You Cannot Bypass The Root Cause With IVF deep discussin with Dr Gabriela Rosa

We sit down with Dr. Gabriella Rosa to name what often gets missed in fertility care and why “unexplained” can be a signal that testing and root-cause work stopped too soon. We talk honestly about male factor, IVF realities, metabolic health, and the simple mindset shifts that help couples take back agency without carrying the journey alone.
• “Unexplained infertility” as a sign investigations have stopped short
• Fertility testing basics that get skipped, including semen analysis
• Why fertility is a team sport and why partners need education together
• IVF as powerful technology that is often overused and misunderstood
• How sperm quality and DNA fragmentation change with male age
• Acting pregnant now to get pregnant later as a practical framework
• Lifestyle, nutrition, stress, inflammation, and long-term health links
• Insulin resistance, PCOS and metabolic screening beyond fasting glucose
• Endometriosis, immune and environmental factors, and individualized timing
• Building a personalized fertility plan based on evidence, values, and access
If this podcast resonated, please share it. Leave a review or subscribe. This helps us support more people that are on this path.

“Everything looks normal, just keep trying” can be one of the most painful sentences to hear when you’re doing everything you can to build a family. We’re joined by Harvard-awarded fertility specialist Dr. Gabriella Rosa, founder of the Rosa Institute, to unpack why so many couples end up labeled with unexplained infertility, recurrent miscarriage, or failed treatment when the real issue is that the workup often stops too early.

We dig into the overlooked basics that can change outcomes fast, especially male factor infertility. Dr. Rosa explains why semen analysis is frequently delayed, how sperm quality and DNA fragmentation shift with male age (often starting around 35), and why fertility truly is a team sport. We also talk about the emotional reality many women describe: carrying the burden alone, feeling dismissed, and losing precious time that can’t be replaced.

IVF comes up with refreshing honesty. We respect how miraculous assisted reproductive technology can be, while also confronting the “silver bullet” myth and the per-cycle failure rates that many people are never clearly told. Dr. Rosa shares why IVF is sometimes overused to bypass problems that should be investigated first, and how optimizing egg quality, sperm health, inflammation, and metabolic function can improve both natural conception and IVF success.

You’ll also hear why insulin resistance can hide behind normal labs, how it can affect ovulation, implantation, and miscarriage risk, and why fertility symptoms can be early warning signs for long-term health. We touch on endometriosis, immune and environmental factors, and how to build a personalized fertility plan that fits your biology, values, and timeline. We close with two practical anchors: get your partner educated with you, and “act pregnant now to get pregnant later.”

If this conversation helps you feel clearer or less alone, subscribe, share with someone who needs it, and leave a review so more couples can find support.

Dr Gabrila Rosa details;

Email - gabriela@rosainstitute.com

Website - https://fertilitybreakthrough.com/

Socials -

https://www.facebook.com/FertilitySpecialistGabrielaRosa 
 https://www.instagram.com/dr.gabrielarosa/ 
 https://x.com/gabrielarosa 
 https://www.tiktok.com/@gabrielarosafertility?is_from_webapp=1&sender_device=pc

Transcript

Welcome To Home Of Fertility

SPEAKER_00 0:04

Welcome to the Home of Fidelity, a space, a real conversation. An expert insight about fertility, healing, and creating family. I'm Alice Walker.

SPEAKER_01 0:17

And I'm Helen Zay. We are two mums who've walked this path and are passionate about supporting you on your journey, emotionally, physically, and spiritually.

SPEAKER_00 0:28

We talk about it all. Fertility treatment, electric support, relationship, mindset, and the emotional high athletics.

SPEAKER_01 0:38

Because sometimes the missing piece lies in someone else's story, in the quiet wisdom of the body, or in a breakthrough that's finally made for you. We are so glad you are here.

SPEAKER_00 0:52

Let's dive in. Good morning, good afternoon, good evening, wherever you are in the world, beautiful listener. I am Liz Walton from the Home of Fertility. Today I feel really humbled and uh so so excited that I get to speak to what I would say is a lady that was around when I feel like was around when I was trying because I feel like there wasn't so many ladies and there weren't so many people then. And this is the wonderful woman called Dr. Gabriella Rosa. Gabriella, thank you so much for being here today and for talking about this deep journey of fertility.

SPEAKER_02 1:35

Thank you. Thank you for having me. I mean, I hear exactly what you mean. And it's been such a long time that I've been doing this work. And sometimes I do get these very beautiful moments of reconnection with people who had met me many decades ago. And, you know, here we are again. I feel like I've been doing this too long.

SPEAKER_00 1:57

Oh well, um, you are looking absolutely stunning. I feel like you look far younger than I do, which you probably are, but you are just well, I'll I'll stop having a romance with you and we'll start with the conversation. So, Gabriella Rosa, if you may or may not heard of her, is from the Rosa Institute. And she is um doing amazing things with fertility and um, you know, supporting all different couples in the fertility journey.

Meet Dr. Gabriella Rosa

SPEAKER_00 2:28

So I think what I'll do is I'll explain, let's let's read who this wonderful, amazing woman is. So, Gabriella Rosa from Harvard University. Now, she's a Harvard awarded fertility specialist, the founder of the Rosa Institute, and an author of The Fertility Breakthrough, Overcoming Infertility and Recurrent Miscarriage When Other Treatments Have Failed. She is a pioneer in telehealth-based integrative fertility care, bringing evidence-based reproductive solutions to individuals and couples around the world. So, Gabriella, she is also the creator and the host of the Fertility Challenge, and this is a free global online program that supports tens of thousands of participants each year. Now, through her proprietary method, which is the fertile method, she has helped more than 204,000 people, and this is across 111 countries, supported them on their journeys. Now, public research on her signature program shows that a 78.8% live birth rate are among patients, even after years of infertility and trying, recurrent miscarriage, and unsuccessful treatment. Oh my goodness, wow, you amazing woman. Um I am I'm just in awe. And I I know I did some of your work. So um I my daughter just turned 11 um the other week, and to it really took me right back to on my journey being absolutely lost and where do I go, and Googling away at the time and finding you and your work. And it was really something that you know it supported my heart and being because there wasn't much else. So I I'm always so grateful to your work. But let's start with this really good conversation.

Why “Unexplained” Happens So Often

SPEAKER_00 4:32

Now, many people struggled to understand that they are having a difficulty conceiving. I I really did. I couldn't understand what was going on with me. What are some of those root causes of fertility challenges that can be overlooked? And why is it important, do you think, to look beyond treating just the symptoms?

SPEAKER_02 4:54

Yeah, that's a really great question. And I think that it's fair for us to start with saying that most causes of infertility are overlooked. And that is observed by the amount of unexplained infertility, miscarriage, failed treatment labels that we see patients being given, right? So whenever we are talking about an unexplained diagnosis, it means that the investigations have stopped short. Because otherwise you would have an understanding of what's going on, right? So it to answer your question about what are the things that get overlooked, well, probably most things. Probably everything. Because the normal, you know, when we talk about everything is normal, just keep trying, which patients so often hear from their caregivers, they're being told, you know, there's nothing wrong, everything is normal, just keep trying. But what patients don't understand is that in the general population out there, yeah, most people can see without trying. In fact, there are population studies that show that 96.3% of people will be pregnant and having their babies within two years of trying. So the people who experience a different version of that story are usually the people who fall into the bucket of difficulty conceiving. Now, we know that when it comes to quote unquote infertility as a diagnosis, it's the only diagnosis that is reported, self-reported on a time frame. Think about it from this perspective. If you went to your cardiologist and you said a whole list of symptoms of cardiovascular disease, are they going to just take your word for it and say, oh, okay, you've got this disease, go and have this medication? Of course not. They would run a battery of tests, they would get to the bottom of what is happening and where the problem actually is to be able to give you the most appropriate and accurate treatment. Unfortunately, when it comes to fertility, it's not the same. And it's not the same for several reasons. The first is that because most people will conceive without trying, the percentage of people who are left in that bucket of difficulty conceiving are very, very small in proportion to the whole population. And so what happens is that the healthcare system has to cater and service the highest and greatest amount of need of an entire population. Now we know that the highest mortality causes in the world today are non-communicable diseases, things like cardiovascular disease, diabetes, you know, cancers. So what happens is that those conditions are very resource intensive. They require expensive treatments, they require a lot of hands-on, you know, kind of resources from the healthcare system, which essentially drains out the resources available for a condition that is deemed as non-life threatening, and not really that important if you think about the fact that most people will conceive within a two-year period. So this is the biggest difficulty and the biggest challenge that couples experiencing difficulty conceiving keeping your pregnancy to term or going through treatments that haven't worked face. Because what ends up happening is that they will have a very strict criteria that needs to be met by a healthcare provider in order to be able to say, oh, you know, we've done all the tests and everything is normal. And those are four things, really. You know, it's do we have ovulation? Do we have fallopian tubers that are clear? Do we have a uterus that can house a pregnancy? Once we've checked those off, then it's okay, everything is normal there. The fourth question or the fourth test is going to be a woman coming into the her GP and being, you know, told that, oh, you maybe your partner should have a semen analysis. Now, I don't know about you, Liz, but you know, most women will come home and give that news to their husbands or partners. And I don't know that many men are going to be jumping off the sofa, picking up the phone to make the appointment to go and get that semen analysis. Right. So that usually actually gets left off the list to begin with. And often it gets left off the list for years. And I know this because by the time people come to me on average, and this is our Harvard study that we did was part of my master's degree there, um, and really looked at what are the types of people that came to us, how long they were trying, what were the issues that they were experiencing. And we had an average number of years of infertility for the patients who came to us of four years. And imagine that so many of those patients, for many, many men, they still hadn't even had a signature analysis at four years of trying to conceive. So I know that this is something that often happens and gets postponed in many different situations. And of course, the more that we leave investigations to chance, the less we understand what's going on in the system, the less we are able to actually apply strategies that are specific to addressing the issue at hand, and we end up with just continuing the passing of time going on, and of course, the extension of that difficulty to conceive. So the difficulty in your question is that you know, what are the root causes that are most um that

The Missed Basics And Semen Testing

SPEAKER_02 10:58

are most neglected? Yeah, all of them. Yeah. As we've discussed, right? And so I think that we need to work backwards from that and figure out okay, if things aren't happening, have we covered all of the basics, you know, the very, the, the very important things that if we were to just really focus on identifying what makes the body the healthiest it can be, are we doing that very bare basic minimum foundation to optimizing good health? And so the way that I like to think about this, and people often ask me, you know, so what are the things that you need to do in order to improve fertility? I often like to say we want to act pregnant now to get pregnant later. And the key thing here is that we have to do this together as a couple, because if we don't do it together as a couple, guess what? We are trying to change a whole picture by only working on 50% of the equation. And so that becomes a really challenging and full of effort situation that wastes a lot of resources, emotional resources, you know, financial resources, relationship connection. There's a whole lot of issues that, you know, end up playing into the mix and that become even more of a problem as time passes because we're not addressing the right issue. So there's a lot of that that goes on. And each person is going to be individual in essentially what affects him or her, and therefore how to treat that situation. Let me give you an example. We've all heard of people that have never smoked a day in their life and died of lung cancer. And we've all heard of people who are changed smokers and never developed cancer at all. Now, it's not to say that the people that had that never developed cancer didn't develop cardiovascular disease, infertility, you know, you name it, other issues. But what happens is if we're only looking at a target outcome for that exposure, we might miss its effects in a direct and indirect way. So what we need to understand from that is this when we are looking at fertility, it may very well be that your brother, your sister, your friend smoked, drank, did all the wrong things, and ended up with quote unquote a healthy baby. But if that's not happening for you, there is no point in you comparing yourself to that person because their way in addressing and experiencing that those exposures is going and what system in their body it will affect will be different to yours. And so that's where we need to really take a very personalized and individualized approach to what is present and what do we need to do about it.

SPEAKER_03 14:01

Yeah.

SPEAKER_00 14:03

Yes, I love that. And um the things that stuck up to me for that was the semen analysis and act like you're pregnant. I know for us, we didn't bother with a semen analysis for a good, well, I'd say the first couple of years until I knew, oh, something's not right. And um now it looks like lots has changed, and semen and sperm and men being more in the picture of the fertility journey is really changing now, which is really good. But I know when I started, no, and when you're right, when my husband when I told my husband he has to take a sperm test, he was not impressed at all. So it's good to hear things are changing, but absolutely um it's it it takes two to tango, doesn't it?

SPEAKER_02 14:53

It does. And I think that, you know, it's also it's interesting because when we talk about things are changing, I think that we have a different perspective of what that means, you know, in relation to what actually happens across the globe. And I agree with you that now the taboo and stigma of a man going and doing a semen analysis is slightly less than it was when I first started doing this work 25 years ago. But I still have the instances where it's a very confronting thing for some men. And I think that, you know, it it really plays to that whole kind of you know, um male ego aspect of like, what does it mean if my sperm isn't the best possible quality? What does it mean if there is a problem? What does it say about me? What does it say about my abilities? And you know, I think that a lot of times men personalize that information in a way that's not helpful to them because actually it doesn't mean anything other than we need to, we found something that we need to address and we address it. And you know, the worst perpetuators of this actually are male fertility doctors. And I'll tell you, oh my God, it is horrific what I see in terms of how male fertility doctors usually, the way in which they report female analysis results to their patients is like, oh yeah, your sperm is great. Oh mate, you're fine. You don't need to do anything. And it's like, hang on a second. Um, you don't need to do anything, is a very big leap from I am having sex, not getting pregnant, and not having a baby. You are telling me everything is normal because you haven't actually tested enough to find what actually is getting in the way. And you've just dismissed my husband from doing and exonerate him from doing any of the work because you have a problem or a view on how he's going to feel about his semen analysis being something or another. And you know, it's really interesting to me because I have seen patients who go through years and some decades of infertility. I had a patient once who came to me after 15 years of trying multiple failed IVF cycles, IUI cycles, you know, lots of different issues. The very first appointment I have with this couple, I ask him, is this the first semen analysis that, as I'm reviewing the case, is this the first semen analysis that your count has been has come back low? And he goes, What do you mean low? I'm like, what do you mean? What do I mean? Like in my mind, it's two million instead of the minimum 20 million. What do you mean, low? You know, and he goes, No, I was never told that I had a had a low count. I said, Oh, really? Because in this report, you have two million sperm

IVF Is Powerful And Overused

SPEAKER_02 17:55

and it should be at least 20 million. And he turns around to me in that moment and he says, Well, my doctor said it was all normal.

SPEAKER_03 18:01

It was fine.

SPEAKER_02 18:02

And I'm thinking, okay, it's interesting what an IVF doctor thinks is fine because they're thinking we can bypass this with IVF, which clearly they cannot, because after six failed cycles of treatment, they still hadn't had a baby. So it's naive at best to think that you know we can simply bypass issues that are going on in a couple by doing IVF. And it's, you know, I don't want to make strong claims here, but most IVF clinics are either publicly listed companies or private equity owned. And in fact, in the United States, UK, and Australia, in most of those countries, over 60% of clinics are private equity or publicly listed, which means that they respond to shareholders and they have a fiduciary duty to have profits in their business. And so what does that mean for patients? Well, patients are then being told, well, it's a numbers game, just keep trying. Numbers game for who? Because if we understand what's getting in the way, if we understand what the obstacles are, and we do what is necessary in order to optimize the chances of not only conceiving, but keeping a healthy pregnancy determine by doing proper investigations ahead of a cycle and then addressing what we find in the best possible way. And we've demonstrated this through our own treatments, which is basically 45.6% of patients who came to us had experienced previously failed IVF cycles. When we looked at the live birth rate of the entire program, it we end we got to 78.8% live birth rate. And 60% of those patients actually conceived naturally. Even some who have gone through IVF and it had not worked for them prior. So that tells me that, okay, there's obviously things that can be done, and if we address and identify them first and then address them, we reduce the need for more, for stronger interventions, for interventions that essentially we may not even end up needing. But if we don't have the approach of understanding first what we're dealing with, getting to the bottom of what's happening and addressing it, and simply try to bypass it with some treatment. And then when it doesn't work, instead of going back to the drawing board, taking that seriously and going, right, what do I need to do about it? But instead, we just say, oh, just keep trying. It's a it's a it's a cycles, you know, it's a game, it's a numbers game. Well, then we end up with more of the same. The biggest issue with that is that some patients don't have that amount of delay on the fertility windows. And so they end up doing more cycles without improving sperm, egg quality, and all of the things that they could improve, and then of course end up with the same result and then being told, oh, now you need donor egg, which is incidentally, this couple that I was mentioning before, that's exactly what ended up happening for them. Because after 15 years, when she was finally 41, they were they started telling her, Well, it's your eggs, it's your eggs now, you're too old, you know. And I'm thinking, but hang on a second, they started 15 years ago. She wasn't old then.

SPEAKER_03 21:23

Yeah.

SPEAKER_02 21:23

Right? And so these are the types of challenges that I think so many patients face and they can't put words to. They just understand that they're being dismissed, that they're being told that, oh, you know, you just have to keep trying. They end up putting the burden on themselves in going to Google the world, right? To try and make sense of what's going on for them. And, you know, it's exhausting and it's tiring, and it of course will have an impact on the relationship in the long term as well.

SPEAKER_00 21:56

Absolutely. I mean, geez, um uh my journey was 10 years and um with the highs and lows it took such a a you know a deep um it was big on our relationship I suppose is what I'm trying to say. It was massive and I did feel like I was holding most of it. And it's it is you know it's a really bumpy ride I think is is the is one of the best ways I can sort of say it. So I just want to check that we've covered this and some of it may seem logical for everybody, but just in case for some people that it's not, why is it really important to treat um because it's it's not a single sport, you know, we need two people in there. So why is it important to treat both you know the male and the female for improving or essentially improving all of the outcomes?

SPEAKER_02 22:51

Because you see especially when we're looking at the ovarian reserve being lowered or egg quality being affected as women age it also happens to sperm. Okay. So this is one thing that often is not discussed is that male fertility and sperm quality and DNA fragmentation errors increase from an age of 35 male age of 35 onwards. So over 40 we are already going to expect a much higher percentage of DNA errors within the sperm. When a woman is younger or when an egg is younger what happens is that her egg has the energy necessary to fix many of the DNA fragmentation and DNA errors within the sperm. As a woman ages and that egg becomes less energetic right through its mitochondria becoming diminished, what ends up happening is that the ability to fix DNA errors in the sperm decreases. Really you see and so what happens is that all of a sudden we have older and sometimes poorer quality sperm and we have an egg that doesn't have the same ability to fix those errors than it did compared to when it was 20 years of age, for example. Right? That's why you hear in the news things like Hugh Hefner at 90 or 93, whatever age he was getting a Playboy bunny pregnant and she was in her 20s. Right. The reason is that there is a lot of capacity in a younger egg to be able to actually affect conception or continue the process of development of that embryo after fertilization has occurred. Whereas it's not the same when partners are the same age or the woman is is uh older unless the guy is much younger. And so then you end up with less DNA fragmentation errors right but still women have a 2026 finite fertility you know there's been a whole bunch of um videos on social media these days I do a lot of patient education on Instagram at Gabriella Rosa Fertility. And you know I being seeing so many of these videos about you know these um stem cells, you know, eggs being made from stem cells the reality is that we're not even close to that technology being available for human use for many decades yet. Okay so it will be a very different conversation maybe in 50 or 100 years from now in terms of women are born with all the eggs they will ever have changing over time. But in 2026 women are still born with all the eggs they will ever have and it will remain that way for quite some time. And so with that understanding we need to understand that we women do not have time when it comes to you know just delaying conception, treatment, you know, all of those things. It's not that women are running out of time when they are over a certain age is that they no longer have time to waste. You see we don't have cycles to waste. And so we have to be aware of the fact that and this is one of the biggest misconceptions I see in clinic is men come in when they're not dragged in by their wives. And they most of the time they are dragged in by their wives but that's okay. I I can handle that well what I can't handle is men refusing to be there to begin with because that is how we end up with the same result that we've already had which is no baby. But the thing about it is this most men think that their partner has time and that it's just a matter of time that they're just gonna get pregnant or you know they think that maybe this is a spiritual issue and that you know if God wills then they will have a baby. I have absolutely no problem with people's beliefs. However we need to be really objective when it comes to biology okay and

Lifestyle, Stress, And Metabolic Clues

SPEAKER_02 27:10

the thing about it is that and I also believe that you know if there is a God, God helps those who help themselves right and so what happens is that we can't just sit and or lay down and expect that the world is going to change around us without us actually doing something about what it is that's going on in our existence, in our experience. So ultimately it's never going to be enough just to say oh if it's meant to be it will be listen if you've had sex for three cycles and it hasn't actually happened and this is what we actually see by the predictive models in reproductive medicine is that it takes up to three conception attempts when there are no obstacles to get pregnant and have a baby. If you've been trying for more than that and it still hasn't happened, it's because there are it's not a matter of is there something that I haven't found or is there something going on? It's what is it? And it might be more than one thing, you see. So at that instance we need to understand that it's no longer enough just to keep trying but we now need to keep trying and looking for the understanding of what are the obstacles that are getting in the way because without that understanding what we are most likely to do is continue going around in circles, doing more and still getting the same results. And that is the critical problem that so many couples on the fertility journey experience because instead of looking at things objectively and going, okay, we know that in the general population 96.3% of people get pregnant within two years but we also know that a great percentage of those actually get pregnant within the first preconception attempts which means that anywhere between three and two years, three months and two years, there are going to be things that you can modify that you can do that is going to either shorten that timeframe or continue to prolong it. And understanding what those factors are is a couple's fastest fast track to baby you see because without it we just keep doing more of the same experience more experiencing more of the same result and crossing our fingers or praying that if it's meant to be it will be.

SPEAKER_00 29:41

Yeah yeah no and I look I so hear you um you know as I said before it was really difficult for me and my husband but also it was the gift because like you're saying we knew we had to do something different and what is that and be curious and how else can we do it? So um you know we went and did more workshops and looked after ourselves more emotionally spiritually physically as well as and this is sort of my next question looking at what else we can change. And so here what are you know how important are those factors like nutrition like lifestyle you know managing healthy stress we realized that we were both stressed you know and um wellbeing influences and how much that influences fertility you know and what I suppose in your uh in in your expertise can couples do to optimize their chances of you know great conception naturally um or if they need IVF.

SPEAKER_02 30:44

Yeah absolutely and this is the thing like I absolutely have nothing against IVF. I think IVF is a miraculous technology. I think it's absolutely amazing. I think it's wrongly used and it's it's it's misused and it's overused. And so and the reason for that ends up being around you know all of the conversation that we've already had about it but also because people have this idea in their minds that IVF is a sure thing. They think it's a silver bullet that's going to get them pregnant and is going to get them having the outcome and they fail to actually understand the data behind it. And they fail to understand that if we look across all ages, we have a close to 80% failure rate on a per cycle basis which means that most cycles or close to 80% of cycles that get started never yield a live birth. And if we actually go over above the age of 40, we're looking at much closer to 90% of cycles that get started not yielding a live birth. So the first thing that we need to understand is that there are no free lunches okay and this one is really very expensive because we're looking at an average cost per cycle in the United States of $25,000. Okay so ultimately it's not cheap. It's difficult to access it's very onerous on the person, the couple you know so there are constraints there that we can't simply ignore right and if we look on the other side of that and we understand that there are issues that are getting in the way that we haven't found, that we haven't addressed and that is increasing the risk of not even the egg and the sperm meeting because that's why IVF was put together to actually be developed into the technology that it is today was actually because of tubal patency issues. So block tubes, inexistent tubes is why IVF became the technology that is used for bypassing tubal defects or tubal issues. But then what ended up happening was like okay well if it can be used for that let's now use it for every other reason that infertility occurs. And we try to then bypass the fact that we've got male factor and the sperm can't get up to the egg or it can't fertilize the egg and that would be happening for biological reasons that we don't necessarily want a very unhealthy sperm that is defective fertilizing an egg because we know that the quality of that embryo the quality of the health of that child is going to be impacted in the long term. So we have these situations where most people are being given it as an option or as a solution to a problem and being and expecting or not being told of the risks but also of the actual real expected outcomes that come out of embarking in that process. So that's one thing that I think is important for us to understand. And then when we're looking at you know what are the things that we can do it's also very important to understand that conception is only the very first step in keeping a healthy pregnancy to term and having a healthy baby. And so if we don't understand the reasons why we may be having implantation failure or we may be having chemical pregnancies or early miscarriages and we just talk it up to oh it's normal it because it's common you see and this is what often people actually exchange those two words. Normal does not mean the same as common and just because it's common does not mean it's normal. And I think that really understanding this concept is so critical when it comes to fertility you see because if we don't if we think that those two things are the same that just because something is common it's also normal and we end up normalizing the fact that we need to do things differently or that we don't need to do things differently, either one of those can be dangerous for our chances of taking home a healthy baby depending on the circumstance you see. And so that's going to be critical to understand too but this is the other very important factor here is that when we're looking at a situation like inability to conceive we may be facing that as one aspect of not seeing a healthy pregnancy determined and holding our baby sooner. But it could be that it's implantation that's failing or that it's you know placentation or that it's something that's going on after the embryo has started to develop. And again without understanding what those parameters are that are not working and I'll give you an example.

SPEAKER_03 35:50

Yeah.

SPEAKER_02 35:50

You know if we're looking at insulin resistance insulin resistance is very common when it comes to creating circumstances like inovulation and irregular cycles. Now polycystic avarian syndrome has been renamed to polyendocrine metabolic syndrome to really look at that entire kind of metabolic picture that PCOS is related to. Now what's interesting about that and what's important about that is that when we look at well let's call it PMOS the new the new PCOS when we look at that condition and we see that having that condition also predisposes a person to having irregular cycles andor an ovulatory cycles so you can still have a period but have no ovulation and if we're having irregular cycles then it's very difficult to time conception. And then we also know that if the underlying biochemical process that's going on underneath that condition includes insulin resistance, which it happens very frequently for many many women who experience it, then we also have an increased risk of implantation failure. We know and we have very clear understanding that for example conditions like diabetes increase the risk of miscarriage through that same pathway. Now if you have insulin resistance and it hasn't been diagnosed because your doctor hasn't even done a fasting insulin because they thought that a fasting glucose would be enough the reality is that if you do a fasting glucose you can have a normal fasting glucose for 20 years before your insulin actually actually rises to the level that you get picked up in a just normal fasting glucose test. So you can end up with a high level of insulin in the body being masked masking that whole fasting glucose to be completely normal when the insulin is like five to 10 times higher than what it should be, you see. And so that ongoing picture is the description of insulin resistance and we know that when we have high insulin we have high inflammation we have high oxidative stress. So then we're talking about egg and sperm quality being affected in this kind of underlying way we also know and this is important because you you'll see in a second if we have insulin resistance it's really just a matter of time until we develop prediabetes. It's not a matter of whether we will develop prediabetes it's a matter of time. If we have prediabetes studies show that it's five to 10 years until you have a diagnosis of diabetes. Now we know that being one of the biggest causes of mortality in the world it's worth picking up insulin resistance at the time that it's only causing irregular cycles and maybe implantation failure. But it doesn't even get screened in most cases at the time where you can actually do something about it that will not only improve your chances of conceiving and keeping a healthy pregnancy to term, but prevent you developing diabetes 20 years later. You see? And so sometimes what happens is that our body's signals of difficulty conceiving, difficulty keeping a healthy pregnancy to term are actually warning signs and red flags that we should note and pay attention to and do something about now so that we're preventing an increased risk of all cause mortality 20 years from now. And in fact there are studies that show exactly this is that for men and women with an infertility diagnosis, there is an increased risk of all cause mortality from all cardiovascular disease, diabetes and cancers as a result of that diagnosis being unaddressed in the underlying metabolic concerns that it's actually creating for down the track. So if we ignore what's what fertility or infertility or difficulty conceiving keeping a pregnancy determiner is telling us now, it's not simply a we'll just bypass this we're not going to bypass what's coming down the track.

Endometriosis, Immunity, And Environment

SPEAKER_00 40:20

Yeah yeah yeah and so my curiosity then as well is another area that's quite big is endometriosis. And so what are your thoughts there with endometriosis?

SPEAKER_02 40:35

I mean endometriosis is an it's being more and more studies have been pointing to the fact that it's an autoimmune mediated condition, right? So there's also an environmental aspect, an environmental component to endometriosis. And so what we need to ask is okay well what comes first? Is it that the immune system is sensitized because of the environment or vice versa? And are there other factors that are playing a role? We know that when we look at modifiable risk factors that decrease inflammation in the system we manage those conditions in a much better way. We manage endometriosis better we manage P Moth better. And of course as a result we increase the quality of the egg in the sperm because we better the environment into which those cells are actually maturing. So again endometriosis acts in this situation as a warning signal that we have there are things we have to pay attention to and it may very well mean that we still might need to surgically address that problem depending on how severe it is but it's surgery on its own is not going to address the underlying undercurrent of the condition and what it's causing in the environment in which the eggs are developing and maturing and of course the embryo as well. So we have to pay attention as a part of the strategy for treatment and as a part of the solution that we need to bring for the body and how the body can actually be supported through all of that. It's not a situation of like because you have this it means that you can't conceive or because you have been having difficulty conceiving this is the only reason. Unfortunately all of those things can coexist yeah I have seen women with stage four endometriosis without surgery actually having pregnancies and healthy babies and I've seen women that have not been able to achieve that same outcome. So and you know and this is the difficulty that we have is actually understanding one, what is it that is causing the problem? What's going on? How do we address it and how do we address it for that person? Because for some people especially those with lower dovarian reserve the solution isn't necessarily to go and do surgery if we have an endometrioma which is endometriosis in the ovary because it that may actually reduce the ovarian reserve further. So we have to state and time appropriate treatment accurately and correctly as well for the individual circumstance. It's not just a matter of there's one size fits all and unfortunately in fertility medicine that's often what a lot of people experience is like protocol driven this is how we do things here. And without taking into consideration the entire picture and everything that is going on for that particular situation and that particular couple.

SPEAKER_00 43:35

Yeah I mean I so many more of my clients um in the fertilities yeah I work in the emotional part um uh have got more endometriosis. So it's um like an area that is you know very prevalent at the moment. So I was curious on your thoughts, but thank you so much.

SPEAKER_02 43:54

Yeah there's more research coming out on it too which I think is one of the reasons why you know we're becoming more Aware of things that are affecting fertility and essentially how to diagnose and how to identify that they're an issue. And you know, and it's important because it does change behavior, it does change how we do things, and that is the whole point, right? It's about understanding what we can do to help ourselves further. And the more that we understand, the more that we can actually do that. And you know, one of the things that you mentioned early on in the conversation is about the fertility

Education Through The Fertility Challenge

SPEAKER_02 44:29

challenge. The fertility challenge is a free program that I've created for exactly this purpose.

SPEAKER_00 44:33

I was gonna ask you about that later. Yeah. Yeah. Which is to help you. Yeah, I I think it's awesome. Please share.

SPEAKER_02 44:41

Yeah, no, it's it's really to help people do exactly that. Understand, okay, what is within my area of influence? What is it that I can actually do to change my results, to change my environment in a way that's going to be conducive to supporting better results. No matter how it is that somebody's trying to conceive, I find that the more you are educated on the process of understanding what impacts you, the more you can choose what to do about it. And that choice that modifies behavior in a positive way is going to be beneficial for now and the long term. And I've been running this program now, gosh, I've been running the fertility challenge for the last 15 years. We've actually the first round of it was in 2011. And that was about 10 years after I started practicing. So we've now taken, gosh, really over 200,000 people in more than 111 countries through that and various programs. So, you know, it really is for me such an important thing to be able to empower people through that education that actually changes how they do things and therefore has the potential to change their results.

SPEAKER_00 45:50

Look, I love that. And I'm going to make sure I sell I share that more on the Australian Fertility Summit page about your fertility challenge, because I I didn't have that realization and I do now. So I just think it's awesome. And for me, that I always found the fertility journey when I look back on it really helped me to understand more about my body, my health, you know, detoxing my space, understanding how me and my husband connect. So it is such a, you know, as I tell my client, it's a gift, it's an opportunity to change how you're living life at the at the present to um create a more fertile space and being, you know.

SPEAKER_02 46:29

Yeah, absolutely. And for the long term too. And I think, you know, it's like, you know, it's like all of the challenges that we face in our lives, you know, like if we if we are to pray for strength, what are we going to receive? It's not challenges to demonstrate our strength, right? If we are to pray for patience, what are we going to receive? The the challenges that helps us to demonstrate our patience and so on and so forth. And I think, you know, there is so much to be said for this time of life, this circumstance of life, and sometimes this really difficult journey in life. As a teacher, and the more that we can lean into that conversation from that perspective, you know, I love the way that Tara Brah, the Buddhist teacher, talks about the challenges that we face in our lives. You know, how she talks about the fact that you have to make friends with your enemies in order to be able to have enough compassion for yourself in accepting them and in getting through that difficulty. Because you see, the moment that you are able to make friends, as she calls it, having tea with Mora, the more that you can have tea with Mora, accept the challenges and not try and fight them, not try to overcome them, but simply just accept that they're there, they are a part of the conversation, and that they don't have to keep you hostage. That you can learn and grow and make meaning out of this difficult situation and create transformation in every area of your life because you've had this moment to reflect. Which by moment I mean whether it's a very difficult fertility journey, whether it's things that fall apart and break down, and that we are forced to look at that we would never have given it the opportunity and the time and the place before, but now we have to, we have no choice. You know, it's like severe and chronic disease diagnoses that, you know, we don't know if we're going to overcome them, but we still have to live with them. And we get to learn and grow about and learn about ourselves and grow through that experience that challenges us in a very, very, very hard way. So the more we take it as a lesson, the more we take it as an opportunity, I think the the better the experience is along along the journey.

SPEAKER_00 49:05

Ah, so true, so true. Yes. For myself, I had so my husband had anti-sperm antibodies, so that's why we were told we had to have IBF. So we ended up having six IBFs over, you know, several years in the emotional journey. And for me, I had to let go. Um, and in a way, that was my tea with Maura. Um, and um, you know, really finding peace. Who am I without ever being a mother? And um, just you know, really finding peace and understanding. And then three years later, bizarrely enough, we get pregnant naturally. Um, and so I had a baby at 46. But it is, you know, it's such a gift, as you say. We meet our demons, we meet the fear, we meet everything, and we find, we find peace and learn so much on the way. Um, so with the fertility, you know, fertility is changing across, you know, with different stages of our life.

Building A Personalized Fertility Plan

SPEAKER_00 50:03

And how can women create that personalized fertility plan? Whether we're trying to conceive naturally, whether we're considering IVF or preparing for pregnancy at a later age. I know for me, I was, you know, at a later age because it took me a while to find a man. So um, yeah, what would be um your advice?

SPEAKER_02 50:24

I think that the more educated you are around the factors that can play a role and that there may be obstacles in the way, the easier it is for you to be able to foresee the challenges around the bend, right? And therefore be able to prepare for what's going to be the best way to approach it. You know, one of the ways in which, and I we've talked about the fertility challenge, and I think that that is a really fantastic start because it gives the opportunity, it's a very guided process that gives the opportunity to look at the situation and go, okay, what are the things here that I can change? What are the things that I can influence? What are the things that I need help to impact? And I think that distinction is also very important, is understanding that, sure, you given enough time, you probably would be able to figure it out on your own. But do you have that time to figure it out on your own? You know, and some people do and some people don't. You know, and so it's it's also adjusting to what kind of level of support and guidance you need given your specific circumstance. And also, do you want to have advice that is going to be solely focused in one paradigm? Do you want to have advice that is broad, broadly focused, and that's going to encompass all of the different ways in which we could conceive? You know, like for the patients that come to us, I literally ask people how and what is it that you are actually looking for? And what are your plans? A, B, C, D, E, F, G. If you don't conceive naturally, and how else do you feel that you want to add and escalate that journey? Because for me, it's not about a way of having a baby, it's about the fact that we have one. And what is going to be the most direct path to baby for one person is not for the other, you know? And so, really ultimately, it's about understanding okay, in this particular circumstance where we might have lower divarium reserve, high FSA, do we even bother doing IVF? The answer is usually no, right? And then in that situation, it might be more worthwhile to actually go and do donor egg. Is that something that somebody would be open to? So those are conversations that we have to then have a have a discussion about. Sometimes people come to me and they think that they need a surrogate, and I'm like, no, you don't. Look like you just need to actually go and do these other things here, and that's probably going to be enough. And often it is. And so, but if people come to me and they say, listen, I want to use a surrogate and I'm going to I want you to prepare me for that, well, then that's the job, right? It's figuring out what is it that we need to do. And sometimes it's actually looking at the evidence and saying, okay, what's actually going to be in your best interest? Because if we have a 0.1% chance of an IVF like IVF cycle working, and that is going to be the same if you are trying naturally, well, you might want to save the $20,000, the $25,000 and, you know, financial for a period of time, and then figure out do I want to consider donorate down the track? So it's about making those decisions and helping people to see what are the decisions that are available to them specifically, because not every decision is available for every person. Not every path is going to be the right path for every person. And that will also take into account values and preferences, affordability, accessibility to treatment. You know, there's a whole bunch of different questions that we have to ask. And sometimes the way that somebody is thinking about their fertility and their fertility journey, there could be other ways to think about it. And so finding those nuances is going to be very important. Yeah.

SPEAKER_00 54:17

Yes, it really is. And so, my, you know, what do you believe is missing from the traditional like fertility care model? How can that be more personalized or maybe more whole person approach for couples to have healthier pregnancies and, you know, find that they get better fertility outcomes?

Why Systems Fail Personalized Care

SPEAKER_02 54:40

I don't think we're going to see that happen within the healthcare system anytime soon. And the reason that I say this is because I have a doctorate in public health from Harvard. Okay. And so understanding healthcare systems is very much what that's about. And understanding what drives healthcare systems and what drives decisions within healthcare systems is even more important. And there are many misaligned interests within the healthcare system. It's almost like, you know, you have pharma, you have insurance companies, you have hospitals, you have, you know, doctors, you have patients, you have so many different components within and different shareholders and stakeholders or individuals within those groups, or even those groups themselves, they want different things. Right? They're looking for different ways to optimize for what is important to them. And so what ends up happening is that you don't get a clean slate upon which to work. You have a situation where there is a mess and you have to try and navigate it, you know? And so the system is not set up for individualized and personalized care when it comes to fertility, unless you are willing to pay out of pocket at a high, high level. So if you are willing to pay, sure, you can have that kind of accessibility, that kind of journey. If you're not willing to pay or if you can't pay, then that conversation changes drastically. And sometimes it's not even an option for some people to go down the IVF path or to have access to any other form of treatment because they can't afford it. Right. And so it comes down to what is it that patients are able to get from their healthcare system in different countries around the world, it will be different. You know, in the US, you have a more privatized healthcare system. In the UK, Canada, Australia, you have a universal healthcare system. And so what happens in universal healthcare systems, you have a public health, you know, kind of umbrella that needs to serve as many people as possible with the least amount of resources. And in a privatized system, it's almost kind of like whoever's willing to pay gets whatever it is that they want. But the charges and the costs are exorbitant. So what happens is that you know, that's really what we're navigating. So when we are within the system, irrespective of the healthcare system that you are operating under or that you're you're kind of subjected to, so to speak, you are going to have to deal with the rules of the place that you're at, right? And so, and it's like I said before, very guideline focused. Let's do the very bare minimum for the greatest number of people. And you end up with four tests being the answers to all of the fertility problems that there ever were, which is clearly not enough because we end up with more unexplained than anything else.

SPEAKER_03 57:49

Yeah.

SPEAKER_02 57:49

And so it becomes, and and of course, when you step out of the system, you have what I call the Wild West, you know, which is you have all sorts of different, you know, claims and people saying that they do, you know, this and that and whatever else, and it's not true, or you know, recommending. I mean, all you have to do is turn on social media for two minutes, and you will hear all sorts of garbage that I I literally like just have to take a deep breath most days as I go into my Instagram account and I get the whole pineapple core and and fries, you know, and whatever after I have VF attempts, and I'm like going, oh my God, please. Let's just where that's where does this misinformation stop? You know, and so and so that's the challenge, that's the difficulty that a lot of people will face as well when they even when they can afford it, is who do I trust? Yeah, you know, who can I trust with telling me what's actually accurate for my situation? So that is a big, big challenge for a lot of couples experiencing this problem.

SPEAKER_00 58:55

Yeah, yeah, yeah, yeah. Um, yes, it's uh it can be a mind field, and it's really lovely to be able to talk to a person like yourself that has so much understanding and knowledge. And I love your fertility challenge. I think it's really good. It was um in 2011 was when I had to learn to sort of give up, and um, I really wish that I'd been there too. But either way, it was one of the biggest learning experiences of my life, my fertility, you know, path. So um I'm really grateful for your chat and like you say, understanding the deeper aspect of what might be going on for our different journeys. So thank you so much. And now, as we, you know, bring our conversation to an end, what would be your sort of big take-home advice, or maybe it's one amazing sort of nugget. I know we could never really choose one, that you would like to finish this as a take-home tool for everybody.

SPEAKER_02 59:53

There are two, and we've talked about them already, but I want to punctuate them. And the first is fertility. Yeah, fertility

Two Takeaways To Live By

SPEAKER_02 1:00:00

is a team sport. You know, there is absolutely no way that you're going to get the very best possible result when it comes to your fertility if you're only addressing one side of the equation. So getting your partner to be educated with you, not by you, because that's a big distinction a lot of women miss, is that even my husband, he did not hear it from me, you know. Like when I was telling him, like, these are the things that you need to do. He's like, nah, nah, that's all overkill. So, what I would do is I actually hired a clinician, and I basically used to call her and say, Hey, listen, just so you know, this is what you need to tell him. And these are the issues, and this is what you need to say when I'm in the when we're there. And she we would arrive to the consultation, she would literally go and tell him all the things that I said, and we would leave. And then in a car, he would go, Oh, you see how she said, you know, blah, blah, blah, blah, blah. Oh, yeah, wow. Yeah, really interesting. Absolutely. Yeah, maybe, maybe that's something for you to consider, you know, I don't know. So the thing about it is that it was funny actually, but um, but I had to do what I had to do. I needed to get him to pay attention, and he wasn't paying attention to me, so hey, let's bring on the strategies. Yeah. And so, but I think that that's an important thing for women to understand is like let them hear it from an expert, let them hear them hear it from and also from an expert that you agree with, because this is the other thing. By being told by a fertility doctor that, you know, oh no, he doesn't need to do anything, his permanent and he can drink and smoke, and it's not a problem. Yeah, I'm sorry, but that is bad advice. And you should definitely not let him hear it from that person, you know, and you probably should look for another clinic while you're at it. But the whole point here is that you do need to ensure that your partner is being educated with you, not by you.

SPEAKER_03 1:01:55

Yeah.

SPEAKER_02 1:01:56

That's the first thing. The second thing is what we've talked about before, which is acting pregnant now to get pregnant later. Every single person, if I was to say, even to a man, what are all of the things, like if you could imagine that you could be pregnant right now, what are all of the things that you would absolutely start doing or stop doing to give your child the best possible starting life? Yeah, they would be able to answer that question, right? And if they were really resistant to answering the question in that way, I would ask them, what about your partner? If she was pregnant right now, what are all of the things that you think she has to do or stop doing to give your child the best possible starting life? And they would answer that question very, very well. And I would say, and that's what you need to do exactly the same as well. You see, because right now, both partners are already carrying 50% of that little baby that they want to create. So now it's about making sure that we're giving it the best possible environment that those cells are meeting in the best possible way. And of course, development from there happens similarly. So acting pregnant now is crucial. And each person is going to come at this from a different perspective. Some people eat McDonald's seven days a week, some people don't smoke, some people drink alcohol. And so it's about figuring out okay, what are the things that are going to be important for me to change in my context and in my situation?

SPEAKER_00 1:03:23

Oh, I love it. Those are two top tips, and I love it. So thank you, thank you, thank you from the deepest part of my heart, Gabriela, for taking time out of your very busy schedule to speak on this podcast and for sharing your deep knowledge and your passion. Um, I am truly grateful. Thank you. Thank you for having me. Such a pleasure. Ah, it's a pleasure, it's all mine. And with that, beautiful listeners out there, I will leave you with you know, fertility is a team sport. So let's bring the person with you and um act as if you're pregnant now, not later. And what would that be like for you? Just put on that hat of curiosity and see what that looks like. And with that, you take care and lots of love.

Closing And How To Connect

SPEAKER_01 1:04:16

Thanks for joining us at the Homer Fertility. We hope today's episode brought you clarity, comfort, and connection.

SPEAKER_00 1:04:25

If this podcast resonated, please share it. Leave a review or subscribe. This helps us support more people that are on this path.

SPEAKER_01 1:04:35

And if you'd like to connect or share your story, find us on Instagram and Facebook at Australian Fertility Summit.

SPEAKER_00 1:04:44

Remember the missing piece that might be waiting in a story. Your body's wisdom or something.