Beyond the Labs – What Holistic Fertility Care Reveals That Standard Workups Can Miss

Have you ever felt like you were doing everything right—but still not getting the answers you need?

This week on The Dr. Mary Louder Podcast, I sat down with Dr. Grace Charles, ND, a naturopathic physician who specializes in integrative fertility care. Our conversation left me reflecting deeply—not just on how we approach fertility, but on how often modern medicine misses the deeper story.

For anyone who’s been told “your labs look normal” but still feels something is off…
 For those navigating the emotional and physical toll of trying to conceive…
 For practitioners who want to treat fertility with more depth, compassion, and clarity…

This episode offers a fresh and grounded perspective.

Dr. Grace helps us see that fertility is not just a function of hormone levels or ovulation timing. It’s an intricate reflection of the whole person—body, mind, spirit, and story.

In this episode, we explore:

What a naturopathic fertility workup actually includes—and how it goes far beyond lab results
Why emotional and energetic factors (like stress, loss, or internalized pressure) often go unspoken—and unaddressed—in standard care
How trauma, diet, lifestyle, and sleep impact fertility at a root-cause level
What true “integrative care” means when it comes to fertility, and how collaboration between providers can shift outcomes

And most importantly, we talk about how this kind of care changes how a woman feels—not just about her chances of conception, but about her sense of agency, peace, and belonging in her own body.

Why I wanted to have this conversation

Fertility is one of those sacred crossroads in medicine—where physiology, identity, grief, and hope all converge.

Too often, the standard model of care reduces it to numbers, medications, and timelines. And while those tools have their place, they can leave women feeling unseen, unheard, and… ultimately, alone.

But what if we looked deeper?
 What if we treated fertility as a signal—not just a diagnosis?

Dr. Grace does exactly that. Her work is gentle and grounded, backed by science and by presence. She approaches each patient with curiosity and reverence—and it shows.

You can connect with Dr. Grace Charles and learn more about her fertility work on her website.

Transcript

Mary Louder, DO
Welcome to the Dr. Mary Louder podcast, where we gather to explore healing, story, and soul.
I'm glad you're here.
Today's episode is for anyone who's ever felt like they were doing everything right on paper, but still not getting the answers they need.
I'm joined today by Dr. Grace Charles, who's a naturopathic physician specializing in holistic fertility care.
Together, we're going to impact what often gets missed in conventional fertility workups, and how root cause integrative approaches can offer so much more than just lab results.
We explore the emotional, the spiritual, and lifestyle factors that impact fertility.
We're going to look at how naturopathic care addresses the why behind hormonal imbalances, and what true partnership in fertility care can look and feel like.

Mary Louder, DO
So if you or someone you love is navigating the tender terrain of trying to conceive.
This conversation is full of insight, compassion, and hope.
Welcome, Dr. Charles, and let's get into the conversation.

Mary Louder, DO

Well, welcome Dr. Charles.
Dr. Louder here.
Let's just drop the formalities and go by Grace and Mary. How's that?

Grace Charles, ND
Oh, Mary, it's great to be here.
This is fun.

Mary Louder, DO

It is.
And you're in Steamboat Springs, which is beautiful.
And I used to live in Boulder, which is beautiful.
And so now I live on the east shore of Lake Michigan, which is also beautiful.


Grace Charles, ND
It's the best. I grew up in Chicago.
Love the lake.

Mary Louder, DO
Yeah, so here we've got that Midwestern thing going, don't we?
Lovely.
Well, we're going to dive into a really fun conversation today about infertility or fertility.
Maybe we should pose it that way.
But before we get into the nitty-gritty, I would like you to share with our listeners how and why you became a naturopath and what parts of that then pulled you into the fertility world.

Grace Charles, ND
Sure, great question.
I was all set to become a more conventional doctor.
I was doing my pre-med credits, and I had a professor that pulled me aside.
He was an MD professor.
And he said, Grace, I think you should learn about this thing.
I just, I would feel badly if I didn't introduce you to this thing called naturopathic medicine.
And he told me about and I learned about it, and it was the next day I was done.

Grace Charles, ND
Because that approach to medicine just called my heart, and it really aligned with my values of not overtreating, believing that the body wants to be great, and using the resources we have.
And I'm certainly also a fan of conventional medicine, but the way I wanted to treat, naturopathic medicine was certainly more aligned.
But in practicing, you know, I did naturopathic medical school, I did a residency, I got into a group of a lot of women's care.
But I started seeing a big gap in the conventional medical system for these really engaged smart women who are just falling through the cracks of conventional care.
So if I could walk you through it--

Grace Charles, ND
If a woman isn't getting pregnant, she usually goes to her gynecologist, good first stop, and says, hey, what's going on?
The gynecologist is going to run some tests.
They're going to follow protocol, the algorithm, totally appropriately.
If those tests come back normal, then the woman is kind of shunted into this gray zone of waiting for eventually, just keep trying.
Everything looks good, keep trying.
And then they're referred, finally, again, totally appropriate referral to a reproductive endocrinologist, so a fertility specialist.
Now, that fertility clinic is certainly going to lead towards IVF as the treatment.

Grace Charles, ND
But these women are saying, well, wait a minute.
I'm not opposed to IVF necessarily, but why do I need it?
My gynecologist said all of my tests were normal.
I feel healthy.
Why do I need this rather invasive, time-consuming, expensive treatment when we don't have a diagnosis?
And I saw that as a naturopathic physician, as a holistic provider, I really could fill that gap of explaining unexplained infertility and doing a root cause approach and finding out just why these women and couples haven't gotten pregnant and then treating them and working with them.

Mary Louder, DO
Yes.
So when you were starting out in your practice as a naturopathic, were you working with allopathic MD doctors or osteopathic doctors or other naturopaths?

Grace Charles, ND
Well, I live in a small town.
I was working as a solo practice.
And because I've been a small town, we all know each other, the allopaths, the naturopaths.
So it feels almost like we're all working together.
Plenty of opportunities there.
But no, I was just, it was just me as a naturopathic doctor treating women for tertiary care.
We don't provide primary care as naturopathic doctors in Colorado.

Grace Charles, ND
So I was secondary and tertiary care women who were like, I just want one person more on my team to help me figure out what's going on.


Yeah.
So a lot of times, you know, and it's interesting you mentioned about the conventional medicine and before the Flexner report in 1913, naturopathic style of medicine was the standard of care.

Grace Charles, ND

That's right.
And you know that because you're an osteopath.

Mary Louder, DO

That's right.
I am an osteopath through
and through.
Just dyed in the wool.

Grace Charles, ND

That's great.
Because you're a real ally.
I mean, our professions are more closely linked, certainly, than naturopathic medicine and MDs.

Mary Louder, DO
Right. Yeah, so for folks listening, MDs are allopaths, DOs are osteopaths, ND, N is in Nancy, D is in Dr., Naturopath.
And so it's very interesting because the Flexner report was really built around standardization, was built around... Oh, I'm going to use the word control because that was in it, politicizing of certain medical standards and marginalizing things that people just wanted to move away from and move
more into pharmaceuticals.
And that came out of the Gilded Age.
And so there's some very interesting history and sociology around that.
A.T. Still, who founded Osteopathy in 1876, I believe that's the right year, was comrades with or compatriots with DC Palmer, chiropractic.
And they went their ways, I'm sure, over a bone.

Mary Louder, DO
They had a bone to pick with each other, no pun intended, right?
But A.T. Still also was more of a mystic.
And I was drawn to osteopathy and my advisor, freshman year in college, said, you should be an osteopath.
I go, oh, no, they're quacks.
Nope, couldn't do it. And then here I am, dyed in the--
Quack, quack, here I come. 
So, not quacks. But--

Grace Charles, ND

No, but we had to follow our callings.

Mary Louder, DO

Exactly.
Root cause care.
The body has the capacity to heal.
The structure and function are inherently related.
And then we're working to uncover that which we can support so the body can make its way, trusting its inherent wisdom.

Grace Charles, ND

Well said.

Mary Louder, DO
Yeah.
So, all right.
So diving into fertility or infertility, what should we call it?
What's the better word of those two?

Grace Charles, ND
Well, they're both fine.
There's fertility potential in everyone, and I treat infertility.
So I'm happy with both.
It doesn't offend me to talk about infertility.
I know that's a tricky word for some women to say again and again, in which case we change the language.
But when we're talking about diagnosing and treating, both are fine.

Mary Louder, DO
Yeah, okay.
So, and I think you described it pretty succinctly.
And in my world, when I did traditional family practice, I didn't do, I did prenatal care the first two years in practice, and I actually strongly considered being OBGYN because I was actually kind of good at it.
You know, it's like, it's kind of like a pilot.
You've got, you know, hours of boredom and then just a few minutes of sheer terror is that, you hopefully... slippery little guys coming into world up to you, or something happening.
But what I found in that labor and delivery part was not only was there science, and if you look, you know, honestly, if you look at the ACOG guidelines, they change all the time.
And I think they change all the time because I think OB changes all the time, because I think women change all the time. And--

Grace Charles, ND
The research is changing because a lot of the research isn't really made about women.

Mary Louder, DO

Right, right.
Yeah, even though that's women having babies, right.
So go figure here.
They're going to, let's soapbox this one in the right way, you know.
And so those guidelines, and that's pretty much the reason why I didn't become an OBGYN was because the guidelines kept changing.
I'm like, that will just annoy me because you're held to the guidelines, more so in that specialty than any of some of the other specialties.

Mary Louder, DO
And I think it's because there's two patients there, you know, and I think that's why.
But it was really fun, but I found a lot in OBGYN, especially the delivery stage.
Tons of intuition you needed to use to bring that baby into the world.
And most of it looked and was a natural process at the end of the day for the baby and the mom.

Grace Charles, ND

Yeah.

Mary Louder, DO

So making that connection with those two was the most important thing.
And then you could figure it out.

Mary Louder, DO
And then, yes, of course, guidelines.
And yes, of course, good care.
But that's what I found most fascinating about the whole concept of labor and delivery and obstetrics.
And anyway, so that's kind of my story.
And so I always had a special interest in fertility as well because in my practice, women would come to me because they've been everywhere else and they were needing IVF.
And they said, what if I don't want to do that?
You're going to have to figure this out.

Mary Louder, DO
That was the caveat.
They would say, Dr. Louder, you're going to have to figure this out.
I'm like, oh, thanks.
So I did.
But before I share some of my experiences, I really want to hear your process of how you take a patient through this idea, workup regarding fertility.

Grace Charles, ND
Sure.
I think what's the most important piece is that we slow down and we get a diagnosis first, not just the surface diagnosis, not just, okay, there's PCOS here.
We really go deeper and say, well, what else is going on?
So getting a really strong intake, it's a long process.
It's over an hour of just us chatting.
It's a lot of forms to fill out.
And then it's a lot of labs to do.

Grace Charles, ND
We do a lot of functional testing.
And the second visit, the deliverable is, I'll show you on the labs why you're not getting or staying pregnant.
I'll give you a diagnosis for that unexplained infertility, or even if we have a good starter diagnosis we're happy, we go deeper.
And then from there we decide, okay, how do we want to treat this?
Do I want, do you want to do IVF?
Do we want to do this in a very conventional way?
Do we want to integrate?

Grace Charles, ND
Do we want to treat this completely naturally?
In most cases we can.
And I think the other really important part about my intake is I rope the men in.
Infertility, I mean male factor contributes to almost half of fertility challenges.

Mary Louder, DO

Okay.

Grace Charles, ND

There's this idea that fertility is a woman's problem.
Pregnancy, that's a woman's issue.

Grace Charles, ND
But fertility, by the nature of conception, it's 50-50. And it really does play out in, like, clinically.
For every three patients I see... And they're all women.
I mean, I'm marketing to women, but a male has never approached me and said, oh, work up our infertility.
It's always the women who are coming to me and saying, something must be wrong.
What's going on with me?
And in one of three of them, I say nothing.
I mean, of course, there's more we can do to improve your health, but this is a male factor infertility case.

Grace Charles, ND
And another one of three, I said both of you are contributing to this subfertility.
And maybe one in three, I say, okay, we're more focusing on you and your fertility.
So bringing in really high-quality testing for the males, I think, is another really important piece of my diagnostic process.
But working with me, we diagnose first, and then we treat.

Mary Louder, DO
Yeah, I think that's a great point because you've mentioned the unknown reason for fertility issues, and then we jump right to treatment.
And that's really the paradigm in conventional medicine.
Well, here's symptoms.
We don't know why they're there.
But boy, do I have a pill and/or treatment for you. 

Grace Charles, ND

Exactly.

Mary Louder, DO

And I just don't know philosophically where we went awry on that.
Why that step of going back, you know, William Osler, Sir William Osler said, if you listen to the patient, they'll tell you what they have.

Mary Louder, DO
When in doubt, go back and re-examine the patient.
If you aren't sure, take a history again.
Those are the three things that I've built my practice on for 32 years, never failed me.

Grace Charles, ND
Yeah.
And it's okay sometimes, right?
We've got a headache, we take an ibuprofen, we never knew what that headache was about, but it was a three-cent solution.

Mary Louder, DO

Right.

Grace Charles, ND

IVF, that's a $30,000 solution.

Mary Louder, DO

Yes.

Grace Charles, ND

So many women aren't willing or able to just go ahead and ignore the in between of what is the diagnosis.

Mary Louder, DO
Yeah.
So what do you see as the leading cause for the unexplained fertility issues?

Grace Charles, ND
I think they're a handful.
I'm not sure if I have a clear leader.
I find a lot of autoimmunity.
Standard workup of fertility is to test TSH only for a thyroid panel.
And it doesn't let us know if there's Hashimoto's there.
And I find Hashimoto's all the time, especially with secondary infertility, that condition will often flare after, in a postpartum situation.
So if someone's already had one or two babies, and now they can't continue to grow their family, we usually find Hashimoto's autoimmunity there.

Grace Charles, ND
Hidden infections.
I had this great case last spring of a... Do you mind if I tell it?

Mary Louder, DO

No, go ahead.

Grace Charles, ND

Okay, great.
She had PCOS and a lot of insulin resistance.
Her insulin was up at a 20 or something.
We got her a CGM.

Grace Charles, ND
She changed her diet.
She was exercising.
She's just doing so well.
She lost a little weight.
Her blood sugars came into normal.
Her insulin got down to eight or something.
But she still wasn't getting pregnant, and she always had this elevated CRP.

Grace Charles, ND
We always knew there was inflammation there, but I assumed with an initial round of testing that was because of the insulin resistance.
We retested mid-case and CRP was still high.
Even the insulin had really normalized or gotten much better.
So I was, I was, it was a mystery.
Why is the CRP still elevated?
And I was thinking like, gosh, maybe we'll run a GI map.
Maybe we'll get into, like, what could it be?

Grace Charles, ND
And then on the call, the next call we had, when I was about to tell her what we've got to do next, she said, and then she's telling me about antibiotics.
I was like, well, what was that about?
She said, oh, gosh, I had this infected root canal that I finally got fixed.
And it was, I mean, I felt so silly because I didn't have anything about dental on my intake paperwork, so I missed it completely.
I know that could cause systemic inflammation.
And of course I changed my forms the next day, but gosh, was I, I was half mad at myself and half just excited for her because Eureka, this is what's causing the inflammation.
My plan was to retest the CRP a month later, just to make sure that was it.

Grace Charles, ND
And I didn't even get a chance to because she got pregnant the next cycle.

Mary Louder, DO

Oh, amazing.

Grace Charles, ND

Yeah.

Mary Louder, DO

So what you're saying is that root causes could be a root canal.

Grace Charles, ND

Well, an infection.
Absolutely.

Mary Louder, DO
Right?

Grace Charles, ND
Hidden infections.
We're thinking about something in your gut, maybe an overgrowth of this or that.
But like an old, you know, cytomegalovirus, EM, like, right, Epstein-Barr.
Yeah, infections could be all sorts of places.
But I, it was such good example.

Mary Louder, DO
Yeah, yeah.
Teeth.

Grace Charles, ND
Exactly.
So, and it's interesting because there's a lot of people that have, you know, implants now when he gets some certain point.
And even when the implants were put in, the bone didn't really take real well.
And it's because there's the infection in the bone.
And so, you know, so if they're, so the key here is hidden something.

Mary Louder, DO
Yes.

Grace Charles, ND
And so, yeah.
And the labs, they'll call it.
If there's inflammation there that's not budging, you have to dig deeper.
You have to find it.
We can't just ignore it and say, huh, that just must be normal for you.
It's not.

Mary Louder, DO

Right.

Grace Charles, ND
So, yeah, autoimmunity, inflammation, hidden infections, toxicities are a big one.
And luckily, they're kind of on blast right now.
The women that I'm working with, the couples I'm working with, they're seeing that on their social media feeds and they're learning that they shouldn't be using the non-stick pans that they need to get the phthalates
and the parabens and the BPAs out of their products and foods.
So they're a little more aware.
Sometimes I need to give a nudge about the scented perfumes and candles and whatnot.
But those are, I mean, those are directly problematic to our organs, right?

Grace Charles, ND
And they're also endocrine disruptors, so they're confusing our hormones on how to communicate with each other.
So that's a big one, though I've noticed that I'm seeing a little bit less of that recently.

Mary Louder, DO 

Okay.

Grace Charles, ND

Because people are paying attention, not because they're less out there.

Mary Louder, DO 

Yeah.

Mary Louder, DO
So, yeah, so what you're saying is things in the environment that interact with our hormones.
Correct.
Cause low-level information, which can look even like autoimmunity.

Grace Charles, ND
Mm-hmm.

Mary Louder, DO
And then as a result, that's because what, so an endocrine disruptor means it looks like an endocrine, walks like an endocrine, but it ain't an endocrine.
And it sits on a receptor because it's close enough to what an endocrine looks like.
And so when it sits on that receptor, that message of “hello Sam” turns into “go away Sally” and nothing is communicated or the wrong message is communicated.
Right.
Yeah.
So how did, you know, so, and I guess I'm sure that maybe other people ask this question, but why do you think this isn't looked at when it's in our culture, you know that in terms of the toxicities.
And we know about, well, we know about some of the pans with the non-stick coatings, and we know about chemicals in the air and the coal factories and the power plants.

Mary Louder, DO
So why is this, you know, do we... you know, where, because I've, yeah, where does that come from that we just don't pay attention to this?
What are your thoughts about that?

Grace Charles, ND
Well, these plasticizers, these chemicals have been invented and embraced because they make life easier.
They make us smell better.
They make it easier to cook our food.
They make us have to do less dishes, right?
It makes sense that we've integrated them into our lives.
And I think when they first were introduced, we didn't quite realize the impact.
And now we do, and we're a little... I had to pry it out of my fingers.

Grace Charles, ND
This really makes my life easier.
We're so used to easy now.
We've gotten, right, as a species, we've gotten a little soft.
So I think it's hard to reverse that once you've had a taste, but it's certainly worthwhile.

Mary Louder, DO
Yeah.
Do you think have women come to you and in their gynecological history had really heavy periods, a lot of dysmenorrhea, which is painful periods.
The heavy period would be menorrhea.
You know, the heavy frequent periods where the cycles are shorter.
Instead of 28 days, it could be 21 to 25. And they're slightly irregular between 23 to 32 type thing, where, you know, they've got a history that if they look backwards, things weren't always easy in the, you know, in the gynecological aspect of their life.

Grace Charles, ND
Sure, and that's one of the first things I start with.
I say, give me the timeline of your fertility tale, meaning what have they tried, what have they done, what have they already been through?
And then let's talk about how your cycles present.
Because those details are... make it so much easier for me to dissect the case and knowing those bleeding patterns and also helping them realize like a flooding period for three days is not normal.
And we can get to the bottom of this.
It's probably too much estrogen.
Maybe it's not enough progesterone.

Grace Charles, ND
Maybe it's the toxicants.
Could be something else entirely.
But, there's so many clues in the menstrual history that that's where I spend at least a third of the visit and the first time I meet with a patient.

Mary Louder, DO
Yeah, and I think there's an aspect to the menstrual cycle that has a soul implication and a spiritual implication.

Grace Charles, ND
Oh, tell me more.

Mary Louder, DO

Okay, so you've got this 28-day cycle of life to death.
Right?
So the egg is made in the ovary.
It matures.
It ovulates about day 14 to 16 to 17, 18. And then it waits for fertilization.

Mary Louder, DO
If not, there's no implantation.
And so it leaves as does the lining of the uterus.
So that's a death.
Men tend to cycle, like in a 24-hour period, relative to their testosterone.
Women, it's a 28-day period.
Women endure much more in that cycle of life to death than men do day to day.
And so we carry things, we hold things, we nurture things, much longer.

Mary Louder, DO
And I've often thought that the, because I've been through menopause now for quite a number of years, and so looking back on things and seeing things is this, that perimenopause is kind of like a protracted period.
So if you take your entire menstrual history as one period, then you put perimenopause in there.
That's like the PMS stage.

Grace Charles, ND

Right?
And then you hit-- 

Grace Charles, ND

Sure is.

Mary Louder, DO

Then you kind of, you know, it's over.
Or not menstruation, but menopause.

Mary Louder, DO
It's over.
And so, and how hairy is menopause?
You know, well, let me tell you the ways, right?
There's so many ways that is.
And so it's the same thing.
It's either 28 days or it's this lifelong cycle.
And I submit that if... now knowing and seeing and living that it's the same thing as protracted as it is every 28 days.

Mary Louder, DO
And so I would, I can predict who's going to have struggles with perimenopause and into menopause based upon their monthly cycle patterns.

Grace Charles, ND
Oh, that's so interesting.

Mary Louder, DO
Yeah.

Grace Charles, ND

And we can, I like the way that you broke that down and I guess I'm going to take it further in that we're, I think this is what you were saying.
We have 28 days.
We have our full cycle for that egg to really absorb the world around us and the experience we have.
And for men, it's shorter.
I've read a study that was, it was a correlative study, it was certainly not causal, but there was a correlation between the stress state of the man at the time of conception and the anxiety later in life in the child.

Mary Louder, DO

Yes.

Grace Charles, ND
So interesting.

Mary Louder, DO
Yes.
And there's, and some of that comes down on the DNA.
That literally changes the single molecular-tied polymorphisms or SNPs.
And it influences how the SNPs present one to the other.
23 from dad, 23 from mom.
46 reasons you need to go to therapy.
Yes, ma'am.

Mary Louder, DO
Thank you, dad.
Thank you, mom.
Here we are.
So, you know, and so we see that.
And so if we've got that stress on those genes that then comes into, well, there is a microbiome in the uterus in the endometrium.
There's a microbiome in the bladder.
There's a microbiome in a joint.

Grace Charles, ND
That's a test I've been loving
is testing the microbiome of the vagina.

Mary Louder, DO
Yes, yes.
And so... You know, none of that is, you know, none of that is, what was I going say?
None of that is by itself, but it's all together because it's got to, vaginal microbiome, got to uterine microbiome, got to, you know, liver.
And one of the things, have you seen where we used to have tests in the olden days, functional medicine of the liver pathways, where they would give them caffeine and acetaminophen, them being the patient.
And then you would do a urine test, and it would excrete through the cytochrome P450.

Grace Charles, ND

Sure.

Mary Louder, DO

Phase one and phase two.

Mary Louder, DO
I don't think those tests exist anymore.
If they do, I can't find them.
And we could really get a good idea of phase one, phase two of liver detoxification.
Then you've got kind of the four steps in phase two with the sulfation, methylation, glucuronidation, you know, after the cytochrome P450.
Frankly, I think that's where the action is.

Grace Charles, ND
Absolutely.
Those tests would be super handy.
I think the DUTCH has kind of replaced that in terms of breaking it down, but cortisol, stress hormone, is broken down through the same pathway.
If someone can't tolerate their coffee in the morning, they're not going to be able to break down that cortisol any more efficiently.
So, yeah, let's bring those back.
That sounds good.

Mary Louder, DO
Yeah, I think it's interesting because that's where the action is.
And what I, so my foray into infertility was because people would come back and say, I don't want to do that.
What are you going to do for me?
I'm like, oh, I don't know.
So I had to figure it out, right?
And that's how I, one of the reasons I got into really truly functional medicine is because people kept coming back after going to specialists.
And so what I found was is I did liver detoxification.

Grace Charles, ND
Yeah.

Mary Louder, DO
And I followed protocols that had been curated that had clinical science behind him.
Are they double-blind placebo-controlled studies?
No, because that doesn't exactly have to be that way.
You can do observational studies.
You can get the right data a few different ways.
But we had the results where we were able to do before and after tests and see the improvement in the pathways.

Mary Louder, DO
And then when we put the genes on there, the genomic aspects, COMT, MTHFR, I have an MTHR, I'm going to die! With it, not from it, let's go, move along here, nothing to see, right?
It's not a one gene does a disease make.

Grace Charles, ND
No, but taking the burden off and also, I mean, you're doubling down with, if we're getting the toxicants out while doing the detox, I start almost every patient with a detox, whether that's because I see that their estrogen is too high or their toxic burden is too high, or because we're living in
toxic places, and we all kind of need it if it hasn't been done in a while, but that epigenetic piece is very critical as well.

Mary Louder, DO
It is.

Have you had patients come to you that have said, I'm trying not to laugh, but it is kind of funny that I'm intolerant to my progesterone.

Grace Charles, ND

I have.

Mary Louder, DO

Progesterone intolerance.

Grace Charles, ND

Yeah.

Mary Louder, DO

I think, I mean, I'm going to pull the gender card in this one.
My hunch is a guy made that one.

Grace Charles, ND
And it's really not possible because you make it.
What I've seen is really poor outcomes with the, you know, taking exogenous progesterone, right, taking an oral progesterone or a vaginal progesterone, that they just, the symptoms really bloat, and bloating being one of the symptoms, but yeah, progesterone intolerance.

Mary Louder, DO
Yeah.
Well, hello, it's liver.

Grace Charles, ND

Right.

Mary Louder, DO

That's all it is.
You've just got to clear the pathways.

Grace Charles, ND

Yes. 

Mary Louder, DO

That's it.
It's really, you know, and it's like it's, you know, and I think because I've done that for literally 25 years in people, like, you guys, it's just right here.

Mary Louder, DO
Well, no, I'm intolerant to it.
No, no.
If you-- 

Grace Charles, ND

Look, there's a balance--

Mary Louder, DO

To progesterone, you'd be dead, because it's really in your body anyway.

Grace Charles, ND

You make it every month.

Mary Louder, DO

Put some in you that you try to metabolize it.
It just points to the fact that your metabolism of it is imbalanced.

Grace Charles, ND

Correct.

Mary Louder, DO
Yeah.
And same thing with estrogen dominance, which is really PCOS, polycystic ovarian syndrome.
There's really some nice genes and eloquence around that relative to insulin sensitivity.
Also...

Grace Charles, ND
What drives that, that PMS stage, and if we want to zoom out, that perimenopause stage.
It's all that extra estrogen dancing around that's making us really… Feisty.

Mary Louder, DO
It is.
Exactly.
And then it drops.
And then because it drops, where did it go?
It's still there because it's in the adipose.
So I've got the toxic estrogen stores there.

Mary Louder, DO
Yeah.
All right.
So, all right, so,
What simple things can people do today say, hey, this sounds like me.
Okay. I, you know, maybe I've already had my children or maybe I am struggling with fertility or maybe I'm planning to get pregnant.
What can I do to make myself the healthiest possible?

Grace Charles, ND
I think, again, we want to use diagnose and treat, and I'm happy to give lifestyle choices that I think are best for fertility, but the first thing I would recommend doing is track. Track something, whether it's cervical fluid, whether it's your temperature every day.
There's such cool tech out there tracking the metabolites in the urine, so the brands out there are Mira and Anito and UVA.
I'm forgetting one, where you can do urine strips daily at home and see just exactly where your estrogen is throughout the cycle and what your progesterone is doing as a response and exactly when that LH surges.
You know, I've had patients who have been in the timeline, right?
They went to their gynecologist.
They waited a couple years.

Grace Charles, ND
Finally, they're sitting with me and nobody ever said, you're not ovulating.
And they'll say, well, yes, I'm having my LH surge.
And I said, well, that's just one domino, right?
The estrogen rises and that triggers the LH surge.
The LH surge tells the ovaries, go ahead and ovulate.
But until we have a progesterone value seven days later, or an ultrasound, we don't know if they ovulate it.

Grace Charles, ND
And somebody, and that can be missed, because I can't tell you how many gynecologists have said to me, how many, I shouldn't say gynecologists, how many physicians have said, if you're menstruating, you're ovulating.
It's not true.
It's not true.

Mary Louder, DO

Nope.

Grace Charles, ND

You can bleed from just an estrogen come down.
So I think tracking and making sure that you are ovulating, you're ovulating when you think you're ovulating, your timing, your intercourse correctly around that.
That other signs of fertility really match up.

Grace Charles, ND
I love tracking cervical fluid.
And it sounds, you know, it's cervical mucus in the literature, and that sounds a bit daunting and yucky.
But... it's really neat.
It's and it's essential for getting pregnant.
It has very good.
I always flip around specificity and my statistical terms.

Mary Louder, DO

Specificity.

Grace Charles, ND
Thank you.

There it is.
If you don't have egg white quality, this great quality cervical mucous, you are not ovulating.
If you do have it, there's an 87% chance that you are ovulating.
So it's really great to gauge.
Am I ovulating or not?
Am I making the cervical fluid?
Temperature tracking, basal body to temperature tracking, I think, is great.

Grace Charles, ND
There's, again, gadgets.
Like, the tech is fun.
There's a product called temp drop on the market.
You put a band around your upper arm every night before you go to bed just to make it a little bit easier.
But those fluctuations in temperature can tell me a lot about when the LH surge is happening, if the progesterone is coming up quick enough So tracking something, I think, is a really good first recommendation.
And then doing an inventory of the foundations, diet, exercise, sleep, stress.
Right?

Grace Charles, ND
Those are critical.
We can't build our fertility unless we've got those secure.
So making sure... you're, you’re moving and that you're getting your 10,000 steps a day.
And if you haven't started weightlifting, now's the time.
You're ready.
It's time to do it a couple times a week.
We don't have to run marathons.

Grace Charles, ND
In fact, maybe we shouldn't if we're trying to get pregnant or struggling to get pregnant.
It doesn't need to be HIIT workouts, but we need to know our bodies.
We need to engage our core because that's just a massage on the ovaries.
More that happens, the more circulation we get, the more nutrients they get.
So yeah, exercise, the dietary piece is the most research is the Mediterranean diet.
So that's kind of the steady recommendation.
Follow as close to a Mediterranean diet as you can.

Grace Charles, ND
But are you sleeping well and are you managing your stress well?

Mary Louder, DO

If you're in fight, flight, fawn, or freeze, good luck.

Grace Charles, ND

Right.
You're not going to make a baby.

Mary Louder, DO

Right.

Grace Charles, ND

And that makes sense, evolutionarily.
You're not in place to.

Mary Louder, DO

Right.

Grace Charles, ND

We have to activate the parasympathetic nervous system.
We have to rest and digest and, you know, populate.

Mary Louder, DO
Yes.
And really have time to have that intimacy.
And you've got to be relaxed to have it.
How many, you know, stories can you share that I also could share of where, you know, somebody went through infertility treatment, got pregnant, or they adopted somebody, adopted a little baby, and then, you know, three, four months later, they're pregnant.

Grace Charles, ND
I know, yeah, absolutely.
And I think that's where that age-old wisdom of just relax, yeah, stop stressing about it, and it'll come.
Like, yes, we've all seen that play out, but to my... God love them,
my type A patients, like that is not a helpful piece of advice.

Mary Louder, DO
Yeah.
So what I'm hearing is that the look at your environment.
So look at the things around you, the things that you use to cook with, the types of food you eat, how you eat them, what your work-life balance stress is, what your relationship status is, are you settled with where you want to be and really, you know, ready to go?
Are you nesting, right?
And then, you know, look at things that could have happened in your history, this unexplained virus in college that just you didn't kick the fatigue with.
Is there, do you have, maybe did you get a tick bite you're unaware of because all the nymphs can bite, the little teeny tiny nymphs that you can't see.

Grace Charles, ND

Oh, good grief.

Mary Louder, DO
Yeah, and so not fear here, but just like if there's still the markers that come back.
Right.
And then if you, you know, they go, you go to your physician, whoever you see, and they don't do the inflammatory test, they don't do the full thyroid panel, request it.

Grace Charles, ND
Yep.
You have to advocate for yourself.

Mary Louder, DO

Yeah.

Grace Charles, ND

And I know that's hard, and that's a silly system.
It's not ideal, but the squeaky wheel gets the grease.
And I did read a research paper a while ago that said difficult patients get better care.

Mary Louder, DO
Yeah.
And that's, you know, it's unfortunate that I think is an implicit bias.

Grace Charles, ND

Oh, yeah.

Mary Louder, DO

I think that that's, I think that's just wrong.

Grace Charles, ND

Absolutely.

Mary Louder, DO

I mean, I've always also maintained patients--
How do you know what they have?
I said, well, they can have whatever they want.
meaning we could diagnose him with anything.
Who knows what it is?
Well, it couldn't be that.
Well, how do you know?
Right?
And so I think it's just super important to listen.
And if somebody feels that there really is something, go searching for

Grace Charles, ND
Absolutely.
And there's plenty of places you can self-order these tests.
I mean, that's, again, not ideal to be ordering blood work as a... as a non-health care provider, but here we are, and you can access it you want it.

Mary Louder, DO
You can.
So I think, let's see.
So what do you think are the, if someone's been struggling for years, because I imagine folks might find you that way.
Middle of the night, Google search, that urgency is high.
You know, some, you know, and so what would you say if someone's been struggling for years and but they maybe they had barriers to the IVF you know either how they felt they didn't want to do that or financial barriers what would you say?

Grace Charles, ND
Well first I'd assure them that we all have this idea that IVF is the safety net at the end of our fertility journey. It's, it's really not.
The outcomes, especially if you're like 40, a lot of with women who are between 40 and 44. Their outcomes aren't that great.
I mean, it's like 5% chance that we'll get it on the first round.
So I assure them that just because they decided not to do it on the IVF row doesn't mean that they've made a terrible decision.
And the second thing I do, and it's hard for them to understand this and commit at the beginning, but it's so important for their mental state, is for them to take a break from trying, for them to purposefully avoid having sex during their fertile window while I do the work, while I get the diagnosis and while we start treating it.
Because there's no disengaging from the stress of having a period of that--we call it the two-week wait, right?

Grace Charles, ND
So when they've tried, they've day 14, they've done everything they can, they've had great sex, when they're ovulating, everything lined up, and now they just wait.
And if they're like most of us, they have a few PMS symptoms that unfortunately overlap pretty well with early pregnancy symptoms.
So every little twinge, every little nausea, every little feisty thought, is it, am I pregnant?
Is it a little bleeding?
Is this implantation bleeding, or am I losing a pregnancy?
Is... Everything causes stress.
And unless you say, don't try, you are not pregnant this cycle for a few cycles in a row.

Grace Charles, ND
It's impossible to disengage.
The men kind of like, they do their job and then they're out of it.
I mean, they're also anxious to find out if it's a positive pregnancy test.
But they're not in it every minute of those two weeks.
And that roller coaster can just be devastating.
It's also really hard on couples' sex lives to be trying for this long.

Mary Louder, DO

Right.

Grace Charles, ND
I mean, the sex loses its luster.
So taking a break from trying is a really nice reset for both parties, but especially, I think, the women that just carry this burden cycle to cycle.

Mary Louder, DO
That's really good advice.
And I think, too, to remember that, you know, fertility and infertility can also include couples who've had miscarriages.
And the unexplained miscarriages.

Grace Charles, ND

Yeah.

Mary Louder, DO

In this day and age, they shouldn't be unexplained.

Grace Charles, ND
Right.

We have plenty of tests, and it's too bad that we have to wait for three losses to get the recurrent loss panel.

Mary Louder, DO

Yeah.

Grace Charles, ND

Don't make them go through that third loss.
Just run it on the second one.
They estimate one in five pregnancies end in a miscarriage just based on chromosomal.
They're not compatible with life.
But if you have two, let's test.

Grace Charles, ND
Let's work that up.
Let's not put you through, God forbid, a third loss.
Let's make the next pregnancy, the baby, the full-term pregnancy.
Yes, it's all in that umbrella of infertility, getting or staying pregnant.

Mary Louder, DO
Yeah, great.
Well, wise words to our listeners.
Thank you.
It's been absolutely
delightful to
talk with you.

Grace Charles, ND
Yeah, this has been really fun.
We have a shared soapbox, it seems.

Mary Louder, DO
We do.

We do.
And what's really fun is that you're accessible to folks.
So we'll put in the show notes how to get ahold of you.
You're in Steamboat Springs.
Of course they could take a lovely trip to see you.

Grace Charles, ND

Yeah, come visit.

Mary Louder, DO

Also, you're doing telemedicine and telehealth and teleconsults. And--

Grace Charles, ND
That's right. I learned during the pandemic that I can do my job entirely tele.
So that's what I do.

Mary Louder, DO
Wonderful.
And so we'll put all that information so that folks can find you and--
I fully endorse you.
I mean, I just think you've got a handle on this.
I think you not only have the patient at heart, but you've got the niche that I think is the right spot to really help a lot of people that are seeking answers.
Because really the answers lie in the things that we can find functionally.
Because if the structure looks normal, you got to look at function.

Mary Louder, DO
That's the functional test.

Grace Charles, ND

Yep.

Mary Louder, DO

And so that's you, that's your job, and that is your passion.
And I think I'm just so thrilled to meet you because I think you just do it wonderfully.
So thank you for all the work that you do for your peoples and your families and your couples.

Grace Charles, ND

Oh, thank you, Mary.
I so appreciate this.

Mary Louder, DO
Yeah, it's really wonderful.
So that’s--
And you’re really, Dr. Grace, there you go, full of grace.
Well done, well named, says St. Mary over here.
we're a pair, I'm sure.
So thank you for your time, and I appreciate it very much.

Grace Charles, ND

Thank you, Mary.

Mary Louder, DO
What a gift to hear Dr. Grace Charles today speak with such clarity and care about fertility as more than a clinical outcome, but as a whole person journey.
If something she shared today offered you new insight or eased a burden you've been carrying, I hope that you'll just let that go and hold on to the hope that there is help for you.
Let it root, let it rise, and reach out.
Please rate and review the podcast wherever you listen and let us hear from you if you have any questions or feedback.
Thanks for listening today and be well.
See you next time.