Endometriosis & how to optimise your fertility with Louise Collyer, Endo specialist

Louise Collyer is a Traditional Chinese Medicine practitioner, specialising in endometriosis and fertility. We discuss the complexities of Endo and considerations you need to make for your fertility: 

 - How endo affects fertility 

 - The Links with your vaginal microbiome 

 - The Links with your gut microbiome 

 - Nutritional support for Endo 

 - How acupuncture and herbal medicine can help 

 - Other practical tips to help Endo

You can contact Louise via instagram @_louisecollyer_

www.louisecollyeracupuncture.co.uk

She also has an online Endo Support Plan - Endo Fertility Solution 

Transcript

Unknown: 0:01

Hi, I'm Rachel Sherriff and welcome to the fertility suites podcast. Our aim is to educate and empower couples who are struggling with all aspects of fertility. By giving you the information to make informed decisions along the way. We've had a little rebrand since series one, we were formerly the fertility method podcast. But in this second series, rest assured, we still have the same high standard of fertility experts coming to share their knowledge and support you. So if you are struggling with fertility, miscarriage or you just want to arm yourself with the facts, then this podcast is for you. Hi, everyone. And welcome back to another episode of the fertility suite podcast and joining us today we have Louise Collier, and Louise is a traditional Chinese medicine practitioner who specialises in endometriosis and fertility. And today we're going to be talking about endo and giving you some really practical tips that you can use and talking about links with other areas of medicine and how to get to sort of like the root cause of your Endo, and how that links with fertility. So Louise, would you like to introduce yourself? Welcome. Hi, Rachel. Thanks for having me on the podcast. Thanks. Good to see my colleague again face to face. So yeah, I'm based in Newcastle upon Tyne. But I work with a lot of endo women around the country, because there's a lot of practitioners that will send their patients to me to support them with endometriosis. And I've been in practice for about 12 years, doing fertility for 11. And I would say I probably became specialised in the world of endometriosis in the last five years, it's like, something just switched on for me. And I became slightly obsessed with the condition. And I love I love working with it because we can just see so many improvements in someone's life when they turned to more naturopathic medicine. Yeah, totally. Like we're going to talk about facility today that actually let's not disregard the impact that endo actually has on people's well being both physical and mental. Like it really can be quite debilitating conditions. So, yeah, I think you're right, we see a lot of change in clinic as well. So it's definitely something rewarding to work with. So let's just talk a little bit like to start with then about exactly what endo is and the main ways that it may affect someone's fertility. So endometriosis is this condition where cells that the lining of the uterus have made their way outside of the uterus and they implant themselves into usually it's the pelvic cavity. This is the kind of endo that most people are familiar with. This these lesions and adhesions. It can be found on the diaphragm, it's been found in the lungs, and as far as the brain, so it's crazy the way it has been able to spread around the body. But for the majority of women, they'll find that it's more this pelvic location that the problem is it affects fertility in two main ways. Really, the most obvious one is the structural elements. So somebody of endometriosis might have damaged tubes, their ovaries might be stuck to their bowel. One of my girls with Endo, her fallopian tube was wrapped around the ovary and that was attached to the bowel, we hear lots of terms like a frozen pelvis where everything has become so stuck together, that nothing is free moving like it should be. So there can be a lot of structural damage with andolan endometrium as the massive cysts that can grow on the ovary, which can cause damage to the ovary itself, some women have to have an ovary removed because of them. It can also affect fertility, if someone has no structural damage, there can be this component of inflammation. So it can create quite an inflammatory environment, which is terrible for developing eggs, and also seems to have an effect on the receptivity of the lining for implant implantation. So it's a bit sneaky as Endo, because doctors might be might say, oh, there's no issues, you know, there's no, there's a small amount of endo in there, but we can't see it's causing any anatomical issues. But it can play havoc with that follicular Genesis that development and implantation. That's the conversation I often have in the clinic. And you're right, like it is often dismissed, as you know, physically, it's not causing an issue, but actually when we look at the inflammatory nature of the condition, and again, like something I always say to patients is we need to look at the the systemic inflammation, you know, and localised, but it is an inflammatory condition. Right. And I think it's interesting what you talked about at the beginning, because I think it's a bit of a misconception with Endo, a lot of women may think that endo presents in the uterus, right? You don't get in there in the uterus, it presents everywhere else in the pelvic cavity, the fallopian tubes, maybe the ovaries like you said, but it's not actually within the uterus, which is why exactly a hysterectomy, where they take out the uterus doesn't cure endo it wouldn't have any impact really on the Endo, because the endo was growing everywhere else. And if you leave ovaries in, for example, with a hysterectomy, it's just gonna keep on stimulating that progression of Endo. I once had a patient who had laparoscopy like diagnostic. She didn't have a lot of symptoms of Endo, maybe a couple but anyway ended up she had private healthcare ended up having a laparoscopy and when they opened her up, she was so riddled with endo that it was deep infiltrated within her appendix. And they ended up removing her appendix and the same surgery like this stuff literally gets everywhere, right? Like it. That kind of stuff can be called a mushroom. So they've seen it where the the infiltrating endo like penetrates someone's bowel, and then becomes a kind of mushroom where you can't just pull it out, because the surface areas become so wide in the bowel compared to the stock of it, you know, from where it started. And that's similar to what happened with the appendix, right? It carves into things and then obliterates things. Yeah, it's crazy like it like, obviously, that's not the case for everyone. But I was in again, you said, it goes in the brain. I was like, Well, I've never heard that before. So, you know, it can get everywhere. And I think it's that like, it gives off like cytokines, doesn't it like it's this tree? Yeah, Yun type response. And the body recognises that the cells foreign and they shouldn't be there. And of course, they should be in the uterus. So the body is constantly in this state of this is I need to deal with this tablet tablet, so you fall into a chronic inflammatory condition. And then of course, the immune system starts to wear out a bit, because it's like, I can't keep attacking this forever. And then, and then there's this case where the body starts to just adapt to it, oh, it's always here. And I've always got a bit of inflammation. And it's it. Yeah, it's not that I forgotten, it's there, it's just that I'm fatigued by trying to fight it becomes your body's normal to some degree. And they say that you get all these different changing colours of eiendom. So it might start white, that's what we see in the teenagers. And then you can become red, dark, red, black, but sometimes it can. It's like, once the body has stopped fighting it, it's still there, it just again, has evolved in the colour. Sometimes when surgeons go in, they can report what they're seeing in terms of, you know, the colours of these lesions. So we how do we break this cycle then because you talked about this cycle of being in like chronic inflammation, like we're going to talk about a bit about links with, like, micro biomes. We know there's a big link between the microbiome and inflammation and certain conditions. So I mean, maybe should we start with the vaginal microbiome? Like, how do how would you start to understand the systemic inflammatory effects and then address them? Yeah, so this is something all of us are starting to look at more, right, this vaginal microbiome working in the fertility field where someone's had long term infertility, or recurrent miscarriages, or if they've reported having weird vaginal scent, you know, sensations, discomfort, any discoloured discharge, sometimes there's no clues and things are hidden, literally. But we've started using these microbiome tests, companies like invivo screen may do them for us. And we're able to get these reports of essentially everything that's living in the vagina. Unusually, the only things we want living in there, the lactobacillus species, but what we're finding in so many patients that we run these reports for is that things have become dysbiotic. So that word means dysbiosis, the microbiome has become dysbiotic, in that there's too much of the wrong bacteria, and not enough of the right, the right being like to bacillus for the vagina and for the uterus. So we get these non beneficial bacterias. And these pathogens things like prepatellar, Gardnerella, ureaplasma, we're even starting to see some mycotoxins like with mould. And that shows us that the environment of the diner is definitely not great for trying to conceive because it usually results in a high pH, we want the pH to be at, like 3.5 to four usually, and that's the acidic environment. If it sits too high, too alkaline, too much of the wrong bacteria can thrive. And that is bad for sperm. We know that couples pass these microbes back and forth to each other. So usually what we find in a woman you usually find in a man, and so they're aggravating each other's reproductive health. This can obviously be bad for sperm development as well. So yeah, the vaginal microbiome we often see with endo women, especially that there is a higher level of dysbiosis because the inflammation in the body makes the conditions ripe for the non beneficial bacteria to thrive. And we see that travelling into the gut as well. Or it might be that things started in the gut trans located eventually to the more of the reproductive area and And a lot of endo women might have a lot of digestive issues like leaky gut being one of them. So the lining of the gut is letting things through into the body. Because it's we haven't got the tight junctions that we need, let you know high inflammation in the body just means everything starts to break down a bit, we can also end up with something called SIBO. So this is where the bacteria from the large intestine translocates to the small intestine. And the reason that's so we see it in endo women so much is because A, they're in chronic pain, the bowel is really tense, they're often quite constipated, they might be taking a lot of pain meds, you know, to deal with the pain, which backs things up as well. So we see constipation a lot, that is a contributing factor often for this small intestine bacterial overgrowth. So it's like you see things getting higher and higher upstream in the body with dysbiosis. So we know that upstream to downstream, the vagina and uterus are going to suffer as well. So it can be very useful if someone has been experiencing infertility. Early trimester miscarriages, can be really useful to do one of these microbiome report. So if we're like, bacteria causes inflammation, right? So it could be if you've got Endo, you have inflammation from the Endo, this systemic inflammation. But also then, because of the, whether it's vaginal or gut dysbiosis, you've got bacterias there that we don't want there, you're then dealing with that inflict, it's like inflammation on top of inflammation, attracting even more precursors to the inflammation. Yeah. So even by like addressing the bacteria that might be occurring in the vagina, or the gut that we don't want there. You could that could be enough to reduce some inflammation to help your chance of getting pregnant, essentially. Because actually, sometimes with fertility, we're talking about small margins of change, we don't often need massive change, it's maybe a couple of things that need to have small changes that are, yeah, yeah, like I often use that metaphor with my patients, I imagine their body is like a control board, and all the dials are a little bit out. And I'm just trying to bring all the dials back into that equilibrium, to recalibrate the body. And that's sometimes when fertility is like, Okay, I'm in a better place now for it. So sometimes you don't need to do an awful lot, resolving some of the dysbiosis. So the bacteria, sometimes with something as simple as antibiotics can do the job. Yeah, sometimes it takes a bit more in the term in terms of restorative work, to try to build the healthy bacteria up in the body, we can do that. With probiotics, we can do that with diet, people eating an anti inflammatory diet, which is, you know, if their body can tolerate it, fermented food can be really beneficial. There's all these different ways that we can come at trying to tackle inflammation. So for a lot of patients who have Endo, they're kind of first offerings, perhaps from the NHS would be, you know, we'll put you on the waiting list for a laparoscopy. So let's just talk a little bit about you know, if you like the benefits of maybe having a laparoscopy and the things that that might not address, for example, the things we've just talked about, like, you know, why why removing the endo might help, but it won't help certain other things. Does that make sense? Yeah, yeah. So, I mean, I am a proponent of really decent expert surgery for Endo, because I've seen it in patients where they've maybe been due to have a round of IVF. And then they have surgery, essentially, to like improve the outcome of the IVF. And then boom, their body falls pregnant naturally, because even just from a structural element, if you've freed up the tubes, if you've brought the ovaries back into a healthy position and separate them from the bowel, and you've like, moved some of those adhesions, just the anatomy is functioning so much better. So that can just really help with your ability to fall pregnant naturally. And when I say expert surgery, there's these two kinds of surgery, right, you've got excision, which is the superior one, and you've got Appalachian, which is what I think the majority of surgeons around the UK practice. And when you go to a surgeons website, often a lot of them do have a website or webpage where they will tell you what techniques they're specialised in, even on the NHS, it'll tell you and it's always a red flag when someone is talking about burning or laser. Because what you want to hear is that it's surgical techniques of cutting out the endometriosis you know, the going into the root with their x, like expert eyes on the lesion and they know exactly how to like drag it out from the root and not just burn it off where it'll grow back. So When we get surgeons going in doing ablation, we can often have more in the way of scar tissue developing, which means that within a few months, somebody's in pain again, and it hasn't really improved for fertility outcome, like excision, well, because excision by removing the lesion can drop the inflammation as well. And with excision, it will still come back, but it'll take longer to come back or once it's gone, it's gone. Because sometimes some surgeons will say, it's not going to come back, I've got every single bit and that's a very confident surgeon to say that, but some of them do, because let's face it, some of them are rockstars in how they have their language that they use. And I think that if a surgeon has done a really, really good job with the excision surgery, then the the regrowth will hopefully be slow and minimal. There are some unlucky women who have good excision surgery, but for example, endometrial tumours, and I hate to swear it but their little chips like you removing endometrioma and that can grow back because the it's like the ovarian tissue just has that susceptibility to developing endometrium as again, just to clarify for anyone listening and endometrioma is endometriosis on your ovaries. So generally you can't see and don't want an ultrasound. Because it doesn't sit within the uterus. It sits outside of the uterus but the one place you will see endo on a trans vaginal ultrasound is if you have it on your ovaries because it presents like a blood filled cyst. Right, Louise That's right. Some of them even get called Chocolate cysts because they've become so stagnant. And usually, the surgeons recommendation is to get them removed if they grow to over five centimetres, because that's when there can be fertility complications, like you might lose your ovary. So a good surgeon will want to remove one of those if it's over five centimetres, but it's it is risky surgery, you're doing it on your ovaries, what are the risks involved in like, well as in, you might end up losing your ovary or you might end up the ovary tissue might not regenerate completely. But the risks of leaving it in there. I've just had a girl at the moment who's gone and had surgery with somebody in the world. And he's really he's a very good surgeon. And he said, because of the endometrium, and it's on your ovary, your body has been attempting ovulation all this time. But in almost like a PCOS picture that the follicles can't break through. So the cysts become more and more complicated and complex. And for fertility, it's just a terrible picture. So in some ways, it's it's best to get it out and for also for it to not rupture or grow to such a point, the liquid and septic, we do want these things out if they are continuing to grow and develop. Yeah, I think this is a classic example of why it's really important to see a specialist or expert, whatever sort of expert they are, who looks at your individual picture, looks at looks at you, rather than just gives you a standard treatment protocol, you know, is really looking at what your goal is, you know, are you trying for a baby, for example, with Endo? And also getting a second opinion, if you're not happy? Or you're not sure, like get a second opinion? You know, there's people like yourself out there who have contacts who can signpost, people in the right direction. So yeah, I think, and that's one of my notes, actually was to say, for your listeners is always always get a second opinion. And I wrote even sometimes get a third opinion, because one of my girls was seeing someone who wanted to run Zoladex for the pain. And that was making me feel even more solid X is like that joke that almost puts you into menopause. I asked her to go into to a second person I said, I think we need a second opinion. I'm sure you've got Endo. And he was very dismissive and was just not I support what the first person said, Let's put you back on the drug. So I said, right, we're gonna get a third opinion. I want you to go and see this person who I really trust to be a specialist went to see him he's like, How can this be anything but Endo, I want to do an MRI, I want to do this, I want to do this. So sometimes you have got to shop around for your surgeon. And I hate that that's the case in the UK. And sometimes we have to pay for that privilege. But never ever take one person's word as gospel. Yeah, absolutely. I've seen it too frequently in my clinic as well. You know, I see often a lot, which is really frustrating when people bring scan reports to you. And it clearly says endometrioma on right hand side ovary, you know, and they're just about start IVF or, you know, they don't even they haven't even been told that they've got endometriosis. It's just like, oh, they just said I had a small system a overweight was nothing to worry about. And you're like, it clearly says there you have endometriosis, but no one's bothered to explain that to you. That is the most frustrating part because all the things we're going to talk about today are things you can do to improve your chance of success naturally and with IVF that helped reduce the inflammation. You know if you know you've got something you can do something about exactly, but to not even empower them like with knowing they've got this condition. We're breaking it to the For the first time is crazy. It's nuts drives me insane. So we talked a bit about the vaginal microbiome and bacterias. We don't want there. So kind of advice to anyone who has been diagnosed with endo or has any of those symptoms, vaginal symptoms that you talked about would be to get one of the vaginal microbiome tests done. We know that women, we then do have higher incidences of vaginal bacteria and gut bacteria that we don't want there. Let's talk a little bit more about the gut. Because IBS is something that comes up all the time we have misdiagnosis, yeah, the T patients, you notice that? Oh, I've got IBS? And then you question a little bit more. And you're like, I think you've got Endo. Yeah. Let's talk a bit about how that might present. And then things people can do about it and sort of risk factors for fertility. So yeah, it does get misdiagnosis, IBS a lot. And I think, like I said, so many women present with the constipation presentation, which we call IBS C. So that that's all for me, sometimes red flag with Endo, like you're chronically constipated here. Then, of course, you've got the other kind of IBS, I call, it's IBS, D, which is more the diarrhoea deficiency presentation. And that for me is a lot to do with leaky gut as well. And it's often a sign that there's intolerance is going on. And, and women often have a higher level of intolerances. So one of the things that I often ask my patients to do, as an experiment is say, Let's take gluten out of the diet. For weeks minimum, let's just see how you feel. Because I said 90% of cases I find, when we take out that inflammatory component of gluten, your gut starts to have a rest and it starts to recover a little bit like gluten is inflammatory for most of us. But those people who don't have endo can almost get away with it. You know, it's like this micro effects of inflammation. But for an endo woman who is already smoking with inflammation, we add gluten in there. And it's like pouring gasoline on the fire really. So removing gluten from the diet trying to move rather than going on to gluten free alternatives. I always say let's cook everything from scratch. Rather than trying to find a gluten free pasture or gluten free this, let's think about our meals being more. Some really good quality protein, like some meat and some fish, maybe having a lot of different coloured vegetables on your plate. If a woman can tolerate a lot of fibre and a lot of vegetables, a lot of plants, it's really good in the end of diet to have the rainbow with every meal that you can really because they're anti inflammatory. So of course it works on that inflammation side of things, but when we take out the grains that might be irritating the gut, her digestive system starts to feel a lot better. He is either not going into the toilet all the time, or she's going to the toilet more if she needs to. This obviously then starts to just improve everything for fertility because if we start absorbing our food better, because the bowel itself is in a healthier state, we start to get more that we want need from our food in the way of the nutrients it gives us for growing good healthy eggs. And it helps get me like having a pill every day helps to detox like you're obsessed with that and Chinese medicine you know, we we want our patients to give us a full pool report that someone's having like any daily evacuation and sometimes I just get an emoji text or people write the blue icon and yes sign Yeah. Yeah, it's so important like and again, if someone comes to me and says, you know, I've got constipation, like you kind of like okay, what's going on here? There's more to this picture. So the importance of pulling daily. So, for endo like that fibre level is important, right, you need to be putting a and also like the brassica case, the vegetables are so good for endo women, you've got your kale, cauliflower, broccoli, Brussels sprouts. There's one more in there cabbage. These are so good because there are a number of women especially if they're suffering with constipation, where their body is hanging on to all that metabolise oestrogen that we want to excrete. It's not the beneficial kind of issue because it's stuff that's been used and metabolised, and it needs to be excreted, and if it's sat in the gut, it starts getting kind of reabsorbed into the body. The brassier Katie's are really good at helping us to clear that stuff out so fibre in the form of the brassica. Katie family is excellent for endo women. So essentially, nutrition is really important for endo patients making sure you're getting a high number of organic fresh fruit and vegetables high protein content. What about I'm going to ask you this because everyone asks supplements it's like the fertility minefield Right? Like yeah, I mean, it's what can people with endo take to support with these things but just talked about So really specific, like my arsenal of endo supplements. Because I don't tend to go into massive things with Ubiquinol. Because the woman's age, she might be 30 There's less pressure with the egg quality supplements, I'm just thinking, how can we improve the picture for the inflammation for you? Or how can we make your life quality a little bit better. And then of course, we get more bespoke with supplements depending on that individual case. But it's a nice generalised recommendation, women with endo can really benefit from magnesium. So magnesium glycinate can be really good for the nervous system. It can be good for cramps. Magnesium citrate is so good for the end of women who suffer with constipation. And there's some really lovely combo formulas for magnesium that combine these different forms. So for me, magnesium is a go to Endo. I interestingly, I'm actually recommending liver capsules to quite a number of my patients, because apparently, a lot of our nutritional issues started when we all stopped eating organ meat. I mean, who of us now does eat liver, kidney heart, right? That awful. Our grandparents did, but we don't. So there does seem like there's a you know, animals in the animal world go straight for the organs, they don't mess on with rest and the calf muscles. So in in Chinese medicine, right, Rachel, we don't often recommend a veggie vegan diet, because actually, women menstruating travel for babies have got a bit more of a demand for the B, you know, the B vitamins. So the liver capsules are like these things are just dried liver. So you almost take them like a supplement. But it means that you get some of the nutritional content of that organ meat that you won't necessarily be eating in your diet. So particularly my and of those who might have a bit of a plant preference kind of diet, some of them are willing to almost try these little capsules as a way to bring in a bit more of that nutritional content. I love it to Mindy because and a woman can often be deficient in vitamin D. And particularly, I mean, I'm in Newcastle in that it's always grey here. We're all like, By February, just absolutely grey in our faces as well. So vitamin D can be really nice for an endo woman. And then we as I say we get more bespoke right with whoever it is that we're working with. Yeah, that's good that you've given people a couple of things straight off the bat. So thank you super helpful, because I know that's an area that a lot of women get really confused about. And it mean it is confusing, right? Like, unless you're under the care of a nutritionist and they're giving you a list and you're trying to do it yourself. Because it you know, not everyone can afford to minefield is the supplement world. Yeah, it's a minefield, so I think it's really helpful to have those little hints and tips. So thank you. What about acupuncture? Obviously, we're both acupuncturists, you're also a herbalist as well. So let's talk about how acupuncture and herbs can support endo and fertility. And we were probably both quite quite biassed partly because we see nothing but great things with it. But and I think that's why I became so specialised in Endo, because I saw just how beneficial acupuncture and herbal medicine worth. And so acupuncture is I joke it's its superpower is that it down regulates the nervous system, someone who's been in chronic pain for quite some time, someone who's trying to get pregnant. Usually they've got this up regulated nervous system, meaning that they're always in that fight, flight or flee way. And often sometimes in that very first session with someone, it's like rabbits in the headlights, you know, they're so wired up. And with each acupuncture session, we find that the nervous system is calming down each time. And one of my girls said to me on Monday that whenever a car used to pass by it, she used to jump almost in fear. And she's noticed since starting acupuncture with me that she's like, Ah, nothing fazes me anymore, I'm definitely more than so that's really nice for trying to get pregnant. Because we need to be in the rest, digest and reproduce place rather than fight flight and flee. It also seems to something we noticed very quickly is how it seems to change period health. So when our women come to us that often complaining of maybe heavy periods, painful periods, or blood that doesn't look quite fresh, you know, people report these stagnant looking bleeds or lots of clots. And usually within a couple of cycles, we see that their periods really starting to improve. So when we finally don't get that spotting right at the start of the cycle, and the bleed starts like a lot more efficiently, it can just that they don't need as many pain meds during the bleed itself, which is obviously better for fertility because it means the linings going to be in a much healthier state come implantation. So I see the benefit of acupuncture and those physical ways. Now herbs I say, acupuncture like moves the blood and herbs are what we put in the blood to direct to the problem areas. So herbs seem to be really good at starting to try and reduce the size of masses, it can stop the progression of cysts endometrioma, as even fibroids, it seems to obviously also benefit the blades themselves. But I also use herbs for whatever might be going on at the gut level. So all of these digestive issues, herbs can really make a difference there. So when you use the two together, they're like this is this powerful teamwork between acupuncture and herbs. So they really can make a big impact. And when we only do acupuncture in our clinic, and we see it like you big change, and I think it's good to know there's something else from a holistic perspective, like herbs that people can add in. And often people will do a combination of things, right. The good thing about these things, you don't just have to do one thing. So what for those people listening, who may have endo and who are trying to get pregnant, so maybe they've been diagnosed, and they're thinking, what else can I do? You know, what, what would be your practical tips to give out? You know, we've talked about looking after your vaginal microbiome, we've talked a bit about gut microbiome, what are the actual practical solid things people can do to start that ball rolling, to help him help them get pregnant quicker? Basically, the I mean, the first one, I've already said, like, shopped around for your specialist consultant, because if you're being dismissed, you're just not with the right person. So that's, that's the major one. Definitely give naturopathic medicine a try if you haven't, and if you're not sure, the best thing is to just try it and find someone who shows that demonstrates they've got an interest in working with gynaecology and fertility, because they often have gone deeper into treating that they know how to support you more. And I also wanted to really point out that IVF isn't always the answer, right? That there's this assumption that, oh, you've been trying for two years to get pregnant and IVF is the obvious solution here. But like we said, IVF isn't necessarily the answer. Because if we've got all of that inflammation, running wild in your body IVF isn't necessarily going to solve the implantation issue. So it's to always think I, there is still a chance for natural conception here, if my tubes are working. And I need to like come at this maybe from a different angle as well. And then there's a guy I absolutely love on YouTube and Instagram, called Dr. Riahi. Victory, I think on YouTube, you'll find him with Dr. Victory, but an Instagram, it's Rahi victory.md. This man is brilliant. He's a consultant and candidate who gives a lot of information about protocols that work better for endometriosis. So it's not just the, in the UK. And what I find in the Northeast is you treat an endo woman exactly the same as you treat a normal woman, you put her on these drugs for a frozen round, and you just you don't individualise it or change it because she's got end out. He says, You need to approach it very differently with an endo woman. And sometimes having that information. And the reasoning behind it means a woman is more empowered to go to her IVF consultant and say, Could we maybe try it this way? Because I don't think that that way maybe worked best, you know, I didn't fall pregnant or I had a miscarriage. Could we try it this way? And if they say no, you go somewhere else, you get your embryos moved? Yeah, it's it's empowering yourself with the information right? And having the confidence to advocate for yourself because no one feels happy about questioning a doctor or questioning their IVF consultant. But I think if you've, if you've got the information, or you've been signposted, like you've just signposted people to go and find that information. It gives you confidence in that ability to to have those conversations that might make the difference, right? Exactly. Yeah. Oh, fantastic. Louise, thank you. That has been amazing. I'm conscious that people may want to get in touch with you after this because you're such a book of knowledge about endo and honestly, all the things you do can help. So tell us a little bit about how people can get in touch with you where you're based, your clinics etc. So, I am based in the northeast, so I do get patients travelling to me for acupuncture from the northeast, but I support a lot of other practitioners patients remotely through a programme that I offer online called the endo fertility solution. And you can find me on Instagram where I talk a lot more about this and on my website, so it's Louise Collier, acupuncture, or just Louise Kalia on Instagram. Usually you'll find me by typing endo fertility solution. I offer like a form of programme where I'm supporting someone with the herbal medicine side of things, the naturopathic approach, dietary recommendations, and just that overall like fertility advice and expertise. So I can definitely work with you wherever you are in the UK, and I can support your acupuncturist if they aren't necessarily working at the law. Over. You and me are Rachel. Amazing. I'll pop for anyone listening. I'll pop all those details in the Episode Notes as well and link them to be able to go straight through to Louise's site. Thank you so much. That's been brilliant and super helpful for a lot of listeners, no doubt. Thanks for joining us as always, thanks for having me, Rachel.