Investigate Before You Intervene To Improve Fertility Outcomes with Gabriela Rosa

“Unexplained infertility” can sound like a verdict. Gabriella Rosa joins me to argue it’s often a sign we haven’t looked closely enough, or we’re asking the wrong questions. Gabriela is a Harvard-trained fertility specialist and founder of the Rosa Institute, and she brings a grounded, evidence-based approach to integrative fertility care that still respects the power of IVF when it’s truly needed.

We dig into why fertility rates in the news don’t always mean what people think, then get honest about the real-world incentives inside reproductive healthcare. Gabriela explains how repeated IVF cycles can become the default when clinics treat infertility as unfixable, even though better testing and better interpretation can uncover actionable causes for both women and men. We also talk about diminishing returns after multiple IVF cycles, and why “investigation before intervention” can save time, money, and heartbreak.

The conversation goes deeper than conception. Gabriela connects infertility and recurrent miscarriage to broader health risks, including insulin resistance and later-life chronic disease, and she makes the case for treating the menstrual cycle as a vital sign. We cover PCOS symptoms, cycle tracking, basic male-factor screening like semen analysis, and her FERTILE method, built to systematize fact-finding, education, and treatment. She also shares her preconception mantra: act pregnant now to get pregnant later by reducing exposures and supporting egg and sperm health.

If you found this helpful, share it with someone trying to conceive, subscribe for more health-forward conversations, and leave a quick review with your biggest takeaway.

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Welcome And Guest Introduction

SPEAKER_01 0:13

Well, hello and welcome to the Healthy Living Podcast. I'm your host, Joe Grumbine, and today we've got a very special guest. Her name is Gabriella Rosa. She's a Harvard Awarded Fertility Specialist and founder of the Rosa Institute and author of Fertility Breakthrough: Overcoming Infertility and the Recurrent Miscarriage When Other Treatments Have Failed. She's a pioneer in telehealth-based integrative fertility care, bringing evidence-based reproductive solutions to individuals, couples, and couples around the world. Gabriella, welcome to the show. It's great to have you here today.

SPEAKER_00 0:50

Thank you so much for having me. It's lovely to be here.

SPEAKER_01 0:53

This is fantastic. I haven't had a lot of guests in the fertility arena, but we have had a couple. And it seems like you're kind of a pioneer in some of the elements of this. Why don't you tell us a little bit about how you even came to this field?

SPEAKER_00 1:09

Yeah. So for me, it was a little bit of an accident and a little bit of just the next thing you do, you know, as you're kind of getting out of

How Gabriella Chose Fertility Care

SPEAKER_00 1:19

high school. I've been doing this a long time. I graduated back in 2001. So I've been literally helping couples overcoming patrolitary parent miscarriage and fail treatments for the last 25 years now. And it feels like yesterday, but I have to say, what has led me to where I am today has been growing with my patients, you know, over the years and understanding their needs, expanding my ability to be able to deliver, you know, the solutions that they were looking for, particularly, you know, when things haven't been easy and straightforward. So, you know, as I was kind of finishing high school, figuring out what I was going to do with the rest of my life, I thought the conversation about health was something that really interested me. I knew that there was enough in it to keep me interested. And as I yeah, and so as I was deciding to, you know, I knew I wanted to specialize in something. I knew I wanted to become very good at a very specific thing. And so basically I decided fertility was going to be it, and I just continued to evolve in my in my growing learning around the subject. And really at the time, I remember asking myself, you know, what is a conversation that I can have for the next 20 years? And it's really been quite fascinating because not only have I now had this conversation for 20 years, I can really see myself expanding and growing and continuing to have this conversation for another 20 years. So yeah, it's been a it's been a journey.

SPEAKER_01 2:54

Well, this is not a field that's gonna get outdated or become obsolete in any way, because in fact, it seems like the the

Are Fertility Rates Really Falling

SPEAKER_01 3:06

information that I've seen is fertility rates have actually been dropping around the world in a lot of places.

SPEAKER_00 3:13

So, you know, the interesting thing about it is that when we talk about fertility rates dropping, really we're talking about the fact that we're having, you know, public health education has worked, and we are having less ting pregnancies. Okay. So, you know, the messaging has gotten through and it's been a couple of generations, and that's been, you know, happening. Women in their 40s are having babies at an unprecedented level now compared to, yeah, absolutely, compared to women many, many years ago. Now, that upsets the balance in population growth in certain countries, certainly. And so we're hearing that, but you know, when we go in, it's nuanced information. And so when we go to understand what it actually means, we see that okay, are we seeing more problems in terms of infertility, or is it just a natural societal, you know, cultural time that we are living? And there's a little bit of both. And you know, in terms of infertility itself and the the rates of infertility, those rates have remained pretty much similar over time.

SPEAKER_01 4:31

Oh, okay.

SPEAKER_00 4:32

So, what is happening, however, is that we have become better at being able to detect causes of infertility and causes of recurrent miscarriage. And, you know, failed treatments continue to be what they are because really no treatment is perfect. That's the first thing. The second thing is that there are a lot of misaligned interests in the healthcare system, and a lot of IVF clinics either are

IVF Incentives And Unexplained Infertility

SPEAKER_00 5:00

for profit or private equity backed, or you know, you have a situation where really the interest of the owner is to have the more cycles the better, because that equates to more profit. And you have the patient's interest, which is they want as few cycles as possible to have the baby that they want. And you have absolutely and you have the doctor stuck in the middle that's kind of trying to serve both both masters, so to speak. You see, and so that becomes a challenge, and it becomes a challenge all over the world. You know, there was a there was a major newspaper in Australia this week posted something on their Instagram page, and the medical director of a particular clinic was basically saying that, you know, for about 70% of male infertility cases, we don't know the cause. Even though we can do tests, we're not smart enough to understand why these problems occur. I completely disagree. I think that if he's not smart enough, that's one thing. But you know, there is enough information, enough knowledge, enough science for us to understand that when you actually go and test for a problem and you interpret those results correctly, you actually end up with actionable information that you can apply. Now, is it in the medical directors of an IVF clinic in best interest to educate the population as to the fact that, you know, yes, hey, here, there's things you can do that you don't need to do IVF. No, it's not in his best interest to do that. So, in his best interest is to keep the conversation of unexplained infertility unexplainable, because then the path narrows to the obvious solution that he has, which is IVF. Now, I have nothing intrinsically, you know, I'm not against IVF. I think IVF is a wonderful technology. Some of our patients will need IVF, but I think that patients need to understand that when they are given the recommendation to go down the path of IVF, it's not neutral.

SPEAKER_01 7:12

I I totally agree with you, and I see some amazing parallels in the world of oncology. I just went through almost two-year battle with cancer, and I had to solve the problem myself because the doctors were trying to sell me on something that wasn't going to be the best answer for me. And I was like, no, no, oh, that's good. I'll take a little bit of that, and a little bit of that, and a little bit of that, and it solved my problem. But it didn't seem to me like any of them were actually operating in my best interest with all the tools that they could have had at their disposal.

SPEAKER_00 7:51

And and that happens a lot because things that aren't patentable or things that aren't, you know, that you can't scale or benefit and profit from. Right. There is a big disinterest to invest dollars in research in those areas. And so you end up with a situation that if we can make a profit, we will invest in understanding more. And if we can't make a profit, well then let's just focus on the things that can make us a profit. So, you know, that there is, and I'm not saying again, this is not an individual conversation of, you know, individual doctors. This is really very much a conversation about the fact that this happens in society. And buyers beware when you are engaging treatment to understand that, okay, if your doctor tells you, oh no, there's nothing you can do, just you know, IVF will bypass these problems. That is that should be ringing the greatest number of alarm bells of every possible kind that you can imagine.

SPEAKER_01 9:01

Because at the very least, go do some exploring, yeah.

SPEAKER_00 9:03

Oh, go understand more. You know, like at the very least, go and understand, okay, let's just pretend for a moment that there is nothing you can do. And now let's go and figure out from that place what I can do. Because, you know, one of the things that I know, and I'm I was originally trained as a naturopathic doctor, but you know, I've since done a master's in reproductive medicine in human genetics, I've done a master's in public health at Harvard. I've just I'm about to graduate from my doctorate at Harvard in public health. And so understanding the fragmentation of the healthcare system is really the job of public health because you need to understand how you're going to navigate that. And so, applied to fertility, it's so easy to see where patients, unfortunately, who really deserve a different level of care end up being treated just by like everybody else in the general population. You see, the issue here is that 96.3% of patients will be pregnant by the end of two years. Wow. When they're trying. And so what happens? It's absolutely most of them. It's really that 4% that is not pregnant at the end of that time, they're the ones that have the problem. And unfortunately, they're the ones that cost the healthcare system the most. Wow. You see, because what ends up happening is that you do have different, you know, uh healthcare systems around the world. So obviously in the UK, Canada, and Australia, you have a universal healthcare system, which basically means that everything is paid for for the population. And by everything, it's inverse of

Why Systems Fail The Tough Cases

SPEAKER_00 10:40

commerce, because obviously, you know, the job of a universal healthcare system is to do the absolute minimum for the largest number of people, right? And so they're basically focusing. And so if you go through a universal healthcare system, you're going to be told you have to meet very strict eligibility criteria to receive care. And no, we're not going to test all of these things because it if we're going to treat anyway, why test? That's the concept behind that. Now, in a privatized system, which we have in the US, and you know, there is there is a semi-private system in those other universal healthcare systems as well, but mostly the population relies on the public health care. And so, but in the US, that's not the case. I mean, other than Medicaid, which doesn't cover fertility recruitment anyway, right? It's very much a privatized system, which means that, again, all of these underlying interests play a role. And so then it becomes a narrative of, oh, it's a numbers gain. You know, having a baby, IVF cycles more and more and more means that you have more chances of having a baby. But what the data actually shows is that there is great diminishing returns after three IVF cycles if you haven't actually been successful. And what happens with that is that usually it's because the underlying drivers of biochemistry and output and outcome, like you know, the egg is an end result, the sperm is an end result, the embryo is an end result. And so those outputs and the biochemical pathways that drive them essentially aren't understood in terms of, okay, what is actually not working out in this particular situation? Now, if 96.3% of people can see without trying, why are we going to spend money from the healthcare system to figure out the ins and outs and the problems that are happening for this, you know, less than 4% of people? Now, if you if you look at that, if you are part of that 4% of people, like it's extremely important, right? And you definitely want to find out what's going on. But if you're not, the kind of urgency and the appetite for really diving deep is kind of left to, ah, you know, most people get pregnant anyway, we don't really need to worry. And so that's how it gets perpetuated for couples who are having difficulty because they're just treated like everybody else in the general population that doesn't have a problem. And so it's almost like, you know, if you have a case, a cancer patient, and you're going to treat that person in the same way as everybody else who just lives, well, that person who is having a problem is not going to fare very well compared to the rest of the population because they are a different person. You see. Which for some people is life and death.

SPEAKER_01 13:51

Absolutely. But but you know, to the general person, you would say, well, it's a much lower priority than you know, trying to cure some disease.

SPEAKER_00 14:01

Precisely. And this is really where couples become very disadvantaged on their journey to parenthood because it's exactly the thinking that gets applied. It's like they're not dying immediately. This is not a life or death. In fact, you know, what happened, you know what's fascinating, Joe? Is that people, there's been studies that show that people who have an infertility diagnosis have higher rates of all-cause mortality down the line from cancer,

Infertility As A Health Warning

SPEAKER_00 14:30

cardiovascular disease, and diabetes. Wow. Compared to the people who don't have an infertility diagnosis. So, what does that tell us? Well, it tells us that whatever the biochemical underlying drivers of infertility are related and linked to the things that also cause cardiovascular disease, diabetes, and cancer down the track. But we are ignoring it at this point because when we label it reproductive difficulties versus when we label it chronic disease that is going to kill you, we basically obviously have a very different frame and a very different perspective. And so what you're saying is exactly what happens when the disease is early on versus when the disease is in situ. Case in point, when somebody has insulin resistance, right?

SPEAKER_01 15:23

It's already gone so far, yeah.

SPEAKER_00 15:25

It's literally that it's a moment in time until they develop prediabetes. And this the research shows this. If you have insulin resistance and you are not actively working on reversing it, you are going to develop prediabetes.

SPEAKER_01 15:42

Exactly.

SPEAKER_00 15:43

The research also shows that it's five to ten years from the diagnosis of prediabetes to a disease to a diagnosis of diabetes. Okay. So this means that if somebody has insulin resistance, which is a lot of people who have difficulty conceiving, and it's one of the major causes, absolutely, it's one of the major causes of an ovulation and irregular cycles, and you know, you name it. It gets dismissed and it gets ignored at the infertility point, right? At the infertility point, it's not addressed. But you see, because it's not addressed, it's going to develop into prediabetes and it's going to develop into diabetes, and you are going to have quality of life deficit as a result of that, no matter who you are. And so this is the thing that we miss. It's a missed opportunity. Infertility, unfortunately, is a missed opportunity for optimization of health in the long term. And most people don't realize that this is exactly what it is. For the most part, infertility is treatable, it's changeable. And my patients show this all the time. My master's thesis at Harvard really looked at 544 patients in my clinic who essentially had gone through treatment. And we demonstrated a 78.8% live birth rate amongst those people. We also demonstrated that 60% of them conceived naturally without the need of RDS. 5.6% needed donor egg when they were told that pretty much all of them needed donor egg. They actually didn't. And so, you know, it's looking at the and 51.5% of people had who had come to us had experienced recarrial miscarriage, and that rate dropped to 13.5% after treatment. Now, am I doing something magical that is called, you know, like what is it that is making these people miraculously have well, it's actually none of it is magical. None of it is miraculous. What it is, it's investigation before intervention. It's understanding what is the problem, what are we dealing with, what are the biochemical pathways that are being affected, how do we optimize them so that we have a different outcome? And for the most part, you do not get to treat a problem you do not know you have. So if you don't investigate, if you don't find out, how would you know how to treat it, right? And how would you treat it? So this is this is really unfortunately for most people. And you know, if people are listening to this, lucky them because they all of a sudden have gained, you know, permission slip to go, hey, go search for the things that are going to help you because they exist as opposed to just being told, oh no, there's nothing you can do.

SPEAKER_01 18:29

Now, so you're basically saying that infertility is kind of a precursor or a warning to other possibly life-altering detrimental issues. And but the only way you're gonna find that out is if you actually want to have a kid, and you can't, because if you're not looking to have a kid, there's a lot of ways to keep that from happening, and you would never know if you are fertile or not if you were taking steps to not have a kid, right?

SPEAKER_00 19:05

Well, you see, this is where I think most people don't understand their bodies well enough, and I think that most people would start at that very high level thinking of like, oh, okay, if I'm not trying to have a baby, I want to know that I'm that I'm not able to. Well, that depends because, you know, ultimately, let's take PCOS as an example. I was diagnosed with

PCOS And Tracking The Sixth Vital Sign

SPEAKER_00 19:30

PCOS when I was 18, polycystic ovarian syndrome. And essentially, what it is, it's the number one cause of infertility in women of the reproductive age. It causes irregular cycles and irregular ovulation. And the way that you sometimes find out is that you lose your cycles entirely, or your cycles become extremely lengthened, or you know, you basically start to have a lot of premenstrual symptoms that are unusual for you. You may develop hair in weird places, you know, like male patterned hair growth, you may have difficulty losing weight, you may have acne. You know, so you start to develop these symptoms that go along with the syndrome. And so sometimes people will patch those symptoms. You know, they will go and find a cream at the pharmacy and put on their face if they have acne. They will go and use laser therapy and, you know, kind of deal with the hair. And they will, you know, so, or they will kind of go on the pill to quote unquote regulate the cycle. The pill does not regulate the cycle, by the way, it just forces a very predictable time limit of when you actually bleed, because when you're no longer taking the hormone pills and you go onto the sugar pills, basically it forces you to bleed and you think, oh, I'm having a cycle, I'm having a period. But that is not what it does. And so, yeah. And so basically, most people they lack the knowledge and the understanding to decipher and to kind of understand the nuance around their symptoms. Most people also don't track their cycles and track their symptoms. You know, I think that for anybody hearing or listening to this, you know, they may have kids or grandkids who might get into the stage of trying to get pregnant at some point, or they might be trying getting pregnant themselves and they're not understanding their cycle, they're not tracking their cycles. That is one of the most important things that a woman needs to do, literally from day one of getting a period. Because, you know, one of my mentors says that, you know, she's the gynecologist of citrus, and she says that the period, the a woman's period, is the sixth vital sign. You know, in the same way that you have your heart rate, temperature as vital signs, the period is a vital sign. And it is indeed because if you understand, first of all, your pattern and you understand. And deviation of that pattern is caused by things that you may need to be addressing. Well, then you actually understand, even if you're not trying to get pregnant, that if there is a change, not all change is an improvement. We may need to investigate that further, you see. And so that's essentially, I think, how people can start to become more aware of their cycles. For men, it's a matter of actually going to the doctor and having screening tests, you know, and having your hormones tested, having a segment analysis, even if you're not trying to affect pregnancy at this point, but for your own knowledge and understanding, because when you understand that, okay, there's something that is going on here, then you can decide what you want to do with that information. You may decide that you don't want to do anything with that information, but if you find that, okay, this is a problem and in the future I would like to have children, then you need to start looking at, okay, what is the cause of this and what else can I do to improve it? So if you look at, you know, what I said before in terms of the infertility diagnosis leading to all cause mortality down the track from every disease, you know, every single, every single major disease that people are chronically dying from these days, which is cancer, cardiovascular disease, and diabetes, all have this kind of like vital sign period early in their in their stages, right? Many of them, you know, and I can kind of sit here and enumerate different kinds of things that we get picked up on blood tests when we're looking at infertile couples or couples who are struggling to keep a pregnancy to term. And we can pinpoint to what that will mean down the track. For example, with recurrent miscarriage, you know, if you have antiphospholipid syndrome or cadillipin antibodies, you are going to have more clotting, like you're essentially thickening of the blood, and clotting is going to be an issue. Well, that doesn't take many, many steps to understand that as we age, we start to become more susceptible to stickier blood and for to clotting. And what diseases can that cause? You know, stroke, cardiovascular disease, you know, you name it. And then you know cancer is another thing. I mean, one very simple thing if you have HPV. Right.

SPEAKER_01 24:36

We know that HPV is linked to what I ended up with was uh squamous cell carcinoma that was HPV driven, yeah.

SPEAKER_00 24:45

There you go. So if your partner has HPV, you know that you are going to be affected. And so you know that, all right, well, this is something that I may need to address now so that I don't have to address it later. You know? And so all of these things are things that you can find out much earlier on.

SPEAKER_01 25:54

Wow, I I feel like we're running out of time and like we didn't barely touch, scratch the surface of the things. I'd love to have you back to go deeper into some of this stuff, but I'd like to hear about your fertile method. It's it's an acronym, obviously, but it's it's you've developed a method to help people and and and how you got into the idea of doing this with telehealth, which puts you literally in touch with the whole world.

SPEAKER_00 26:20

Yeah, absolutely. Well, actually, how I got to do it with telehealth is that I had a child. Okay, all right. And I could no longer do 60 patient hours a week. And, you know, certainly in the way that I was doing it. And so I thought, okay, how else am I going to do this? And I decided to shut down my bricks and water clinic that I had had for, you know, over a decade and take it all home so that I could breastfeed in between calls. And uh, and actually that turned out better than I thought. You know, we did that in 2013. My son is going to be 14 this year. And so, you know, that was a that was a big kind of change. It was a it felt, it actually felt like a no-brainer at the time because I was just so exhausted, you know, as a new mother, I was like, oh my God, just like I don't even know my name, let alone, you know, how I'm going to continue running this clinic. And uh, and so it felt like a very low pressure move. Uh looking back, I think, wow, that was kind of brave. But it wasn't really, it was just the fact that, you know, like I had to manage

Telehealth And The FERTILE Method

SPEAKER_00 27:27

all of the different pressing, you know, things and needs that people around me had. And I had lots of patients who were under care and I didn't want them to just not have the support that they needed. And so I had to kind of figure out a way of marrying the two, which is essentially how telehealth came about, because a lot of the referrals we were getting were for people who were overseas anyway, and we were doing telehealth, but not fully telehealth. And so I thought, you know what, I'll just keep the patients that I am treating so that they have continued care. And, you know, if it doesn't work when a couple of years down the track, I'll restart a practice. You know, I'll I'll do something else. And as it turned out, it worked better than I thought. And I never actually went to another, you know, we ended up with a head office, but we don't, you know, patients don't come into the clinic. We treat patients in every continent other than Antarctica at this point. So that's essentially how that happened. And, you know, the fertile method really arose from this process, this idea that for me, fact-finding, which is the F in fertile, is the most important step in beginning fertility treatment. If we don't understand what it is that we're dealing with, it's going to be very difficult to treat it. And so really it was this idea of okay, how do I ensure that I systematize a process that's going to be repeatable, reproducible, and it's going to deliver the results that we're looking for. And we know very clearly at which stage we're in each each path along the way. Now, and and you know, E stands for educate, R starts for recommends for recommend, and T starts stands for treatment, and then you've got I, which is incubation, and L, liberation, which is, you know, the incubation piece and the liberation piece, they really go hand in hand, and it's based on something that you said before. Nobody's gonna die from infertility. And, you know, what's interesting is that there was a study that showed that 20% of women who experience infertility would rather be paralyzed than be infertile. And so, you know, it's a huge impact on couples in general, not just women. And, you know, and so that time of allowing the body to have the response that it needs and combining that with this mental emotional liberation of I'm doing my best and I'm going to do that, and I and I am not the problem, is really part of this method because I find that it's so important to address the physical, the emotional, the spiritual in conjunction with what it is that we're trying to achieve. So that people are left better off no matter what their end result is, you know, which is the the last E in fertile. So when people ask me, so okay, how do you apply this? You know, what is it that I can do to improve my fertility? Well, I actually always respond in the same way. It's act pregnant now to get pregnant later, you know. And that really is for both partners, because really at the end of the day, every single individual right now is carrying 50% of the little baby that they want to create. And so you are going to be bringing a hundred percent of your contribution to that conversation of having a baby. Therefore, it's vital that you nurture that those cells in the best possible way. So, what are all of the things that if you were pregnant right now or if you were holding your newborn baby right now, what are all the things that you would absolutely start doing or absolutely stop doing to make sure that that baby is the healthiest that it can possibly be? Well, those are all of the things that you would start doing and stop doing now before you actually even start trying to get pregnant, you see? So you would reduce your exposures. I mean, you wouldn't put, you know, vodka in a baby bottle, you know, if you are a responsible adult. You know, you wouldn't be smoking in your baby's, you know, vicinity. You wouldn't be so all of these things that you would not be doing then, don't do them now, because if you do them now, you are negatively impacting the cells that have the potential to create the healthy baby of your dreams.

SPEAKER_01 31:56

Wow, that's a beautiful, a beautiful message there. I know you've written some books, you've got a practice. Share everything that you might want to share with our audience.

SPEAKER_00 32:07

Absolutely. So Fertility Breakthrough, which is my latest book, is available free on Spotify and YouTube, but it's also available on Amazon. So if people want to go and get that, they can literally just Google my name, Gabriella G-A-B-R-I-E-L-A. It's Gabriella with one L R O S A and Fertility Breakthrough book, and they will find that. Very active on Instagram, and it's Gabriella Rosa Fertility. I do a lot of patient education there, so people can come and join me there. And of course, my website is fertilitybreakthrough.com. So people can go onto the website as well and explore further from there. I run an event, it's it is a 14-day program, free program called the Fertility Challenge. And it essentially has now taken over 218,000 people in more than 111 countries through education that helps them understand what are the things that I can do to improve my chances to take home a healthy baby. Whether

Resources Book And Fertility Challenge

SPEAKER_00 33:07

somebody is just starting out on their journey of conception, whether they're having difficulty, whether they're experiencing foul treatments or miscarriages, it's it's really a place where they will learn a lot about how they can help themselves. So they can Google Gabriella Rosa Fertility Challenge and they will find that as well.

SPEAKER_01 33:26

Beautiful. Again, I've got a whole nother episode worth of questions for you. So I'd love to have you come back another.

SPEAKER_00 33:36

Absolutely. I'd be happy to.

SPEAKER_01 33:37

Beautiful. Well, thank you so much. And what a I I love your holistic approach. I I completely agree with the way you're going after this. I think you're doing a great service to the world. So thank you for that.

SPEAKER_00 33:50

Thank you.

SPEAKER_01 33:51

Beautiful. This has been another episode of the Healthy Living Podcast. I'm your host, Joe Grumbine, and I want to thank our listeners for making the show possible. And we will see you next time.