POI is on the rise and many women are told they won’t be able to have biological children….this is a harsh prognosis and not necessarily true for women diagnosed with POI.  In this episode I break down the development and progression of disease and what are some things you can do to slow down it’s progression or even reverse it. Tune in to learn more

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Key Takeways

5:03 Three mechanisms of ovarian insufficiency

7:06 Methylation's role in follicle development

13:13 Generational impacts on ovarian health

18:19 Timeline of follicle development and recruitment

21:23 Inhibitory vs stimulatory factors for follicles

24:55 Case study: Addressing premature ovarian insufficiency

Memorable Quotes

"The body reproduces from the parasympathetic nervous system, which is this rest and digest and relaxation."

"Healing is two things. You need good blood flow and you need nutrients in that blood.”

"I'm not here to instill fake hope, but I'm always going to have hope for my patients. And to be honest, sometimes I have more belief and more hope for my patients than they do themselves, because they're trying to protect themselves. They don't want to be devastated. They don't want to be hurt."

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In the potential dominant follicle that's going to be hopefully ovulated and then fertilized, the antral follicle count is, you know, happening. I said day six to 11 of the cycle, those follicles have been maturing. They're coming from the primordial follicles, which is, you know, that first step. We cannot see that on the ultrasound. That's about 150 days. And then there's the primary follicles that take 120 days to mature, the preantral follicles that 70 days. And then we go into the antral follicle count, and then it's 40 days until we ovulate, or about that time. So when you hear things like the initial recruitment starts 150 days out. Pregnancy is a natural process. 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 Dr. Jane Levesque. I'm a naturopathic doctor and a natural fertility expert. Tune in every Tuesday at 9am 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 premature ovarian insufficiency. This is actually a topic that I'll be speaking on at ECO in this year, in May of 2025. So ECO is stands for exponential Clin Outcomes. It is a conference that's hosted by cellcore. If you're a practitioner, I highly recommend that you guys attend this conference. And again, I will be speaking this year on premature ovarian insufficiency. Last year, I was on stage speaking about unexplained infertility. And unfortunately, this is a concerning issue. And so I kind of want to record a podcast. I do have a case study that I'll walk you through as well, but lots of questions around why is it happening? And then when it happens, is there anything that I can do to reverse it? Is it possible for me to still use my own eggs? So I'm not here to instill fake hope, but I'm always going to have hope for my patients. And to be honest, sometimes I have more belief and more hope for my patients than they do themselves, because they're trying to protect themselves. They don't want to be devastated. They don't want to be hurt. But, you know, I have two children. I've had a miscarriage. And I think when we have the drive, when we have the pool and we really want to have a family, it is not something that I would give up on. And the way that we want to make sure that we're approaching this is when we are going through our fertility journey, we are actually getting better. The mistake that I see a lot of couples make is because it's such a highly emotional state, and there's so much time pressure, and sometimes the diagnosis of premature ovarian insufficiency comes really suddenly, that now you're making decisions from this highly emotional state with time pressure, and it's very easy to make the wrong decision. And my hope is that by consuming some of my content is it will allow you to make a decision that aligns with your goals and your values and actually gets you closer to your family goals, at least puts you in a position. Knowing that I've done everything, I have no regrets. I'm at peace, and I'm actually so much healthier than I was before. The problem that I always see is by the time couples come to me and they've made all these other decisions out of being rushed in the timeline and the emotional component of it, that they're actually, actually in much, much worse shape than they were when they first started, because now they've been pumped full of medication or, you know, and like, they've gone through all these procedures, they feel exhausted. The women are in worse shape, meaning they've gained weight, they have acne, they have all of this stuff that's going on, and they're actually further away from their family goals now because the body is in much, much worse shape. So that's always my lens, is you need to be getting better. When you're going into the fertility journey, there might be moments not feeling good, but you should be better. Your skin should be glowing, your digestion should be improving, your energy should be improving, your hormones should be improving. If those things aren't happening, it's a sign that you're moving in the wrong direction. And so we want to make sure that we pull back and then, you know, get back on course. So let's dive into premature ovarian insufficiency. And some of the things that I'm seeing in what I'm learning from my mentor, and just like the research and where this field is going in the next little bit, because there is a lot, there's a lot that's happening. And essentially when we are struggling with premature ovarian insufficiencies, there's three components. The first one is there is just a decrease in the amount of the initial primordial follicle number. So you were born with less follicles. Number two is there's an increase in how quickly those follicles are dying off. So instead of losing 20 or 30 follicles per cycle, you're losing 100 or 200.

Now I'm just making these numbers up. But essentially it's, you have less or you have this apoptosis. The dying off of the follicles is really fast. Or there is a lack of response between the follicle is not responding to the hormone stimulation, to the gonotropin stimulation. So those are kind of the mechanisms of premature ovarian sufficiency. You can have one, you can have all three. And just so you kind of know the difference between an ovarian aging and aged oocyte, the ovarian aging is when you have decrease in the quantity and quality of the oocytes. Whereas an aged usite just means that there's reduced amounts of mitochondria. So mitochondria is going to be the reason why we are struggling or we're seeing women struggle with premature ovarian insufficiency. Mitochondria is at the root of fertility. It is the powerhouse of the cell. It is the thing that helps us make hormones, the estrogen, the progesterone, the cortisol. It is the thing that helps us detox. And when it's struggling, we are going to experience the low energy, low hormones, anxiety. We're not going to be able to detox as well. And essentially our ovarian health will not. Our follicles will not be as healthy. And so I'll take you back to understanding, you know, how many follicles were actually born with. When are the big components of when we're losing them. And then what we're seeing when someone is diagnosed with poi. So at 20 to 40 week gestation, so when you are pregnant with your mom, you have 26 to 7 million follicles. Six to seven million, you guys. And then at birth it goes down to about 700,000. So this is a very big drop off. We don't actually know why that drop off is happening. The sense is that it has something to do with methylation. Now Methylation, if this is the first time you heard about this word, is a biochemical process that happens in every single cell of the body, is how our body repairs DNA, repairs tissues, produces energy.

It's a cycle. You might know about MTHFR gene that talks about, you know, if you have it mutated or not. MTHFR gene is part of the methylation cycle, but there's 13 genes that are in the methylation cycle and then there's certain nutrients. The reason that the speculation is the huge drop in the follicles is happening due to methylation is because when a woman is pregnant and it's between week 16, week 17 to week 25, the demand on methylation is really, really high for the FEMA because the baby has so much that, you know, he or she is growing. So when it's a she, this is when especially I think if the mother is depleted and doesn't have the proper methylation factors. So there's genetic snips, we're going to see a huge drop. I think that there's like, these are kind of speculation. I think there's going to be a lot more research that comes out on this. But basically at birth you only have 700 follicles versus, you know, at week 20, you have 6 to 7 million. So there is stuff that's happening in the process that's causing this really big atresia, this really big die off at puberty. We're now at about 400,000. And then monthly you're losing about 20 to 30 follicles per cycle. So what happens when the brain stimulates the ovary is that it stimulates the ovary to start maturing a follicle. And there's only a couple that get picked that are dominant that we can start to see on the antral follicle count. So that's when we do an ultrasound between day six to 11 to see how many are starting to mature and which one is the dominant one. So in a disease like pcos, there is no dominant one. All the energy is just going. So there's many, many follicles, but not one dominant. And that obviously causes issues because you can still be ovulating, but because the follicle isn't growing enough, not dominant enough, there's not enough mitochondrial, there's not enough genetic DNA in there, there's not enough of anything in there because it hasn't been matured. And so miscarriage rate is really high. But also you're just not. It's unlikely to get fertilized Even if it will, in premature ovarian failure, when you do an antral follicle count, you can't see very many. And in a healthy individual, you're going to see four or five follicles, maybe sometimes eight, and then one or maybe two dominant. Obviously, if there's twins or you're likely to have twins during that cycle, you can literally see those, that follicle growing. We still don't know why the follicle that gets chosen, we honestly, like, we don't understand why that happens. But it's that one that gets chosen. And then there's 20 or 30 that die off and both ovaries get stimulated. It's not that you're gonna only stimulate the right side or only stimulate the left side. The brain just releases the follicle stimulating hormone and both ovaries will respond. But only one follicle, you know, maybe two, three. Very unlikely. Obviously, when we're doing stimulation with drugs, that's different. But on the natural cycle, one is going to be a dominant one and then the other ones are going to die off. So there is this constant atresia. And to be honest, this early menopause or premature ovarian insufficiency can happen to any woman. And if I can take a sidetrack and talk about menopause for a second, we actually start experiencing menopausal symptoms, the shift in the hormones that lead to menopause 10 to 15 years before our moms went into menopause. So if your mom went into menopause at 50, you're gonna start experiencing some perimenopausal symptoms at about 35. If your mom went into menopause at 40, then you can go as early as 25. Right? 40 is early menopause. Something is triggering that. And we obviously wanna really understand our mom's history around hormones. Most women have no idea. So if you have no idea, please ask your mom about her hormonal health throughout her whole life, during your pregnancy, during the postpartum period, and when she went into menopause and how long she had symptoms for, but we start to experience subtle changes. It's not like one day all your hormones just go nuts. We start to see a decline in the peak of the estrogen or how much progesterone the body produces. And so then we start to see the symptoms that are associated with that. And maybe that's lighter periods, maybe it's heavier periods, maybe it's difficulty sleeping, maybe it's the belly that you start to have that Just you can't seem to lose it. Maybe it's your skin, it doesn't feel as vibrant, or your hair, it doesn't. You know, your muscle mass is not the same. It's easier for you to gain weight, or maybe you have some cellulite. Those are all hormonal changes, and they don't happen overnight. They're happening over years and, you know, a decade plus a little bit, which are all leading signs to menopause. And so in premature ovarian failure, we're just seeing that change a lot faster. And some women, I've had some of you message me where you're in your early 20s and you have FSH levels of that of a menopausal woman. And the case that I'll share with you here today, Chantal, like, she didn't know she had premature ovarian insufficiency. She just assumed that her hormones were normal, because guess what, she went to the doctor and they told her it was normal. And so she believed it. And then she tried to do things naturally, but, you know, it wasn't until she wanted to get pregnant. And when we tested and looked at her FSH, and it's like, your FSH is at 36, at 35 years old, what's going on here? So, unfortunately, that is the situation. So I encourage you, if you have any symptoms of hormonal imbalances and your doctor says it's normal that you find another doctor. If you want to apply to work with myself, one of my practitioners, please send us a message on Instagram, send us an email, fill out the form on the website. We're happy to see if we can help you, but please don't take your hormones as this is the norm, because it's not.

And so one of the biggest things that is really important in premature ovarian insufficiency is understanding the timeline and the development of disease. It is a generational disease. If you think about there's a trigeneration effect. When your grandma is pregnant with your mom, the oocytes are being developed. That's you, that's going to be you. That's the mitochondrial, the genetic download. And so when I meet a woman who's in her 20s with an FSH of 76, I know I'm taking a lot of history around pregnancy, the toxic load, the. Why was there so much? Did she not have any pool that she's coming in with follicles, or did they all die off? Especially during pregnancy, if the mom was exposed to a lot of toxins Maybe there was. And whether it's toxins, environmental toxins, or there was a really toxic relationship, so she was really stressed. All those big, like, distress is going to impact how our body responds to everything else, right? Stress shuts down the communication between the ovaries and the brain, because the last thing your body's thinking about is, oh, I should reproduce. There's so much stress going on, I should make more babies. Right? The body reproduces from the parasympathetic nervous system, which is this rest and digest and relaxation. So if we have a hit of cortisol when we are in our mom's belly or our mom is a stress ball, that's our norm for our cortisol. That's just like, we don't know what else it's like to be anything else, because that's, you know, this is how we were in the womb. Lots of things that we can do to help retrain our nervous system. The point being is that this didn't start when you went into puberty. This started before you were born. And I will always look at the history of the grandmother, because the grandmother, if the health of her when she was pregnant, you know, your cells were being carried, you know, your mom's oocytes were being developed at that time, which then becomes you. And there's some really beautiful studies that show the connection between the nutrient levels of the mom and the grandma and then the ovarian reserve. And how, if we have. The study that I'm thinking of particularly is done from the World War II, where they looked at women who went through the starvation period, and essentially they followed them and their granddaughters to see how it impacted fertility. And so the famine didn't actually impact the ability for the grandmas to get pregnant and to breastfeed. And not even their daughters. Their daughters were able to get pregnant and breastfeed, but it was their granddaughters that had a difficult time either conceiving or breastfeeding. So there is this trigenerational effect. And I share this with you, not to discourage you, that, oh, my God, it's just the way that I am. I think the conventional system is really good at letting us know that, oh, sorry, you're broken. Nothing you can do about it. I seen incredible things. I think the body is capable of incredible things. We just need to set a realistic expectation of what it is that we need to do in order to heal this generational disease and be able to have our own children and to, you know, not pass this on to the next generation. So the first thing that we want to know is really understand the full history. Grandmother's health during pregnancy, mother's health during pregnancy, your zero to seven period, because that's a huge imprint, lots of trauma that we can accumulate. And it's either we're going to feel safe or we're going to have a lot of stress. And that stress could be because the parents are being divorced, or, you know, there's lots of moving, or you lived next to an industrial toxic wasteland, and so you were exposed to a lot of environmental toxins or maybe you just got. Got sick frequently, so you were on multiple rounds of antibiotics before the age of two. You know, I've had women who've struggled with infections all of their life, and they just didn't really realize that they were struggling with infections until they tried to conceive. And then of course, you know, whether they couldn't conceive at all or they had recurrent pregnancy loss, those are all really important aspects to understand. The around puberty is also a really important time to understand what's going on, because around puberty is when the brain and the ovaries connect. And so if there's a lot of stress, then it's really hard for the body to make that connection and to make it healthy. So remember what I said, the three mechanism of premature ovarian insufficiency, One of them is the failure of the follicle to respond to the hormones, the gonadotropin stimulation. That connection happens during puberty. And so if there's a lot of stress during puberty and when that connection is trying to be made, it's almost like that signal doesn't get strong enough and the ovary just never responds to it as it should. And so I know you're going to ask, what are we going to do about it? I'll summarize it in a second for you. The history is really important because when you understand the history, you're going to have aha. Moments. You're going to go, oh, okay, I didn't realize that release, mental, emotional, aha. Moment release actually helps the body heal. And it just provides clarity, right? The more clarity we have, the more specific we can be. The next thing that's really important is how long do you actually need to give yourself time. So when we're doing an antral follicle count, meaning we're looking at the amount of follicles that are getting ready in the potential dominant follicle that's going to be hopefully ovulated and then fertilized. The antral follicle count is, you know, happening.

I said day six to 11 of the cycle. Those follicles have been maturing. They're coming from the primordial follicles, which is, you know, that first, first step. We cannot see that on the ultrasound. That's about 150 days. And then there's the primary follicles that take 120 days to mature, the preantral follicles, the 70 days. And then we go into the antral follicle count and then it's 40 days until we ovulate, or about that time. So when you hear things like the initial recruitment starts 150 days out, that's not three months, that's five months. And so if we want to stimulate the ovarian tissue and bring lots of blood flow and help the follicles mature properly, it's minimum five months, but it could take a little bit longer depending on what's causing the follicles not to be in recruited. So there's either inhibitory factors or stimulatory factors. So there's things that are going to stimulate the recruitment and then things that are going to inhibit it. And so the first step we want to do is make sure that we are removing all of the things that are going to inhibit the recruitment of these follicles because we want the stimulation to happen and that recruitment to happen, that happens five months before you actually ovulate. So most women are thinking one month, three months, and we need to extend that timeline because it just sets you guys up for failure. You're thinking that my efforts don't count, I suck, I'm never going to have a baby. And you start to have all this negative self talk because you think your body is failing you. Where in reality, we just don't really understand how our body works and therefore we get upset with it. I promise you, your body is working as hard as it can. So if it's not doing the thing that you want it to do, then we need to change something, right? There's usually a lack of knowledge. There's something that you're missing as opposed to your body is broken. I just like, I really want you to feel that your body isn't broken. It's doing the best that it can. And so if it's not not doing very good, that means something is missing. And we need to come on the same team as our body and ask it, how can I support it? And of course, work with experts that are going to help you here. So the initial recruitment starts about five months. And it's. There's inhibitory factors and then there's stimulatory factors. And the initial recruitment is not actually dependent on the Gadot tropin, on the. I don't want to say on the brain. But like, the initial recruitment does not depend on that, whereas the next recruitment does, from the primary follicle to the preantral follicle is dependent on the gonadotropin response. So what are some of the inhibitory versus stimulatory factors? The inhibitory stuff is going to be all the things that you guys have heard me talk about. High oxidative stress, inflammation, infections. It's the body. The last thing it's thinking about is reproducing when it's under high stress. So if you have a high toxic load, whether it's a heavy metal or mold or fungus or industrial toxin like glyphosate, the last thing your body's thinking about is I should ovulate.

It just doesn't have the energy to do that because the toxin is taking it all up. If you have chronic infections, and so many people do, in your gut, in your vaginal microbiome, in your endometrium, your body is not going to want it to reproduce. All of those things are going to inhibit the initiation of these follicles. The things that will stimulate it are the opposite of that. That, right? The antioxidants, the good nutrients that we have, the sleep, the decreasing the stress, the having the blood flow to the area will help to inhibit and of course, help the mitochondrial function that will basically help the follicle to grow. The more mitochondria there is in the follicle, the healthier it is and the more likely it is to get fertilized and to make a healthy baby. So we want to optimize our mitochondria levels. And that's, like I said, decreasing the toxins. First. You always want to remove the reason that the body isn't doing something and then you. The nutrients. So we remove the inhibitory factors before we increase the stimulatory factors. Because a lot of the times when we remove the cause, the body can just already do it. What I will say here is, I kind of say, like to make it really simple. Healing is two things. You need good blood flow and you need nutrients in that blood. And so the follicles need blood flow. And so if we're overweight and we're carrying most of our weight in our belly, if our hips are really tight and we can't actually get down into a proper squat or we're sitting a lot and there's not a lot of movement, if digestion is really bogged down, where you're not pooping on a regular basis, you feel bloated, there is constriction in the blood flow that's going to that area, and then we want the nutrients. So if there's no blood flow, even if you have the best nutrients in the world, it's not going to get in there because there's no blood flow. So I find we want to create lots and lots of blood flow to the ovaries and to the uterus, because then when we put the nutrients into the blood, that's how the body heals, right? That it has the nutrients that it needs and the blood flow is life. We want that. And many women that I see with premature ovarian insufficiencies have one, if not all of these things where they are carrying extra weight, they are not pooping on a regular basis, or they have diarrhea. So there's a lot of inflammation in their gut. They have infections, they're not moving very much. They have tight hips, and so we can't even get that, you know, the blood flow. Nothing is moving there. Here's what I'll leave you guys with. Everybody is going to be very different in te what we need to do to optimize and get these follicles turned on and, you know, functioning properly. So minimum, I would say five to six months, but you might need a full year to get the follicles going, because it might take three to four, anywhere three, four, sometimes even five, six months to get. Get any infections out. Ideally, it's only about three to four months, but like I said, there's some. Another infections pop up where you got sick, and there's some side tracking. You have to get the infections out. Sometimes if you have a heavy metal that's really, really high, it's going to take time to get this guy out. Now, if you're 35 versus you're 25, my approach is going to be very different. If you're, you know, 38 versus 20, it's because there's less time. But you want to make sure that you're getting the inhibitory factors out as quickly as possible. And then we're bringing in the nutrients to support methylation, to support antioxidants, to support mitochondrial function.

So then we can see, you know, the impact of that follicle growing and improving. What I'll leave you guys with is, you know, Chantel, my case, when she didn't even know she had a premature ovarian insufficiency. It doesn't have to be perfect. She realized that, oh, my God, I might not be able to have kids, but I want to do everything that I can to try. And we started with really thorough testing. She had a very high environmental toxic load. She had mold. She had infections in the gut. She still has breast implants. She. There's lots of toxic load that she had in experience in weight loss, resistance and lack of sleep and, you know, all the hormone fluctuations that she had that she thought were normal, but actually signs of menopause. And so we did a lot of testing, and then when we were able to do the plan, she just focused on one thing at a time. And we focused on the detox. We focused on getting the blood flow up. We focused on decreasing her exercise because she was actually going too intense, and so it was causing a bunch of stress. We optimized the sleep. It's keeping the eye on the prize and having hope and then tracking things as much as she could. So she was in Canada. She couldn't get a lot of testing, but she asked for what she could. And so we would just track the progress as much as we could. And I think she had a very strong belief that she could do it, and she just wanted to focus on getting as healthy as possible. And she knew that was, you know, the only option for her. She didn't want to explore ivf. Sometimes we can't explore ivf. Sometimes we can. Every couple is different. The point is that before you give up, before you write yourself off, make sure that whatever you are gonna do, you feel at peace. It aligns with you. You are getting better, and you feel like this is the right direction. If something doesn't feel right, you need more information. Okay? And get that information so you can feel right, because here's where the sciences right now, or, you know, some of the clinics, what they're doing. We know that women are born with all their follicles and that the follicles were losing every cycle. But what we've actually seen in experiments as well is when the woman goes into menopause, she still has follicles that are there. They're just asleep in the ovarian tissue. So there is. It's not like when she go. Woman goes into menopause, there's no more follicles. There are follicles. They just never responded to the hormone stimulation. They never matured. We still don't know why that is, like, why certain follicles gets chosen and why don't. Some don't. But we're seeing therapies like stem cell therapy and PRP therapy, where we're actually stimulating the ovarian tissue. We're bringing blood flow, we have nutrients, and that allows the follicles to grow and mature. So the ones that have been quote, unquote, sleeping, we can actually see them grow and mature. And the other thing that we're seeing is that when you're doing an ovarian tissue transplant, we can actually generate oocytes. Just think about that for a second. So, yes, we know that everyone is born with follicles, but we're actually seeing that we can make new ones from ovarian tissue. And I'll leave you with that, because that's not for everybody. Right. Like, it's very expensive procedures. You know, there's a lot of stuff that we need to do in order to get to that place. You know, doing an ovarian transplant tissue, like, that's not an easy thing. But there is more to it than just, you don't have any more follicles left. And if I can be a voice of hope for you and open up and stretch your mind that there is multiple ways that we can get you your baby with your own genetic material. Because, of course, for some, we do need to do a donor cycle, and that is the case for. And there is no right or wrong. It's just, what are you comfortable with as a couple and what makes sense? But there is a lot more out there. And I just hate it when doctors put this label on you and tell you, nothing you can do about it. You're done. Go get donor eggs. There's a lot more that's coming out, and I will be sharing it, and I'll share my cases and I'll show you. You know, the Chantal, they got pregnant within a year, and she just went slow and she did her things and she focused on the right stuff. And, you know, I've worked with cases where they didn't get pregnant in a year, and I still do believe that they will get pregnant, but we have to make some adjustments. And, you know, when I can't help a couple, that propels me to learn more, because I know that there's couples that can do it. It. And, you know, we've seen miracles. Like, I've seen miracles. I've seen my mentors do some really incredible stuff. And I'm a huge proponent for the body. I think the body is incredible. I think the USITE is incredible and we can get it to work and maybe our bodies can even make it, which is an incredible thought. So I'm going to leave you with that. If you guys are interested to learn more about myself and my practitioners and how we work, please send us a message through Instagram or fill out a form on the website. I'm happy to explore that option with you, but if you found this podcast helpful, please rate it and then send it to someone who you think will find it useful. But thank you so much for being here, you guys, 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 reading resources that were mentioned on the episode, visit drjanelevesque.com forward slash podcast and if you're getting value from these episodes, I'd love it if you took 2 minutes to share it with a friend. Rate and leave me a review at ratethispodcast.com forward/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.