EPISODE SUMMARY:

In this special 200th episode, I walk through three real fertility cases to show you exactly how I interpret labs, connect patterns, and identify what’s being missed. We dive into common scenarios like endometriosis, diminished ovarian reserve, and “unexplained infertility,” and why fragmented testing keeps so many couples stuck. If you feel like you’ve been doing everything but still lack clarity, this episode will help you understand what actually matters and what to do next.

ABOUT DR. JANE’S PRACTICE:

Dr. Jane is a Naturopathic Doctor and a Natural Fertility Expert. She and her team of expert practitioners help couples navigate infertility for 1+ years, get to the root cause of their struggles, heal, and bring healthy babies home.

After having a family member struggle with infertility and experiencing a miscarriage herself, Dr. Jane realized how little support and education women receive. She is on a mission to change that. Since 2020, she has dedicated her practice to fertility, where she and her practitioners work with couples 1:1, running functional lab work, customizing treatment plans and providing her couples with the support they need to get pregnant, have a stress free pregnancy and a healthy baby.

Learn more about Dr. Jane’s practice: www.drjanelevesque.com/practice

Apply to work with Dr. Jane & her team: www.drjanelevesque.com/application

Join to receive Dr. Jane's weekly Fertility Files: https://link.getcmm.com/widget/form/JStvkHpRAamc7VwPMEQE

CHAPTERS:

00:00 - Introduction to the case discussions and the importance of clarity in fertility plans

02:22 - Case 1: Endometriosis, ovarian reserve, lab testing insights, and root causes

05:05 - Why urine mineral analysis isn't sufficient and the value of blood nutrient panels

08:48 - Hormonal cycle tracking and progesterone resistance in endometriosis

12:19 - Gut health, microbiome, and immune system connections

15:09 - The impact of environmental toxins, inflammation, and genetics

20:23 - Interconnected roles of estrogen, copper, and iron in endometriosis

25:46 - The significance of hormone ratios, liver function, and detox pathways

30:25 - Male partner assessment: stress, gut, and sperm health

35:27 - The autoimmune view of endometriosis and targeted protocol strategies

40:02 - Case 2: Ovarian reserve, hormone patterns, and perimenopause insights

45:58 - Electrolyte balance, digestion, and ovarian signaling issues

55:27 - Hormone testing nuances, Dutch test interpretation, and fatigue support

66:59 - Addressing fibroids, inflammation, and hormone pathway support

68:29 - Case 3: Unexplained infertility, comprehensive lab review, and lifestyle factors

73:44 - The importance of timing, retesting, and integrated testing for optimized outcomes

83:25 - The role of environment, inflammation, and preventative health in fertility

95:33 - Wrap-up: collaborative care, next steps, and encouragement for your fertility journey

TAKEAWAYS:

1. The clarification stage is crucial before addressing fertility issues.
2. Inflammation, microbial imbalance, and hormonal dysregulation are key factors in conditions like endometriosis.
3. Comprehensive testing (hormonal, gut, methylation, microbiome) is essential and often overlooked.
4. Gut health, nutrient levels, and environmental toxins play significant roles in fertility.
5. Stress, lifestyle, and environmental factors have a profound impact on reproductive health.
6. Practical advice on hormone support, supplements, and test timing specific to fertility challenges.

ABOUT NATURAL FERTILITY:

Pregnancy is a natural process, so if it’s not happening or it’s not sticking, something is missing. Join Dr. Jane, a naturopathic doctor and a natural fertility expert, every Tuesday at 9am for insightful case studies, expert interviews and practical tips on optimizing your fertility naturally.

If you’ve struggling with infertility, pregnancy loss, women’s health issues or just want to be proactive and prepare yourself for the next big chapter in your life… this show is for you.

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Individualized care is essential for effective treatment of chronic fertility issues.

Hi, and welcome to the 200th podcast episode of Natural Fertility with Dr. Jane. I of course am Dr. Jane. And today we are doing something very special. So if you've been following me for a while, we got a bunch of you to apply to discuss cases live. I think the biggest thing that's always missing is you are looking for clarity. You're grasping at straws. You've been on the hamster wheel of infertility, trying to find all of the supplements and the right things to do. And my hope is with today's podcast episode,

you're going to gain some more clarity around your case. So the three applicants that I have picked, I have picked them for a reason. It is because it is the most common things that I see. So I know as I discuss a case about endometriosis or diminished ovarian reserve or pregnancy over 35 or even pregnancy over 40, there's a lot of you that are going to get value out of this. So thank you for all of you who applied and to the three lucky applicants, I'm really excited to go through your case and the amount of labs that you have.

done is going to allow me to go a little bit deeper into the case. So I picked the cases because it is the most common thing and you have already quite a few lab tests done and you just need someone to actually connect the dots for you and look at it through a fertility lens. So Our process, you know, in my clinic, we always start with clarify. So then we know what we need to correct. So then we know when are we ready to conceive and everything is

rooted in data. Because if we're guessing, if we're jumping to the correct phase, which most of you are when you're jumping into trying different diets and supplements and all of this stuff, then you don't actually know what you're correcting. And it might not be the thing that you need. You might not be taking the right dose. Your digestion might not be absorbing it. You might be missing something else. So the clarify stage is really, really important. So as I go through each case, I'm going to give a

brief kind of history so you are aware and see how many of those pieces are connecting to you. And then I'm gonna share my screen and then we're gonna go through the labs and I'm gonna do a couple of sidetracks because there's just a lot that's happening in the fertility space. There's lots that's changing. And you know, our company, our mission is to set a new standard in natural fertility care and in fertility care in general. And that does mean that we stay on top of research and we stay.

on top of the latest recommendations. Are they working? Are they not? And I want to share all those things with you so you are not going down the wrong rabbit holes. So the first case is AMN partner. She is 39, he's 41. She has endometriosis. She does have some thyroid issues and she's been told that she has diminished ovarian reserve. She has been trying to conceive for a really long time, like close to 10 years. She has had...

she's been working on her health for 10 years and then she's done multiple endometriosis surgery, but essentially she had mercury that were removed. was a lot wisdom teeth, lime testing, full blood work, know, GI map, nutrient testing, all of this stuff. And essentially her questions are still around like, what am I missing? What am I missing? I've already done a lot of this testing. What is, why does the endometriosis keep coming back?

And that is actually a really common thing that's happening right now. There's a lot of buzz on the internet about endometriosis because a lot of women are struggling with endometriosis. And it is the reason why you're having difficulty conceiving or staying pregnant. Where I think I'm gonna, I want you to stretch your thinking a little bit is in the conventional world, if you can't get pregnant, A,

Like it will take eight to 10 years to get a diagnosis because essentially by the time you need it, by the time you get a diagnosis, you're going in for surgery, which is very broken if you think about it. And then on the holistic side, we kind of see practitioners just go, yeah, it's endometriosis. So let's support endometriosis. And nobody's asking the deeper question of why do we have endometriosis in the first place?

And so this is one of the reasons that surgery isn't working is because you're not treating the root cause of why the endo is there. So when you remove the endo then, but you haven't removed the inflammation, the toxic load, the microbial imbalance, the hormonal imbalance that comes with it, the trauma, the stress, the blood sugar, dysregulation. It essentially is just the perfect environment for that endo to come back. And sometimes it comes back with a vengeance because you know, it just comes back a lot faster because you've just removed this comp-

all of this tissues and these adhesions, but now anytime there's surgery, there are going to be scar tissue and adhesions formed and you haven't worked on any of the other processes, then of course it's going to come back. You know, the body is very, very smart. So there's a lot of really great questions and we're essentially are just going to jump right in and I'm going to go through the labs. the labs are not, you know, I'll flip back and forth between the labs because essentially

There are some things that don't make sense as we keep going through it together and I'll draw some components out. So first thing that I'll say around the first test that I see, which is a urine essential elements analysis, I do not trust these, not for any other reason that urine is what you are excreting. So it gives us an idea of like, okay, you have some low minerals and an imbalance there.

but it doesn't tell me what's going on in the blood and what is actually like within the red blood cell or within the white blood cell to be used. I do prefer to run a nutrient panel and to actually look at the levels of nutrients that are available within the blood. Now, even those sometimes it's difficult to, I don't want to say trust, but there's a lot more that will come out in terms of the accuracy and seeing is it in the plasma versus in the red blood cell.

What are the levels, which magnesium are they testing? So on and so forth. So when I see this, I think about, okay, it tells me that there are some nutrients that are deficient, but I definitely would not jump into the copper. And I'll tell you why, especially when a woman has endometriosis. And I'll draw that out in a second, but there's a really big connection with copper, estrogen, and iron, and zinc, and immune system dysfunction that...

when we add copper without understanding all of the other components, you can actually be creating a lot more of a mess. So, for AM, if you are supplementing with copper, I would be very, very careful and I would be wanting to double check the nutrient levels. So we'll run a nutrient panel, by us biotech that has the copper zinc, sir, a plasma ratio. has all the magnesium zinc, malignant manganese, cobalt. So then we can see what's in the blood.

And then obviously, and then there's the urine analysis of it and what are you excreting and what are you metabolizing? And we can match that up. But just based on this, I would not say that you have low copper. You might have a lot of free copper that's unbound that's causing a lot of issues, but I would not be supplementing on copper just on this. So really, really important. I think when you have, there's a couple of

you know, components that she wrote about the endometriosis surgery and then having your plasma and BV, those things have come up negative. I think that's really important to rule out, but I'm also always looking, what is the accuracy of the test? When did you actually test these things? So there's times where infections are quiet and there's times when they're allowed. If you're testing when infections are quiet, you're not going to catch anything. So it's going to show up as negative. And this is where I think the nuancing of doing

testing at the right time in your cycle and making sure that potentially we are even taking things to help push some of these infections out, whether that's glutathione or NAC, that would be, you know, that's important because when someone is unwell and they know, and like endometriosis, there is a microbial component, there's an infectious component and everything is showing up clear. I just know that the infection is hiding versus it's not there. So then it's

figuring out what tests you need. it mold? it, do we need more extensive blood work testing to assess that, you know, the antibodies and that kind of stuff. So, I think it's good that you have ruled that out, but I'm not convinced that there's nothing there. they need a hormone chart. I love seeing these. There's a couple of things that I would right away that's missing for me.

is I don't know what's happening in that second half of the cycle. And I think the biggest mistake that women make is they'll look and not because you are, it's because you don't know. Yeah, it's not because you're doing something wrong. It's when we know better, we can do better. I have no idea what's happening in that second half of the cycle. And with endometriosis, there's a really big component of progesterone resistance and estrogen dominance. So right now I can see that the estrogen is there.

And there are some cycles that's a little bit low in that FSH is spiking. So there is definitely a component of perimenopause that's happening. And in my opinion, know, women are in perimenopause when they are over the age of 35. And we have to stop fearing menopause is this thing that just happens in a year. It's just like puberty doesn't happen in a year. The female brain starts to go through puberty. And I mean, the male as well, but we'll talk about the female in

at nine, eight, nine, 11. That's the female brain starts to go through puberty. And then you start to see the budding of the breasts. And then typically within one to two years, you're going to start to see the menstrual cycle after that. And then it takes another, you know, seven, eight years, at least for the brain to finish developing. So it is this 10, 15 year process. So perimenopause is the same thing. It, after 35, you are going to start to see a decline. It's not a cliff.

It's not an all of the sudden, my God, I have no eggs left. All my eggs are bad. But when you have oxidative stress, when you have inflammation, all those things are adding up. with women with endometriosis, they have, let me just share it back again. They have.

resistance, essentially. So the receptors of the, on the progesterone receptors have not developed properly and they essentially have a hard time accepting that progesterone. So there's different kinds of work that we need to do. I'll use a lot of homeopathics to help support that, but of course, inflammation, blood sugar, you know, estrogen balance within the progesterone. So my advice to you is to track for the entire cycle. So start on day, you know, five or six.

or seven and then track until at least day 21, 22, but ideally 23. And I would want to see that progesterone higher than estrogen after ovulation. And that could be now, if it's not, you typically need supplementation. Now the supplementation is we want a really good level bioidentical progesterone. We want to understand the dose. then, so when I'm testing with my patients or I'm giving them the dosages,

I'm getting them to test these things so I can see and I can make sure that that progesterone gets above the estrogen and stays there. So then the following cycle, we're going to see a much healthier ovulation and all of the symptoms will go down. but you also want to make sure that the gut function is good. You want to make sure that the bio flow is there. You want to support mitochondria with ubiquinol. So I definitely think that if you look at it, there's probably very little progesterone and that's causing a lot of the issues and is having, it's very hard for the body to.

Progesterone is like this calming, soothing hormone. So when we don't have it, not only do we feel anxious, but our immune system is dysregulated. We can't rest properly, so our sleep is disturbed, so then inflammation is elevated, then blood sugar is dysregulated. So we need healthy levels of progesterone to overcome infections and to feel safe within our nervous system. She's also had some really good...

stool analysis testing done here. And the things that stand out to me right away is the phyla, the bacterioditis versus the fermucides. I used to run a lot of the, you know, this type of tests. We've switched to another one because I get a little bit more detail and a little bit more accuracy. But you know, that acumencia is the one that really helps with the, the terrain and essentially making sure that the gut mucosa is set and lining.

of the gut lining, so the acrimensia species, we get it from our mom. And when it's deficient, I think a lot about being depleted, especially in that mothering energy. So where is that mothering energy going? Who else are you mothering? Or is it just you never got it and there is that lack of kind of connection to your own feminine energy? And then when I see the bacteriophila that we're supposed to see lots of, and it's quite

wiped out, I'm concerned about the health of the gut and how that's related to hormones and how it's related to the immune system. And endometriosis, if we are going to stop thinking about it as a reproductive condition, which we will very soon, then start looking at it more as an autoimmune condition, then when the gut is not working well, or when there's really low good beneficial bacteria,

and 80 % of the immune system is in the gut, now we're concerned, you know? So now this is us talking about the root cause of the endometriosis. Is the endometriosis there and it's causing all of those issues or it's all of those issues are there and they're causing endometriosis? And I think that, you know, the answer is somewhere in the middle. It's all playing together and there isn't one single factor that's impacting everything. When we're looking for

And I, my hope is that, you know, that just helps everybody. If you're looking for one single thing that's impacting your fertility, you're never going to find it because it's never one thing. It's there's nutrient deficiencies. There's low dysbiosis over here. There's inflammation over here. There's a toxin here. There's a, like there's trauma over here that you haven't processed. There are so many hits that the body takes that eventually it goes.

I'm done. And then, you know, the autoimmune process starts. again, genetics obviously play a role because, you know, I can put two people in the same moldy house and one person will have brain fog and we'll have all the neurological symptoms while another person will have digestive system and someone else will have skin issues. So this is where your genetic component is going to come into play. But you know, something is telling those genes to be turned on.

or turned off. again, looking at the environment. There is a little bit of that streptococcus that's overgrown. You know, we're not seeing fungus or yeast. Antimaeva coli, when we're seeing it in the parasites, I do not want to see anything. So if I'm seeing something, my first question to you is, did this get addressed? And did you retest this? Because if this did not get addressed, then it kind of makes sense that you have all of these beneficial bacteria that are essentially not there because there's this pathogen.

and parasites are pretty big. They're going to take up a lot of space and they're going to take up a lot of nutrients. So, you know, this is something that we want to make sure that you have treated properly, you know, at least three months of good anti-parasitic herbs, and then essentially some liver support, mitochondrial support, all that kind of stuff. So then your body can actually have the energy to overcome it. And then we can see what else comes up.

And the reason that I know, so like your secretory IgA is very, very high. So over 6,000. So we have no idea how high it is. That's telling me that your immune system is so dysregulated. The calprotectin is at 82. I want to see it non-detected. Like you should not have inflammation in the GI tract. The elastase, this is how our pancreas, you know, is working in producing enzymes. That's really low. I want to see it in the 400s and the 500s.

And the beta glucuronidase for you, you know, it's a pretty good balance. And for endometriosis women, here's what I'll find is beta glucuronidase is, know, this enzyme that essentially helps to package up your estrogen and make sure that it gets excreted properly. When this enzyme is high, it, it will break up the package. then estrogen starts to flow around and you're recirculating it. So for women, sometimes what I'll find is that

in the urine, the estrogen is not super high, or in the urine, the estrogen is high, but in the stool, it's not, but then in the blood, it's a little bit high. It's measuring all of these different levels of estrogen, and then essentially figuring out, is this a high estrogen issue, or is this a circulating of the estrogen? Because sometimes that estrogen is just concentrated in one area, and be that your breasts, or your uterus, and the ovaries, and the reproductive system, so then you have a lot of these GI symptoms.

And a lot of endometriosis growing around the GI tract versus in the breasts where we have the really heavy fibrocystic breasts, it's figuring out where's that estrogen stuck and what do we need to do to help the body process it? Because sometimes it's not that it's too much estrogen, it's that how it's circulating and how the body's using it and metabolizing it is off. And for me, this is quite an inflamed gut. So there's not a lot of things like I wouldn't be touching

there's no point of doing really high nutrient things because the body just doesn't have the capacity to be able to absorb them. So I do think that this is a very high inflamed gut and that's kind of my question to you is did you, what did you do with that? Did you treat it? What happened? is it any better? What was the protocol? And my hope is that this kind of helps everybody from a perspective of if you run a test and you find a bunch of things,

And your test is only as good as the interpreter, right? So the whole point is that you're going to get a second opinion here and you're going to get a much deeper lens on a much more that fertility lines is I'm looking for optimal. I'm not looking for just good enough. And what kind of symptoms do you have? Cause I'm assuming you don't have insane amounts of diarrhea and bloating, but you probably feel bloated with most things you eat. You probably feel, you know, there's probably some extra weight. There's probably some dysregulation that's uncomfortable.

Point being is if you're gonna run a test and you find all of these things that are wrong, what are you doing with that information? If you just run the test and then you don't do anything and then obviously you don't even retest, how do you know whatever you did worked? And then why are we jumping to the next thing? Because to me, if somebody interpret this for you and they said there's not that many things that are wrong, they're missing a lot.

They're missing a lot. When I see an immune system that's upright, just that immune marker alone makes me go, what is happening with her body? Like that is stress. You know, the, the, we use a U S biotech and we use the gut IQ and they'll run a histamine component as well. And iron metabolism, which I find is super, super valuable because I bet that that histamine is really high. And I know you have questions around histamine, so we'll, we'll get there, but it's.

there's a lot in that stool analysis that my question is did that get addressed? The BT charts look pretty good. There's a couple of things that are dipping, but for the most part they look okay. So there's probably an estrogen rise, just not enough or progesterone rise, just not enough. Now, before we go into the male partner, there's a couple of things that I want to help write out and connect the dots when it comes to endometriosis. Just so you guys

No, and hopefully you can see that. So there's two triads to endometriosis. There is an estrogen imbalance. There is a histamine component, and then there is inflammation. And to draw in this copper piece, so estrogen, copper, and iron metabolism is all very, very closely connected. As you can see, that estrogen

is the link between these two. And for a woman with endometriosis, the histamine is being, and the inflammation is being driven by some kind of infection, some kind of microbial imbalance. On this test that you have, we see lots of imbalances in the gut.

I would be curious to see what the vaginal microbiome is doing and have we had that assessed? I think when we're looking at hormonal balances, I don't see like a really good, you know, day two, three, day 19 to 23, and even the in-needle.

progesterone levels in that second half of the cycle, what's going on there? I think the nutrient panel is super important to understand this. So the copper is connected with the zinc and the seroplasm.

ceruloplasmin. And I apologize if my writing is a little bit off here. So there is free copper and there is bound. Ideally, you want the copper to zinc ratio to be one to one. When we are pregnant as women, that ratio starts to go two to one and you know, we'll get as high as four to one or even higher right as we're about ready to get into labor.

And so that's a natural state of the pregnancy is that copper is higher than the zinc. So we will test that's part of our nutrient panel. We will look at the copper and the zinc ratio. We will look at the free copper versus not. And we'll look at the seroplasm and because the seroplasm is the protein that binds to copper. And so when that seroplasm is low, then it's not going to bind to copper. And what happens is that free copper starts to rise. The immune system is taxed. So the zinc starts to go.

That's why that first year in analysis, I don't believe it. I don't believe that you have low copper. I think you probably have that low seroplasm and you probably have high free copper and very low bound because the seroplasm is a protein. So if it's a protein, now we're looking at digestion and absorption. And in order to digest and absorb protein, we need certain prebiotics and fibers within the gut to be able to make

to be able to make protein into usable amino acids. And the amino acids can then restructure themselves and build themselves into peptides, which is really popular right now. And then the peptides go into whatever tissue that they need to go into and literally rebuild the entire system. So the simplicity of it is that you need enough protein, but you also need good fiber and good digestive tract function in order to be able to assimilate all of these things. So when we have free copper,

going around that's actually very toxic to the nervous system. So a lot of neurological symptoms and whether that's that shooting and sharp pain or headaches or migraines or even anxiety and that kind of agitation feeling. I see that a lot in my women with estrogen, with endometriosis and the estrogen component just kind of tends to feed in all of it. Infections love estrogen and you know, infections will produce more histamines. So for those of you who have allergies,

and you have endometriosis. I have women who have no allergies, but they have so much water retention in their body, which is essentially a histamine reaction, right? It's histamine when you feel this bloat, this puffiness where things are just not coming off. It's like water is just staying in the body and the estrogen is going to drive the infection and it's going to then drive up the inflammation, which of course is going to tax the immune system. So then the seroplasm is this protein that actually gets

depleted when the immune system is taxed. So when we are trying to look at a protocol and say, can I take copper?

I go, well, let me understand what else is happening. Cause if I feed copper to you and there's potentially iron dysregulation, which again, a lot of women with endometriosis will have an iron is very inflammatory. know the iron transfusions have been really popular, but you know, the body is not really designed to have such high volume of a very harsh molecule. And you're like, but you're bypassing the guy. Yeah. It's not just the guy that the iron is harsh on the iron is just a harsh molecule. There's hemochromatosis.

is a real thing that causes a lot of issues for people. So I do want to make sure that that gets ruled out before I'm throwing copper in. And I would want to make sure that the balance between the zinc and the copper and all of that is really, really, you know, is really balanced. So let me see if I can just keep scrolling and that stays on that page. Yes, perfect. So like I said, I want to look at the...

I would be looking at the vaginal microbiome. I would be looking at day 19 and 23. I would be looking at, you know, like I said, the nutrient panel and I will be looking at a methylation panel because methylation is the foundation. And this is just beyond MTHFR, but it is the foundation of how the body repairs itself. It, how it detoxes, how it makes energy hormones, all of that stuff. So I think it's.

it's a huge thing that gets missed. When I look at the mail, now the reason that the mail is really important is because you guys are sharing the microbiome. So I know you have immune system issues. Now, where is he contributing it? Does he have those? Why, why did you guys attract one another? If I go back to why do we attract our partner? The fundamentals of it is the pheromones, like the things that we smell of our partners, their smell that attracts us.

And so what is it that they're smelling? It's essentially their microbiome. It's their bugs. And so we, think that if we look at it from this kind of Buddhist point of view of like, why do we attract our partner? Well, we attract our partner to help us reduce our own karmic load and to resolve some of our own karmic issues. we

they can either spark that and you can grow together or essentially can create a lot of tension. And I've had couples who have a lot of fights and tension and then we clear out their bugs and all of sudden they can actually just be together and be present. And there's times where we've cleared it and they go, you know what, you're not the person for me. And obviously that's a, you know, a whole other story point being is you attract the smell, the microbiome for one another in the disease process for something like endometriosis.

starts many, many like arguably in the womb, but then definitely there's components that happen between zero to seven. There's components that happen during puberty that are really fundamental. And then obviously in the early twenties, so depending on when you attracted your partner, there were still components that were essentially driving that.

attraction. And so I always, always look at the partner because I find is you're only treating 50 % of the equation. And when her immune system is so dysregulated, it's just a matter of figuring out where's the dysregulation for him. So here's my first thing. What I'll say is it's collected at eight of six. It's received in the lab at eight 14, but it was not analyzed until nine 30. So it's an hour and a half and that's way, way, way too long.

And my assumption is that's why the motility is low because it sat in a cup for 90 minutes and it needs to be analyzed within 30. Because you know, when I look, the volume is a little bit on the low side. The concentration is good. I want to see it over 50, but it's, you know, it's okay. The total motility I want to see above 70 and the progressive motility I want to see above 50. So

the fact that, you know, and the morphology is at 4%. So I would just be redoing the test and making sure that it's analyzed within 30 minutes, because to me, the sperm just sat there for way too long. And that's obviously a concern. And on the male side, you know, when I see something like the H. pylori, my questions are, and one of the reasons I stopped running this test is because everybody was coming up with H. pylori. And the test that we're running now,

I find that there's a lot more accuracy, so I don't see that. So I don't know if I quote unquote believe that. And potentially if there's no symptoms, I'm not sure that this is actually a concern for the person. My concern is again, some of these really beneficial bacteria that are essentially non-existent. And then when we're seeing some of the bacteria, diadies really high, but the fermuocidae is really low.

I'm thinking this is a high fat diet, a high animal protein diet, not enough fiber, a lot of fermentation, a lot of things hanging around in the gut. You know, and you see some of the over, dysbiotic overgrowth. Again, I think it's not insane, but it's there because I think things are not moving through the gut efficiently. I think the gut is quite sluggish and it's probably coming down to...

not enough protein. There is some autoimmune bacteria here and I do want to see this on the lower side. I think a lot of these are actually quite elevated even though it's not flagged and knowing that you as his partner has inflammatory conditions. I'm concerned about this and then his elastase is really low and his beta-glucuratinidase is actually really high. So there's an estrogen component how he's metabolizing estrogen.

and maybe he's feeding off your estrogen and that's what's causing the issue for him because that's too high for a male and something like calcium deglucrate would be super helpful but again, really understanding what's going on with the gut to help move it through and the elastase, the pancreatic elastase is quite low for me. The antibiotic resistance are just there.

And you know, cortisol and DHEA is really high, like very, very high. So I'm wondering the levels of stress for this male and why he's so stressed. I think a lot of the times people say it's just work, it's this, the life. And I 100 % agree. But you know, what is keeping the person in that state and why are they, what is in the environment that's causing it? Like I can work for eight or 10 hours a day and I would never be in that high cortisol state because I really enjoy my job.

And so is it that he hates his job? Is it that he hates his boss or his environment or he doesn't feel fulfilled? So he's spending a lot of time doing something that he doesn't like. Is it that he feels helpless in his job? For a man, I think there's a lot of components that are really important for him to get out of the job. So when I see that DHEA and cortisol really high, and now I know you guys are sleeping in the same bed and you're sharing hormones, the estrogen, testosterone, the cortisol is something that's

rubbing off on the female for sure, or maybe it's the female that's causing it because we don't see those tests. But the TSH is a little bit on the higher side for me, so I would be looking at thyroid function and just making sure it's all good. And the creatinine when it's a little bit high, potentially just some dehydration that's happening. The AST and ALT liver enzymes, I like to see them lower. I like to see them in the mid-teens.

So when they're elevated, I know that there's some stress within the liver. So then that's going to impact blood sugar. That's going to impact hormone production. I mean, it's everything essentially. The liver is really important. Triglycerides are too high for me. I want to see them below 100. So blood sugar is at 5.3. That's too high for me. I'm thinking that there is some early metabolic disease processes that are starting to happen. I want to see the vitamin D higher.

and the CRP lower homocysteine is too high. There's definitely, if there's cardiovascular risk in the family, homocysteine is something that feeds into the methylation panel. methylation is like I said, how the body detoxes, how it makes energy, all of that good stuff. That homocysteine is basically, it's like glass shards within the blood vessels. So we want to make sure that.

we're addressing that, that's B9 and B2B, like some kind of B vitamin imbalance there. And then obviously the liver, potentially choline. Again, I would just be doing further testing, but that homocysteine is quite elevated and it's more concerning, especially if there's cardiovascular risk that's already at hand. I think for the male partner, I would want to see a methylation panel. I would want to understand the stress component a little bit more.

We already had the gut, but I would potentially just retest the gut and see what's going on. I would definitely just retest the semen and make sure it gets tested properly. And then, you know, there's nothing that's like really quote unquote bad here, except that stress is really high. It's understanding a little bit more about what is that stress and how is it causing the testosterone to be elevated or not to be existed in.

Those are the things that are kind of missing for me. There isn't enough there in terms of understanding, like I'm assuming this is a hormone production versus...

Is this blood or is this urine is what I'm.

is what I'm wondering.

Because basically if it is blood, then it could be, hey, did you have a really spiky morning? If it's like literally you came in and there was traffic and you slept really poorly and it's, you how soon after waking did this get tested? And then, you know, when you look at the testosterone, it's like, it's definitely on the lower side. The estradiol is present, which is good. The progesterone is present, which is a good sign.

and the DHEA is just really high. So the adrenals are pumping it out. again, if this is urine versus blood, it tells us different information. So I would just want to do a little bit deeper understanding here and potentially doing like a CAR response, a cortisol activating response, cortisol awakening response. So then you could see the cortisol throughout the day and what's happening. So hopefully...

That is enough for this case. Like I said,

the histamine issues and the immune system issues, what I want to wrap up with there is it absolutely, endometriosis is no longer going to be part of the gynecological group because it is not a disease of the uterus only. We are seeing it as more of autoimmune, inflammatory, kind chronic inflammation diseases. And when I'm talking about that histamine,

estrogen and infection inflammation component. It's very much understanding what is the microbial imbalance? What is the terrain or the lack of that terrain that's essentially allowing the pathogens to run the show and that becomes the terrain and you know, and we can take it deeper but the histamine you cannot address the histamine on its own. You have to address the infection. You have to address the mitochondria. You have to address the methylation and support the histamine because you want to get that out of the system. But if you're just looking at histamine

You're essentially, and like I said, if you guys can get anything out of these, you know, me walking through these cases, if you're looking for one thing that's causing an issue, you're never gonna find it because it's actually usually a combination of multiple things. And what I'm seeing in practice now that, you know, I didn't see five years ago is the complexity of the cases. And I do think that our environment has a lot to do with it. There is a lot of complexity to every case that I'm seeing. And maybe it's because I'm just,

way more thorough now and so I look at things a lot, you know, a lot deeper, it's essentially we wanna make sure, we wanna make sure we're not missing, we're not just looking at one component, because it never is just one component. So let's go into the next case. And let me just open it up to make sure I have it here.

J-O-B, and partner. So she's 42, he's 44, diminished ovarian reserve, and just feeling really dismissed by her doctors because there's just been lots. So she did have an IUD. My question is how long that IUD was in for. And let me kind of give you guys an opportunity to explain a little bit more about perimenopause and kind of when we should be starting to introduce some kind of hormone therapy.

When you are in Canada, I'm going to tell you right now, you're going to hit a lot of frustrations because I actually feel very, very limited in Canada in terms of even what we can do as a practice because the stool analysis, the vaginal microbiome, those things are really easy, but anything that requires blood work, then you're looking for different phlebotomists in the area. You're seeing with the shipping instructions and so on and so forth. And the medical system just simply brushes you off. mean, I have a pregnant patients right now in Canada.

where they won't test progesterone because they don't understand the need for it. Like that is the most bananas thing I have ever heard. They're like, well, we don't test progesterone because we wouldn't know how to interpret it. It's like, what? In first trimester, you guys don't know how to interpret it. You don't know that low progesterone causes issues. So when it comes to a 42 year old, you are in perimenopause. And then the goal is to figure out what stage of perimenopause you are in so we can slow down the process and essentially,

get what we need. I have some 40, 42, 45, 46 year olds right now. And it's like they are in perimenopause 100%. But are there good quality eggs still left? Absolutely. Do you have to do a lot of work to optimize those eggs and make sure you're very strategic about your time and what you do? Absolutely. So the seed that I will plant for you is you, if you feel like you're running out of time is you

have to do a lot more at 42 than you do at 32. And don't get me wrong, I have some 32 year olds who have to work very, very hard. You just don't, they have a little bit more time than someone who is approaching that menopause. And then I would be looking and considering of how you're going to go outside of the country to essentially potentially do some of, the things that you need to do in order to have a baby. Because I just feel very limited by some of the docs here in the system.

So I would just plant that seed because there's a lot of people like you just travel over to Europe where you travel over and you can have fantastic treatments and fantastic outcomes where you're just not going to be able to get that here because they follow a certain process. And I think because there's a lot more people who are doing that, like they are traveling in different places. We are starting to see the holes in our own, you know, community where we go, what the hell? Like these people are doing all of these things. Why don't you do any of the testing? And it's essentially, they're just limited by the system.

That's it. That's not where the research is. That's not where the latest and greatest information. They're just being told this is the only thing that you can do. So there you go. That's the only thing that you can do. So I find that that is a concern. Okay. Let's go.

So let's talk, let's, let's start with the mirror testing. And so I like this cause now at least we get to see a little bit more of that progesterone rise. I'm assuming you're not on progesterone, but you're just taking some of the progesterone herbs that you are doing, which is really great. what I don't see is a really nice peak in LH. So, the communication between the brain and the ovaries potentially, or depending on when you are testing, there is a little bit of a peak in that estrogen, but it's quite low.

And then the progesterone is coming up. But again, my question is, is this natural or are you doing some kind of progesterone therapy? I do always want to see it much, much longer because I want to see what's going on overall. This is a, you know, it's on the low side. So it just tells me that it helps me understand that you are in that perimenopause stage and it's making sure that you support this. Some of the things that jump out at me right from the blood work.

And there's a lot of fragmented information. So I think this is the case for a lot, a lot of you guys where you've collected a bunch of different testing and it feels like you're doing a lot of testing, but when you actually look at the information, it's not that much information. And then when you're retesting, you're just retesting the same things as opposed to what is the missing piece? Like what is the, did the lab that I ran the first time, what was it that I learned from it? What did I do? What did I implement?

And then how did that change it? So a lot of the times the basic blood work is there's a couple of things that are going to stand out. And then if you're retesting the exact same thing, then great, whatever you did, did I'd actually change it. But when I see that initial testing, what I'm thinking about is like, what about this? What about this? What about this? So you're actually missing a lot of information. So I'm very cautious. Like I've been talking about testing for so long. What I don't want you guys to do is spend your precious time, energy and money on doing

like really random pieces of information that are fragmented and then trying to put them together, which is what I feel like a lot of people are doing, which is why I picked these cases. But I actually feel like it creates so much more anxiety for you because you feel like you're putting in all this effort, but that effort is like 2 % of what you need to be actually doing. And not that you're not doing enough, it's that you are doing the wrong things because you have no idea.

what it's like the iceberg pictures, like you just see the top of the iceberg, you have no idea what's actually causing it and how deep down it goes. And so it kind of gives you this false sense of hope that like, okay, I'm doing it. And usually it's after a couple of years, you start to get tired because you're like, I have been doing so much. Why isn't this better? And it's not better because you're essentially, you just don't have enough information.

But the thing that stands out for me here right off the bat is those electrolytes are quite off. So the sodium I like to see higher, but the potassium is quite low and the chloride is off. So I, I'm wondering about, know, do you feel cold? Do you feel like things are, is the energy in the body just really low? It feels like things are not flowing through that metabolism was really slow because that electrolyte essentially component is going to help.

to invigorate electrolytes is electricity. allows for cells to communicate with one another better. And for a follicle growth perspective, now we're even looking and thinking about calcium, magnesium, sodium, potassium in that.

fluid that has to move in and out of the follicle and can it do it easily or there's not enough energy in the body for it to actually do that. So I think those electrolytes are important to look at. The lipases and even the albumin that's low, I'm kind of thinking again of protein consumption. I'm thinking of gallbladder and liver function. I'm thinking of pancreas function. I know there has been any stool analysis testing, but there is a sluggishness I think within the digestion.

And that's probably the sluggishness within the system altogether with that sodium and potassium where things are just cold and they're not moving through. I think the progesterone, I'm assuming that was, you know, day 21, looks good for that cycle. And then again, you know, you're just getting little random pieces of information here where there's not enough for me to interpret.

There's another time where your sodium and potassium are quite quite low So and maybe you tested this one in the second half of the cycle versus the first half of the cycle, but I

I do think that that's quite low. whether that's an element, there's a couple other companies like SOTY that are creating really high sodium, RELITE is another one, really high sodium electrolytes and consuming more salt and having some potassium. And again, I just kind of curate the electrolytes for my clients because I do not find that there is one

electrolyte that everyone should take. So even if I do say like you need the element, but then you need to add a teaspoon of this, you need to add five drops into this just to make that. But sodium and potassium are definitely deficient here. And I think the electrical charge of the cells here is going to be quite low.

You know that B12 is low for me, I want to see it closer to a thousand. And then my big question to you is like, what's going on with the fibroids? There's nothing that you mentioned in here about fibroids in terms of your form, but there is, you you have the endometrium lining is thin. So that's telling me that estrogen is probably on the low side. Progesterone is probably on the lower side as well. So potentially you need progesterone.

supplementation but you probably need some estrogen supplementation but I want to understand what's going on with these fibers and these cysts because if you're starting to add hormones and you're supporting hormones and you don't know how these fibroids are being fed you are just going to make them worse but this to me is a very congested uterus and you know if you think about a fibroid is a benign tumor it is that cancer type of growth where it's a little bit out of control and it's

just it's in a controlled area, if you will. But now I'm thinking about oxidative stress, I'm thinking about pathogens, I'm thinking about infections, and those are pretty large fibroids. So I would want to understand a little bit more.

what's happening in really understanding your hormone picture, something like the Dutch test, but also to understand how you're breaking down your hormones, but then also just the overall inflammation levels. So it's good to see that the HSG was cleared and then the progesterone here, I'm assuming again, that's in the second half of the cycle that

estrogen is a little bit on the low side for me and in the luteal phase that 37 is not terrible. You're definitely still ovulating but there's for sure some room for improvement. The thyroid itself, I think the T4 and the T3 are a little bit on the low side for me and what I have to tell you is that they've changed a lot in how they run these tests and I'm just going to draw this out but there's the brain and then there is the thyroid.

The brain talks.

The brain talks to the thyroid via TSH and then the thyroid makes free T3 and free T4. We make mostly T4 which is inactive and then it has to get activated in the liver. So when I look at that T4 being on the low side, I'm thinking there are nutrients that are low.

and so tyrosine that's an amino acid so again we're coming back to protein protein consumption protein absorption and digestion you're looking at things like vitamin c e selenium zinc iodine and because vitamin c and e and zinc and selenium are all really important for immune system and they're really powerful antioxidants now i'm thinking about is there something going on in the immune system

And so there is never, the thyroid is never the root cause. The thyroid is absolutely really critical for a healthy pregnancy and postpartum and for us just to feel healthy. But I never think of it as the root cause. you know, it's, there's something that's causing the issue with the thyroid. Then the prolactin looks good. FSH, I'm sad, I know you had to test it again, but like just testing FSH on its own is not enough.

then there was DHEA, you said you started taking it, then you stopped taking it. Kind of really prime example of like, do you actually need DHEA? Are those the issues that are causing it? Or, you know, is it, is there something else? The AMH is still there. And then we have some picture, you know, why blood cells are starting to drop. There's a little bit of this MCA agent, the...

ferritin is high. So there's a couple of times that ferritin is high and now I'm wondering what's going on. The pieces that are missing for me. and let me just double check if I'm remembering this correctly, but iron metabolism is super important and ferritin when it's elevated, I'm thinking the liver stores ferritin. So there's something that's being stored in the liver and it's causing inflammation, white blood cells. Something is suppressing the immune system. The neutrophils are quite low. Now again, I'm

thinking about some kind of an infection. that immune system component is always going to come back. The MCH, when it starts to get elevated, it's the how much hemoglobin is within the cell. if there's a lot of hemoglobin, it's then you're looking at, they didn't do like the width of the red blood cell or the size of the red blood cells. So there's a couple of things that are missing to be able to complete this information. So it could be a start of microcytic anemia and

Now we're looking at the folates, the B12, the B9, the ferritin and the iron and you know, do you have enough protein to make those red blood cells? So there's a lot of cutting corners here in terms of testing for me that's missing because here we see the ferritin but you don't see the iron panel. You don't see how much iron do you have, how much iron is saturated in the tissue. Is it too much? Is it too little? Is you know, what else is going on with the red blood cells?

I think that, and there's quite a few, I apologize, it looks like the tests are just the way that we've connected them. The tests are duplicated. Your lipids look good, which I think is a really good sign in terms of like perimenopause and how well you're taking care of yourself. When I'm looking at cortisol in the morning, my biggest question is what time of day did you test it? What was the morning that you had? I think if we just have one,

single thing that we are looking at like cortisol, it is very difficult to see what the actual function of it. So let's say you went in and you did it within 30 minutes of testing, within 30 minutes of waking versus two hours of waking, we're going to see very different results. If you, it was about two hours of waking. And then when you drove in to go get your test done, you actually,

saw witnessed a car accident or someone tried to cut you off and you got really stressed out or you were late for an appointment, that's going to be a very different test. So understanding the circumstances that the test was done in and trying to be as neutral as possible is always, you know, really helpful. And the, the testosterone, the D the vitamin D, I do want to see it closer to that 125. So I know you had it low, but I do want to see it nice and high for optimal pregnancy.

That homocysteine is a little bit on the low side. Homocysteine is going to again feed into the methylation. So now we're looking at that B9 and B12 and you're looking at choline levels and electrolytes and protein consumption. And then when I'm talking about protein, I'm always talking about, it's not just slamming your body with protein. What is the protein that you're eating? What is the fiber? What is the digestive capacity? Is your body able to really use it?

So I do think that there's some depletion, there's potentially some detoxification issues that come with that homocysteine being low because we need homocysteine to detox. It feeds into the glutathione pathway. Again, some more questions here that I have. And then you look at the FSH and LH and it's like, okay, that looks pretty good. That progesterone looks pretty good. This is the MCHC.

Again, that comes up the red blood cells, didn't do the width of the red blood cell, but now you see that iron and your iron saturation and all those markers are in pretty good range. That ferritin is still high though. So something is being stored in the liver and that ferritin is not, you know, processing, it's not moving through. So that just, it could be just a marker of inflammation basically in its understanding what the inflammation is being caused by.

I do think that those neutrophils are still a little bit on the low side. I want to see them above three. But you know, obviously it's good to see that you've made some improvements and the now seeing the liver enzyme a little bit on the high side. And again, they'll do the alkaline, the GGT. There's one more that's missing the AST. I like to see it in relation. So the liver is inflamed. There's something going on in the liver.

but again, they didn't test all of it. They missed out one of the liver enzymes. Don't ask me why they do that, but they do it. TSH is not enough for me to see what's going on with the thyroid because there's no free T3, no free T4. Free T3 and free T4 are the actual thyroid hormones. TSH is just telling me that the brain is communicating. They're reverse T3, you know, at 14, that's pretty good. When it starts to get higher than that, I start to think about immune system function.

I think with an aura ring and I love that you have that, I actually really like seeing that it's spiky. So the spikiness is good versus it's kind of a flat line. It's definitely on the lower side. I think when you're thinking about, you know, but there's like the days that you have more spikes, I want to know what you did on that day, you know, cause then how can you repeat that? then biggest things that are standing out for me that I know.

is gonna be how much HRT support do you need and what is it? And I'm thinking that progesterone is probably one of the first ones. And then do we need support with estrogen or if we just support progesterone, is the estrogen gonna go? I think that there is some liver stuff and then with that fair tin, I do think that there's some inflammation. And so I don't think that the thyroid is a huge quote unquote component, but...

it's there and so there's something going on with the immune system. So when I'm looking at creating a protocol, first of all, I wanna have more questions answered. Like what is your gut function doing? What is your methylation doing? And so that's a, we do a saliva and we do a blood test to assess the actual methylation cycle and then what are the genetics that are involved? So that homocysteine that was on the low side, that's really important to tell.

And then I think just from like a blood work standpoint, there's some more components that are, we're just trying to piece together. So whether it's a little bit deeper into the nutrient analysis, not having like having all the liver enzymes, looking at all the electrolytes at the same time, looking at all the blood sugar, looking at the hormones, like looking at everything at the same time instead of this fragmentation. So.

I do like the ubiquinol. The NAC is probably too high of a dose and the quality of that NAC really matters. I think the vitamin D you probably you can go 5 to 6,000 I use. The inositol and the NMN I'm not sure like I know what you're doing is you're trying to improve the quality of the egg but the thing that will optimize the quality of the egg

is not just the supplements that you take once a day or twice a day. It's what is the food that you're fueling yourself? What is the microbiome doing? And are you actually able to use it? And so, you know, I love the Brazil nuts. I think the magnesium is really important. The, you know, the melatonin is important. You stopped the DHEA, which is great, but there's a couple of things that are missing. Like there's no liver support. There's nothing that's addressing the inflammation. There's nothing addressing and helping us understand.

the immune system and I think that you probably do need some progesterone. When it comes to your questions about stress and I'll talk about him in a second, but our system is really simple. We want to clarify so we can correct, so we can conceive. You are over here and you don't actually really know what you're trying to correct. That's the biggest problem.

you're trying to optimize and you're trying to be over here, but you can't optimize if you don't, if there is big markers that are wrong. And so again, my frustration with Canada is that like, unless you're basically on your deathbed, they don't actually consider it a serious problem. And I think in the fertility space in general, infertility is not treated seriously enough because it's not cancer and it's not hard disease and you're not dying from it. But we tend to see that couples who struggle with infertility actually tend to develop those diseases because

that process, cancer doesn't develop overnight, diabetes, cardiovascular disease, autoimmune disease doesn't develop overnight. So for me, I would ground myself into doing some more testing before I go in and start to change it. Because it's like, I think that you need omega-3s? I don't know. I don't think, like is the inocidal the thing that's missing? I don't think so. I think you probably need a higher dose. Like I just do one dose of 600 and making sure that that is a good...

I'm not sure the brand of the ubiquinol, but the brand of the ubiquinol really matters. So we use Bioclinic Naturals and I love that one on the Canadian side. But you know, I don't do prenatals because I can curate the exact electrolyte protocol for my patients. And there is some electrolyte imbalances for you. So there is the potassium, there's the sodium, there is potentially the zinc that you need. There's maybe some.

Iodine that you need, you know, to support some of the estrogen and the thyroid component that's related. But I wouldn't try to correct until I really clarify what's happening. And then when I look at his, it's the same thing. It's like, these are all the things that are quote unquote, studied in research to help support it. My question is, do you actually need that? And I don't know, because there's not enough testing to say that yes, this is exactly what you need.

because for his sperm analysis, the big things that stand out for me is that pH is way too high. It should be below eight, ideally 7.5 to 7.8. So a high pH within the semen, just like a high pH within the vaginal microbiome, tells me that there's probably a microbial imbalance. So then it's what kind of infection is it? The collect and the receive date looks good. So it's like, you know, within 30 minutes that it's there.

The morphology looks good. The motility is quite, quite low for me and the sperm concentration is quite low for me. He should be at 50 million per mil and total motility should be over 70. Progressive motility should be ideally over 50. So I think that there is, you know, there's something going on with a, I don't think it says how many days of abstinence. So that's important to know because if it's more than three days, then it's old sperm.

And then, you know, we have...

Here's what I want people to demand is if the collection is at 806, it's reported at 721, but when did they analyze it? You need to understand when it was analyzed because, again, if that motility is really low, that's the first thing that's going to go when it took too long to actually be analyzed. And the semen volume is, again, how many days of abstinence?

and that CNPH is quite high, that concentration is quite low for me. At 18 is very low. So these parameters, you guys, are IVF thresholds. So if you don't wanna do IVF, you cannot look at these reference ranges. You need 7.2 to 7.8. There's definitely such thing as too high pH in the semen. So we are starting to run things like the seminal microbiome, obviously the vaginal microbiome, blood work, gut.

to understand what's going on. But motility, you're thinking about mitochondrial function. And concentration, you're thinking about, like, is this a brain issue or is this a testes issue that the brain is not telling the testes to make sperm or the brain is talking to the testes but the testes don't have what they need to make lots of sperm. and I think for the men, it's just, it's not enough in terms of the actual.

testing. So the B12 for me is a little bit on the low side. And the neutrophils I think are also a bit, no his neutrophils are pretty good. I don't know if this is just dehydration to be honest. And then the GGT, ALP, ALT again I want to see that below. I want to see it in the teens. So a little bit of something going on in the liver but this is very high.

very high cholesterol. So that is blood sugar probably. The triglycerides are quite high for me. I want them below one. The HDL is like, it's okay. It's getting there and we can get it higher, but LDL is quite high. So the way that we need to make testosterone, you need cholesterol. And in order for the cholesterol molecule to become testosterone, you need good liver function.

and you need good mitochondrial function. So when that cholesterol is really high, chances are that testosterone is not very high and we're gonna see that in a second. So at 9.4, it's like, it's not terrible, but it's not great. The CRP is not bad, but we don't see the DHEA, we don't see free testosterone, like we just see one number for testosterone. So again, not enough, TSH is 2.5, it's not bad, but it's not great.

So then one of the liver enzymes got missed. Again, that kind of helps to see, tell us if it's a mitochondrial issue versus more of a liver issue. And is he absorbing? Is there a blood sugar dysregulation? So sometimes the HbA1c is okay, but that fasted insulin, this is quite a bit of inflammation in the body. So that's very concerning for me. And that testosterone is not great. So then I'm thinking about...

you know, does he have extra weight? Is he sluggish? What's his libido? Is there...

Is there erectile dysfunction? you know, you're essentially the cardio, this is cardiovascular risk. So is there cardiovascular risk in the family, blood flow, et cetera, et cetera. And, you know, to answer your question around the stress, well, sperm production starts in the testes and ovulation starts in the testes. So everything is related to stress because the brain is interpreting things as either stressful or not stressful.

And reproduction is actually not very high up on the list in terms of you can live without your ovaries. You can live without your testes. You cannot live without your liver. You cannot live without your heart and or even immune system function that's dysregulated. That's a pathogen that's coming in and the body has to protect itself. So we want to be really mindful at understanding all of the stressors, not just like we had a really stressful year. It's how much stress is my body under so that HRV tells us that

you know, I have some spikiness, but it is on the low side. So I am potentially a little bit more run down. And my question is like, when you first put the aura ring on, was it always like this? Because you can't compare yourself to somebody who naturally has a higher HRV. It's more of what is realistic to see in terms of an incline. But for some of my clients, if they started at 50 and then they're at 25, three years later, then you could see that stress wearing them down.

versus you just put it on so you have no idea, you don't have that data. But stress impacts everything. And from the ovulation standpoint, it will just shut down ovulation or it just shut down sperm production. And obviously it doesn't shut it down completely, but it doesn't shuttle a lot of energy because it's dealing with other things that are more important for its survival. So creating a safety within the nervous system is probably the most important thing that you can do when it comes to ovulation. Because, you know, it's a...

It's just a really big component of the body. The nervous system has to feel safe. Pregnancy is a vulnerable process. When you're already feeling vulnerable and stressed, like pregnancy is an inflammatory process. So when you already have a bunch of inflammation, the body just can't handle the stress on the body. And then we start to see either you're not able to get pregnant or you're starting to see a lot of complications during pregnancy or postpartum and that kind of stuff. yeah, stress is a really, really big component. And

In terms of like what is contributing to that low lining, it is the lower estrogen and, but it's figuring out how long, like, I don't know if you know how long you've had these fibroids for, do we need to remove these fibroids? And I would be looking at like a Dutch test or an endoinside plus where you can just see the breakdown of the hormones and how your body is shuttling them to make sure that, you know, the estrogen pathway is clear before you start to add some kind of HRT.

into your body, you want to make sure that that is assessed. that and can the body clear it naturally? It's like, absolutely. What you need to do for it is going to be very intensive. It's not like, I'll just take these herbs and I'll do these supplements. It's like preparing the body and, you know, being very strategic, understanding the methylation, understanding the nutrient levels, you know, doing some fasting, doing specific diets.

to really help the body focus and herbs to essentially help bring energy into the uterus to help to clear it. So there's lots of things that you could do and I would absolutely be addressing it. And to see if it's, know, surgery is necessary or not. Is there a blood supply that's going to these fibroids or is this just gonna make things worse? Because sometimes they'll say, well, the fibroid isn't causing an issue and that's not why you're not getting pregnant. But the reason that the fibroid is there is the reason why you're not getting pregnant. So there is something that told

body to form this and it has formed it and it's pretty big and that's a congested uterus. So that lower estrogen could just be the body naturally trying to down regulate the growth of this fibroid. I think doing a vaginal microbiome or even a uterine microbiome to see if there is an infection of some sorts that's essentially causing this growth to happen and obviously evaluating the stress levels and know progesterone and all those kinds of stuff. Okay

I hope that was helpful. Let's do it. We got one more SC.

and she's 41, he's 36, and they have been told that they have unexplained infertility. And we know that that's a load of BS, so we're gonna go through that and help you understand that it is, in fact, not unexplained infertility at all, and there is other components that are there. The testing for this is a little bit blurry, so I will walk you through.

And I just want to make sure that I answer all of the questions. You know, what is she not aware of? What is the biggest thing? And again, this is someone who has quite a bit of testing, but it's quite fragmented. And so we're just going to go see if we can make sense of it all here for you.

As soon as I see this, like three tests right off the bat, I'm like, okay, what's happening here?

it's not enough testing or there's a lot of duplication or there's something. So, you know, the folate for me is a little bit on the low side. The B12 is a little bit on the low side for me. The hemoglobin A1C is high for me. That vitamin D is definitely much better. I want to see it 60 to 80. So there's still room for improvement. Hemoglobin A1C I want to see below five. And so the older that you are, the more important that blood sugar regulation becomes because one of the issues or how we know how far along we're

progressing in perimenopause is our ability to regulate blood sugar, it's our ability to regulate stress and inflammation, if cholesterol tends to go up that's one of the first things. So if I see hemoglobin A1c I'm thinking about you know can you do a continuous glucose monitor so you can see which foods are really triggering you in making sure that you can get you know your blood sugar balanced.

and get it, let's say, like 90 average, 85 to 90, which is very difficult to do, but, you know, to see what foods are essentially throwing you off and causing havoc in your body. The progesterone in that second half of the cycle looks good. So that's a good sign. And then I think that there is times where you retest and you're like, my God, how come the progesterone was high one time and low the other time?

And that is because there's not a single cycle that's the same. There's not one single cycle that's exactly the same. You will have a cycle where you ovulate more strongly and then a cycle where you won't ovulate very much. And in that perimenopausal stage that just starts to happen where you're going between really big robust ovulation to not such a robust ovulation. And it does come about, it does become about kind of testing and finding out and figuring out.

how many more of those we have in the bank. Or what I do is when I look at the block work, you could tell that, okay, there's a lot of depletion here. There's a lot, like she's pretty far along into perimenopause. I'm not sure if, you know, a natural conception is possible, let alone what our outcome will be with IVF, et cetera, et cetera. So.

Point being is don't worry if the progesterone is alternating, especially in this phase, it is going to alternate. And then my question is, do we need to supplement it to make sure that we have good levels of progesterone in that second half of the cycle? Because that's naturally, you're just going to see that decline in estrogen anyways. I think over here, I see that the liver enzymes are good. Again, that sodium and potassium is too low for me. And so the electrolyte balance, electrolytes are like the charge of the body.

And when we have low electrolytes, it's the essentially things are just not going to be moving through as well as they should. So that's something that's really important to remember that I think is a simple, you know, it's a simple thing. And there's a lot of tests that are duplicates. So that's why I'm just scrolling through. When the platelets are low, my question to you is, were you sick when you tested this? How long after the sickness?

And you know, was this just a fluke? Because there was other times that obviously the platelets were not low. So it was just a one off. The monocytes, I want to see them as low as I can. The same with these enophils. I want to see them below 2%. That kind of tells me a little bit more about histamine and parasites and allergic reactions or bacterial with the basophils. So if I'm trying to be picky with the tests that I have, this is

It's telling me that there's probably more to explore here, especially since the platelets are low. But again, you could have been really sick when you tested that or two weeks after you were sick. And so the system just has not covered it. Just another tip for you guys, when you're going in for blood work, you should be going in first thing in the morning. You should be going fasted, usually within one to two hours of waking, no electrolytes, no supplements. You should be taking at least a couple of days off supplements, ideally three to five.

before you're going in to test so we can kind of get an idea where the body is at. And you're trying to create the same conditions. So I either test my women on day two and three or day 19 and 23. It's very rare that they're coming in on other times of the cycle, especially when we're doing full blood panels. So then I kind of know what I'm comparing. I'm comparing apples to apples. I'm trying to compare the system in the same state instead of in multiple different states. um,

The BUN is high, so there's something going on with hydration. And I do think, you know, some of the electrolytes that are balancing out and my question is like, when are you testing them? Maybe the sodium is okay in the first half of the cycle, but it's not great in the second. And that is because we need more sodium in the second half of the cycle, progesterone uses it more. But your filtration through the kidneys is, you know, is good, it's fast.

And that's why that creatinine is low in the EGFR. The GFR is the kidney filtration that's on the upper range, but is it, is it hyper filtering basically? And so is there something potentially going on in the kidneys? And I don't know if you've had a urine analysis with a culture test to see, cause liver enzymes look pretty good. Again, the platelets, I think that's just a repeat where we saw it low.

And I'll just zoom in here because I think some of these tests are quite... And you there is the... You did a little bit of clotting. So my concern again here, like when I'm running a full clotting panel, it's like 20 different markers. When you're just running one or two, you're not really checking off to see if you have clotting issues or not. This is just one component of it. So if you are just like, they tested me for clotting things, they have not. They have not tested you for clotting things. You need like a full clotting panel and...

You know, if you, including like in the APS panel, the antiphospholipid syndrome to rule out and make sure that that's not a component, not to mention things like factor two, third factor five, empty eats. Yeah. It's just like, that's not enough to tell me that you don't have any coagulation issues. tells me that this component of it is right, but, this is what I mean by when information is really fragmented, you don't actually have.

all the information. Now, when you have this iron that's elevated and you have the iron saturation that's high, I would be looking, a, I would retest this and make sure. So if you just retested it and this is the first time that you've seen that iron up, okay. iron that's elevated in that saturation, that's really high. Hemochromatosis is something that I want to rule out on a regular basis in

Even though your ferritin is not high, it might be not high because you are still menstruating. So when you are menstruating, you're losing that blood, but iron is an inflammatory molecule. having it elevated, I'm now thinking that there is inflammation. So there's definitely something here that I would just want to rule out and check and make sure that, you know, it's not in fact an issue. And then I see that those platelets, you know, kind of rebalance themselves. So that's good to see.

The monocytes are still hovering at around 8 % and I'm assuming there's nothing crazy. It looks like there's nothing crazy within the immune system. And I'm not sure why you're testing the PT and the INR if you have coagulation concerns. But again, it's not a full panel, so it's not giving me enough. I think the B12 and the folate can definitely be optimized more. The blood sugar still needs to be...

regulated, I want to see more vitamin D, I think these are some of the same panels. I would do something like continuous glucose monitor for you because I'd want to see how your body is balancing and managing that glucose on a regular basis. When I'm looking at the thyroid, the T4 is, you know, it's in a better range, it's a little bit lower than last time and the reverse T3 is in good range.

I don't look at the thyroxine like just the regular T4 and T3 needs to be the free T3 and the T4 just because the accuracy of those numbers isn't there. But that TSH if anything is dipping towards hyperthyroidism. And again, I'm not sure what your state was, was this in the morning? Thyroid is definitely gonna be fluctuating. So if I can get you to test at the same time all the time, you can actually compare apples to apples instead of, okay, what was different this time?

when you test it. It's good to see that your cycle, you are seeing the BBT, the temperature rise, it does dip a little bit so it does tell me that there's probably something going on with that progesterone because that progesterone should be elevated the whole time and there is a dip in most of the days, most of the time so that progesterone, unless you're testing at different times of the day, so that's really important if you're testing

you woke up at a different time, then you're gonna see different things pop up. And then, you know, when I look at these, like progesterone support and it has all of these things, my question to you is like, do you need all of those things? You know, I think that there could be quite a bit of noise here and I'd rather see you add ginger and cinnamon and fennel into your diets. The red raspberry leaf tea, I'm not sure that it actually does anything for progesterone. It does other things, obviously.

Vitex is great, but are you getting enough dose of the Vitex? I like to dose it in the morning, first thing in the morning, and then I'll do a lower dose in the first half of the cycle, a higher dose in the second half of the cycle to help support that. Do you need the white P &E, the licorice? The licorice I'm very careful with prescribing. So I find that a lot of these pianos, they just have a lot of noise and they don't have enough of a certain...

Nutrient in it. So it's like I have no idea how much ashwagandha you're getting or old straw or astragalus So it just kind of creates a bunch of noise, but you're not getting enough of one component that you really need And the same here. It's like, yep. This looks like the the milk thistle beetroot fever you ginger dandelion It's like it's good if I think about drinking this it's probably way too much for me and I need to cut back so the body does Better with less if you will

So that's kind of my thought, you know, about those components. When it comes to the Dutch test. So let me get to the actual Dutch test in what I'm seeing. The melatonin being out of range. So you being on a little bit of melatonin is going to be, you know, super helpful. Then if I look at the actual production of cortisol and cortisone and your switch back and forth.

The way that you are metabolizing and breaking down cortisol is, I don't want to say hindered, but the body needs some support there. So melatonin is a big component for sure. And the biggest thing that I see is this spike from the moment you wake up, like that CRR, the actual cortisol waking response is very, very high. So it's telling me that you're waking up in a panic. So from zero to a hundred.

And when I'm looking at your estrogen, the estrogen metabolites within the urine are on the upper range. I didn't see enough estrogen measurements in the blood. So we didn't see a D2 or three where it's FSH, LH, AMH, estradiol, even 17-O-E progesterone so we could see what's happening. The metabolism is actually, obviously is on the upper range, but you are metabolizing it into the good.

you know, into the good pathway instead of the bad one, which is really good to see. My question is, you know, do we really need to change anything here? And in terms of, I think that's not your test, but I'll see over here.

For the Dutch Plus, again, this cortisol waking response, you're going from basically no cortisol and then that 30 minutes is really fast. So this is when I think about someone who is stressed. This is when I think about someone who is, know, quote unquote, waking up in a panic and then that cortisol is quite high. So I'm assuming there are some issues with sleep in terms of how rested you feel and possibly some grogginess when you're waking up.

you have the aura ring, you can kind of take a look at when the heart rate is dropping in the aura ring because if it's dropping too late, like right before you wake up, you're just not getting enough rest throughout the day. You know, your progesterone is nice and high, there's nothing really going on in the testosterone. And again, remember this is how you're metabolizing it. And there is quite a bit of that estrogen. Now, if I look at the monthly pattern,

It's great, your progesterone is coming up in the second half of the cycle and then we see that estradiol match up, so you're definitely ovulating. I would love to match that up with what you're seeing in the blood work as well. And the metabolism is really important, obviously, but do you have enough in the blood? And I think that knowing your age, 41, I think those are great hormone numbers.

I would be looking at the terrain and seeing if there's anything else. Like, do you have the antral follicle count done? Do you have uterine lining? Do you know if the tubes are open? I think those are the kinds of tests. And then when things show up really good on the blood work for the most part, then I'm thinking about what's the methylation doing? What's the gut doing? What's the vaginal microbiome at 41? You want to make sure you are up like

You don't want to leave anything unturned and you don't look at it. And when you take care of yourself, you're not going to have these numbers that are really bad. like, have someone in clinic who's coming in and they have, like they haven't eaten well forever. Like of course they're going to have dysregulated blood sugar. Of course they're going to have, but for someone who takes care of themselves, you have to be a little bit more picky to essentially see what's happening. So

I think the good news is that you are ovulating, but the, and like that ovulation looks robust through the Dutch. You can totally retest the Dutch if you want to. I'm not sure it's going to give you any more information. Like I'm not sure what it's going to change because hormones in your treatment, because hormones are not the root cause. And if you like, now that I see that, I want to see what's going on in the gut from a standpoint of like, are you breaking down that estrogen and is it being recycled?

And so you're just accumulating and it's more of the older estrogen versus the estradiol. you could look into the estradiol, the esterol and the estriol in the blood on day two and three and then day 19 and 23. So you get, even around ovulation to see what's going on there. Because I mean, I just don't think the Dutch is going to tell you enough. And if you want to run the test, go for it. But I just don't know that

it's going to tell you enough information. I would want to see a gut. would want to see a nutrient panel. You know, I would want to see an antral follicle count. I would want to see, to see if the tubes are open and you know, cause your liver and again, that sodium and potassium are just so, so low. So you definitely need some support with electrolytes and maybe that's, you know, that's your little, fix here. So the uterus,

length and the endometriosis thickness, thickness of 7.6. The antral follicle count is 10, but there's none that are growing. So, I need to know what day of cycle this is on because if this is day five, okay, so there's not enough that grew. But if this is like day eight, nine, 10, and there's none that are growing above 10, there's something going on with the way that the

the follicle is not growing. So is it the signaling from the brain?

And there could be potentially a little bit of that, or is it how much fluid is moving in and out of the follicle? So then we can see, we can see, what you might call it, is it the fluid is not moving in and out of the follicle. So basically the follicle can grow and it's not responding. And you know, with a progesterone, I think prometrium,

I don't see it working very well for a lot of my patients because it has titanium dioxide. is with peanut oil. And so, you know, it's not great. There's a lot of, allergens there, but the let's resolve tablet. Sure. What happened with the lectures all tablet? Did you take it? How did it go? you now have some subcutaneous.

progesterone that they're trying to do as well. And, did you actually end up going through with this or not? And how did you respond? Because was the risk, was this the response because you, the follicles obviously did not respond to it. So it's good cause you do have 10 follicles and seven, but none of them are above 10 millimeters. So there isn't, they're not growing and,

Everything that I see right now, I would say it's more from an electrolyte standpoint, something is going on there in fluids and how the fluids are moving in communication within the body. But I definitely think that there are some things that are missing and I'll tell you what those are. Like I'll just draw them out. I think that, you know, you need gut. If you're going to run another Dutch, it's basically pointless not to have that. I think you need a nutrient panel. And then I think of methylation.

would be super helpful. Sorry. And the methylation would just be super, everybody in our practice needs to run a methylation. And here's what I'll tell you right off the bat, that morphology is quite low for me. And that especially for, I think you said he's 34, 36. The volume is okay, that pH is very high.

So something that's going on, how many days was abstinence and then the head defects 82%, I would be running a DNA frag. So DNA fragmentation will tell us if you have really high DNA fragmentation, the egg quality at 41 is not going to be the same as a 21. So I know you said, you know, the partner is not super duper on board. I think

And it's not a matter of like, if the partner is not on board, it's like, does he actually understand the implication and how things are working? I'm just going to look at data. So for me, I would want to retest and see if that pH is high. Has it been two to three days abstinence? Did they actually look at everything? Cause total motility for me is still low. I want to see it over 70%. And then the concentration per mil is 48.8, which is great. The total volume is a little bit low for me.

So is this just dehydration? Is this just not frequent ejaculation? So then the body has kind of stopped the production of sperm on a regular basis, you know, and having 82 % of the sperm with head defects, I'm thinking DNA fragmentation. So I'm thinking oxidative stress. And then I'm obviously thinking that's going to impact the ability to not just conceive, but for the embryo to form and healthy embryo, all that jazz. And we see that the volume produced, you know, was on the low side.

and the total motility is on the low side. Motility is gonna, the energy that the sperm has to actually move and get there and it has to travel very far to get to the egg that.

it's if it doesn't have it, it's I'm thinking about mitochondria, you know, and like I said, mitochondria could be around in the mid piece that helps it move, or it could be around the in the head that helps with the DNA fragmentation. So I would be looking at the DNA fragmentation. And then honestly, I think the biggest other mistake that I think this is all of the same stuff. I'm just just gonna double check.

Mm-hmm.

Yeah, I'm not sure. For some people, everything uploaded to twice. So if the man is not on board because he doesn't think anything is wrong, you cannot treat him just like a sperm bank. That's essentially what I think all fertility clinics do. They're just treating men as the sperm bank. The contribution of the man is not just the sperm. And even if you think about the sperm, it's like, he makes the sperm. So the healthier that he is, the healthier the sperm will be, or obviously the opposite is true.

And if he makes new sperm every 72 days, let's say, right, it's that two to three month mark, then that sperm has the imprint of his lifestyle. So is he sleeping well? Is he drinking? Is he drinking enough water? Is he eating enough fiber and vegetables? Is he pooping enough? Or is he really tired? Does he have brain fog? Does he have a lot of stress? All of those things are going to be a reflection.

of the level of nutrients that he has, what his methylation in doing in there for what is in his sperm that he's passing down to the next generation and the capacity of that egg to actually choose the sperm for that sperm to make it all the way up. The microbial imbalances and the differences or the, have to be there in order for that fertilization to happen. And then when fertilization happens, the zygote, which is just when the, it's not an embryo yet embryo is, you know,

five cells or the blastocyte is five cells and then the embryo is further along. But the zygote is just the two cells. That's when the zygote downloads the information, the DNA information, including the methylation process from the mom and the dad. And then it goes, it basically downloads its genetic code and then it starts to form it. So if the genetic code that we're getting in the information that we're getting from the sperm is really rubbish, the egg can only do so much to fix it.

And if you can't fix it, either that pregnancy isn't happening or that, you know, implantation isn't happening or the essentially a higher risk of miscarriage. So I think that as a woman, if I was in your shoes and I'm 41 and I have this male partner who's 36 and I have a couple like that, and she's actually even older than that, it's not about what he thinks. It's about your biological clock. So if he doesn't think it's a problem, well, then show me with the data.

And with the data so far, just on the sperm analysis, well, I see that the sperm pH isn't good and I see that the morphology isn't good and that most of the defects are in the head. Now I'm assuming there's some kind of brain fog, some kind of weight gain, some kind of stress, some kind of something, not all of those things, but I'm assuming there's something that's going on for this male. So if I look at his cholesterol levels, if I look at his liver function, if I look at his blood sugar, if I look at his gut, I'm going to find something.

it's not about me finding and looking for problems. I see the problem. I need to understand where that what is causing that problem to be there. So if the sperm is not good, then where is the problem coming from? And so when we're looking at just hormones, that's not that's not the root cause hormones are messengers. They're acting because something is telling them to do that. So if that testosterone is really low,

where estrogen is really low or progesterone is really low for women, then I'm like, what else is going on? So for this case, for SB, okay, the progesterone, that estrogen actually looks pretty good and we can see that things are, but the information is so fragmented. Like even when I looked through it, it's like, what's going on over here? And this is missing and then this random marker is missing and this is missing. So.

My advice to you would be to number one, like can we just run everything at the same time, get a proper cycle through and look at.

Methylation look at gut and look at day two and three of all of the cycles. Let's look at day 19 and 23. Now you had those that antral follicle count. Great. Was that medicated or was that not medicated? If that was medicated, you definitely didn't respond to that medication. So then why didn't you respond to that medication? What else is going on there? And then is it the quality of the progesterone that you're on? Is there something else that's going on in terms of the nutrients and the stress and the inflammation?

in the body. And so when you're 41, you just have to be very picky because you're at the end of your fertility window. You have to put in a lot more quote unquote effort. And I genuinely like everybody who is in my practice. They have to put a lot more effort because it is a disease like fertility is an Infertility is a disease. It's just not like I said, treated as seriously as it should because it's not cancer. It's not diabetes. It's not cardio. Like you're not dying from it, but

If you look at research and you look at studies and know, women and couples who then go on to develop these diseases also tended to struggle with fertility issues. And that is because it's connected to blood sugar and, you know, ovulation and egg quality and mitochondrial function, nutrient levels, all of that stuff. So I am really like, I highly focus on the quality of life and look at what else is going on. And then fertility is the secondary, like obviously you're here because you want to get pregnant.

but I actually want to figure out why you have all of this inflammation. Cause I know that that causes this in this disease, five, 10, 15 years down the road. And if you don't want to die from it, you don't.

then let's start working on it now, because that's actually when the prevention is. And then in our case, the couples, that's the thing that's preventing them from getting pregnant. So I know we are way over. I hope you guys really enjoyed this. I want to say thank you for all of you who applied. And like I said, it's the hope is that it just gives you a different perspective on all of the things that could be missing. And I've really enjoyed, like I really enjoy just looking at labs and discussing them. Of course, we'd love to meet you. So if you want to continue and work with us, please.

reach out so then we can go ahead and book the next call in the process. And if you want to learn more about any of this, and this is your first time listening to this podcast, just fill out an application and we're happy.

to point you in the right direction and show you if we are the right fit to show you what that looks like. So thank you guys again so much for being here. Thank you for listening. 200 podcasts recorded, which is insane to think about because that's four years, almost five years of sitting down and recording things. So thank you so much for being here. I appreciate you and we'll see you soon.