that monitoring as well as hormones and supplements throughout. Kay went on to deliver a healthy baby girl at about 39 weeks. without any pregnancy or postpartum complications. The best part of this story is that when Kay is ready to come back for baby number two, we already know what worked last time. We know where to start and we can continue with ongoing health promotion in the meantime because now we have an actual diagnosis for why they were having a hard time getting pregnant. We're working to improve that for the long run in order to be able to promote fertility in the future. Bye bye. Just a little aside, the cost of our services came in at only about 15 percent of the cost it was for the three rounds of IVF that were unsuccessful. So, let's start off with what is normal when it comes to fertility. You know, most OB doctors or primary care doctors won't start any type of evaluation unless you've been trying to get pregnant for a full year without success. Now, in our world, if you are somebody who is charting your cycles, if you know when your fertile window is and you can identify your day of ovulation, we'll start an evaluation even as soon as six months without achieving a pregnancy. Through many different studies done over time, we know that more than 95 percent of the time, a couple that does not have any fertility issues will get pregnant within that six months. So if you've gone more than six months, you're using your window of fertility and your known ovulation time and you're not achieving a pregnancy, it's time to start looking a little bit deeper. Now, if everything is normal, on average, most couples will achieve a pregnancy about 25 to 30 percent of the time each cycle. And again, that's if everything is optimized. So what are some things that you can do if you're ready to get pregnant in order to help optimize your chances of fertility? One of the first things we always say is make sure that you've checked in with your health care professional. Check in on your prescription medications, check in on your supplements, make sure that everything that you're taking is safe and recommended and try to transition off of anything that is unnecessary or potentially harmful. It's also a good idea if it's been a while since you've had any lab work done to make sure that you're optimizing some of your blood counts. So making sure that you get checked for vitamin D, your iron stores, your blood counts, and thyroid at a baseline minimum. And most primary care doctors are pretty comfortable and happy with ordering those things. If you have picked up any bad habits over the years, so if you have started smoking, if you're drinking excessive amounts of alcohol, or if you have a significant caffeine addiction, it's time to start working on stopping all of those things. At least for the caffeine work on cutting back, you may not have to stop it all together, but certainly working on stopping for sure the smoking and the alcohol. And then the biggest things, which are sometimes the hardest, is to try and optimize those lifestyle factors we talk about. So getting adequate sleep of seven to eight hours per night, trying to decrease your stress levels, especially taking extra things off your plate that you can say no to, working on cleaning up your diet, making sure you're getting lots of good healthy proteins, healthy fats, Good fruits and veggies, lean meats, et cetera, are going to all be really beneficial from a dietary standpoint, and then monitoring your exercise. Again, making sure that you have regular movement, but not too excessive because we don't want to add that extra stress on your body during this time of fertility. If you're not already tracking your biomarkers or charting your signs of ovulation, it's really important to make sure that you know how to identify when you're ovulating. Now this can look different for different women. And most of the methods that we teach within our clinic are going to be fertility awareness methods focused on observing your cervical mucus. Now the reason we prefer this method, especially if you're trying to get pregnant, is that we know that mucus is necessary in order to allow sperm transport to occur. If you don't have any of that cervical mucus, even if you have a temperature shift or even if you see an LH positive on your urinary strips, if there's no cervical mucus there, it's really challenging to be able to get the sperm to where it needs to go. So certainly we can look at those other biomarkers as far as temperature shifts and urinary hormones, but it's really important to be able to identify clearly that you know when you're ovulating. Another thing that's important to know as far as timing intercourse and some of the basics is that once you have identified your fertile window, the recommendation is to try and have intercourse optimally every other day during that fertile window. The most fertile time is typically the two days prior to and the two days after ovulation. Now you aren't always going to know in advance exactly which day you ovulate and so that's why we say every other day during any type of fertile mucus. The other thing that's important to know is that you want to avoid most of the over the counter lubricants that are out there. Many of them are petroleum based and can actually decrease sperm viability and motility. It's also recommended to avoid saliva or olive oil for lubricants because these can also decrease sperm viability. If you absolutely need to use something for a lubricant, you want to go for something that is water based. One of the brands out there that we recommend is called Pre Seed. Now, when it comes to evaluating for infertility, one of the biggest pet peeves I have is that so many people come with a diagnosis of unexplained infertility. And in my world, this just means we haven't dug deep enough. We don't really know what's causing that infertility. In general, when we look at infertility, we kind of break it out into different categories as to which components are playing a role. Now, estimates show that about 30 to 40 percent of the time, it can be a sole female factor. However, another 30 percent of the time, it may be a solely male factor. And then about 20 to 30 percent of the time, it may be that actually both partners in the couple are having some issues that are playing a role with this. And only about 10 percent of the time is it truly unknown. And I would say even probably less than that. So when we look at female factors, the way we're going to look at this is we're going to look at charting, we're going to look at hormone evaluation, we're going to do an ultrasound, not just checking for anatomy, but also checking for follicle development, and making sure that that egg is released at the time of ovulation. We also will often check on a hysterosalpingogram to make sure that the tubes are open, as well as treat any underlying causes that are found on any of our evaluation and possibly refer on to a specialized surgeon to evaluate for endometriosis, scarring, or adhesion. When it comes to male factor, a lot of people think they just need to look at a seminal fluid analysis, and if that looks good, everything is checked off the case, and that's not necessarily what we find. You can also have decreased quality of the DNA that is provided in the sperm, and that is checked through a specialized lab test called a DNA fragmentation index. Oftentimes we'll also order additional labs if there is needing to be further evaluation, and sometimes male factor needs additional ultrasound of the gonad area as well as referral to a urologist if there is underlying anatomic conditions. Now, cases where we have issues of both, obviously it could be a combination of any of those factors I just mentioned, but also can be this leukocyte adhesion deficiency, which is a problem that happens when the male and the female components come together. And so that's a blood test that we can do to look if there are any concerning features that may be related to both people. Now, if we truly think that this is unexplained infertility in my world, this means that I you must have negative surgery evaluation for the female side or it has to be corrected. You have to either have no male factor or improved male factor after evaluation. You have to have balanced cycles that look good as far as your charting goes, at least six cycles. cycles as well as optimal hormone levels. And oftentimes we're able to get close on some of those things. We may not be a hundred percent of the case, but if we're able to achieve all of those things and we're still failing to have fertility happen naturally, that's when I'm willing to give that diagnosis of unexplained infertility. But in my practice that has happened less than 2 percent of the time. So let's shift gears a little bit and talk about secondary infertility. Now, this happens to about 10 to 15 percent of couples, and secondary infertility means that you have had a normal pregnancy in the past, but for some reason or another, you're having a hard time getting pregnant again in the future, whether that's a second pregnancy or a third or a fourth down the road. Now, the most common cause that happens is there's some sort of new medical condition and it can be from either partner. In females, we often will see there's a hormone imbalance that may be left over from a past pregnancy. So, there may also be undiagnosed thyroid dysfunction, which is very common to happen postpartum, or additional hormone imbalances that maybe have picked up since that last pregnancy have occurred. In males, if they have taken up some new habits that may not be so great, if they've gained some extra weight, those things can play a role as well in the male factor. And then for both partners, any change in lifestyle, any increase in stressors will absolutely make an impact of this. So oftentimes weight will increase over time. Sometimes diet will change, especially if you have a baby or a toddler at home. as well as sleep changes. So all of these things can impact secondary infertility. And it's not as always quite as easy to pick that out. But knowing we go through the same process of evaluating each of the pieces, correcting those underlying problems in order to hopefully be able to achieve another pregnancy. So let's go back real quick and talk a little bit about Kay's case and why did IVF fail? Why did IUI fail? What should we do next? And one of the big issues that we see is that when we jump to these artificial reproductive technologies, we are failing to correct the underlying cause. In fact, in the case of Kay, they never even went through a full diagnostic evaluation to determine why she was unable to achieve a pregnancy. which then created additional problems with getting pregnant. They weren't able to force implantation to occur. They weren't able to get her hormones stabilized because they were giving her these mega doses of medications in order to stimulate ovulation, in order to help try and produce a bigger response on her hormone levels. And the reality was this did not correct any of her underlying issues. In fact, artificial reproductive technologies do not appropriately treat recurrent miscarriages. They don't address any underlying metabolic abnormalities, hormone imbalances, thyroid dysfunction, autoimmune factors, unusual bleeding, or anatomic issues. They try and just force a pregnancy to happen, which is oftentimes why we have so much troubles with achieving a pregnancy. If people are able to achieve a pregnancy, it can come at a very high cost, not only financially, but also emotionally and in time and in medications and in side effects. And so really, my proposal is a better way forward with restorative reproductive medicine. The way we treat with RRM is that we evaluate the individual cycles to address those underlying abnormalities. We look for luteal phase defects, so problems that happen after you've ovulated with improper hormone abnormalities. We look for any abnormal bleeding which can indicate underlying anatomic, infectious, or inflammatory causes. We look for an ovulatory pattern. So maybe it looks like you don't have enough cervical mucus, or maybe you're not ovulating at all. We also can utilize what we see in your charting to assess for proper timing of intercourse to make sure that you clearly know when is the best time to try and achieve a pregnancy. We also will evaluate for all hormones, vitamin deficiencies, and insulin resistance, again, with the attempt to assess for that root cause. And then we treat those problems to improve your cycles and improve your overall health. Now, does this approach take longer? Yes. However, it does also treat underlying health conditions, solves those health problems for the long run, and helps with better pregnancies as well. For example, if we find out that a patient has problems with insulin resistance, and I help to correct that when she's 32 years old, rather than waiting and letting it go on to develop diabetes when she is 52 years old, we have not only helped to improve her health as a 32 year old, we've helped to improve her menstrual cycles, we've helped to give her back the ability to achieve a natural pregnancy, And more importantly, in my mind, we've improved her long term health and hopefully helped to either prevent or at least delay the onset of diabetes, which is obviously a much, much, much bigger condition, which will affect her for the rest of her life. So overall our approach when we're evaluating somebody from this restorative reproductive medicine standpoint, the first one to two months, we're working on diagnostics. So getting that charting instruction done, checking the labs, figuring out what the appropriate diagnosis is, depending upon what's going on. It may take a few months to optimize and balance. And during this timeframe, we're adjusting lifestyle, We are adjusting supplements. We're adjusting prescription medications. And once we get everything optimized, we say we're in the balanced phase right now. Hormones look good. Charting looks good. And then we sit back and relax and we allow the next four to six months to go on while the couple is trying to naturally achieve pregnancy. We try to decrease the intensity, lower the stress levels, and remembering that each normal cycle, even when things are balanced, only has a 25 to 30 percent success rate. So that's when we start counting our six months going forward. Now the huge benefits with this approach are that, again, we're correcting those underlying problems, but we're also avoiding excessive medications, we're avoiding excessive ovarian hyperstimulation, And we're avoiding all of these extra procedures, as well as avoiding downtime from work and life and family. The cost is relatively much less than IVF or other artificial reproductive technologies. The overall success rate is much better, even in people who have already failed IVF or IUI, because we are correcting those underlying causes from the start. So imagine if you were able to understand why you were having troubles with getting pregnant and worked to treat those unique root causes rather than just trying to force your body into pregnancy. Restorative reproductive medicine is the way forward to finding those real answers and treating everything we can find to improve your health, the health of your partner, and to promote your fertility. If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic. com, to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in our Cedar Rapids, Iowa clinic, or can arrange for a telehealth visit if you live in the states of Iowa, Illinois, or Minnesota. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.