How To Enhance and Support Fertility with Functional Medicine | Podcast #332

There are two main methods for getting pregnant and if you’ve struggled with conceiving then you’ve likely looked into and/or pursued traditional medicine. This doesn’t necessarily make you healthier, but your doctors will try to change your hormones to encourage pregnancy. On the functional side, Dr. J would focus on enhancing health, enhancing physiology, regulating hormones, etc. Even then, sometimes measures like IVF are still necessary for the end. But before we get to that, we want to look at all the natural ways we can encourage your body to prepare for baby-making in both men and women.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:24        Two Approaches in Fertility

7:29        Root Causes

17:20      Right Diet

30:40      Prenatal Supplements

34:54      Adrenals

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Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house. Evan, how are we doing today man?

Evan Brand: I’m doing better. I had COVID Believe it or not. And that was like a five day journey. I think I’m over the hump. So if I sound a little weird, that’s why, but family’s healthy. And I’m a survivor. Now I’m going to be in the, quote, recovered category.

Dr. Justin Marchegiani: Love it. That’s good. Excellent. Well, today we chatted kind of pregame that we wanted to talk about fertility, talk about natural ways to enhance fertility. We see lots of patients that as a side effect of getting healthier through natural medicine, functional medicine, good nutrition, diet and lifestyle. They get pregnant, even if fertility wasn’t a goal, and we have some patients that come in with a goal of fertility and the nice thing is, fertility is a byproduct of getting healthy. So I mean, there’s kind of two approaches to it. There’s the conventional medicine side where they’re not really making you healthier, they may just be changing some of the hormones in your body. So you can get pregnant, right? IE via IVF therapy, those kind of things, right. And then there’s kind of natural ways that we are utilizing the enhancing of healthy and enhancing physiology to get pregnant. And sometimes IVF may be necessary. If you’ve done everything you can do on the health side, and you’re still not getting pregnant, that may be an option, right? But we want to do everything we can do on the natural medicine side, because if you do that, you know, 80 to 90% of people I think are going to get the results they want, which is getting pregnant. So I’m excited to dive into this topic with you today.

Evan Brand: Yeah, I would say that it’s pretty rare to need IVF based on some of the people that you and I’ve seen clinically, I’ve had several men and women and it’s good as a couple right. So that’s the important thing to mention. It’s important for the couple to get healthy the a lot of the blame is placed on the woman but in many cases, you know, male sperm motility or sperm concentration is a big issue. So the men kind of, you know, I don’t know why, but in general, the men get ignored in this conversation, but it’s really important for them to get optimized as well. And we’ve had couples where they looked at the cost of IVF, you know, typically 10, upwards of $15,000, depending on where 20,000 Really? Yeah, okay, so 15 to 20. And people come to us first and say, Well, you know, we didn’t want to go to IVF yet, because of the cost cost was kind of their main motivator, and maybe they, you know, hopefully had some sort of a natural minded bias. And so they said, well, let’s see what we can do first. And then 100 out of 100 times, so far, we’ve been able to avoid IVF for those people. And we’ve had, you know, between you and I alone, we’ve had four healthy children on our own. And then, you know, countless women that have had healthy pregnancies with our support

Dr. Justin Marchegiani: 100% it’s all about getting to the root cause, right? And yeah, there is that whole idea of the pottenger cats experiment where pottenger was in a medical doctor, I think, in the 50s, and he had different cats and he would feed some raw food, some processed food and and then there was, I think, within three generations of eating processed food. The cat group that ate the processed food lost the ability to reproduce. So there is this idea that we’re on like the third generation or so of this pottenger cat experiment. And there is some people that are just at that and end level where they may have reduced fertility just because they’re living out the pottenger cat experiment in real life. It’s possible some of that is the case. So we want to do our best to really emphasize a whole food nutrient dense anti inflammatory diet. We know that pregnancy involves healthy hormones. And as a starting off point, we don’t want to eat foods or toxins or hormones in our animal products that could throw off our fertility. So the first step in any fertility program, nutrient dense anti inflammatory, low toxin, that’s going to mean an organic whole food diet. that’s going to mean cutting out hormones and antibiotics and pesticides, and GMOs. A lot of these pesticides are xeno estrogens, they mimic hormones as well because they affect the insects from reproducing. That’s how they kill them. Right. And so it can also have an effect a cumulative effect on women and men on the sperm count women on the fertility side. So diet is going to be one of the first things and the second thing is going to be blood sugar stability. I think this low fat low cholesterol era, skipping meals fad dieting has prompted lots of insulin resistance, lots of reactive hypoglycemia, meaning too much sugar, too much carbs, blood sugar goes up and then spikes down, which then creates this insulin surge and high levels of insulin is really what’s behind the leading cause of infertility in women which is pcls. That’s polycystic ovarian syndrome. And that the mechanism there is high levels of insulin, insulin resistance insulin surges, thus increase androgens, and then the androgens also can throw off prolactin and then that can dis regulate a woman’s cycle. So you can see There’s a lot of different hormonal rhythms that can that can go off together and create many issues. So the major mechanism is in the beetus, insulin resistance, followed by increased level of androgens, free testosterone, testosterone, and then also prolactin issues to boost. Those are kind of the big initial sequelae that we see. And of course, usually if they’re eating a lot of crap or hydrating junky foods, people that are missing that level of awareness, tend to also be consuming the pesticides, maybe going to low fat, low cholesterol, maybe not getting high quality animal products and getting all the hormones in there too. So that’s like kind of my first two things out of the gates.

Evan Brand: Yep, well said and just want to quickly go over the conventional treatments for infertility, especially resulting from pcls. That’s what we did on our gut health podcast, kind of the conventional versus functional gut health. People loved it. I got a lot of good feedback on that. So thanks for the feedback. But it’s not pretty you mentioned it’s not root cause and it’s not so you’ve got this clomiphene which is the American College of obstetrician gynecologist recommendation that’s their primary medical medication for pcls patients with infertility, it indirectly causes eggs to mature and be released. Then you’ve got Metformin, which we just talked about the insulin resistance problems. So Metformin would come in and help. They talk about it helping just in terms of population, but that would probably be just due to helping to lower insulin. That’s what it is.

Dr. Justin Marchegiani: Yeah, Metformin, it liquefies. That’s a big one.

Evan Brand: And then you’ve got the letrozole. This is a drug that slows estrogen production causes the body to make more follicle stimulating hormone FSH, which is what you need for ovulation. And what else here they’ve got just other hormones in shot form, which are going to cause ovulation and then the craziest one, let me just read this one here and then we’ll we’ll move on into the functional you’ve got ovarian drilling. And so the surgeon makes a small cut in your abdomen inserts a long thin tool. And they use a needle with an electric current to puncture and destroy a small part of the ovary. This surgery leads to lower androgen levels, which may improve ovulation. So Wow. And if you do all those and you don’t get pregnant, then you could go to the IVF, which is where the sperm in the egg are put in a dish outside the body fertilization, fertilization happens, and then they put the fertilized egg into the uterus, and then boom, there you go.

Dr. Justin Marchegiani: Exactly. Now, I kind of want to tie back to the root cause I want everyone thinking about fertility from a root cause perspective, because when you think about it from a root cause then you can say, hey, are we getting to the root cause doing this procedure or doing this thing? So first off, like I already mentioned, pcls is a big one. Now with infertility, there’s usually going to be some level of insulin resistance or blood sugar dysglycemia meaning your blood sugar is up and down. And your body has to make a lot of hormones to regulate that flow blood sugar So when your blood sugar goes really high, right, because of excess carbohydrates in balanced meals, not enough protein and fat, you’re going to surge a whole bunch of insulin to bring the blood sugar back down. Now, women that tend to be more on the heavier side, usually that blood sugar eventually start staying higher, because that’s that’s what diabetes is right chronically high levels of blood sugar, but usually before that, there’s some level of reactive hypoglycemia where blood sugar goes up and then crashes down because the body over secretes insulin. And when the cells are still sensitive to insulin, that blood sugar will drop down really, really fast. And then your body has to make a lot of adrenaline and cortisol to bring it back up. Okay. So if we tie in prolactin, prolactin is going to go high when there’s high levels of estrogen. So when we start having more estrogen dominance, Okay, first mechanism, how does estrogen dominance happen? Well, it’s going to happen one through exposure of estrogens and the environment to with gonna happen through metabolism of progesterone. So progesterone is a really important progestational Pro fertility hormone very important. When we get stressed we’ll actually convert progesterone downstream into cortisol. So when we get chronically stressed, we’re going to decrease progesterone. And then number three high levels of estrogen, estrogen dominance, that is going to start driving prolactin issues. And when we start burning up dopamine, right, dopamine is a very important neurotransmitter. Dopamine gets used to make adrenaline so when we start making a lot of adrenaline, a lot of stress neurotransmitter, dopamine gets used, and dope means a tonic inhibitor or prolactin. So imagine you have prolactin and you have dopamine level is like the foot on the brake, right. And as you start depleting your dopamine and you start getting more stress, you’re taking your foot off the brake and what happens to prolactin, it goes up and prolactin starts to go up one of the side effects Next is loss of ovulation. Right You can go, [inaudible]. So you have a couple of mechanisms, right? You have this prolactin mechanism from dopamine, you have estrogen dominance, which can affect prolactin as well. You have this infertility through pcls. And insulin resistance and elevation and androgens, right. And then also all of the food components, all of the hormones and the toxins and the pesticides also contribute to that.

Evan Brand: Yeah, those are, I would say the biggest and most important things affecting your average american. There’s a couple other small subgroups, I want to mention what I’ve seen with infertility, one being people that are overtraining with exercise, you mentioned also the period. So I had a woman who she was, she was in the small percentage, but we have to talk about the small percentage because you know, people who are healthy and want to be healthy, listen to our podcast, and so there’s people that may be overachievers will call them and so we had a lady that was doing CrossFit like four or five times a week 45 minute sessions, and just beating the pavement. Now, typically when someone’s doing that we don’t really need to run a hormone profile. But just because I knew that it would increase her compliance. If I told her to stop exercising, she may not listen to me. So we use the testing to prove on paper what we already knew intuitively, which is that she was causing her cycle to be disrupted due to the chronic stress of the overtraining. So when we ran the hormone profile, and we showed her what her cortisol look like, it was basically flatlined, except for the time of the day when she did the exercise, she had a mild spike, which is why she felt better. You know, she said, Oh, my day is not complete until I exercise that’s because her cortisol was so low, and when she whipped the tired horse, all of a sudden she got this temporary boost of cortisol and adrenaline. She felt normal and that was it. But the prescription for her to get pregnant was simply just go down in the exercise. I just told her do three days a week Max, but do yoga, restorative, do biking, do hiking, do gentle things that are fun for you, and fun. For your family, and that’s all she did. I mean, her diet was already dialed in. We did look at her gut. We didn’t see any infections there. You know, we knew that there was no insulin problem, the carbs were not an issue. And she got pregnant just by simply reducing the training. And then another small group of people are people, women, specifically that were just going to low carb. So I had several women that were on a ketogenic diet. And some would argue well, our ancestors they could have been ketogenic, right, they were out in the prairies eating the bison, and they may not have had access to potatoes and whatever else but I do believe that some carbs are beneficial and necessary for fertility and for healthy pregnancy. So I had some women that were on keto for a long time, all we did is just add in some starch, organic white rice, we did some potatoes every once in a while and boom, they got pregnant and we didn’t change anything else. This is of course after we do the whole functional medicine workup, which you and I will talk about in a minute. That was after we did all that then we tweak the diet and then boom, she got pregnant.

Dr. Justin Marchegiani: Yeah, and I would say because information ability is primarily driven through PC OS and PC OS, the major mechanism behind it is going to be insulin resistance. I think a default template should be a lower carb paleo ketogenic template. But just because that’s our default doesn’t mean we’re not clinicians and adjusting things for the patient. So of course, with this girl, she may have done really well with that. And then she may have tapped out her benefits with it. And she may have already been at a really good place with her insulin. Because if you get insulin too low, and you’re already are relatively healthy body comp, that could also be a problem too. So this is why we have to individualize it for patients. So we’re talking about pcls and insulin resistance. And for most people, that kind of a dietary strategy is going to be a really important starting point. But for some people, you may hit the wall, and you have to adjust like you haven’t talked about others, you may have to hang out there a lot longer. So it’s kind of keep that in the back of your mind because we’re kind of having two conflicting recommendations. And that’s because everyone’s at Individual, and we have a starting point for most and then we adjust according to the patient’s needs after.

Evan Brand: Yeah, and that’s just an extreme case, but I at least wanted to mention it right? Because you always have the people that say, well, I’ve already done paleo and I still you know, had issues of course, there could be other underlying causes, you know, infections or whatever else we’ll get into, but in her case, this lady who was literally just doing like meat, and maybe a salad, you know, she literally had almost like virtually no carbs at all. So, so that’s just an extreme manifestation. But if you’re doing your, like you said, just kind of standard paleo template, you’re probably going to do maybe it’s plantains or some berries or you’re probably eventually over the day would accumulate enough starch or carbs to to fuel the fertility, but in her case, no, she was too low.

Dr. Justin Marchegiani: And again, if you’re insulin resistant, the starch or carbs may be keeping you infertile, right? Yeah, we can always do testing. We can always run fasting insulin and we can see where your fasting insulins are at. If there’s pcus. We may also want to look at prolactin, we may also want to look at free and total to stop Throw a see where that’s fitting to make sure it’s not, you know, in the top half top top 25% of the reference range. That’s pretty good to look at. So what’s the underlying mechanism? So if this person’s over exercising, it’s probably one over exercising, it can create estrogen dominance, right? So it can decrease progesterone. It can also decrease your dopamine and adrenaline which can be that driver that increases prolactin, right. And it can also just deplete hormones in general, I see a lot of women that are low estrogen, low progesterone, and they still may be a little bit in estrogen dominance because the ratio is still skewed, but their hormones are just low across the board. I see that a lot as well. So you have to this is why it’s super important to to test right because if you’re not testing you’re guessing. So with fertility cases, we may run a month long test to see where you’re at from day one when you bleed, all the way to oscillation all the way to the end of the month looking through the luteal phase to see how high that progesterone gets. We may just come in there and run a snapshot on the luteal phase two If patients have some infertility issues, but it’s not a primary thing, then we may just come in there with the luteal thing. If they’re really struggling on the fertility side, then we may do that full month. So I’ll typically do one or the other. And of course, looking at the adrenals are so important. Why? Because the adrenals interplay with dopamine and adrenaline and cortisol and estrogen dominance, ie via progesterone going to cortisol, we have to look at the adrenals because they play a major role as a backup generator with the female hormones.

Evan Brand: Yeah, absolutely. I mean, adaptogenic herbs are part of my life. They’re part of your life, you know, on a daily basis for us clinically And personally, and it’s a game changer. I would say it’s one of the biggest, one of my most favorite and biggest tools that I will use with a woman who is struggling with infertility, especially because there’s so much emotional stress. And there’s trauma associated with this, especially if a woman’s had a miscarriage or if a woman you know, has worked on this for months and months and years and been to several doctors in practice. And she feels like she’s at the end of the rope and she’s aging and she’s kind of running out of her her fertile window anyway. I mean, there’s so much stress associated with the emotional component of this as well and maybe family pressure when you’re going to have kids and that whole thing so, to me, that’s where adaptogenic herbs come in and not only help with the hormonal side, but the mental emotional stress as well.

Dr. Justin Marchegiani: Exactly. So in general, like with women and men, similar things with the diet, right men, there’s less of a hormonal fluctuation that’s going to be throwing fertility off. So keeping the pesticides, the hormones, the artificial hormones, these you know, estrogens, the growth hormones, really emphasizing good proteins, good fats, high quality cholesterol from animal products, lots of good antioxidants from leafy greens, keeping insulin in check. That’s a good first step. Of course, we can add in resistance training, we can add in mitochondrial nutrients like carnitine and co q 10, and arginine and zinc and selenium. Again, it was certain male patients will come in. We’ll run a nutrient profile and see what nutrients Their low end as well and of course, we’re going to be fixing the gut fix to the adrenals. And using a lot of those first line things, it’s also herbs we can use as well. ashwagandha is a big one tyrosine and dopa means a big one right? You see macoun as well as a big one. Why? Because dopamine helps with fertility. You mentioned earlier tongkat Ali really helps with that upstream signaling from the banana tropic releasing hormone, which then helps with FSH and LH. Lh is really important for spermatogenesis and making healthy sperm. So these are really good first line steps for enhancing male fertility. Anything else you want to add about that?

Evan Brand: Yeah, we weren’t. We didn’t press the record button yet. When we when you were now we’re talking about that. So let me just give just a quick little story on Tongkat Ali. There’s a Latin name for it as well. It’s something that’s beneficial for for men. We give it a lot to athletes, it does help with testosterone levels. And there are a couple of really, really cool papers on it. Where it’s increasing supermoto Genesis by influencing that HP ga axis the hypothalamus pituitary go Natl access. And long story short, not only did it increase the sperm count, but it increased the sperm motility. So you’ve got better swimmers. So when we talk about men, you know, having an important role in this fertility, you know, piece, that’s also a game changer. And then tribulus is another, you know, tribulus is once again kind of used in the bodybuilding community quite a bit to help with muscle mass and androgen increasing effects and all that, but it does help with the testosterone in the DHT DHT levels, which are all sex hormones that are important. And then also, what about the What about the influence of the gut? Do you want to talk about that now because I’m just thinking out loud with you here. We should probably talk about the mechanism of beta glucuronicdase issues with men and women where they would be re circulating estrogen and having issues with estrogen due to the beta glucuronicdase. enzyme being hired. Due to like a bacterial overgrowth problem, for example.

Dr. Justin Marchegiani: Yeah, so in functional medicine, right, we may look at things a little bit closer when it comes to fertility, but we’re still going to be doing the same things with the gut because if we don’t go to the six R’s of healthy gut function, we don’t go to the six R’s, removing the bad foods, replacing enzymes and acids repairing the gut lining in the in the hormones, removing the infection, repopulating rynok elating, good bacteria retesting. The gut is where everything happens 80% of the immune systems there, that’s where all the nutrients are absorbed and digested and assimilated and utilized. So if we just were to skip that and go to a hormone protocol, or a typical augmentation program with progesterone, we may miss a lot of those nutrients getting assimilated, broken down and absorbed and utilized. So we have to always assume the gut could be a major interplay. And again, most people, they’re not connecting the gut with their hormones. They just never right. But like you mentioned beta glucuronidation plays a role in hormone detox and We could be increasing estrogen dominance to the bad bacteria causing us to reabsorb estrogens. Right. We could also just have bad liver and gallbladder function because we’re not digesting fat, partly because of low stomach acid partly because of an H. pylori infection or grd infection. And that can make us hard to break down and assimilate cholesterol and essential fatty acids, which are important building blocks for fertility, right. So these things always kind of connect whether they’re one two or three degrees away from the root.

Evan Brand: Now if you’re a little brain fog, and you’re listening to Justin talk, you’re like, Oh my God, he’s talking fast. What is he saying? Giardia? What the heck pet parents Oh my god. So yes, literally, gut infections can literally make you infertile. We had several women who were infertile, and we ran their stool panel, they showed up with parasites, whether it was Giardia or krypto. As you mentioned, H. pylori being a big influence on stomach acids. So now, if we think about we always talk about good diet for mom, which is going to be a good diet to feed and grow a baby. But what if she does have these infections, and she is doing a paleo template and she’s doing her Grass Fed Whey or whatever to get her amino acid profile complete. And now all of a sudden she’s got these gut infections. So literally, just by running a gut panel and walking someone through using herbs to eradicate these infections, boom, I’ve had I lost count many women who, during a parasite protocol, they’ll email the office, I’m pregnant. What do I do? I’m like, holy crap. Yeah, by the way, this protocol by eliminating parasites, it actually increases fertility. Boom, there you go. Congratulations. And so it’s, it’s pretty nuts.

Dr. Justin Marchegiani: In general, anything else you want to say about that? So we talked about gut being really important. So HCl, enzymes, those kind of things are really important. We talked about the six hour if you’ve done podcast on that topic, so just make sure if you’re thinking about fertility, make sure we don’t ignore that right. has to be on the women has to know On the men, usually male men are easier to deal with because they don’t have a very unique symphony of a cycle. They kind of have a foghorn of hormones. And usually that’s going to be depleted by stress and poor nutrition and gut stuff. So it’s a little bit easier on the hormone side. But with women, it’s a little bit more complicated because of the cycle. So we talked about IVF. We talked about medication like clomiphene citrate or Clomid, which is a stimulates gnrh, which then stimulates FSH and LH and follicle stimulating hormone luteinizing hormone from the pituitary, which then stimulates egg maturation and oscillation. So there’s that right. But that’s kind of like a stimulator. Like Think of it as you got a tired horse. Do you really want the horse to perform by whipping it harder? Right? Is that the mindset? So for some people, that’s like an easy, you know, quick, simple, okay, I’m pregnant now. And most people who are aren’t as natural minded, that’s usually the first line of therapy that they’re going to do on the fertility side right. Then usually after that, they may go I UI which is the inter uterus insemination and then they may go into IVF or they shut down the whole HPA access using Lupron, they come in there with certain like follistim and different hormones at certain times so they can grow the eggs, harvest them, put them back in, get the whole hormone cascade going with all the injections, and then while you’re pregnant and then maintain the pregnancy with progesterone, that’s kind of what happens on the IVF side. But that may not be necessary for a lot of women. We already talked about the major mechanisms. Now, what are some deal breakers that may hold you back from getting pregnant even with doing all this? So there are certain things you have to look out for fibroids are a big one. If you have some big fibroids that are just hanging out, they could be there could be enough there where it’s disrupting blood flow, because the fibroids are a blood flow hog, and that could be preventing the egg from implanting into the uterus lining. Also, the fibroid can create a little bit of inflammation now everything we’re talking about is designed to To help prevent those fibroids from growing, the question is How long have they been growing they’re they’ve been hanging out for like years and years and years and decades. Some of the natural things just make take may take too long. And so you have to be very, very aware of that. Or it may be so big where it has so much momentum, it may need to be removed surgically. So you have to be mindful of things like fibroids. Also, endometriosis is a big one. That’s endometrial tissue, can it which is basically the endometrial lining tissue starts growing in areas it shouldn’t be, it could grow on the ovaries, it could grow on the bladder. Sometimes endometriosis, endometriosis can cause inflammation in that area. And then a lot of times with a simple procedure where you come and take a laser and kind of laser it off can be very helpful. conventional medicine won’t fix the root cause of why the fibroids there or why the endometriosis is there, but sometimes it’s gotten so bad where that may be necessary. There’s also something called a chocolate cyst, which is basically an Dimitrios in the ovary and that can Definitely be a problem as well. So that may need to be drained. So that you have to look at some of these things, some of these tissues that have grown for a long period of time, they may need a conventional intervention. Now, as long as you’re relatively young, and you have some time, try the natural stuff first and see if your body can handle it. If not, that may be the next thing to look at. And then of course, we already talked about pcls, which is polycystic ovarian syndrome. And that’s where there’s system the ovaries from all the things I mentioned, elevations and insulin and androgens, and I seen those reabsorb time and time again. So I’ve seen the body be able to handle that. I don’t see most patients that will have to go in and get those things drain per se, I find the body can handle that. The other things may need to be addressed at some point over time, but I always say wait and see work with a good functional medicine Doc, have a good ob gyn or a reproductive ob gyn kind of in your back pocket. So you’re monitoring things as you move forward. And if you have to go a surgical route, don’t throw away the functional medicine doctor keep both of them working together.

Evan Brand: Yep. Yeah, good point. And you know, it’s possible that you could find like a holistic or more natural minded ob as well, that would be good to have on hand that way they would help support you with some of the dietary stuff. But yeah, with endometriosis, you know, there’s a hormone component to that as well. So we already talked about diet and things like that, but of course, in the beta glucuronidation, so like calcium D glucose rate, for example, you know, that’s something that we may use to help with getting out these excess xeno estrogens. And that could be a game changer too. And of course, in the diet, you’re getting some like, you know, calcium D glucose, right? You’ll get some of that naturally in the diet. So whether you’re doing like broccoli, or blueberries or whatever, I mean, different. You know, cruciferous veggies, you’re going to get some beneficial stuff like that. Anyway, that will help. Regarding the hormones. It sounds crazy that broccoli could help pregnancy but yeah, but it definitely could. And then also, I mean, there’s no there’s various exercises to that can be helpful. Exercise in general is helpful. So I mean, if you have a sedentary woman, and you get her moving, but not to the CrossFit, five, you know, five times a week level, you know, that could be a game changer.

Dr. Justin Marchegiani: Exactly. So you got to look at everything holistically, like, I’ll tell you my personal story. We have two Healthy Kids, two healthy boys. And my wife and I had a hard time getting pregnant in that first year. And we found she just had a really, really, really, really, really big fibroid, very big-

Evan Brand: Was that ultrasound or how gel, figure that out?

Dr. Justin Marchegiani: Transvaginal ultrasound, and my wife before she met me, she was on birth control pills for over a decade. So I think there was that she wasn’t he she was eating a lot of conventional foods in the beginning before she met me before we tweaked her diet. So I think there was a lot of hormonal growth that was going on for decades that caused some of that growth. And you can’t just pull it away and expect it to just reabsorb all of a sudden, right? You can’t take 10 years and just expect it to go away. And so we actually tried reducing it. Now there are things you can do, they can work there. You can do things like egcg epigallocatechin is in the green Green tea you can do things like resveratrol and lipids or curcumin, and you could do systemic enzymes like Sarah peptidase and lembrar kinase, which are helped to metabolize some of that tissue and can work. The question is, can it work fast enough? And so we went the surgical road that the fibroids removed and literally within two months of it being gone pregnant, no problems. And so sometimes that can be an issue. So you have to look at, okay, what’s the root? Cause? You know, do we have some limitations of matter, right? Were those tissues just been hanging out too long? Just the body needs a little bit of a head start getting that tissue removed. And if you got time, you know, do the natural things and just watch and wait, right watch and wait. So if you’re a female listening, and you’re not in a relationship, or you’re not looking to get pregnant anytime soon, but you want to at some point, I just recommend getting good, good workup with your ob gyn to make sure there are no endometriosis or fibroids, endometriosis. This is hard. Typically the only way to figure that out is laparoscopically, little incision for the scoping. So it’s kind of tough to know that one. But you know, usually a lot of the telltale symptoms like the painful periods, like those kind of things, if you’re having those symptoms work with a good functional medicine doc to help it, but keep an eye out on bigger issues, like fibroids and those things so you can act on it early.

Evan Brand: Yeah. Thanks for sharing the story. And now you got two little boys and they’re keeping you busy. So everything worked out.

Dr. Justin Marchegiani: You got it? Absolutely. So keep that in the back of your mind. Anything else you want to add? On the supplements? I know you were kind of riffing on a couple of adaptogens earlier. Anything else you want to add? You mentioned while you listen tongkat Ali?

Evan Brand: Yeah, so that could be for the men. I would just say during during the you and I’ve talked about this idea before we kind of call pregnancy more like a four trimester thing which women like cringe at like, Oh my God isn’t pregnancy long enough, but not just meaning that there’s a kind of a pre, a preNatal phase that happens before you even get there. Right now kind of a pre, you know, fertility supporting area. So we’ll bring in multis and omegas. And like you said, maybe systemic enzymes will bring in trace minerals, micronutrients, maybe Grass Fed Whey protein, maybe some Oregon supplements. I mean, there’s a lot of things that we can do right away to kind of prep the body before you even get pregnant. It’s not I disagree with this idea of you got, you’ve got a pot of positive pregnancy test start the prenatal, it’s like, No, you could be six weeks in already, like you should have been on the prenatal six months before you got pregnant in my opinion.

Dr. Justin Marchegiani: Yeah, and most prenatals I mean, prenatal is a more of a marketing thing, like in some of the prenatals that we recommend, what makes it a prenatal Well, there may just be a little bit more calcium, there may be some extra full weight in there. And of course, everything’s active, full light, no folic acid, everything’s mthfr. Of course, everything’s methylated. There may be some extra iron in there, right? So there may be a couple little nutrients that are a little bit extra. But if you look at a really good high quality multi versus a prenatal they’re going to be about 90 95% At the same Yeah, if you’re getting a high quality couple little tweaks here and there, of course, you may want to add in some extra essential fatty acids cod liver oil, those kind of things I think are are very, very helpful.

Evan Brand: I get so mad I get so mad when you go like if you go to like Whole Foods or I mean even even places like that where you’ll go and you’ll see these little cute gummies in like a clear container. And it’s like six gummies a day and the first ingredients like fructose or fructose tapioca syrup. And it’s like, okay, here you are taking the woman who, you know may not know exactly what’s going on may not understand the root causes, and he or she has eaten these little gummies every day as a prenatal it’s like no, it’s like candy.

Dr. Justin Marchegiani: Totally 100% agree. One other thing if you have to go a surgical intervention I recommend personally, if you’re a fertility age and you want to get pregnant that you see someone that has a specialty in reproduction as well as being a gynecologist. I find that certain gynecologist have a A perspective on what’s happening surgically with the goal of removing the tissue, while others have a perspective of that while maintaining fertility. So I find someone that’s a ob ob gyn as well as a reproductive specialist, they looking at the procedure with a lens of keeping fertility intact. So I always recommend if you have to go the surgical route, try to find an OB GYN that also has that reproductive specialty as well. Yep. Good advice. Yeah, I think that’s important. I’ve just seen, I’ve heard too many stories from ob gyns, who don’t have the repro specialty, and they’re just and again, some of these are older stories. They’re too easy. They’re too They jump the gun on just doing a complete hysterectomy or doing a partial hysterectomy just removing the uterus or just removing too much tissue and and that scaffolding of that uterus can collapse and other issues can happen. So I always like to make sure you have someone with an eye Keeping fertility intact.

Evan Brand: Yep. No, I mean that if that’s their job to just remove uterus and ovaries all day Yeah, they may not care about the fertility aspect at all.

Dr. Justin Marchegiani: Yeah, it’s really, really important. And then yeah, and that’s, that’s incredibly important and of course, the most non invasive to invasive is is the best way to go. Anything else having you want to add on the topic? I mean, Today’s been really great. I think we really hit a lot of things from the nutrition aspect to some of the herbs and nutrients just to dovetail that progesterone is a big one we may be adding in progesterone we may be adding in things like chase tree and damiana and different herbs that help modulate maka that modulate estrogen receptor sites and or modulate progesterone and even support progesterone and of course, we’re also supporting the adrenal so all of those key tenants there need to be fully looked at and supported that you want to add anything else that Evan?

Evan Brand: I don’t think so. There’s a Yeah, there’s a good handful of like female supporting herbs, things that we would typically use anyway. To help with like PMS, for example, things that are going to help regulate hormone levels, those things alone can contribute to fertility. So yeah, it’s sometimes where a woman comes to us with a different problem with hormones, they may say, Oh, I eventually want to get pregnant. But right now I need to focus on this major PMS. I’m out of work every week, you know, I’m laying in bed in pain, and we just help regulate hormones using some of those herbs you mentioned there and then fix the gut and then boom, hey, we got pregnant sooner than anticipated. Cool. Let’s go ahead and kind of transition now let’s, you know, let’s get you into this, you know, maternal support phase now and it’s really fun I tell you, there’s there’s nothing better than you know, whether it’s getting a picture in my inbox of a new baby or just a mom telling her birth story. It’s It’s fun, and it’s a very, very rewarding thing. And, and, and I always, I don’t know I like to pop my collar a little bit more after I hear a good story like that, especially when a woman was dealing with the conventional medical world and she was so frustrated. And so hopeless, and then she was able to actually do it naturally. It’s like, Yes, I told you so I told you you could do it because the conventional doctors are obese will be like, nope, you can’t do it. You’re not going to get fertile. You’re too old. Your hormones are too messed up. It’s not gonna happen. And then boom, a baby comes. It’s always just like I told you, so.

Dr. Justin Marchegiani: I like it. Well, after you talked about popping the collar, I’m gonna I’m gonna join you on that one. There we go. Excellent. Very good. So yeah, I love those stories. I think that’s excellent. We always want to focus on the root cause so just anyone listening we want to make sure our goal is that you’re looking at your fertility from a root cause perspective. If you have to bring a functional medicine doctor in great if you have to bring a conventional fertility MD and great just always make sure you’re looking at the root cause. If you have to go you know more invasive on the IVF or surgery side, that’s fine. Just make sure you exhaust all of the foundational options first, nutritionally and functional medicine wise. And then also make sure your husband’s a part of what’s going on. So Make sure he’s getting tested, his nutrients are assessed. He’s doing all the right things on the fertility side, we can also get a sperm count on him as well make sure sperm numbers are good, you know, at least 50 million, make sure shape and morphology and all that good stuff is dialed in as well to assess that being okay. And of course if, if it’s not, then we have to work on all the nutrients and work on removing a lot of the toxins that we already talked about.

Evan Brand: Yep. So get off the mountain dew. Oh God, we had a friend that was an old friend who was having issue with fellow body and her and her husband both just pounded the Mountain Dew. I’m like, who even drinks Mountain Dew anymore? I mean, it’s like, it’s like 80 grams of sugar per bottle. I was like, oh, get off the mountain dew. So of course, you know, typically people would think everybody around you and I like we’re just the circle of health, our family, our friends and everybody would just listen to us and reach out to us for help. But that’s typically not how it we’re not how it is. So of course they don’t ask me anything. What do they do? They go do IVF they spent, I think it was 15 or $20,000. They did like a fundraiser raise money. It’s like how about just like, let us give you the workup, it’s going to be a fraction of the cost. And you’re going to have, you know, minimal to no risk. I mean, like with other procedures, you know, you could have risk of twins and triplets. I mean, they’re not, you know, death necessarily risk, but there are risk associated with some of these other things. So, it’s just sad. It’s sad that people just don’t know. And, you know, you always say, oh, let’s talk about the root cause of this. It’s like, why is that so revolutionary? That should be the first way people think but it’s not.

Dr. Justin Marchegiani: 100% you’re never a prophet in your own town. And also, if women have to go the IVF road, the goal remember the end goal is not just to get pregnant, right? What’s the angle? Let’s huddle up and focus on what’s the end goal the end goal was to have a healthy baby, right that’s that’s the angle and pregnancies one step in that journey. So don’t confuse the first step as success number one, and then number two, If you’re going to engage in more conventional approaches that don’t address the root cause, I strongly urge you to make sure you’re addressing the root cause. So the angle should be having a healthy baby at the end. So just keep that in mind, make sure you are really focused on what the root cause and goals are.

Evan Brand: Let me say one last thing, and then I want to get your take on this real quick. And I love the way you said that, you know, the pregnancy is not just the end all Gold’s it’s the healthy baby and all that. So, you know, what about if a woman does get pregnant, and in an unnatural method, like IVF, for example, but she still has an insulin problem. I’ve seen cases where you could argue with something else, but I would argue that the elevated insulin and the sugar and the carbs and all the crap in the diet could potentially make the baby get too big. And then the doctors are saying, Hey, you know, now you’ve got a nine pounder, we’re gonna have to do a mandatory c section, for example. You know, there’s other complications there.

Dr. Justin Marchegiani: Yeah, I mean, just having that high amount of insulin, gestational diabetes. kind of thing going on, which a lot of times the Hopis don’t even acknowledge, really being a diet thing. I mean, I remember going in and my wife was getting testing on the blood sugar, and we were monitoring her blood sugar at home. And the nurse practitioner said, you know, hey, you know, the gestational diabetes is a genetic thing. And I’m like, I literally pulled up a study of like, literally says more grains, and trans fatty acids can actually increase it. And it was like a, it was just, it was like a paradigm thing. It’s like, even though like, if people are conventionally trained, and have to pass all these, you know, mainstream boards for their licensing, they’re not really up to date with the conventional literature in the conventional literature isn’t really injected in the first line therapies for what these doctors and nurses need to know. So it’s kind of sad. So we just want to bring that information everyone on the forefront now so they’re aware of it, and also test the blood sugar and if you’re at high risk for a miscarriage, then you’d want to keep an eye on your progesterone levels. As soon as you get pregnant. One of the easiest first things is using progesterone, an inter-vaginal progesterone probably 200 milligrams or so a day throughout that first trimester can be a godsend for a lot of women. So if you’re at high risk for miscarriage, make sure you keep an eye on testing those progesterone levels, you know, 15 to 20 or so in that first week, couple weeks of getting pregnant and to be important, so keep an eye on that with your ob. So you’re monitoring if you’re high risk.

Evan Brand: Yup. Well said. Well I’m sure I could break off a few of the things but let’s wrap it up and keep on reaching out clinically. We’d love to help you. Justin is available around the world at JustinHealth.com. Me, EvanBrand.com and we’ll be back soon to talk more.

Dr. Justin Marchegiani: Phenomenal chatting with you all. Have a good day.

Evan Brand: Take Care.

Dr. Justin Marchegiani: Bye.


References:

https://justinhealth.com/

https://www.evanbrand.com/

Audio Podcast:

https://justinhealth.libsyn.com/how-to-enhance-and-support-fertility-with-functional-medicine-podcast-332


The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.