Just As Well, The Women's Health Podcast - 30+ Fertility: Your Questions About Getting Pregnant Now or in the Future

Starting point is 00:00:00 That's annoying. What? You're a muffler. You don't hear it? Oh, I don't even notice it. I usually drown it out with the radio. How's this? Oh, yeah.

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Starting point is 00:00:39 Let me tell you this. It's got to be consequences. Mayor of Kingstown, new season now streaming on Paramount Plus. You are listening to Going for Goal, the weekly Women's Health podcast, and your chance to plug in and be inspired to work on your health and wellness. I'm your host, Women's Health Senior Editor, Roshin Derbyshe-Cain. So it's our penultimate episode of 2020 and we are as ready to see the back of this year as you are. But rather than ease our way out with some fairly unchallenging content, today we're tackling one of the trickiest and still not spoken about enough elements of health, fertility.

Starting point is 00:01:16 We've forgotten the script this week and instead handed over the reins of questioning to you. Over a hundred of you have been in touch with your questions for today's Q&A and you covered a lot of ground. expect information on everything from understanding the timeline fundamentals of female fertility to facts about interventions like egg freezing and the lifestyle tweaks that can optimise your chances of having a successful IVF cycle. The first expert answering your questions is Dr Larissa Corder, an obstetrician and gynecologist who works in the NHS and also in private practice. If you spend time with Holly and Phil on the regular, you might also remember her from

Starting point is 00:01:53 the conception plan, which was a mini feature on this morning. that followed several couples struggling with infertility on their journeys to fall pregnant. The second is Melanie Brown, a nutritionist who uses food and lifestyle-based interventions to help couples overcome infertility. She has almost two decades worth of experience working alongside gynecologists, urologists, midwives and IVF specialists, which has given her unique insight into the process of fertility treatment and an understanding and empathy of how being unable to conceive affects the whole of your life. One of the most surprised things I found having this conversation, was that even though Melanie and Dr. Larissa was speaking

Starting point is 00:02:31 directly to the experience of women thinking about getting pregnant or struggling to, so much of what they say is brilliant, evergreen advice for health, regardless of whether you want to become a mother mother in the near future or not. And while the questions we received were skewed towards the experience of heterosexual couples, there are many roots to motherhood. Dr. Larissa Corder and Melanie Brown, hello and welcome to the podcast. How is she? And so in today's show, we're going to be talking all things fertility. We've had over 100 questions sent in from our followers on the topic.

Starting point is 00:03:04 Well, I say topic on the lots of topics involved within the topic of fertility. And I'm so glad that we get the chance to put them to you both because you both bring such interesting and complementary areas of insight. Can you guys tell me about the work you do, helping women with their fertility? So I'm an obstetrician and gynaecologist, and my particular interest is, in fertility and I am really, really interested in combining Western science, which is what I was trained in, with Eastern medicine as well that I have a huge belief system in and which I have seen offer many, many benefits to my patients. So yeah, for me, it's about really bridging that gap and

Starting point is 00:03:46 combining the two and allowing people to understand that actually there is so much that they can do to try and help themselves. Tell me, Mel, about what you do. I became interested, really. I kind of fell into the world of fertility, but it was kind of a lucky coincidence because I suffered from infertility myself and had a couple of miscarriages

Starting point is 00:04:09 and generally had sort of the full gum. Oh, you know, that was a long time ago. But I think what it has given me as a bit of an insight into what it's like to worry about your fertility. And then combined with my interest in nutrition, it sort of seemed like the perfect job to do, really. So basically, people come to me. Often they come because they've been on the internet. They've, you know, the internet, wonderful as it is,

Starting point is 00:04:34 Dr. Google and everything, does actually sometimes make people even more in even more of a muddle because they think there's the perfect diet. And if you take, you know, a million supplements, you're going to get pregnant. And actually, what I try and do is sort of use a bit of evidence space, stuff that there is research on, and if there isn't much research, at least it's common sense-based, and give people back a bit of control. I think when you're trying to have a baby and it's not working, you feel all women, I don't know about you, Rochene and Larissa, but I am one of those people that has traditionally always, when I'm out of control of my life, gone on a diet, I sort of think, well, that's the only thing I can control. I don't do it so much now that I'm older, but I used to do it

Starting point is 00:05:21 when I was younger, oh, I'm out of control, so I'll just go on a diet and then everything will kind of be all right because you rest back a bit of control when you can control something in your life. And I think it can really help if people have a bit of a plan and a bit of evidence and a bit of support and a bit of knowledge, a bit like Larissa said, it's empowering to kind of know what can help and what can't help. And certainly, neither of us would be doing our jobs and feel so passionately about what we do if we didn't see it work. Of course, changing your diet isn't going to get you pregnant.

Starting point is 00:05:55 You know, that's ridiculous, you know. It's all part of a puzzle of fitting things together, really. You put it so perfectly there where you were talking about it being this massive puzzle and there's no one fix. So I want to start with maybe just a little bit of myth busting and a little bit of clearing up about the kind of the context around fertility. So the first one that we've had is when does your fertility drop and what is the window? As a general rule of thumb, people talk about this age of 35. Now, that's not to say that after the age of 35, you're on this cliffhanger and all of a sudden all your eggs are going to disappear or they're going to be really, really poor in quality and you're not going to be able to get pregnant. That's not the case at all. But what as a rule of thumb, it outlines is that essentially for most women around that age, they will start to notice a more significant impact in terms of age having an effect on both.

Starting point is 00:06:49 their egg counts and also egg quality or how good those eggs are, how normal they are. And so the main principle to remember here is that we as women are born with the maximum number of eggs that we are ever going to have. And unlike men who produce sperm throughout their lifetimes, we don't. So all that happens to our egg numbers is that they start to decline and they're longer they're in our bodies for the more exposure they have to that aging process, Much like any other organ in the body, the ovaries are exposed to that same aging effect. So what happens with these eggs is that as a result of aging, they become affected and their chromosomes can become abnormal, which is why the rate of miscarriage can also go up after the age of 35 and also any sort of chromosomal-related problem.

Starting point is 00:07:42 So congenital abnormalities can also start to increase. And having said all of that, for some women, they will be at risk of having a more premature menopause. So that means they may even go into the menopause and have all their eggsupplies depleted even before the age of 35. And that does sometimes run in families. But, you know, likewise, for some women, they may still be very fertile even when they're 40, you know, and be able to get pregnant. So it really does vary. And I don't want anyone to panic who's out there who's age 35 or just gone over that age. in that we are all different, we are all individual.

Starting point is 00:08:17 But I think that is usually the age we talk about when we start to pay a little bit more attention to settling down, having families when are we going to do it, increasing, safeguarding your fertility, that sort of thing. Okay. And that brings me on really nicely to our next question, which is from Jane. And she wants to know,

Starting point is 00:08:37 is there anything that I should be doing in my early 30s to be in a better position with my fertility in my late 30s? A very, very important thing, and I cannot emphasize this more, is if you smoke, stop smoking. We know that smoking biologically ages, oozytes your eggs. So probably, you know, by the time you get to your 30s, it's probably about time if you do partake in the odd bag to knock it on the head because it really is quite significantly aging for eggs as well as the rest of you, mind you. but eggs, a Dutch study has shown that biological changes to eggs are quite pronounced if you smoke. So that would be one thing. And, you know, this probably the next thing leads on to probably lots of other questions,

Starting point is 00:09:23 which is about just being the right, I don't know what the right weight is, but being the right weight for you, if you're overweight or, you know, very overweight or obese even, to try and, you know, make steps slowly to reduce your weight. And conversely, if you're underweight and you're controlling your diet so that you are a little bit on the low end, to try and get a little bit more. Now, the latter is a bit more difficult because it's totally counterintuitive. Actually, there's quite a lot of research suggesting that being underweight is, you know, it's damaging, not permanently. These are things that can easily be controlled. So when you get into your early 30s, you're just, you're not thinking, oh my god i've got to go on this massive diet and make these enormous changes you've got to just

Starting point is 00:10:12 think okay well i'm a bit overweight so maybe i'll start thinking about losing weight or or the opposite on the point there about the kind of being underweight another really common theme within our questions which i think is is to be expected of our audiences yes people who have had a very low body weight in the past we've had someone messaging who's suffered with anorexia another one who just was training too hard and eating too little because she wanted to be more underweight than her body is naturally. And I think that's something that most women are staged that many women, as you say, have been through at some point. When there's also people that are talking about, they've had amenorrhea, so when their periods haven't come back. What's the, you were

Starting point is 00:10:55 talking there before about, so if you do experience amenorrhea and you are underweight, that this can be, this doesn't necessarily permanently damage someone. Can you speak a bit more to that because I think there's a lot of, I think there's a lot of confusion and worry around that topic within our audience. Well, everybody's got a sort of set, mostly body fat, actually. We're actually really, we shouldn't really be focusing on BMI. Body mass index is such a kind of big area and it doesn't really, you know, because muscle weighs more than fat. Everybody knows, probably who reads health. And so, you know, you can weigh yourself. and be a perfectly normal BMI, but you might have very low body fat, and it's the body fat that is

Starting point is 00:11:43 most influential, because basically it's a kind of reserve. You need fat to support your pregnancy, and we need fat to sort of allow us as a backup, you know, if we're going to have a famine, then we've got enough stores to keep that pregnancy going. It's very sort of evolutionary, biological, protective stuff. So that's part of it. And our pituitary glands are the part of our brain that controls our hormones picks up. If you don't have enough body fat, then it's like the brain saying, well, we'll just give the periods a miss this month because we don't want, you know, we don't want pregnancy because we haven't really got enough fat to support this. And so it, you come to a sort of, it's a trigger point and it's different for everybody. You know,

Starting point is 00:12:30 very, very slim people, of course get pregnant. And, and quite, quite overweight people get pregnant, but everybody's different, but it just depends on how your own system works out whether you're in the right position for pregnancy. And there was a very interesting woman called Rose Frisch, Professor Rose Frisch. She was a professor at Harvard, and she did most of the research on women being underweight and fertility. And unfortunately, she died a couple of years ago, but she was the pioneer of this. And one of the things she found, which was very interesting that if you're a little bit underweight for you and have to emphasize that everybody's different again, it can affect the potency of your hormones.

Starting point is 00:13:11 So you still can be having a normal menstrual cycle. You're having a period every month. But actually your hormones, your estrogen, your progester, they're not quite strong enough. And when I'm talking to my clients about it, I kind of equate it with milk. It's about maybe your hormones are skimmed. You've got skimmed estrogen and skimmed progesterine. And actually what we want is full fat, channel islands, rich, creamy, estrogen and progester.

Starting point is 00:13:43 And so that's the other thing, that little bit of padding. It's just a bit of overall padding. You don't have to go out and eat 10 crispy green donuts a day. We work out a diet that, you know, is calorie and nutrient rich. Just to put on that bit of padding that then triggers that brain to go, Yes. But I kept seeing stuff linking like a lack of carbohydrates in the diet. Tell me a bit about that. Because there's still a lot of carb phobia. And we've been banging the drum about why carbs are good for ages. But it seems to be one kind of dietary myth that is having a hard time shifting. It is because I think people sometimes don't recognize that there are, you know, the healthy carbs and perhaps the less healthy carbs. And all carbs are sort of morphed into one.

Starting point is 00:14:31 big horrible devilish carb pile. But we need certain amount of carbohydrate. I mean, our brains need carbohydrates. So, you know, they need glucose from carbohydrates to work properly. And if you are taking a very high protein diet, so research back in the 80s when the Atkins diet first hit the market, which was, you know, loads of butter and fat and steak. and then to get your cholesterol down and then, of course, Mr. Atkins, then died of a heart attack. But that showed that that wasn't very good for women going through IVF because the end result of no carbs and high protein is ketosis, where you use ketone bodies instead of glucose to run yourself, as it were, is very acidic and produces high levels of ammonia.

Starting point is 00:15:23 And that level of ammonia seems to damage eggs. Now, so that's too much protein and not enough carbs. What carbs, what we call complex carbs, so carbs that you can cue and sit in your stomach, they're not high sugar, but they've got lots of fibre in them and vitamins and things. They seem to promote ovulation. There is a method that promotes ovulation, proper ovulation, you know, of ovulating that egg into the fallopian tube, relies on various components of carbohydrates. So you've got a double whammy if you've got a very high protein low carbohydrate diet,

Starting point is 00:16:04 which seem to impair that impairs ovulation. So you do need your carbohydrates, but they've got to be the right ones. So whole grains, you know, nice chewy brown things. But not a major part of your diet. It's about, again, about balance, isn't it? You know, you've got to have your protein. You've got to have your carbs. you've got to have your fats because low fat diets are a bit of a thing and they are absolutely

Starting point is 00:16:28 terrible for fertility. Interesting. Tell me why. Because we need our fats to our good fats again, probably. Lots of plant fats and fish oils and nuts and, you know, even things like nuts and have got a bad reputation because they're high in calories. But they're also high in very good fats because our hormones are made of fat. Basically, it's as simple as that. Our hormones are made of fat and if we don't have fat in our diet, our hormones go a bit haywire. Remember all our organs and all our hormones, every single means of communication within our body is made up of cells. And our cells need all the major macronetrient in order to be healthy cells. So when we talk about fats, you know, fats are super important for the cell membrane. So that's the coating of the cell,

Starting point is 00:17:14 which increasing research is showing is having a major role in terms of communication. So not only how it communicates with hormones like progesteroid, progesterine, I can't even say, progesterone, too much progester on my mind. But also to do with fertilization. So it's really, really important that we look after ourselves through our diet. And as Mel was saying, you know, our brains need carbs. They need fats in order to be able to function at that optimal level, right? And actually our brains are so instrumental and crucial when it comes to fertility because our brains are part of what we call the hypothalamomy pituitary axis. So what we're in essence doing through our diet is influencing how the hypothalamus also communicates with the pituitary gland,

Starting point is 00:18:03 which then communicates with our gonads, which are our sex organs, our testicles and our ovaries. So, you know, diet is one key component of how we get to look after that and optimize that whole signaling pathway and, you know, to go back to the expression Melus before, it's all pieces of a jigsaw coming together because everything communicates and everything is interdependent on one another. The new BMO, V-I-Porter MasterCard is your ticket to more. More perks, more points, more flights, more of all the things you want in a travel

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Starting point is 00:19:09 It's essentially an assessment. So it is actually part of that the same thing as, an assessment whenever someone comes to see me for anything fertility related. So it could be a couple coming together. It could be someone looking to start IBF or IUI. But in this situation, someone is coming because, as you say, they're not necessarily looking to get pregnant straight away, but they want to safeguard their fertility. They want to think about the future. They want to protect it as best as they can. And they want to be able to plan. You know, I think that's a really big thing for a lot of people to be able to plan their families and, you know, their careers around

Starting point is 00:19:45 and what they're going to do. So essentially, what we do in a fertility MOT or assessment is we sit down with the person, we take a history, we do an examination. Quite often, this also involves an ultrasound scan that more often than not is an internal ultrasound scan. So that means that we use a probe that goes through the vagina as opposed to the tummy. We can do it using an abdominal scan too, but it's just not as detailed. And then we look at the reproductive organs, so the womb and we look at the look at the ovaries. And remember, for a lot of people, this may be the first time that they actually get to see a gynecologist because for a lot of women, they don't really, well, in this country anyway, they don't really see a gynecologist unless there's something wrong with them. So you mentioned

Starting point is 00:20:32 amenorrhea or lack of periods before. That could be a reason your GP refers you to see a gynaecologist. But other than that, you know, smear tests get taken by GPs and you don't really get to see anyone qualified in this field unless there's a problem or unless you're pregnant, which is when an obstetrician looks after you. So it's actually a really good opportunity to get as much information as you can about your own reproductive state, about your current level of fertility or as best as we can assess it through a combination of the ultrasound scan, through a combination of the information that's in your history. And there's so much information that we can go into there, you know, to do with how you were born.

Starting point is 00:21:13 to, you know, things that may have occurred to you as a teenager, to later on if you developed any medical conditions or problems, to, as we were just talking about, what your diet's being like, how you've been looking after yourself, what your level of stress has been like, all these things that we amalgamate together. And then we can also do some blood tests. So one of the commonest blood tests that we use is called the AMH, which you might have heard of, or antimilarian hormone, which is made by the ovaries. And it gives us an indication of really how, fertile your ovaries are. Now, it's not by any means a sensitive number that is going to tell you, you know, how soon you have to get pregnant and how soon that egg supply is going to start to get

Starting point is 00:21:55 depleted. There isn't really an accurate way of being able to predict that, but what it can do is either offer you some reassurance that your AMH is within the average range and therefore we predict that most probably your fertility is going to follow an average. sort of pattern, or in someone whose AMH comes back as very low, well, that can immediately indicate to us that there could be issues in terms of potentially of premature menopause or in terms of diminished ovarian reserve and that we actually need to start thinking about doing something for this woman at this particular point in time before she loses that opportunity to have biological children of her own. Likewise, if the AMH is really high,

Starting point is 00:22:39 it's a common misperception to think that's a really, really good thing, but actually really high AMHs tend to be related with polycystic ovaries, which is a condition that involves a hormonal imbalance and doesn't necessarily mean you're very fertile. It means, yes, you have lots of eggs, but most of those eggs are quite immature. And again, if you have a very high AMH, you need to start thinking about lifestyle factors. You need to start thinking about whether you might need some potential treatment to help you. So it's a useful indicator, but it isn't so. sensitive enough to be able to tell us how soon, what sort of trajectory or fertility is going to follow exactly and what that, you know, perfect age is going to be for you. But it can help

Starting point is 00:23:22 to offer and educate you lots of these things that I think most women just would never have really thought about before or never have been told about before, you know, when we're at school, we're just not told about the fact that actually having children could be a real struggle. Are these available on the NHS or is this something that someone would need to pay privately for? If you do want to have an MOT, I'm afraid that will have to be done in the private sector. But you know, you can shop around. You can do your research, see where it is you want to go. Is it worth the price?

Starting point is 00:23:53 You know, I'd always argue yes, because you're investing in your health. You're investing in yourselves. And there's nothing more important than that. I wanted to ask about egg freezing. This is something we've had lots of questions about. So Stephanie wanted to know when is the best age to freeze. eggs and when did you start looking into this? And then quite a few people wanted to know when's the latest, when's the latest that is sensible to freeze your eggs? Really, really good question.

Starting point is 00:24:18 The general, again, rule of thumb with this is to do it sooner rather than later. Now, what you don't want to do is do it too soon, you know, maybe when you're in your 20s, when actually there's a really high chance that you might go on and meet a partner to settle down with. And actually, you will never have needed to have done the egg freezing in itself. And therefore, you know, it's not something that you would have spent money on to safeguard, but you won't necessarily use it. And let's face it, you know, egg freezing is an expensive process. And you may need to do several rounds of it.

Starting point is 00:24:48 Sometimes one round isn't enough. Likewise, what you don't want to do is at too late. So generally speaking, above the age of 40, it can start to get really difficult because there may not be enough eggs to freeze. And also the quality of those eggs, even if we do freeze them, may not be good enough. But the problem is that you may lull yourself into this false sense of feeling, okay, well, you know, I've got 10 eggs frozen, I should be fine, I've done, you know, three rounds of egg freezing, I should be okay to have children age 45 or whenever you're planning.

Starting point is 00:25:18 But the trouble is that we don't know enough about these eggs until they're actually fertilized with sperm and they create embryos. So because you've not formed embryos at that point in time, you just don't know how good those eggs are and if they're even capable of fertilization. So that's why if someone is a bit older and they come to me, I always also encourage them to think about creating embryos, whether it's with their current partner or using a donor, to be able to see and have something there that is a little bit more tangible than just a frozen egg. So I guess what I'm saying is that we have to find that middle ground, which is usually in a sort of early 30s up until the age of about 36, 37, that appears to be an optimal time for most women. So it's when, you know, they're thinking about potentially prolonging their careers, becoming financially independent. They haven't necessarily found the partner that they want to be with. They know that, you know, by the time they get to sort of their late 30s, that's when they might start thinking

Starting point is 00:26:18 about children, but possibly that's where they might struggle or need to have intervention. So in order to try and avoid some of those problems, they might think about freezing their bags. But I would say, given that we've spoken about MOTs, the best way to, decide what is appropriate for you is to have an MOT done earlier on in your life to be able to predict, you know, are you someone who's going to be fairly average? And if you're thinking about it, freezing to do it in your sort of early mid-30s, or are you someone who needs to think about doing that much sooner? Yeah. And that's really, really important because what I don't want anyone is to miss out on that opportunity to be able to freeze their eggs if that's what they

Starting point is 00:27:00 want to do and that opportunity to have biological children. I think can I just add something to that because I think what Larissa said is just absolutely bang on the point actually is just knowing where you are because for me I was one of those people I had no idea this was going to happen but I went into menopause at the age of 42 and I it was a big shock you know and I remember asking my mom I said mom when did you go into men And she said, oh, it's about 43. Like, oh, thanks for telling me, you know. And then my younger sister, exactly the same.

Starting point is 00:27:39 So had, you know, we both had been lucky enough to have our children by then. But had I, you know, wanted to have maybe a baby of 39 and maybe hadn't met the right person. And then I sort of thought, oh, okay, I'll just go and freeze my eyes. That potentially wouldn't have worked for someone like me. So I think just empowerment, knowledge is empowerment, just knowing where you are is very important. And remembering that egg freezing isn't necessarily for everyone. You know, it's a very interventional procedure as well.

Starting point is 00:28:10 And it's something that not all women will want to put themselves through, nor will they necessarily have the financial means to do. But what is important is that you consider it as an option because there are also other options and other means, you know, other than settling down earlier. it is, you know, adoption or surrogacy and things like that. But I think it's just important to talk about this, to get that information out there. And as Mel says, you know, to speak to your mom, to your grandma, to your siblings about, you know, if they've gone through the menopause, well, when was that?

Starting point is 00:28:40 Because there is a genetic link of some sort there. We don't think it's a very strong one. I mean, the number of women that I see who go through an earlier menopause, I mean, it's inevitably someone in their family will have had the same thing happen. And so I think it's just bringing these conversations up and not feeling afraid or ashamed to talk about fertility at an earlier rage because it's something that ultimately will empower you to make the best possible decisions for yourself. Totally. Just to move on then to IVF, and this is something again that we had lots of questions from people going through it at the moment. What are some of the best kind of lifestyle changes that people can do to kind of support their bodies when they're going through an IVF cycle? There's a very good paper, which I'm now giving to my clients, showing the effect of movement on IVF outcome.

Starting point is 00:29:28 And that's sitting down all day, you don't get proper blood flow to the ovaries and the uterus. You get very low levels of what's called lymphatic drainage. Lymph takes all our rubbish away. And it only works if you move. So make efforts to do a little bit of exercise. Do your exercise. I'd probably say to people, look, don't do hit. you know, don't kind of stress your body too much. But certainly do your exercise and stand up as much as

Starting point is 00:29:57 possible. Get your sleep. Our circadian rhythms are so important with the way our hormones work. And while 24 hour body clock, we try as we as hard as we can now in today's society to try and break our 24 hour body clock. But the way our hormones work is very much governed by when it's dark and when it's light. And so, you know, looking at your iPad and your phone before you go to bed, the blue light that emits from gadgets is really bad for our hormones. We need to get enough sleep. We know that if you get six, but most people, if they get under six hours or six hours or under, it has a long-term detrimental effect on our health and it causes premature aging. So you're always thinking about aging, aging, aging eggs, aging sperm, aging brain, aging skin, you know,

Starting point is 00:30:51 everything that you can do. And these are just normal things, just exercise and sleep. Yeah. I was going to say when that question was about IVF, but those things all sound like, it sounds like kind of the evergreen health advice that we trot out time and again on every show. And it's interesting how you, I think with fertility, you almost assume that there's going to be some special extra magic. thing that you have to do, but it with the best will in the world, it's quite, it's pretty fundamental, like the basis of fundamental good habits, isn't it? Yes, there are certain dietary components which really help the IVF process. So having enough, so eating enough protein. And, you know, so protein doesn't have to be animal protein, it can be vegetarian protein, it can be

Starting point is 00:31:40 vegan protein. But often I see a lot of people who are vegan. And when you have a vegan diet, you've got to be very mindful of the fact that you're taking out huge food groups for whatever reason. You have to make sure that you get all those nutrients back and things like protein. It's very easy to eat chicken breast and have a yogurt or half a big glass of milk. Because you're building lots of eggs. You're not just having one egg. You're having lots of eggs and protein is part of the building blocks of all our body and our eggs are no different. There's some evidence that milk, that dairy products help IVF. So if you're not allergic or sensitive or have a condition that means that dairy is out for you, then don't shy away from it

Starting point is 00:32:29 because the evidence is quite good on milk, probably full fat. So again, we're on a full fat. So again, we're on a full fat thing. It seems to be negatively associated with low-fat dairy. Interestingly enough, both observational and studies around IVF have shown that. And this might be because milk is full of estrogens and it's full of lots of vitamins in the fat. And it has growth factors in it. It's basically for growing baby animals bigger. Potentially, these growth factors might act on the follicles and the eggs. We don't really know. But there is some evidence that if you like milk and if you're happy to have full fat, yogurt, milk, cottage cheese, you know, in your day while you're going through IVF stims, the stimulation part, then have it. It's good. Yeah. And then there's lots of various small studies on chemicals to avoid.

Starting point is 00:33:19 So I bang on quite a lot about things like BPA. BPA is sphenyl A. It's the chemical in plastics. Yeah. Now, that does seem to, there are several studies linking the higher the level of BPA in a woman's blood, the poorer. follicle development and the poorer rates of implantation because BPA seems to affect the way IVF drugs work. Stress is something I also feel has a really significant impact, yet most people totally underestimate

Starting point is 00:33:48 it. Or they say, well, I'm not stress. And the minute you sit down and go through an average week with them, you suddenly realize, oh my God, we're all carrying this massive burden of chronic stress, which is putting our bodies into this permanent state or fight or flight and increasing our cortisol levels. which can wreak havoc with so many of our hormones and also lead to all sorts of miscommunication between our different cells and organs. So it's looking at all of these factors that would seem insignificant in themselves.

Starting point is 00:34:17 And I'm certainly not saying, you know, if you, me and Mel are not saying if you use, you know, something plastic to coat your food with, that's it. You're going to become infertile. Absolutely not. That's ridiculous. But it's the fact that all of these things have a cumulative effect. So if you start to change one thing after another, what you start to do is improve and enhance your chances over time. That's whether you're trying naturally or whether you're going through IVF.

Starting point is 00:34:44 And I use the conception plan even for couples who are going through IVF because it's just as valid. It's just as important. And there are certain things you might need to tailor. So for example, if you're exercising, you can't do some of the high impact sports if you're having IVF because you're stimulating your ovaries, which are going to be large and you might lead to talk. and problems there. So you're going to do much gentler exercises, but you're still going to do things to keep the blood flowing and to keep yourself healthy. So really, really important that people hopefully take away that message, that there's a loads of stuff that they can actually do themselves and change themselves in order to try and improve their chances of getting pregnant,

Starting point is 00:35:21 however they get pregnant. Absolutely. We've had a couple people message in, Kerry and Joe and Fran talking about unexplained infertility. About 33% of couples are going to have what's called unexplained infatility. So this means that we don't have a credible diagnosis that explains why they can't get pregnant. And we've done all the tests to rule anything major out. Now, I don't believe there's such a thing as unexplained infertility. I think that all of these factors we've spoken about do have an impact. But I think the problem is that we don't look at those factors in an average fertility consultation. We don't ask people about all of these things. And actually, what happens as a result is that a lot of people

Starting point is 00:36:06 end up potentially having interventional treatment like IUI and IVF, perhaps far too soon or sooner than they should without being given a chance to improve all of these other factors in their life to see if they can get pregnant naturally. And we've seen that with COVID. So because of the facts that, you know, many clinics have been closed and people haven't been able to access treatment, what's happened is that a lot of people tried naturally. You know, I mean, there was very little else to do during the first lockdown, right? So, you know, for some people, they tried naturally. And actually what we found is that quite a lot of couples did manage to conceive

Starting point is 00:36:42 without needing IVF in the first place. So what I'm saying is I think we need to pay more attention to why we're calling something unexplained. You know, have we really considered and looked at all of these other factors, especially that studies and major research is sure? showing to have an impact? Are we just ignoring that? You know, before we've actually got a collective evidence-based. And should we not be looking at that far sooner when we can already see, and we have lots of anecdotal evidence, we have lots of research studies that are beginning to prove that all of these factors, remember, you know, that word I used epigenetics, that they can epigenetically

Starting point is 00:37:19 modify our ability to get pregnant. So to me, there's no such thing really as unexplained. I just think in some ways we're too lazy and not aware enough of the things that we need to be looking at. And, you know, in what other area of medicine do you use that term unexplained? If you went to get, you know, your heart assessed and someone said to your cardiologist said to you, I'm sorry, you know, it's unexplained. You'd have a bit of a bone to pick, wouldn't you? It's sort of go, well, you know, how is it that it's unexplained? And sure, there's lots of stuff we don't understand in fertility at the moment.

Starting point is 00:37:52 That's why we have all of this research going into it. and it's very, very exciting. But I just think we need to be looking a little bit further afield at why some of these things are happening and what we can do to help people. I mean, what do you think, Mal? I totally agree with you. You couldn't have put it better, actually.

Starting point is 00:38:07 I think the unexplained label is often, well, we haven't even looked for an explanation. It's not obvious, so we're not going to look for it. I certainly would always, you know, back to the man, always get the man properly investigated. It is quite astonishing how many people, people are going for IVF and the man has not even had his testicles examined. It's completely bonkers, actually. So certainly male, the man is part of the couple. The couple is presenting with the

Starting point is 00:38:41 infertility unexplained such as it is. So I agree a lot more work has got to be done uncovering that. And if you just have sex, it doesn't have to be particularly exotic. Dino, just sort of regularly getting together and having a bit of patience. When you're 16, you only have to look at a sperm and you'll probably get pregnant, you know, no matter how healthy or unhealthy you or the sperm owner is. But when you're in your late 20s, 30s, it just takes a little bit more time. And you're not infertile if you haven't conceived in three months. If anyone is struggling right now, what would you, what would you want them to know? Make a plan. You know, find out why think about the reasons that might be affect everything from how much you have sex to how healthy

Starting point is 00:39:30 you are. Do you drink too much? Does your partner drink too much? Do you smoke? Does your partner smoke? You know, are you having regular periods for you? Are you totally stressed at work? And, you know, if you can unpick some of those day-to-day things and give yourself a little picture about what you might, what might be going wrong that you can fix. And then if you think, well, we're doing everything that we should be doing and we're very healthy and things like that, then you need to just go for a little bit of help. And that might be your GP or it might be a private gynaecologist. Yeah, I'd say my message is pretty similar to Mel's. And I'd say, you know, for anyone who's listening to this podcast, this is a real opportunity for you to empower yourself with lots and lots of information to be able to plan ahead, control the controllables. and really understand and process what it is that you want to do, what's important to you, to start

Starting point is 00:40:29 prioritising and to start making some of those changes. And, you know, I keep going back to it, but the whole idea behind all of what me and Mel have spoken about is the fact that we want people to feel that they can seize that control. And this is also a message for the LGBTQ community because I don't want them to feel left out with some of the stuff we've spoken about regarding couples, you know, that in some of those circumstances, yes, you will have to think about freezing your eggs or sperm ahead of time. Yes, you will have to think about how you, you know, you're going to carry your child and whether it's going to be you or your partner and so on. But again, this podcast is just as relevant because

Starting point is 00:41:07 it's all about trying to make your eggs and sperm as healthy as possible and empowering yourself with that information to be able to go to your doctor and say, look, you know what? I've had to think about this. This is what I feel I want to do. Can you help to advise me from here? And remembering every single person is individual, is unique, as is their fertility. And there's no size fits all. But a lot of the information we've discussed is very general information that anyone can use to apply and to try. If not enhance their fertility, enhance their overall health and well-being. And that's really what all of this is about.

Starting point is 00:41:40 Yes, I agree totally. Absolutely. It was such a pleasure speaking to you both Dr. Larissa Corder and Melanie Brown. Thank you so much for coming on going for goal. Thank you. Thank you for having us. You've been listening to Going for Goal with obstetrician and gynecologist Dr Larissa Corder

Starting point is 00:41:58 and nutritionist Melanie Brown answering your questions on the topic of fertility relayed by me, Roshin Derbysh Cain. I hope you found the information helpful, especially if this is something you're struggling with right now. If you want to comment on anything raised in the show, you can get in touch with us via the normal channels or the information is in the show notes.

Starting point is 00:42:17 If you like the episode, please remember to raise and review on Apple Podcasts as it really helps other people find the show. Finally, if you've got any new year health goals that you're determined to nail in 2021, let us know. And we could be helping you realize them in an upcoming episode.

Starting point is 00:42:31 That's all from us. We'll be back next week with the final episode of 2020. See you then. Bye.

Just As Well, The Women's Health Podcast - 30+ Fertility: Your Questions About Getting Pregnant Now or in the Future

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