As a clinician I am dedicated to staying on top of the latest research. Over the past 3 months I have had the pleasure of learning from Dr. Leah Hetchman - a globally respected naturopathic clinician specializing in fertility, pregnancy and comprehensive reproductive health. Today, I want to share some things that I have learned from her around lab testing. Believe it or not, you need to do more testing. If it’s unexplained infertility, you need to test. If you’re stuck, you need to test.  If you feel like something is missing, you need to test. So in this episode I share the lab testing that you should be doing to get to the root cause of your fertility struggles and create a personalized treatment plan based on your findings.   

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Every month, Dr. Jane takes on 2 couples where she works with them 1:1 to identify and overcome the root cause of their infertility.

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Key Takeways

02:33 Learning from Dr. Leah Hetchman

03:34 Male Health in Fertility

06:39 IVF Treatment Customization

16:49 Detailed Testing Protocols for Women's Health

18:24 Methylation and Health

21:54 Impact of BPA and Endocrine Disruptors

23:25 Heavy Metal Exposure from Diet

31:05 Importance of Prostate Assessment in Male Patients

32:07 Autoimmune Conditions and Male Health

Memorable Quotes

"The things that you're doing today will change the expression of the genes and therefore the health of the future child. This is true for both male and females because, let's face it, the sperm is 50% of the DNA and the female is the other 50%."

"If deep down inside, there's still something inside of you that's going, 'I need to figure this out. I know that there is an answer here,' you're right. There is an answer, and the answer is going to lie in doing a thorough health assessment."

"I don't believe in motivation. I think knowledge drives compliance. If you have knowledge and understanding of what's going on in your body and you can see the data, it's really easy for you to make a better decision."

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The things that you're doing today will change the expression of the genes and therefore the health of the future child. And this is true for both male and females because, let's face it, the sperm is 50% of the DNA and of course the female is the other 50% and the female carries the baby. So we have a little bit more influence on, for example, the methylation, which has a really important critical, whatever the word you want to use here, it's a critical component of the health of that future child. Pregnancy is an so if it's not happening or if it's not sticking, something is missing. After having a family member go through infertility and experiencing a miscarriage myself, I realized how little support and education women have around infertility. I want to change that. I'm doctor Jane Levesque. I'm a naturopathic doctor and a natural fertility expert. Tune in every Tuesday at 09:00 a.m. for insightful case studies, expert interviews and practical tips on how you can optimize fertility naturally. If you've been struggling with infertility, pregnancy loss, women's health issues, or you just want to be proactive and prepare yourself for the next big chapter in your life, this show is for you. All right, ladies, today I want to talk to you about an update on some lab testing because I have been learning from Doctor Leah Hetchman. She is a globally respected and known clinician and naturopathic doctor who specializes in fertility, in pregnancy and just comprehensive reproductive health. I've had the honor of learning from her in the last two months and I will be part of her program for at least another four months, if not longer. It's an advanced fertility program for clinicians. So if you're a clinician and you want to specialize in fertility, I highly recommend to check her out, but I have been learning a lot in terms of her approach. So just to give you an idea, she's out of Australia. She has a one year waiting list to see her and she specializes in fertility. So I think that has something to say about who she is and what she does. So I have been absolutely honored to learn from her and really understand her approach and why she is as successful as she is as a practitioner. Because obviously that is something that I'm always striving to be. And as I get more and more complicated cases, it challenges me as a practitioner. And I believe that challenge is up to me to either rise up to the challenge or to just say that I'm not treating those kinds of patients and I tend to be the kind of person that wants to rise up to the challenge and help, you know, my patients figure out what is it that's preventing them from being able to get pregnant, whether it's naturally or through IVF, or maybe it's at a case where they're trying to reverse some of their perimenopausal symptoms and see if there is a chance for them to have a baby still. So we're going to talk about lab testing today. And one of the things that I learned from Doctor Leah that I absolutely love and I have adopted is that I don't like clinical surprises. And this is why we need to do thorough testing. Now, ideally, you're going to do your thorough lab testing before you even think about having babies. Because the worst case scenario is you're going to get really, really healthy. You're going to feel really amazing in your body. You're going to fix your digestion, your hormones, lose the excess weight, clear up your skin, and then you're going to be at the best possible place in your life to start a family. And of course, I recommend this for both male and female partner. I think the male partners get left out lot thinking that they're fine because they did this one sperm analysis that only had four markers on it. And a lot of the times that sperm isn't good, it's far from optimal, or it's barely within the range, which actually tells me that there is much deeper issues going on. And because I like when you're working with me in my maximize fertility program, I'm only working with couples, and I'm always. I'm not as shocked as I used to be, let's just be honest. But I was always so shocked to see how poor the health of the male is and that they're told everything is normal, whether that male is getting diagnosed. Like, I'm often diagnosing autoimmune disorders like Hashimoto's, it's not just the female issues and other thyroid issues. I'm often diagnosing cardiovascular disease, metabolic issues. So basically, you're either on the verge of developing type two diabetes, or you have already. They have already developed type two diabetes in extreme inflammation, you know, rheumatoid arthritis, you name it. So it's, to me now, just the way that the world is and the state of everyone's health. I don't think that anyone is in optimal health, present company included. I just ordered a bunch of tests myself because last time we did the testing was about a year ago. And then of course, I learned a little bit more, which I will share with you today. And it's just time. It's time for us to look at what is it that we might be missing, what other symptoms we still have, and both for me and my husband, because we do still have symptoms. Like I said, who doesn't? Whether it's the random breakouts or a little bit of the bloating, or I'm feeling a bit more tired or I have a bit more brain fog around this time of my cycle, not this time of the cycle. I just think obviously as a practitioner, I'm going to stay on top of all of that. So then I can continue to do the research and present it to my patients. But so ideally you would do this before you even started trying. This is something that I do with all of my patients in maximize fertility program. In my fertility 101 program, I give you access to do it. You don't have to do it, but fertility 101 is very much about being in a community, being in a container where you're not just in the wild, wild west of the Internet trying to figure out what you should be doing. You actually have a roadmap and then you have a guide, aka myself, a natural fertility expert that can help. There's not a lot of personalization because I don't know your case, but if you're getting testing done and we can discuss it and we can kind of start tweaking and helping you direct your energy better, that's what I would say fertility 101 is for. And that's really a lot of the times when, you know, you as a woman are in this phase where you're not quite in the full on trenches of infertility, but you're starting to get there and you just want to avoid them. Whether it's, hey, I want to optimize my hormones, I want to optimize my digestion before I even start trying, or you've already started trying, but you know that there are some issues still that are lingering and you want to take care of those, you know, before you're ready to potentially jump in into doing one on one, or maybe you just don't really need it yet and that's okay. So before I, I go off, you know, talking about everything else but the labs, let's talk. Let's come back to the labs. So you need to do this. Even if you're like, I'm going to can, I'm going to do IVF because insurance covers it. Like, I hear that as the most common thing. Like, yeah, we've been doing IVF because it covers it. And I just thought that was going to be the thing that was going to work. And the truth is, again, something that I'm learning a lot about, and you guys are going to hear a lot more content about IVF and how to approach it and understand what's going on. The reason that I didn't learn about it earlier as a natural fertility expert is I genuinely want people to figure out why their system is not getting pregnant in the first place before we jump into IVF. But the longer that I'm in the space and the more clients that I take on, I also realized that at some point, this may be, I don't say the only option, but that might be the right next step for some of my couples, based on what we have found in their lab, testing based on their age, based on how much time they've. They have again. And that's usually based on the age. And I'm not just talking about, like, you're 40 years old or you're 43 years old, but also just what's going on with the body, because IVF can bypass certain things and certain things it can't. So we. There's a lot more to IVF, then let's just sign up and let's do it. And what I have found out, you know, the more clients that I work with, my patients are told that it's just, here's the standard dosage. They're not looking at the patient as an individual or as the couples. They're just starting them with a standard dose. And if that happens to work, great. And if it doesn't, then they start to tweak the doses. And usually they go much higher in medications the second time around versus lower. Unless you're advocating for yourself, unless you know exactly what you should be asking for, which, of course, most people have no idea. So this is something that I'm excited to learn about and to share more with you guys, because, um, again, from doctor Leah, she knows exactly what the person needs to be on for the perfect stimulation of the egg and how that egg and the sperm needs to interact and the medication that we need to do, it's not as. It doesn't need to be as blindfolded as it is for, and that is what it is for most couples. So I'll be sharing a lot more information about this, but like I said, for testing, you need to do this testing. I think either way, one of the AHA moments that my patient, I just took on a new couple, has been about two months. They just started their protocols, and they started their protocols about a month ago because we had to wait for all the lab testing. It does take some time, but he had this big aha moment that, like, oh, man. The things. The symptoms that I have today are not just the reflection of my fertility, but it's also the reflection of what's going to happen down the road. So if he, for example, he had an insane amount of oxidative damage, stress, and he had this apolipoprotein e gene that was positive, which actually puts you at a higher risk for cardiovascular disease or developing Alzheimer's. And so you could see if he didn't change anything. Of course, we can't run that experiment, right, because we only have one life and we can only make one decision. But from what I know, it's like if he keeps going the way that he's going, he's not controlling the inflammation. And he had a lot of fungus, he had a lot of yeast, he had probably a lot of parasites that come with that and other inflammatory things going on. He already had those early signs. What I would say of, you have a predisposition to Alzheimer's, it looks like, and you have a lot of inflammation, and you're already experiencing anxiety and brain fog, that if we don't deal with this ten years, 20 years, 30 years down the road now, we're shocked that there are signs and symptoms of Alzheimer's, and we're almost caught off guard. And I don't. That disease, especially Alzheimer's, literally takes anywhere between 30 to 40 years to develop. And so there's a lot more research that's coming out on this. But my patient had this huge aha. Moment that went, oh, man. Like, the things that I changed today is going to impact how I age long term. Like, what happens to me when I'm 60, what happens to me where I'm 70? What happens to me when I'm 80? And what I said is, hey, I want to stretch your mind even further, because the things that you're doing today, because obviously, they're not pregnant yet, is literally going to change the health and the genetic expression of your future child. So just let that sink in for a second. The things that you're doing today will change the expression of the genes and therefore the health of the future child. And this is true for both male and females, because, let's face it, the sperm is 50% of the DNA, and, of course, the female is the other 50%, and the female carries the baby. So we have a little bit more influence on, for example, the methylation, which I'll talk about in a second, which has a really important, critical. Whatever the word you want to use here, it's a critical component of the health of that future child. And I think that if you're down the rabbit hole right now and you have no idea what's going on and no one's giving you answers, and you've kind of. Maybe you've already done a couple of rounds of IVF and nothing has really turned from it, and you feel like, okay, I don't know what's wrong with me. I must be cursed, or this might. Must mean that I'm not meant to have children. I'm just here to tell you that's not the case. I think if deep down inside, there's still something inside of you that's going, I need to figure this out. I know that there is an answer here. You're right. There is an answer. And the answer is going to lie in doing a thorough health assessment so we can figure out your symptoms and how your body's talking to you. It's going, and it's going to come down to a lot of testing, an insane amount of testing. And I say that because I just want you to prepare. Prepare yourself, that it's not just running some lab work. When people come to me and they're like, oh, I've had all this testing done, and it's literally ten markers. It's 20 pages, but it's spread out over ten markers. And it's the most basic stuff that I would like, I've already ran on my daughter, who is seven years old, versus, like, actual thorough assessment for somebody who is sick and struggling to conceive. And I think when we're struggling with infertility, that is a sign of the body being sick. So if you think that everything is healthy except I can't get pregnant, we right away, need to take a step back and say, well, the body is sick, because if it wasn't sick and it was thriving, then you would be able to get pregnant. But the problem is that we've been sick basically since the time that we have been born. We do not know what it's like to be not sick. Now, not all of you have been sick ever since you've been born. But I take my history back when I'm going with my patients all the way back to what was your mom's pregnancy like with you. And there is a lot for some people. There's been a lot of stress. For some moms, they had their gallbladder removed as soon as they gave birth, which is usually, again, a sign of toxicity, really high toxicity and poor hormone function. And because that gallbladder bile helps us to the stores the bile. And so if the bile is really sluggish, it calcifies, and that's how we get the stones. But that means we're not getting releasing that bile on a regular basis. So we're not absorbing our fats as well as we should. Those hormones, we don't cholesterol, let's face it, that's the backbone of all of our hormones. So right away, we're going to be in trouble there and then, not to mention all the fat soluble vitamins and then getting rid of excess cholesterol, that's bad. Like triglycerides, it all spirals, right? And that has a huge impact on how, of course, the baby develops the ability to breastfeed, you know, the calm state of the mom and so on and so forth, it plays a really big role. And I just. I'm here to challenge you guys to say that your issues haven't been here just since you've been trying to conceive. The issues have probably been there for a long time. Just nobody has ever paid attention to them, including yourself, because you were told that's normal and it's fine. And maybe you've even been suppressing certain symptoms because that's just the best that you knew, which is, you know, being on birth control, let's say, for 1012, 1520 years, because that's just what you thought. So we're not here to blame. We're just here to bring awareness and to help you understand why your body is doing certain things, so then we can fix it and optimize it. I never want to focus and dwell on the past. We just need to understand the past, to have understanding and compassion for ourselves, but we're not going to dwell on it, so then we can, you know, move forward. So let's go through all the testing that I'm currently doing within my program, and the reason that I want to share this with you is, number one, I don't want you to ever feel that, oh, I've done everything and nothing is wrong. I guess it's just the way that I am, or, you know, I'm just meant to live with these symptoms. Absolutely not true. And when you're told that there is no explanation, we've already tested everything. I promise you that you haven't, and I'll give you kind of a bit of a reason as to why I test everything, but I'm not going to go down the rabbit hole of every single marker I test because, I mean, genuinely, you just don't need to know that and it's going to overwhelm you. But when you do go in front of a practitioner and they're talking to you about testing and they say, oh, we just do this, one, two, three, and this gives us enough information. This is where I would be, you know, raising a yellow flag. Not necessarily a red flag, but a yellow flag thinking, huh? Are they maybe not testing everything that I need? Or maybe you're listening to this and you're like, okay, I've had all these tests already done, but then maybe it's the interpretation. Maybe there's something that's missing in the optimal ranges versus. Because let's face it, your labs are only as good as your interpreter. So we absolutely want to understand everything that needs to be tested, just so you know. But at the end of the day, you'll need someone to help you interpret it. And whether it's myself or someone else that you work with, it's unlikely going to be yourself. I do have some resources for labs, you know, understanding optimal ranges and how to read them and what you really need to test, but it's nothing. Again, I think that's just a preliminary information. It's not something that, unless you're a practitioner, you're going to be able to really, truly understand and put it all together. So let's go through the ladies first. So, ladies, really important to test on day two or three of the menstrual cycle. And this is when we're looking at the amH, estrogen, fsH, lh. You can also do all the other markers as well. At this time. I kind of. I do a bunch of the testing between day 19 and 23, so progesterone being one of them. But I also run the sex hormones like parathyroid, prolactin, testosterone, dhea. All of that stuff gets ran. Vitamin D, b, twelve b nine. Iron, homocysteine, kidney, liver function, cholesterol, blood sugar assessment, inflammation, thyroid function. All of these are getting ran on day 20 to 23. You can run them on day two or three as well, but it's just the way that my labs work. The only thing that needs to be run on day 20 to 23 is really your progesterone, because we want to see what your, you know what your progesterone is doing and the quality of the egg, it is going to be dictated by the level of progesterone. Right. A lot of the times women are focusing on progesterone, they're saying that it's low and I need to eat foods to support progesterone. That might be the case, but usually there's something else that's causing that progesterone to be low. And I've recorded a podcast on progesterone. I'll probably do another podcast on progesterone because it's such a big hormone. It's nothing, just what it does for the reproductive system, but also nervous system, immune system, gut function, all that jazz. It's really important hormone to assess. Something new that I started doing is a methylation panel. So methylation is basically an assessment of methylation, which is a biochemical process that's very vital to and critical to our function. Basically, every disease, whether it's genetic or not, can be tied to issues with methylation. Definitely things in the nervous system. So things like ADHD, OCD, any behavioral issues, autism, even down syndrome, like things that are genetic, if you will, versus behavioral. Absolutely. Can be tied to methylation. Of course, anything, even with, like recurrent pregnancy loss, miscarriages, you know, an inability to carry, and anywhere it can be a recurrent pregnancy loss. That's happening in those early weeks, like five to ten weeks, or in the later times where it's going into the second and even into the third trimester, because methylation is, there's a really high demand on methylation in, during implantation and then especially kicks up very high in the second trimester. DNA repair, cell repair, hormone balances, is all reliant on methylation. Now, there is a blood test analysis that can show us how your methylation works, and then you can do some genetic testing as well to see if you have a predisposition to, let's say, that MTHFR gene that is not going to function properly. What I will say is I don't do a lot of the genetic testing because I think it's just a whole different rabbit hole. And I think for some people it is important. Right now, I just haven't gotten into it, and I don't think that's important at this time. And also just talking with doctor Lia and what she's doing, and reason being, is just because you have a snp. So, like, just because your mTHFR gene is not optimal doesn't mean if you have all the right nutrients, your methylation cycle might be working just fine and vice versa. If your methylation gene, the MTHFR gene is fine, there's no mutations, but you don't have the right nutrients, that methylation cycle isn't necessarily going to work. So what I want to see is what is happening with your methylation right now as opposed to what is the predisposition of your gene. Because there's lots, lots of times we're like, oh, I don't have a mutation in the MTHFR, so my methylation is fine. Or hey, I just need to take folate or b twelve to support my methylation. There's a lot more nutrients that are involved and I think it's a really important test to run and I've been basically running it on all of my patients because it just gives us so much insight. Of course, the environmental toxic burn, I think it's not a matter of if we're exposed, but how much we're exposed. And heavy metals, mold, industrial toxins, pfas are all very prominent in our environment. So we need to assess and understand how much your body is excreting and it'll give you an idea of where things are coming from. So, you know, if you're seeing a lot of parabens or a lot of phthalates, I almost, you know, can guarantee that you're still using products on a regular basis, whether it's your mouthwash or your toothpaste or your face cream or your cleaning products or something that has those chemicals and those toxins in. You know, I had a patient with really high bpas and she's like, yeah, probably because I'm still microwaving things in plastic. And I'm like, you're still microwaving things in plastic? Oh my God. So obviously everyone kind of comes to this information at their own time, but it's really insightful to see it because you don't think that it has that big of an impact. But when, you know, for her, you see it in the red, you're like, yeah, you got to stop doing that. Like it's, and you know, the issues with BPA. Like, you can look at BPA and endocrine disrupting, you know, estrogen mimicking, like, what is it doing to the body? Even if you just do a quick Google search, it's going to pop up so many things. So I think it's just really valuable to see that information. It helps you take action. One of the things I'll say is I don't believe in motivation. I think knowledge drives compliance. So if you have knowledge and understanding of what's going on in your body and you can see the data, it's really easy for you to make a better decision. Like, she doesn't need to be motivated to change her plastic container out because she just sees this bright red marker, and she has all these symptoms of PM's and estrogen dominance and bleeding and, you know, losses, whatever. It's like, okay, this is probably tied to it. It's probably not the only thing, but this is a quick action item that you can take. Right now then, I've been running a comprehensive nutrient analysis. So, looking at a mineral analysis, but also at a metal analysis. The reason that I'll test heavy metals in the blood is because I want to see if you're currently exposed, uh, to something. So anything that we catch in the blood means you're. You're being exposed as we speak. So whether you have mercury fillings still or you're eating a lot of fish. I had, um, you know, a patient come up to me. He had some mineral testing already done, and he wanted me to help assess what he was seeing. And he had a lot of mercury in his blood. And I'm like, are you eating a lot of fish? And he lives in Costa Rica, and he was just like, yeah, we. We eat fish all the time. And I'm like, yeah, you're gonna, like, you need to cut that down, because it's quite high levels. And that's just, unfortunately, the world that we live in, where we are, the oceans are not a clean place right now. And the fish that is swimming in the ocean is accumulating a lot of those toxins. You know, we have an island the size of Texas of plastic that's just stuck in a vortex in the ocean. I. And that is the sad reality of the world. And so we need to do everything that we can to help decrease that load on ourselves and also on the world. I think it's just a huge reflection, right? Every time. It's not just about stopping microwaving things in plastic, but it's how can we stop using plastic and stop throwing it away? Because it's essentially coming back into the environment, aka into the ocean or into the soil, or. And then it's coming back to us. So it's just really decreasing and becoming aware of, you know, what's going on with the environment. Copper, zinc, and free copper index. This has been something also new that I've been running because turns out your copper can play a really big role in your ability to get pregnant or not. So when you're pregnant, the copper tends to spike a little bit. So if you're walking around with high copper, it's almost like the body thinks that you're pregnant, and it therefore will not like you just won't get pregnant because the body already thinks it's pregnant. So it's like a really simple test, and it's not the case for everybody, obviously, but sometimes it's just a quick little thing that you want to rule out. I do look at essential acids, I look at amino acids, I look at organic acid pathways, because it tells me kind of how the nutrient markers, your krebs cycle is working. Detoxification compounds of bacteria and yeast, all sorts of stuff that I think is really valuable for women. I've also been running the vaginal microbiome analysis, and this is something that probably gets retested a couple of times, especially if there is is a pathogenic bacteria, fungi, candida, whatever that has been found. We want to make sure that we treat it, and then we reassess and see if it's truly gone, if there is more. And then, of course, the comprehensive gut stool analysis. Like you, the gut is so important. It's so important to look at infections, inflammatory markers, digestive capacity, your mucosal lining integrity. Do you have leaky guts? So many people, like guys and women, are walking around with leaky guts, inflamed and puffy, and, like, eating the best quality foods that they can, but they just are not absorbing it, and it's this inflammatory cascade. So I think it's so important to look at the gut, and sometimes I'll look even further into, um, urine testing. So I love the Dutch, the dried urine analysis for comprehensive hormones. Sometimes I'll do it for the entire cycle, sometimes I'll just do it in the second half of the cycle. It kind of depends on how much time we have, you know, with my patients and where they're at in their journey. But for women who have those estrogen dominant symptoms, whether it's really dense breasts, heavy bleeding, painful bleeding, a lot of brain fog, it's so important to understand how you're breaking down that estrogen, because you could be breaking, you know, estrogen can go down into these three pathways, and it can go into the pathway that's more beneficial, because let's face it, we as women need estrogen. When we don't have estrogen, we don't feel great, aka menopause. Right? And perimenopause. When that hormone starts to drop, we just don't feel like ourselves. And then there is the pathway that's really more carcinogenic and is associated with a lot more cancers and whether it's breast cancer, uterine, ovarian, cervical cancer, you name it. We want to understand how your body is breaking that down and, you know, presenting some information to. I knew a couple that I just took on, and I'm like, hey, just based on your history and your mom and grandparents and aunts, how much cancer there is in the family, I just think it's wise for you to know this information because this is where personalized medicine kicks in. If your body automatically shuttles in an unfavorable way, it's not. That's your genes now, and there's nothing you can do about it. There is literally things that you could take, eat, changing your lifestyle to help switch the pathway that your body goes. That's why I love what I do in the medicine that I do is because we can get the body to change how it works. It doesn't just because you have a certain way that the body is doing it now. I think there's predisposition to it, and it's easier for it to go that way, but you can absolutely change it. And the way that I try to describe it is like if you're going down a ski hill and there's a this path that's very clear, you're just, it's easy to continue to go down that path versus looking on the other side and going over the fresh powder where there is no path. But you can create a path. And so it's harder at first to create that new path. But once it's created, you can go down that path just as easily as it was this other, you know, on the left side, the pathway that was really clear before. So the initial work is absolutely difficult because you have to lay the foundation. But after that, it gets easier and easier and easier. So that's how I like it to describe it to my patients. And, you know, obviously this is a lot of different information, but now we're not missing anything. So let me summarize it one more time. The dutch hormone panel that's going to look at how you're metabolizing your hormones, your sex hormones, so progesterone, estrogen, testosterone, also looks at your cortisol. So that's always really valuable. A gut stool analysis, a vaginal microbiome, a comprehensive nutrient analysis including, you know, minerals, metals, copper, zinc, environmental toxic burden methylation panel and blood work analysis on day two. And three for the female on day 20 to 23 of the cycle. So basically seven days post ovulation. That is what I consider a comprehensive lab analysis. And let's face it, it takes about a month to get all the labs done and get the results in. It takes anywhere between five days to ten days or even 14 days to get results for some of these things. And then, of course, we have to time it with the cycle. Methylation panel should be done around ovulation, so should be your total environmental toxic burn and the vaginal microbiome and the guts to analysis. And the reason that you want to do it around ovulation is because microbes love estrogen. So as that estrogen rises, they come out and we want them to come out so we can catch them and get rid of them as opposed to, you know, when you're testing on day three of your cycle. I do very little testing on day three of the cycle because the body is really calm, there's no hormones. Like, it's just, there's no. The inflammation is down. This is usually when we as women feel good, but all the microbes are down, too. And so you can do the testing and it'll show there's not much that's showing up. Typically, it's because of the time of the cycle that you tested and you just missed that window. So ovulation is probably the best time to test it. And like I said, my rule of thumb is I don't have to have everything to start the protocol because there's some things that we can start working on absolutely right away, but we will, as we continue to get more and more information, we can do, you know, we can work a little bit faster and get even more personalized. So those are all good things as it goes. For the males, honestly, it's the same thing. We need blood work. Obviously, there's no day two or day 21 or whatever, but what I do think is really important to include in the blood work analysis for the male is a prostate assessment. I have regretted not testing this sooner for some of my patients because I kind of assumed, again, just what I've learned is you just need to test it later in life, like forties and fifties and when they're having issues and concerns and they're not emptying their. Like, they have that frequent urination and they're not emptying their bladder all the way, or it feels like they're having to go frequently. I've tested my males and I had been shocked how many of them have prostate issues and inflamed prostate, which can actually be tied to an infection, which will absolutely be tied to the quality of the sperm and the ability of that sperm to survive in the female, in the female reproductive system. So checking the prostate, assessing autoimmune conditions, I can't tell you how many. It's not like 90% of my males have autoimmune stuff, but it's also not zero. So it's important to do an ANA screen and Ena profile as well, just to see if there is a reaction. Like recently I've had two males that all of a sudden popped up really high. Inflammation and immune system stuff. And of course they don't know. Like, they have no idea. Oh, but like, I can't sleep and I'm a little bit bloated, or I can't really seem to lose the weight, or, you know, I feel inflamed and they don't know that's what they're experiencing. And again, autoimmune conditions are going to be tied to infections and leaky guts. So it's just part of helping to understand and connect the dots. I do test the methylation panel for the males as well. Comprehensive nutrient analysis. Again, heavy metals is probably one of the most common reasons that I see morphology issues. Obviously, it's not the only one, but heavy metals is a big one, so we want to make sure that gets assessed properly and look at the total environmental toxic burden. Mold, again, heavy metals through the urine, and industrial environmental toxins and PFAS, absolutely going to have an impact on the nutrients that the system has to make good sperm. And if the male is not making good sperm, it's because there's something else that's going on in the body. So we need to figure that out. And then, of course, a good gut stool analysis, because the gut microbiome is going to dictate the seminal microbiome as well. And yes, there's, you know, you can semen cultures. The one thing that I don't have for males yet that I think is maybe on the rise now. And I think in the next six months we will have more information where you could do a semen analysis at home that's reliable and also like a semen culture or urine culture, where we can start to do the STI's and STD tests and just infections. I mean, essentially it's the equivalent of the vaginal microbiome, but for the male and for, for the sperm and the urine, because infections are probably one of the most common reasons that you are prevented in being able to get pregnant because it's a pathogenic bacteria. So it's very hostile environment. And the reason that I treat both males and females is the female can do all the work in the world. But if the male is carrying an infection of sorts, whether it's just as simple as Candida, and he, he doesn't really have any symptoms, but he has some toe fungus, maybe he has some dandruff, maybe he's a little bit, you know, bloated, tired, maybe he has some rashes, whatever. You guys are just passing that bacteria back and forth. And it doesn't necessarily mean you have to be intimate, but like sleeping in the same bed, cooking for one another, kissing, hugging, like just even breathing in the same space, you're sharing the microbiome. So I'm a strong advocate for treating both because when it comes to the microbiome, sharing is caring. And we, some bugs is good to share, but others not so much. And so we want to make sure that we're treating both. I know that was a lot. I hope you guys, honestly, what I would do is I would pause this podcast, like, write down all the tests and see what you have had done. If you've had done like two or three out of, you know, the seven things that I listed, for example, for the female, just know you're probably still like, you're missing more than 50% of the information. And so just like I said at the beginning of the episode where you're like, deep down I feel like something is missing, it's because it is. And again, the reason that I become even more thorough is thanks to Doctor Leah. Because when I look at someone like her, who's been in practice for 30 years, she's made the mistakes that I've made already. And like, here I have somebody, a mentor, who can help me bypass those mistakes. I'm absolutely going to listen. And yeah, that means it's a bigger investment in lab testing. And yeah, it means, you know, you have to wait for a month to get all the testing done and it might be overwhelming to figure it out around your cycle and all that jazz, but at the end of the day, you're going to have information and you're going to save yourself a lot more time. So the testing is not something that I want you to try to short change because it's literally the thing that's going to provide the roadmap. Like, I rather you stop taking all of your supplements and whatever else that you've been spending money on and biohacks trying to figure out to fix an issue that you're not aware of and put that money away towards lab testing because it's going to give you so much information. Like so much information. It's absolutely phenomenal. So I hope you guys found this helpful. Like I said, pause the podcast, write down all the tests and see what you have had done. And if you're curious to see if I'm the right person to help either one of the programs, I have an application down below. Fill that out and one of us will get in touch with you as soon as possible and let you know what we have available. And maybe it's just some more resources that you need. Or maybe it's time to see if it's fertility 101 or working with me one on one is the right option. The goal is to help you make the next right step based on where you are in your journey right now. So I hope you guys enjoyed this episode. Thanks so much for tuning in and I'll see you next week. Thank you so much for listening. To read the full show notes of this episode, including summary, timestamps, guest quotes, and any resources that were mentioned on the episode. Visit drjanelevesque.com podcast and if you're getting value from these episodes, I'd love it if you took two minutes to share it with a friend. Rate and leave me a review@ratethispodcast.com. doctorjane the reviews will help with the discoverability of the show, and who knows, I might share your review on my next episode. Thank you so much for tuning in and let's make your fertility journey your healing journey.