Cycle Wisdom: Women's Health & Fertility

73. A Fresh Look at Fertility: Conversation with Dr Erica Bove – Part 1

• Dr. Monica Minjeur & Dr. Erica Bove • Episode 73

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 ​On today’s episode of Cycle Wisdom, Dr. Monica Minjeur and fertility coach and specialist Dr. Erica Bove explore holistic approaches to optimizing natural fertility. From cycle tracking with cutting-edge apps to lifestyle adjustments that support long-term health, the doctors share actionable insights to empower women on their fertility journeys. Join this inspiring conversation, where science, awareness, and practical tips come together. Don’t miss part one of this two-part series—your roadmap to understanding and restoring natural fertility starts here!

Erica Bove, MD, is a double board certified OB-GYN and Reproductive Endocrinologist (REI) physician at the University of Vermont, She is also the CEO and founder of Love and Science: Thriving Through Infertility.  She has a keen interest in marrying an evidence-based approach with intuitive knowing in the context of a trusting relationship. She empowers women physicians to build their families with confidence, self compassion and community. Her mission is to heal and support the healers and to create a legacy she is proud of.  

Website: loveandsciencefertility.com  

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Podcast: loveandsciencefertility.com/podcast


Monica:

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 as we start off 2025 with a conversation I recently had with one of my very favorite colleagues, Dr. Erica Bove. Now, Dr. Bove and I have many similar passions when it comes to fertility, education, and long term health for our clients. Dr. Bove, Additionally, I am lucky enough to be friends with Dr. Erica, so we decided to have a conversation that would air on both of our podcasts to serve our audiences as we talk about optimizing natural fertility from a holistic perspective. I hope you enjoy today's episode, which is part one of a two part conversation as we had so much to talk about. Make sure you tune in again next week for the second part of our discussion. I'm Monica Minjeur. I am a family medicine physician and I practice currently in Cedar Rapids, Iowa. I do also do telehealth visits through other states in the country right now. But I'm the founder of Radiant Clinic, and we help women. Creating natural menstrual cycles, trying to get things back aligned in order to help their health, but also to improve fertility because we really believe that once we find the root cause to some of those underlying menstrual concerns, that natural fertility oftentimes will follow. And so we really focus on where can we find those root cause treatments and where can we help you get your lifestyle back in line so that we can achieve that natural fertility when it's possible to do so.

Dr Erica Bove:

That is absolutely amazing. And I'm so, so grateful for the work that you do, because I will tell you, especially when I wear my doctor hat in rural Vermont, it is amazing how many people I see who actually don't really need fertility treatment. They just need, a little nudge to the system, or maybe they didn't really realize that some medication they were taking was shutting things down. Like there's so much that we can do. Outside of sort of traditional treatments that, you know, people are surprised when it works, but it's like, Hey, sometimes we get lucky. Sometimes we use our brains and our smarts and help people with their menstrual cycles. And it's just amazing. for your audience, my name is Dr. Erica Bove and I am a fertility specialist by training OBGYN REI. Which for people who may not be in medicine, that means obstetrics and gynecology, and then also reproductive endocrinology and infertility. So we basically were kind of like spokes on a bicycle wheel coming to the same place of helping people with their menstrual cycles. Everything I do in my work centers around the menstrual cycle, truly. I am also the founder and CEO of love and science thriving through infertility, which is a program that helps mostly women physicians navigate fertility journeys, usually once they're in treatment. So it's usually sort of after all the other things have not worked, unfortunately, and it's a lot of help with mindset and overcoming limiting beliefs to really bridge people to become parents. So we have the same goal. And I think we have, Many similar insights, but maybe some insights that we can sort of learn from each other. And so I'm so grateful to be on your podcast. Thank you for having me.

Monica:

Yeah, I'm excited to be on each other's shows and kind of talk to each other's audiences.

Dr Erica Bove:

So I was thinking, one interesting conversation starter might be what do we both wish people knew about natural fertility? That is less common wisdom. I feel like there's so much information out there, but what is the most relevant stuff that you feel actually makes a difference for people.

Monica:

I think the thing that many women don't know is just in general that you're able to track your cycles, you're able to identify when you're ovulating. And we do this through different fertility awareness based methods. And, you know, some people may have heard of this as NFP, natural family planning, all of those terms kind of align, but really, we use this term fertility awareness based methods and they are essential. scientific study of what's happening with your menstrual cycle from day to day. And so really being able to track what am I observing today? And that may include tracking things like your cervical mucus, basal body temperature, urinary hormone, metabolite strips, all of those pieces. When we put it together, we get a really good picture of what's going on with your cycle, not only to identify if you're ovulating, but when am I ovulating, when am I fertile, as well as being able to tell A whole bunch of other things about what's going on with your cycle. some women come and they're like, Oh, I'm only having a period every 38 days. I know that's not normal. And we look at it and we go actually between when you're ovulating and when you're actually having your next period, that can be normal. And so just helping women to really be empowered to understand that They do have the power and knowledge to be able to track that is really step one. And that really sets the stage then for being able to do all the other evaluation and kind of turns us into like, Hey, this is where we may need to check labs, or this is where we may need to get an ultrasound, but timing it specifically to your cycle and optimizing your lab levels for exactly where you are. Rather than just doing a cycle day 21 test, for example, which is really common in conventional medicine, but timing it to your cycle really helps us to be able to figure out what's going on with you. So it all starts with charting. I cannot do the work that I do without knowing what's going on with your cycle. And that's where we really become partners in figuring out what's happening.

Dr Erica Bove:

Yeah, I think that's amazing. You know, even yesterday I was talking with somebody who's actually going through IVF, who is hoping to have an embryo transfer. And in the previous month, she did some cycle tracking and she's like, Oh my gosh, I didn't ovulate until day 18. and that information helps her IVF doctor to be able to better understand this current cycle. And I know that's not conceiving outside of treatment, but I think Menstrual cycle awareness is always useful no matter what we're doing and sort of understanding our bodies. Like I remember when I was an early adult and I was like, well into my medical career, but I had an ultrasound and I'm like, Oh my gosh, I have a uterus. Oh my gosh, I have ovaries. And I'm like, why am I just thinking about this now? You know, I knew somewhere in my brain that this was true, but I think we really need to do better, especially educating, girls about their bodies, young women about their bodies. So it's not like, Oh gosh, here I am, you know, now I've got my partner and we're trying to conceive. I had someone tell me the other day, she really didn't really understand how to have sex. And I know that's sort of The exception rather than the rule, but it's like we have to sort of bring awareness to the amazing vehicles that our bodies are so that we can understand them and use them to the greatest potential, you know,

Monica:

absolutely, absolutely. How about for you? What are things that you wish that people knew more about? Yeah, whole fertility journey. Sure.

Dr Erica Bove:

I think that like lifestyle cannot be underestimated. And I can't tell you the number of times that I have talked with somebody who has been trying for years and, you know, maybe it's that, you know, I practice in Vermont where there's a lot of marijuana. You know, a lot of people are daily marijuana users. And it's just like, you know, I'm not trying to kill your joy, but I think we got to cut down and maybe eliminate this altogether. and that in and of itself, you know, any change you make, it's probably going to take about three months to see an effect down the line, especially with, sperm, because that is the life cycle of the sperm. It takes that long once a new sperm is made to actually get outside the body. But you know, marijuana, smoking, chewing tobacco sort of even gentle optimizations of weight and incorporating daily exercise. I say, don't go on social media until you've done your. 20 or 30 minutes of walking for the day, whatever it is, like these little tricks that we can play with our mind to optimize our lifestyle. I cannot tell you the number of people who, we had the initial consultation and somewhere between, the first visit and the second visit, which is typically four to six weeks later, they call me and I'm like, Hey, Dr. Bove, guess what? I'm pregnant. You know, we're trying to start treatment and right before they try to start like letrozole, which is a pill to help people ovulate, they call because they've actually gotten pregnant outside of any treatment. So I really, really think that, sometimes we're in these situations, our lives are chaotic, they're busy, they're stressful. Sometimes we don't eat the healthiest with a lot of fast food and processed food. But once we can really look at, dietary and lifestyle stuff and break it down and be intentional about that I see a lot of people who become fertile once those things are even very gently addressed.

Monica:

Absolutely. Well, and again, we're not addressing just, Hey, put a baby in you, right? Like we're looking at what's your longterm health and all of those things help improve the health of the pregnancy, improve the health of mom. And sometimes dad along the way, it's like anywhere that we can make that difference that is sustainable without just saying, Hey, here, take a bunch of pills. Absolutely. It's going to be a win for everybody.

Dr Erica Bove:

Yeah, absolutely. And I wanted to sort of ask a follow up question about the menstrual cycle tracking, because everybody has their different apps. I was looking at your website. You use something called the FEM app in your, in your practice. Is that right?

Monica:

We have a couple of different apps that we utilize. So actually the one that we prefer now it's chart Neo. And the reason I love chart Neo is because it allows clients to share their charting directly with me. So that's been really amazing. So people can call and they're like, Hey, I think I need to get labs drawn. I sign in and I look at their chart and it's. Amazing. So there's multiple different methods that are available. So I'm trained to read lots of different charts. So FEM is one of them. Creighton is one, symptothermal Marquette Method. But Neo Fertility is a newer one and Chart, Neo is the app that goes along with it. And primarily, especially when we're dealing with fertility, that one is. is incredibly crucial. It's targeted primarily for fertility. Now, if you're not trying to get pregnant, sometimes we'll direct you a different way, but especially for our fertility clients, chart Neo is really the way to go. It is a free download, which I love. And so you can get started with stuff and it's very, very simple. You can choose which pieces that you're tracking with it in order to make it customizable for you. But like I said, it does have that component where you can share it with Of medical professional that you're working with so that they can see it in real time and you can work together rather than here. Here's a picture of my chart or This is what I saw. I'm trying to explain that through a text or an email is really frustrating. Whereas if I can see that chart in real time, it's just like, Oh, boom. Picture makes it really clear.

Dr Erica Bove:

That's so interesting. So what information do you think is the most valuable? You know, cause you look at these apps, sometimes you can sort of put in like. 30 different symptoms and parameters. Like when you see these things, what are you most interested in? Cause I mean, again, my clients are mostly physician women who are trying to get pregnant. And if you tell them to chart all 30 symptoms, they will. What's sort of the most high yield stuff that helps you make decisions about your, your patients and your clients.

Monica:

The number one thing we see as far as if I can identify ovulation is always going to be cervical mucus. And we're looking not only at quantity, but also more specifically quality of that cervical mucus. And typically, people kind of know when I'm seeing that egg white mucus, so they don't really understand when which days are fertile. So in general, if you're seeing that egg white mucus, that is good quality. Fertile mucus, which allows sperm transportation. Okay. Now you can have that multiple days. And usually we say the day that you ovulate is the last day that you see that egg white slippery mucus. Okay. So that is the number one sign. The number two sign that we will look for where if that's not really clear, or sometimes women come in and they're like, look, I've got fertile mucus every single day of my entire cycle, then we say, okay, your next most reliable indicator is going to be your basal body temperature. So this is going to be, if you're checking your temperature every day, or if you're using a device that checks your temperature, it doesn't matter. You don't have to get a fancy device. You can just use a regular dollar store thermometer. It doesn't matter what the actual number is. We're looking for that temperature shift. So generally what we see is you can confirm ovulation has happened. Okay. when you see that temperature shift increase. And typically that's going to be by 0. 2 degrees Fahrenheit. When we see that temperature shift sustained for three days, that's our next most reliable indicator. And then the third that we use sometimes is going to be the urinary LH strips or urinary LH monitor. There's lots of different devices out there. Again, I list this as third because we see that it's only accurate about 70 percent of the time. Now that's not terrible. But I wouldn't want to rely on that as my sole thing to look to see that I've ovulated. It can be helpful to confirm that things align and this looks right, but we know that LH strip positivity and the actual day of ovulation based on ultrasound can vary by up to two to three days. Now, if you're trying to get pregnant, it's maybe not that big of a deal. Hopefully, you're trying to aim for intercourse every other day during that fertile window. But if you're trying to avoid a pregnancy or space out a pregnancy, we want to see, hey, what's the most accurate? And really, we say that cervical mucus is the most accurate. So really, in my world, I have many, many of my clients that only chart cervical mucus. And that is totally fine. If it's clear, if it's obvious, that's fine. And I tell them, please don't stress yourself out with all of the extra charting pieces. In fact, I love that you mentioned about lifestyle because stress can be one of the biggest things that we struggle with when we're working with couples that are trying to get pregnant. And oftentimes the very first thing that I tell people when, when couples come in to see me is I say, great, tell me, who is doing your charting almost always it's, it's the woman. And I say, cool, from here on going forward, it is the male partner that gets to do the charting, right? And sometimes that just lifts this burden a little bit. Like, obviously she's going to still be saying and observing. Here's what the signs are, but if it's one less thing to kind of take some intensity off that he becomes an active role with. That charting. First of all, it gets him on the same page real quickly. He has to know what's going on. And second of all, it just helps to kind of alleviate that stress and go, okay, this is something that's shared it also helps women to not obsess over their charts because sometimes they're looking at their charts. They're going, this is not normal. I am broken there's something wrong. And it plays into that mindset piece, right? Where we go, okay, I, you know, I can't get pregnant because I see that my chart doesn't look like the textbook. Okay. Who cares? Like there, there's almost nobody that's textbook. That's okay. But really getting out of their heads about that.

Dr Erica Bove:

I love that so much. So again, I knew going into this conversation, I was going to learn some things I'd take with me from my own practice. I'm going to start suggesting that because here's the thing. I see this dynamic between couples that I love working with couples so much where it becomes almost like this nagging dynamic. Like nobody likes to be the nagger and nobody likes to feel nagged. And so, you know, I find it's like the woman who has everything in her brain, you know, we talked about the mental load and she's like, okay, you got to get your semen analysis. You got to do this. You got to do this. And I think that sort of sharing that responsibility, it, also changes the dance of the relationship. You know, I used to be a relationship coach such that it's just a more equal shared experience. And that's what you want. I mean, this is a team. And this is not like, the woman has another child she has to manage, you know, especially if she already has children. This is more about a shared experience of bringing about a child into the world together. And I just think that on a sort of practical level, that's amazing. But I think on a even deeper, like philosophical metaphysical, level, I think it just, it just speaks volumes as to sort of what we're actually trying to create here. So thank you for that. I'm going to take that back for sure. What are some misconceptions that you see about natural fertility? I love sort of debunking those if we can.

Monica:

Sometimes I get people that come to see me and they say, Oh, I hear you're the natural fertility doc. And does this just mean that you're going to give me like teas and tinctures and potions and you know, that kind of stuff. And, generally the way that I look at it, as I say, we approach treatment with three different legs and I can't do it without. All of them. So the first is always going to be lifestyle modifications. We talk specifically about sleep, diet, exercise, stress reduction, as well as mental health and clarity with that. So those are always the cornerstone of everything we do. The second piece we talk about is supplements and whether that can be. vitamins. If we can sources, I'm always a big oftentimes that supplement quitting a lot of your su so many women come in and because they're like, oh, pregnant on this. My sist take this. And sometimes work against each other. Always at the first visit, we say clean slate. I want you only on these specific things and we're going to get rid of all of the rest. So just minimizing that and that can be a huge burden relieved as well to say, oh, cool. I now saving a ton of money, a ton of time. I don't feel like an old lady because I have a pillbox of 80. supplements. And then the third piece is that I do prescribe medications. I prescribe many similar medications as to what you do in the reproductive endocrinology world. We utilize letrozole, we utilize HCG, we utilize bioidentical hormones, and we do time those with your cycle. And so I think that's probably the biggest misconception is I think people think that natural fertility always just means that I'm going to do some weird voodoo magic, but the reality is we utilize conventional medications that are FDA approved, that are falling in line with where things are at in your cycle. And so I think that's the biggest thing. Now, the difference is, is that I don't do IVF procedures. I don't do IUI procedures. I'm not trained in them. But it's more a matter of saying, okay, how can we work in concert with your body to let these medications do what they need to do? And we're monitoring that every cycle. So for example, if I start you on letrozole, which is a medication to stimulate ovulation, I'm checking your lab levels again later on in your cycle to make sure that we have the correct dosage. So we adjust your letrozole every cycle. You know, we may do an ultrasound that cycle to determine are we on the right track? Do we need more? Do we need less? And so really that fine tuning to see what does your body actually need? The other is that not every woman needs letrozole. You know, sometimes we find things are looking okay, you're ovulating regularly, your hormones look good and we're in okay shape there. And so that's more where that natural piece comes in is that it's not just here, go, you know, drink some tea and you'll get pregnant or just sit and meditate over being pregnant and it'll happen. We do utilize those mindset pieces and lifestyle pieces, but absolutely. And in addition with using conventional medications in a science based approach,

Dr Erica Bove:

I love everything you said about that. To your comment about the supplements, I've had people bring in like such heavy purses. They could barely carry them. Like these giant, I've even had somebody bring a small travel sized luggage, you know, like the roller carry ons. Once I came to my clinic with like a carry on size full of supplements. And I just like that image will forever be burned in my brain because I'm like, you know, Not only can you imagine the expense, but like also like lugging that thing around, we talk about burdens and putting down in the backpack, like, Hello, I need to manage that. Even last week in clinic, I had an experience where like a whole countertop was full of these supplements. And I'm like, okay, you need this one and this one and the rest can go away. So sometimes a lot of times less is more. I agree with you. And then just in terms of thinking about just what is natural, that's something I, help people with all the time because, I think some words like I sort of believe that like we are in this world sort of caring about things basically we are the people, the hands higher power. And, you know, I'm like, Who am I to say what's natural and what's not natural. And so when I think about like, what is natural, I think The menstrual cycle is natural. And if I can help people and that's your website, it's just amazing. When I saw like the graphs of the, estrogen and the follicle stimulating hormone, like my, it just made my heart so happy because that is what we're trying to do. That is natural. And so I think sometimes we're like, well, I need to do this without medications or I need to do this without X, Y, Z, or. You know, I really do feel in my heart that when we can simulate a menstrual cycle, so many things can happen. And, it is very complicated. I mean, it, it takes us years and years and years to learn it. I'm still learning new things about the menstrual cycle. It is not a simple process. It's a, choreographical dance. Actually. when I teach the med students, I'm like, it needs to be a cylinder and not just like a linear thing on a page. But I'm just so excited that you do this for your patients and your clients because they deserve that. And you empower them to understand their bodies in a way that expands the definition of natural. And empowers things to work. So I think that's really, really important to understand.

Monica:

And I tell people, I say, if you were able to live in a void of stress in a perfect world where your meals were perfectly prepared for you, you had time to exercise, you had time to relax, all of that stuff, your cycles would fall back into line. And for many, many women, either, you know, job situation, family situation, maybe they've got kids, at home already. It's near impossible to live in a void of stress, right? You know, many of us living in the real world, we can try everything that we can. And because of that, that's where sometimes those medications are needed. And it's, you know, we talk about that. It's not a failure to need medications. And, you know, even if we're doing all the other things, we say, let's try the medications for now to move things in the right direction. We can always try off the medications in the future. As we get some of these other lifestyle things in place, but realizing and eliminating that guilt from it, right? Where you go, okay, don't feel guilty that you have to use a medication in order to get you to that point. If you had diabetes, you wouldn't feel guilty about needing to be on medications in order to control your diabetes. So you didn't end up in the hospital. This is no different, you know, until we can get to that point of saying, Hey, this can be very normal or, you know, just living in a bubble. You know, is that medications are a part of the journey for many women.

Dr Erica Bove:

Yes. And I mean, I always tell my patients this too, like they're safe. They're well tolerated. The side effect profile is usually pretty low. I, I talk about giving the body a little nudge. And I think that that sort of works for people because it's like, your body's going to do what it needs to do. It just needs a little sort of push. push to get going. And you know, that's the beautiful thing.

Monica:

Okay. I know this conversation has been great so far, but we do need to take a quick pause for now. However, make sure to tune back in again next week for part two of our discussion, where Dr. Bove and I dive into identification of your fertile window, keeping your relationship in a good place when you're trying to conceive, as well as what fertility coaching can look like. In the meantime, 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 the Cedar Rapids, Iowa area, or can arrange for a telehealth visit if you live in the states of Iowa, Illinois, Minnesota, and other states coming soon. 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.

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