1 in 8 couples struggle with infertility yet answers can be hard to find. In the past decade, those struggling have opened up, companies are developing innovative products and solutions. However, we've transitioned into so much information, it is challenging to know where to begin. Dr Aumatma Simmons, a double board-certified Naturopathic Doctor & Endocrinologist specializing in fertility, speaks about the 5 things you won't find on Dr Google but that will help you on your fertility journey.
What we Discuss
Why being proactive is important and how to do so
Why the formulation of supplements matters
Which hormones to test, when and why
Simple changes to daily activities like sleep and diet that have a big impact
Georgie Kovacs: Before we speak about the five tips, what are main lessons for those struggling with infertility based on the patients you have seen?
Dr. Aumatma: Fertility is not just a female issue, it is equally the partner and we want to test and know everything about both people. If you're a single mother by choice, that is different. But if you have a partner, your partner needs to participate in this journey and be at least empowered with knowing what's happening. This is so even if his sperm are great, he's showing up to the appointments, and doing his part in supporting both of you to create this family together.
There have been many clients over the years who think the partner sperm is fine and he is not into the “natural stuff” so I should only work with her. I don’t do that because that just tells me the partners are not on the same page.
I also see many women who blame themselves or have lost faith given the struggle to build a family. What I say is, “There is nothing wrong with you. You're amazing. You're perfect just the way you are. Your hormones are out of whack. And let's work to address that.”
Georgie Kovacs: Tell us about how women can view the “fertility cliff” and perhaps avoid the panic that may come with the biological clock, so to speak.
Dr. Aumatma: What I discovered in a lot of the research is fertility doesn't drop off of this cliff, and a lot of what we tell women has been based on research from the 1800’s in France. There was a 3% lower chance of the women between 35 and 39 getting pregnant as there was for 25 to 29 getting pregnant. To me, it’s empowering, because we can now have the mindset of wait, if age is not the only factor, then what else could I be doing and paying attention to?
Georgie Kovacs: I want to challenge it a bit. How do we really look at this, because the fertility cliff is embedded in medicine and by top specialists.
Dr. Aumatma: On some level, there isn't a lot that we are going to do to change it. We need more studies to better understand this and have such consensus.
Georgie Kovacs: Currently, the definition of infertility is if you are over 35, you should see a doctor if you have been trying 6 months or more and are unable to conceive, but if you are under 35, that time frame is over 12 months. Do you know if insurance reimburses this way?
Dr. Aumatma: Yes it does.
Georgie Kovacs: What is your first tip to support fertility?
Dr. Aumatma: Testing is super critical. In my opinion, the sooner the better. Some women come to be after 2 months of trying and are worried. Testing early can perhaps alleviate those fears and provide helpful information if there is something going on. And rest assured, many of these same women come back to me pregnant without having changed anything. We need to give it time, but we also need the knowledge.
What I look at initially to guide those just starting with their trying to conceive journey includes:
Basic Hormone Tests
Trends in the Menstrual Cycle
Whether they Suffer PMS
So testing is great when you're able to review it with someone who can guide you on whether your results are optimal or not.
Georgie Kovacs: What are the foundational hormones to test in order to understand one’s fertility. And I would like you to address progesterone in this list.
Dr. Aumatma: I think there are some clear signs of when progesterone testing is needed. A lot of women are already doing LH testing at home with the urine sticks, right? If you've been trying to get pregnant, you're already doing LH strips, you know that you're ovulating at a certain point in your cycle. And then if you don't have a full luteal phase, 10 days is kind of minimum. If your luteal phases any shorter than 10 days, then we know that more likely than not, there's an issue with progesterone. So that's definite testing.
If you have PMS, you have short cycles, heavy bleeding, spotting, there's some clear indicators of when I would test progesterone. If you don't have any of those things. If your cycles are like 26 to 32 days, on average, it's pretty consistent. Your cycles are relatively predictable. The basic testing is enough, at least in the beginning, maybe we want more testing later but at least to start I think the LH, FSH, Estradiol on day three are enough to give us a sense of what's happening.
Progesterone is almost always a second tier test for me because let's say your FSH is high. FSH being high, is almost always a clear matchup to poor egg quality and if you have poor egg quality, you almost always are going to have poor progesterone production. The quality of the progesterone production is based on the corpus luteum or the shell of the egg after the egg has been ovulated,that shell is what's making the progesterone so you start out with one that splits off that egg and gets populated and then this corpus luteum, the shell that's left is going to produce progesterone for two weeks. So if you have those four hormones, and they look great, or in an optimal state, more likely than not that progesterone is going to be great.
Georgie Kovacs: You mentioned sleep is another tip. I assume this means how much sleep, when you go to bed and wake up, how well you slept. What else do we need to know?
Dr. Aumatma: If people could just sleep and get good quality sleep, that is going to have the biggest impact on fertility, and it's free. So it's one of my first things I recommend because I feel like everyone can do it, unless you have insomnia. Then we have an issue. If we can get a good amount of sleep every single night.
Based in Ayurveda, (which I'm trained in) the amount of sleep is really based on your body type. So somewhere between six and nine hours is optimal. You really have to find what that place is for you.
When you wake up in the morning, you should feel awake, alive, alert, and ready and excited for your day. If you have to hit the snooze button 10 times, that is a clear indicator that you did not either you didn't get enough hours or you didn't get enough good quality sleep.
The other connection is there's a thing called a cortisol awakening response. In those first 30 minutes of waking, your cortisol is going to rise and reach what’s optimal for the morning time and gets you through your day.
The biggest impact to cortisol awakening response is what you were doing the night before, before you went to bed. So if you were in front of a screen that gives off blue light, which is our TVs, phones, computers, all the things that we use these days, the blue light from our computers, or our screens are essentially like hitting the part of our optic chasm that turns off melatonin production. So this blue light creates this impact on our melatonin production, which then means we don't sleep well through the night.
Then when we wake up in the morning, there's no switch to turn it to cortisol. So now we have this melatonin deficiency creating cortisol deficiency in the most basic way. So the way to fix it is blue light glasses if you're going to watch TV or whatever, get blue light filter glasses. Good ones not the cheap ones on Amazon.
Georgie Kovacs: You know what I'll admit? I had purchased the cheap ones and then I found more costly ones and there it's a difference. It's a difference. It really works. It is not a marketing thing. It really works.
Dr. Aumatma: Limiting blue light at night and then getting good full spectrum light in the morning. That's the way to fix this cortisol melatonin thing that happens.
Melatonin is one of my favorite hormones for women, because it impacts fertility, it helps increase egg quality. So if you're getting good quality sleep and you're having natural production of melatonin, you're naturally supporting the quality of your eggs. When your melatonin production goes down or you're not getting a good response with that, egg quality will go down.
So again, one of the easiest things to do is get good quality sleep and make sure that you're sleeping through the night. If you're not, you can take melatonin.
Georgie Kovacs: What dose of melatonin is optimal and when should one take melatonin?
Dr Aumatma: In general, I start slow. The lowest dose is one milligram. Start with that, try it for a week, and see if it's helping your sleep. The biggest thing with melatonin is if you take it too late at night, you will awake feeling groggy. Take it early enough that you don't feel groggy, but late enough that it helps you fall asleep and stay asleep, and you feel more refreshed when you wake up. I usually suggest 2 hours before bedtime.
The word of caution is, don't give melatonin to your partner. Melatonin is not so great for sperm health. Men need different things.
Georgie Kovacs; What about Vitamin D? Who should be taking it, who shouldn't, and what is the optimal dose of Vitamin D?
Dr. Aumatma: Many of us are deficient in Vitamin D, We test everyone, and there are very few times that people have optimal levels of vitamin D on testing.
Generally speaking, a safe dose for almost everyone across the board could be like 1000 IU’s, and then we would go up based on how deficient you are. The more deficient you are, the higher the dose required. But that's usually for short periods of time and then we fall back to like a maintenance dose, which is 1000 to 2000 IU’s per day.
Georgie Kovacs: How does one decide which supplements to take to support their fertility? Not only the supplement type but also the brand or formulation.
Dr. Aumatma: In my experience, patients come in with garbage bags full of supplements, and a majority of the time I'm going to remove three fourths of them. We read the ingredients. I'm not even looking at the active ingredients. That's what's going to be on the supplement label that tells you how many milligrams. I'm looking at the other ingredients, which are very telling about the quality of that product. The longer that list of other ingredients, the more likely that product is garbage.
The second thing about supplements is whether they are the right kind of supplements. So for example, magnesium. We can talk about all the benefits of magnesium. It helps with your cycles, period cramps, optimizing hormones, and better quality sleep. While magnesium is amazing, the type of magnesium is important. There is magnesium carbonate, citrate, malate, gluconate, glycinate, among others.
Magnesium can’t be taken on its own. It is an element and has to be bound to something to make it into a form that you can ingest, whether it's a powder, a liquid, or a capsule. That binding process is what stabilizes it so that you can put it into your body. When you put it into your body, your gut has to cleave off whatever that other ingredient is. This is the carbonate, citrate, malate, gluconate, etc. Once your gut cleaves it off, then your body absorbs that magnesium.
So when you're talking about putting the wrong ingredient, let’s take magnesium carbonate as an example. Carbonate is essentially chalk. So you take that carbonate component, bind it to the magnesium, and you get this really crappy form of magnesium that probably will not benefit you at all.
I wish that there were easier ways to educate on each and every nutrient. These formulations are important because it impacts all supplements.
The last tier is whether it actually helps your fertility because you don’t want to expose yourself to something you don’t need or should not take. I get this asked a lot because someone will hear about a person on Facebook who got pregnant because of something they took. One I hear about a lot is DHEA.
Let’s talk about DHEA. It's a really popular fertility supplement. It took me seven years to figure out the optimal person to give DHEA to but there's maybe 5% of people who need DHEA. That person is someone who has a really specific hormone pattern. Also, DHEA levels in urine must be tested before knowing whether or not to supplement someone's DHEA. It is not a hormone you want to mess around with. DHEA can shorten your periods and shorten your cycles, and impact egg quality.
Georgie Kovacs: What are some things they wouldn't find on Google that you want people to know when it comes to diet?
Dr. Aumatma: I think the biggest trend that I've seen with diets is limiting major food groups, and my suggestion is not to do this. It is important to eat your proteins, eat your complex carbs, eat your fruits and vegetables, and get the variety and spectrum of good, healthy, unprocessed food.
There's no perfect fertility-related diet, and it is about being balanced and to eat less and less processed foods. Also, rotate your food because our gut needs variety. The more variety that you have, the better for the microbiome of your gut, the better for the microbiome of your uterus.
Georgie Kovacs: What is your greatest hope for women's health?
Dr. Aumatma: My greatest hope is for women to be able to have the relationship with our bodies and with ourselves. This means allowing ourselves to be in charge. This means not giving our power over to our doctors, or our friends, or Dr. Google, as an example. Instead, it is about being in tune with ourselves. We can use that as our guide on our healing journeys rather than some external power or authority.
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About Dr Aumatma
Dr. Aumatma is a double board-certified Naturopathic Doctor & Endocrinologist, in practice for close to 15 years. She specializes in fertility and is the best-selling author of "Fertility Secrets: What Your Doctor Didn't Tell You About Baby-Making.” Dr. Aumatma was awarded the “Best Naturopathic Medicine Doctor″ award locally in 2015 & 2020, and recognized as a top “Women In Medicine” Doctor in 2020. In addition to supporting couples through individualized care in person and long-distance, she also trains practitioners who want to specialize in fertility. Dr Aumatma has been featured on ABC, FOX, CBS, KTLA, MindBodyGreen, The Bump, etc., along with being interviewed for countless podcasts on topics of fertility, pregnancy, and postpartum health.
About Fempower Health and the Founder
Georgie Kovacs, is the founder of Fempower Health, the go-to resource for all things women health serving women, their providers, and companies looking to build/improve on products for women. She also hosts the Fempower Health Podcast, where she interviews experts to help women better understand how to navigate their health both day-to-day and in partnership with their providers. Her mission is to minimize the years many take to seek proper diagnosis and treatment.
Georgie founded Fempower Health after her first-hand experience with infertility and endometriosis. Leveraging this experience along with her 20+ year tenure in the biopharmaceutical industry and consulting, she leads this movement to empower women. With limited research dollars and women’s “training” to grin and bear it, both women and doctors are in the impossible position to diagnose and treat conditions with little information. Women deserve more and better information, insight and innovative health solutions.
**The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor. Always talk to your doctor before making health-related decisions.
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